Medication Safety in Anesthesiology: A Closed-Claims Analysis

Background: Despite longstanding guidelines for safe medication administration during anesthesia care, medication errors continue to be an area of opportunity in perioperative patient safety. Analysis of closed claims can help identify contributing factors involving patients, health care providers, and medication, and suggest opportunities for reducing harm. Methods: A claims database from a national malpractice insurer was queried for closed claims—with or without paid indemnity—from 2012 to 2022 involving medication-related liability in anesthesia. We performed a descriptive analysis of the injury severity, injuries, complications, allegations, anesthetic technique, practice setting, types of medications, clinical themes, and the financial value of the claim. Results: We identified and reviewed 140 medication-related closed claims involving an anesthesia provider. Most medication-related closed claims involved a high severity of injury (59%, 82/140), including death or permanent injury. The most common injuries were adverse reactions (44%, 62/140), respiratory or cardiac arrest (43%, 60/140), death (41%, 57/140), and organ damage (32%, 45/140) —sum is >100% because each closed claim may be associated with multiple injuries. The most frequently identified clinical theme was oversedation with respiratory arrest with or without cardiac arrest (29%, 40/140). The mean gross total amount incurred was 704, 000 (median 312, 000). Conclusions: This analysis of medication-related closed claims in anesthesiology demonstrates the continued need for addressing perioperative medication safety and in both hospital and ambulatory settings. Oversedation during anesthesia care is an area of high concern, in addition to the known risks of neuromuscular blocking drugs and local anesthetics.