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Veterinary medication errors

 

Medication errors and incidents are unfortunately not uncommon in veterinary practices. These are usually simple
mistakes caused by human error which can result in minimal or no harm to the animal. Sadly however, there have been serious consequences with some animals suffering significant harm and some have died.

 

Case examples

A client claimed her dog was harmed as a result of a medication error. She alleged the dog suffered ‘tick poisoning’ after the practice supplied an inadequate dose of ‘tick prevention medication’. The dose given was calculated on a lower weight range than the dog’s current weight.

 

A client alleged his dog died from renal failure as a result of incorrect dosing with an anti-inflammatory agent. The wrong weight had been recorded in the animal’s record. Although the dog was a small breed, a weight of 28kg was recorded. The veterinarian then used that weight to calculate the dosage, without recognising that it was unlikely to be accurate for a dog of that size.

 

Guild Insurance also receives a number of similar claims every year where the cause of the incident is difficult to identify.
In some instances, the veterinarian simply made a prescribing error and recorded the wrong dose or medication. In others, doses were weaned or titrated incorrectly. That is, a dose was increased when it should have been decreased, or a medication was continued long after it should have been ceased.

 

Tips for practice improvement

 

The cases outlined serve as a timely reminder about just how easily errors can occur. Fatigue, distraction, lack of decision support tools and poorly designed work areas are all recognised as common contributing factors. Therefore, take the time to evaluate your current prescribing and dispensing practices. Are you really doing everything you can to reduce the risk of error? Is your clinical workflow conducive to safe practice? That is, do poorly designed work areas make it difficult to access things like dosing charts, calculators or product information?  Is your prescribing system easy to use and supportive of safe practice? Have you considered using software with inbuilt alerts to warn you of prescribing errors?

Always verify an animal’s weight before prescribing or dispensing medication. Weigh the animal at the time and reconcile what’s documented in the record. That is, does the recorded weight seem reasonable for the size, breed and condition of the animal? If it’s not possible to weigh the animal at the time, clarify the recorded weight with the client and again consider what is reasonable for the breed.

Instruct staff to be particularly careful to double check and dispense the correct size of any medication. For example, 20 mg and 50 mg tablets of some popular NSAIDs may look very similar, but dispensing the wrong ones may cause disastrous consequences.

Consider the benefits of asking another member of the practice to double check your calculation or selection, particularly if you are working under pressure or fatigued.

To reduce the chance of inadvertently selecting the wrong medication from the shelf, introduce measures to differentiate between medications that look or sound similar. Ideas include the use of separators and flags, along with avoiding the temptation to store stock in strict alphabetical order.

Instruct staff to point out all directions on the label and packaging when handing medications to the client. This not only helps to educate them, but serves as a final check against any error.

Ensure staff always take the time to explain to a client what is meant by using a medication ‘off label’. There have been cases where this has not been explained to the client and they have later complained when they have read the label and seen it is not recommended for their animal.

Use ‘alerts’ to help distinguish between the records for different animals belonging to the same client. Errors can occur when information, such as weight or test results, are inadvertently entered in the wrong record.

Promote a culture where all staff are confident to point out risky medication practices when they occur.

Finally, don’t believe these scenarios couldn’t happen in your practice. While the financial impact can be costly, the impact on your reputation shouldn’t be underestimated. Increasingly, people are choosing not to return to a practice once an error has occurred, instead venting their dissatisfaction via social media and the like.

Download PDF here.

 

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