Liability for drug interactions?

[Pharmguy07]

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How much liability is involved when a pharmacist dispenses a medication that interacts with something a patient is already taking?

Obviously this involves a lot of clinical judgement and experience and I'm not talking about completely ignoring an interaction or when an absolute contraindication is involved, but it seems in many cases when there is the potential for a "major" interaction my pharmacist will just warn the patient about the interaction, what should be monitored, and that he/she should check with their physician before taking it.

For example, a couple of weeks ago he counseled a patient taking verapamil who was prescribed clarithromycin. He warned him of the potential danger, what would need to be monitored, and that he should check with his doctor before he started taking the antibiotic. He asked the patient if he wanted us to check with the doctor, but he said that he would and bought the prescription.

Is this enough in situations like this? How much liability would be involved if a patient, despite being warned by the pharmacist, took a medicine that caused harm due to a drug interaction?

 

[genesis09]

It's a mixed basket of laws and court cases. In Illinois, the most recent case said in the case of a known drug interaction, the pharmacist is liable to contact the doctor and/or patient about this and try and get this changed or stop patient from taking. The previous courtcase ruled pharmacists are only liable for the extent of information they give to the patient.

 

[Epic]

How much liability is involved when a pharmacist dispenses a medication that interacts with something a patient is already taking?

Obviously this involves a lot of clinical judgment and experience and I'm not talking about completely ignoring an interaction or when an absolute contraindication is involved, but it seems in many cases when there is the potential for a "major" interaction my pharmacist will just warn the patient about the interaction, what should be monitored, and that he/she should check with their physician before taking it.

For example, a couple of weeks ago he counseled a patient taking verapamil who was prescribed clarithromycin. He warned him of the potential danger, what would need to be monitored, and that he should check with his doctor before he started taking the antibiotic. He asked the patient if he wanted us to check with the doctor, but he said that he would and bought the prescription.

Is this enough in situations like this? How much liability would be involved if a patient, despite being warned by the pharmacist, took a medicine that caused harm due to a drug interaction?

Great question.

It all depends on the ability of the plaintiff's legal team to sway a panel of jury that the pharmacist was negligent which resulted in injury to the patient.

I can't imagine anyone can convince the jury that the pharmacist failed to perform his/her duty if in fact the counseling you described above occurred and documented.

As a practicing pharmacist, everything we do can be a subject of civil liability case. Dot your T's and cross your i's.

 

[mike36]

Great question.

It all depends on the ability of the plaintiff's legal team to sway a panel of jury that the pharmacist was negligent which resulted in injury to the patient.

I can't imagine anyone can convince the jury that the pharmacist failed to perform his/her duty if in fact the counseling you described above occurred and documented.

As a practicing pharmacist, everything we do can be a subject of civil liability case. Dot your T's and cross your i's.

Do pharmacies actually keep records of these types of consultations? Please forgive my ignorance as I have no pharmacy experience.

 

[Epic]

Do pharmacies actually keep records of these types of consultations? Please forgive my ignorance as I have no pharmacy experience.

I can't imagine everything is documented. But I'm sure retail pharmacy system has a mechanism of documentation. I can't say... other than 6 weeks of community rotation, I've spent less than 10 days in retail pharmacy.

 

[pinkyrx]

Do pharmacies actually keep records of these types of consultations? Please forgive my ignorance as I have no pharmacy experience.

If something like this comes up and we are concerned that it might bite us later we'll document it on the hard copy. (which is scanned in for long-term record keeping)

 

[confettiflyer]

Documentation at my pharmacy includes the pt signing a box saying either "I decline consultation" or "I will receive consultation." Then, to a lesser extent, there's the closed circuit video feed. You can correlate that with the pick-up time and date of the Rx and select the camera for the consultation window.

 

[genesis09]

We would told to just write it on the back of the prescription or on a separate piece of paper and attach it to the prescription. Pharmacist Mutual gave us these documentation books, also.

 

[Old Timer]

I would never rely on the signature log. In any case where you think there is a serious issue, I write on the hard copy of the prescription. If I speak to the doctor or to the doctor through his staff, I note what I said, who I said it to and the time of the conversation and then I initial it.

 

[dgroulx]

I fax the doctor, then get their fax backed response. This is saved with the original script if he/she chose to override it. Some times they just phone and ask me to recommend a therapy change.

 

[BamaBoy75]

I would never rely on the signature log. In any case where you think there is a serious issue, I write on the hard copy of the prescription. If I speak to the doctor or to the doctor through his staff, I note what I said, who I said it to and the time of the conversation and then I initial it.

Excellent advice for all practicing pharmacists!!!