7. Give me clear instructions. Use language I can understand. Give me my diagnosis; help me understand the treatment plan, and tell me the next steps. If I am receiving drugs known to be at high risk for errors, give me instructions in writing. Encourage me to carry a list of my prescriptions and doses, physician names and phone numbers, and pharmacy numbers in my wallet. This list will aid me in communicating this important information to my physicians.
The plaintiff, age eighty-two, took a prescription for Coumadin to Overturf Drug to be filled. The prescription was for one milligram pills, but she was dispensed five milligram pills. The plaintiff stopped taking the drug after noticing that the pills were the wrong color. A large black-purple hematoma then developed on her shoulder due to the excessive anti-coagulant. The plaintiff suffered a stroke twenty-three days after filling the prescription, causing her severe speech impairment and right-sided weakness. The plaintiff had been living independently in her own home, but had to reside in a nursing home after the stroke. The plaintiff’s doctor’s records indicated that he recommended that she resume taking Coumadin about a week after receiving the excessive dosage. The plaintiff’s own notes stated that the physician had taken her off the anticoagulant, but warned her that she could suffer a stroke. The defendants, the pharmacy and its franchisors, claimed that even though the prescription had been mistakenly filled, it was corrected soon thereafter and the physician’s doctor was called. The defendants maintained that the stroke was not connected to the Coumadin and that it was due to the plaintiff’s actions in failing to resume her Coumadin once her condition was stabilized. According to a published account the jury found Overturf Drug Stores fifty-two percent at fault and assigned forty-eight percent fault to the plaintiff. The verdict was for $720,000, but the net amount was $374,400. McKesson Corp. and Healthmart Systems were not found at fault. Jeanette Settlemoir v. Overturf Drug Stores, Inc., McKesson Corp. and Healthmart Systems Inc. Mississippi Count (MO) Circuit Court, Case No. 08MI-CV00757.
8. Be truthful. Verbal communication is most often used to convey diagnosis and treatment. If you tell me bad news, I may stop hearing. I may not be able to process anything you are saying. Offer to talk to me again. Explaining and responding to questions is key to guiding me in my care.
Patricia Iyer MSN RN LNCC teaches nationally to nurses, physicians, attorneys and paralegals about how to reduce liability. She is president of Avoid Medical Errors, and runs her business in Flemington, NJ.
Barbara Levin BSN, RN, ONC, LNCC is the Clinical Scholar of Orthopaedics Trauma at Massachusetts General Hospital. While providing direct patient care, she educates patients and their families about a variety of health issues. Nationally, she teaches nurses, physicians, occupational therapists and physical therapists about documentation in clinical practice.