Medical errors frequently arise out of use of anticoagulants such as Heparin, Warfarin and Coumadin. These errors cause harm when the level of anticoagulation is either too high, leading to bleeding complications, or too low, leading to clotting problems. Either type of complication can have catastrophic consequences, such as hemorrhagic stroke, thromboembolic stroke, pulmonary embolism, HIT syndrome, amputations from blood clots, and other serious complications. Patients who are on anticoagulation require careful monitoring of INR, PTT and/or PT levels to ensure that they remain in a therapeutic range. But additional measures are necessary to promote patient safety.
The Joint Commission (formerly known as the Joint Commission on Hospital Accreditation or JCAHO) recognizes the risks associated with anticoagulation therapy. In this regard, JCAHO recommended that hospitals implement National Patient Safety Goals to “
- use pre-prepared dosages
- for kids, use pediatric-specific doses
- use approved protocols for initiating and monitoring treatment
- manage potential food and drug interactions on anticoagulation
- implement consistent and accurate dosing
- establish a written policy for establishing a baseline and doing ongoing testing
- Educate staff, patients and families about risks, benefits and safe practices
Medical negligence can occur as a result of a prescription error, when a patient is given the wrong dose or wrong medication, leading to injury. Another common scenario is where the anticoagulated patient is not monitored properly. Finally, patients need to be carefully educated about the purpose of anticoagulation, its risks and benefits, and the need for careful dosing and monitoring.
In Ohio, a medical malpractice claim may arise out of medication errors, failure to prescribe anticoagulation for certain high risk patients, failure to monitor anticoagulated patients, failure to reverse anticoagulants when clotting time becomes too long, failure to counsel patients about the risks and benefits of this important drug, mistakes in dosing or prescription errors, and similar medical errors.