Physicians need to carefully screen and monitor patients to avoid opioid-related malpractice claims, says report

Errors in how doctors screen and monitor patients on opioids have resulted in malpractice claims against those doctors.

And those often involve serious injuries and even death, according to a new report from Coverys, a company that provides liability insurance for medical professionals.

Over half of the patients involved in opioid-related malpractice claims had a serious injury or died, according to the company’s analysis of five years of claims that included 165 events involving opioids.

The analysis showed that 41% of claims cited error in the screening and prescribing stage of the pain management process, followed by 30% of claims citing the monitoring and management stage. The company said 39% of all indemnities paid involved the screening and prescribing stage.

However, there are risks throughout the pain management process from the first decision to prescribe opioids to monitoring patients as they continue on the medication. The report identifies major risk factors, warning signs and safety vulnerabilities within the pain management process.

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“The big takeaway we are sharing with our clients is to be very vigilant with your assessment and patient selection when you start a patient on opioid medication for pain management and encourage alternative methods if appropriate,” Sharon Gilmore, senior risk specialist at Coverys and an author of the report, said in an interview with FierceHealthcare.

The very first step for prescribers is whether or not a patient should ever be put on opioids in the first place, said Ann Lambrecht, R.N., who also helped author the report. If a patient is prescribed opioids, physicians and other clinicians need to carefully manage every single step in the process, she said.

Of the malpractice claims that cited errors in the screening and prescribing stage, over 50% of the patients involved had either a psychiatric or substance abuse history, which should be a red flag for prescribers. For those patients, “opioids overall should probably not be prescribed as a first-line pain management solution,” Lambrecht said.

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The top opioid drugs involved in the malpractice claims were fentanyl (22%), followed by Dilaudid (19%), Percocet (13%) and morphine (13%).

The report found opioids are often prescribed to patients who already have complex medical regimens. The top drugs prescribed with opioids were anti-anxiety medications (29%), anti-depressants (24%), muscle relaxants (13%) and NSAID medications (13%).

To help avoid malpractice claims, the risk specialists recommend that practice leaders complete a self-assessment on their opioid prescribing practices to identify gaps where they need improvement and then audit for compliance so those improvements are hard-wired into practices.

“Our advice is always the same. We feel like if you have a process in place and you follow that checklist, the likelihood of you really getting into trouble is somewhat reduced,” said Lambrecht. “Assessing the patient, checking the Prescription Drug Monitoring Program database, conducting screening for opioids, contacting the patient’s primary care doctor if they have one and conducting medication reconciliation—those are just tried-and-true aspects of care.”

Practices should educate all members of the care team about opioid prescribing and monitoring.

“It’s not just the dollar cost. It’s also the cost in lives—pain and loss to the families, loss of talent and resources in our communities. It’s far-reaching,” Lambrecht said.