Court rulings on medication errors in Germany: focus on heparin, acetylsalicylic acid, and oxytocin.

Medication errors remain a challenge in the pharmacological treatment of patients. To improve the safety of drug therapy, 197 publicly accessible court rulings from Germany were systemically analyzed in various dimensions according to the PRISMA 2020 statement. Particular attention was paid to the three active ingredients that were mentioned most frequently in connection with allegations of medication errors in court. According to the results of our keyword search, current as of April 2024, these are heparin, acetylsalicylic acid, and oxytocin. Cases involving MOR agonists and benzodiazepines were intentionally excluded from this study. Even though heparin and acetylsalicylic acid (ASA) are two active ingredients commonly used across a range of disciplines, the errors were ultimately similar in their recurrence. The occurrence of thromboembolic events and bleeding complications, as well as the development of the feared heparin-induced thrombocytopenia, repeatedly raised questions about the appropriate extent of monitoring during heparin therapy. Preoperative management in the case of antiplatelet therapy with ASA was likewise discussed in several trials, as bleeding and thromboembolic events had primarily occurred in connection with this active ingredient. Although oxytocin is used almost exclusively in obstetrics, the consequences of its administration can be equally dramatic. Difficulties with dosage were repeatedly identified, resulting in hypoxia in the child in almost all cases, and even requiring subsequent resuscitation in one of them. The latter, as well as the overall finding that the patients in our study suffered moderate or severe long-term damage, with a notable proportion of them dying, underscores the assumption that court rulings tend to deal with more serious cases. The most common alleged errors were identified as incorrect indication or overlooking of contraindication (50.8%; 100/197), followed by inadequate monitoring (22.8%; 45/197) and dosing errors (18.3%; 36/197). However, in almost two-thirds of cases, no clear medication error could be identified, meaning that of the average €78,702.2 claimed in compensation for pain and suffering, only an average of €29,488.2 was ultimately paid out. The situation differed for underage patients, who presumably had fewer pre-existing conditions, as strikingly more medication errors were clearly identified in this group. In summary, medication errors repeatedly cause harm to patients and, due to the associated hospitalizations, are also repeatedly responsible for a major proportion of healthcare expenditures. According to our findings, most medication errors were already known to be a potential risk associated with the administration of the drugs in question. Improvement of medical education and pharmacovigilance, optimization of process sequences and safety, as well as support for medical therapy decision should therefor rely, inter alia, on the high alert list and current guidelines to help avoid future cases of medication errors.