Work as a Team to Reduce Prescribing Errors.

NEW YORK - The basic medication errors that are likely to mean medicolegal mischief for physicians are essentially the same as they-were 30 years ago: wrong dose, wrong drug, wrong route of administration, or wrong patient.

But a massive proliferation of drugs has increased liability risks dramatically, and this change highlights the need for cooperation among health care professionals, David Benjamin, Ph.D., said at a meeting on malpractice sponsored by the Association of the Bar of the City of New York.

"When I started my graduate training in pharmacology in the late '60s, it was almost possible to memorize the interactions and problems that you might encounter. Since then, however, more than 700 new medications have come on the market, and health care is so complex that it is not possible for any physician ... to carry all drug interactions and contraindications around with them in their heads.

"That's why reliance on all members of the health care team to assist in reducing medication errors is so important," said Dr. Benjamin of Tufts University and Harvard School of Public Health, Boston.

The risk is especially noteworthy for drugs that have been on the market for only a few years, since adverse reactions may take time to become apparent, he said.

Even such prosaic factors as legibility are ignored at the practitioner's peril. Dr. Benjamin cited a 1995 Texas case in which the prescribing physician wrote the name of a drug illegibly, and the pharmacist guessed at what it was.

The guess was wrong, the patient died, and the pharmacist and physician were held equally liable for a $450,000 judgment. "This is the first time that handwriting has been a major issue" in a malpractice action, Dr. Benjamin said. But more generally, "faulty communication among the health ...