Lawyer Resources for Medication Errors

Errors in dispensing medicationMedication errors in inpatient medical facilities such as nursing homes are so commonplace that they are recognized as a common problem in the medical field. The facility’s medication error rate is identified by state inspectors who have to ensure that the error rate of medication errors be kept below an acceptable or standard percentage. While it is positive to note that state inspectors are keeping track, we also have to be realistic and wonder how many errors go unreported.

Dealing with these issues

It is true that minor medicine errors are inevitable. Especially when dealing with elderly patients, staff members may sometimes be confused about what medication is required. However, it is important to refrain from any severe medication errors. When looking at the definition, medication errors are mistakes that happen while administering or preparing medicine. This goes against accepted professional standards, manufacturer’s instructions, or doctor’s orders.

Examples of medication errors

To the untrained eye, it may be difficult to determine whether something qualifies as a medication error. However, once you have a better understanding of what constitutes a medication error, it is easier to be aware of them.

  • Splitting medications that should not be split – These include tablets, capsules, or other types of medication that specifically say, “Do not crush.”
  • Not having enough fluid – There are countless prescription medications that require the elderly patient to consume a certain amount of fluid when ingesting the medication. Improper hydration or not taking in fluid when taking the medication may actually cause harm to the patient.
  • Inadequate antacids or food – Just as some prescriptions require fluid, others require food. There are also medications that require the patient to take an antacid before ingesting the medication. It is important that the nursing staff ensure that patients follow the recommended guidelines regarding antacids, fluids, and food.
  • Not preparing the medication properly – There are a number of nursing home medications that require that it be shaken or mixed before the patient takes it. Without following the proper procedure, the resident is at risk of receiving too much or too little of the medication. For example, it is important to mix insulin suspensions without air bubbles before administering the medication.
  • Swallowing sublingual tablets – Sublingual tablets are administered by placing them underneath the tongue and allowing them to dissolve. However, some elderly patients will swallow these sublingual tablets instead. While once or twice might not be terrible, it is important that the staff recognize this is happening and address this as a reoccurring issue. Perhaps the medication needs to be altered to ensure proper ingestion.

Negligent errors

Because many nursing home facilities do not have enough staff members, it can lead to staff members feeling overworked or not paying attention to the small details. It may also cause them to feel rushed when administering medication. Some of the negligent medication errors include:

  • Outdated, or expired, elder medication order
  • Errors with lab work
  • Incorrect elder patient or documentation
  • Incorrect elder medication administration technique
  • Incorrect rate, duration, or time of medication administration
  • Using expired medication
  • Medication overdose or multiple doses
  • Medication dose omission or under dose

While a single wrong dosage is not likely to cause severe problems in most cases, if it happens consistently, it could lead to serious medical problems, possibly even death. If you suspect medication errors for your loved one, it is important to speak out to ensure that appropriate steps be taken to avoid these mistakes in the future.

iStock_000018092490XSmall-300x199Coumadin is the brand name of a drug called warfarin, an anticoagulant that is commonly used to prevent blood clots. It is used for various heart conditions and circulatory problems, including heart attack patients, prosthetic heart valves, treat or prevent venous thrombosis (swelling and blood clot in a vein) and pulmonary embolism. Although effective in many of these uses, it can also be deadly if not monitored.

Coumadin/Warfarin Contributing to Deaths of Nursing Home Patients

The main concern with Coumadin or warfarin is excessive bleeding or hemorrhaging. Due to the blood thinning quality of the drug, it can cause life-threatening bleeding and even death if not regulated. Some known risk factors for excessive bleeding with Coumadin are:

ntipsychotic Drugs Over-Used In Nursing HomesAn alarming amount of nursing home patients are medicated with antipsychotic drugs, yet most do not have any type of psychosis. One nursing home in Massachusetts, Farren Care Center, has 71% of their patients on these drugs and they are far from being alone. The question is why are nursing homes using these drugs and what are the repercussions for the patients?

Why antipsychotics are being used

The reason antipsychotic drugs are being used in nursing homes is also the reason they should not be. Sound ridiculous? Unfortunately, it is exactly that. The drugs are being used to supposedly treat dementia, yet the FDA has released two black box warnings that specifically state that these drugs are not to be used for that purpose. A black box warning is the strongest warning issued by the FDA and is printed on the outside packaging of the drugs.

shopping-cart-with-medications-300x199Since many, in fact, the majority, of nursing home residents are on some form of prescription drugs, they need to have adequate supervision of the quantity and in what combinations their drugs are administered. One of the many areas that are under scrutiny in the nursing home industry is how medications are managed. The amounts of medications being administered to patients in nursing homes are high. A study done on 1106 residents of 12 different homes showed an average of 7.2 medications per patient. Another study showed similar results with 800 residents using an average 8.1 medications. With residents on so many drugs, it is paramount that they are being properly monitored. Unfortunately, a recent case in California points to the fact that this is not always the case. Recently, a nurse in California was convicted of giving a drug overdose to one of her 84-year old patients in a nursing home in Orange County. The nurse was also found guilty in medication abuse with six other patients, who were given morphine even though it was not prescribed to them. The nursing home was also found be to guilty of several violations including their failure to protect their patients from medication errors and receiving non-prescribed narcotics.

Adverse Drug Events (ADE’s)

With so many prescriptions being prescribed to nursing home patients, the monitoring and prevention of ADEs is of high importance. In a study published in the Archives of Internal Medicine, a case study of residents from 18 different nursing homes found that over a one year period, over half of ADEs found in patients were preventable. Over 10% of these were life threatening and .04% were fatal. The main consequences of ADEs are falls, malnutrition, dehydration, incontinence, delirium and behavior problems. It is estimated that the annual costs for ADEs in nursing homes is $7.6 billion. This is money that could be better spent on improving care and staffing within the homes. It could be argued that if staffing and care were improved, then ADEs would be greatly reduced. The main causes for ADEs are:

https://www.nursinghomelawcenter.org/news/wp-content/uploads/2012/05/Screen-shot-2012-05-23-at-7.55.03-PM.pngOf all the responsibilities we entrust to nursing home staff, medication errors should worry us the least. After all, compared with the daunting logistics of physical care taking, can it really be that difficult to administer a set number of pills at a predetermined time?Apparently – yes. Quite difficult. Study after study – including a recent report from the Boston Globe – proves that even in this “simple” arena, nursing homes continually come up short. As we’ve reported before on Nursing Home Law Center LLC, medication errors account for thousands of unnecessary hospitalizationseach year.Adding to that scary fact is the increasing use of anti-psychotic medications to “control” conditions like Alzheimer’s and dementia. Powerful dugs like Risperdal and Seroquel are being prescribed to as many as 185,000 nursing home residents a year – nearly one in five nursing homes, according to the Globe. This despite the fact that doctors are prohibited by the FDA to use antipsychotics for “off label” conditions such as Alzheimer’s.

The problem’s become so out-of-control that three senators today called for stricter legislation concerning the administration of anti-psychotics in nursing homes.

“We need a new policy that helps to ensure that these drugs are being appropriately used to treat people with mental illnesses, not used to curb behavioral symptoms of Alzheimer’s or other dementias,” said Senator Herb Kohl (D-Wis).

prescriptionThe reported settlement of a nursing home negligence case in involving a medication mix-up caught my attention because of my perceived increase in the frequency with which medication errors are occurring at nursing homes across the country.

Like many nursing home patients, the patient involved in this incident was a frail, elderly woman, who was dependent on the staff at the skilled nursing facility to provide her with the medications prescribed by her physician.

Also, similar to other errors involving nursing homes injuries– such as deadful bed sores, the errors related to this incident are reflective of mistakes made by several employees providing care to the same patient.

Medication Error Results in DeathLike many nursing home patients, Milton Aucoin was a sick man who was reliant on a nursing home to attend to medical needs.  In particular, he needed the nursing home staff to properly administer necessary medications that were prescribed by his physicians.

As part of his rehabilitation from a stroke, Mr. Aucoin was to receive blood thinning medications to prevent another episode.

Despite physicians’ orders for blood thinners and other necessary medications, a news report concerning a recently filed wrongful death lawsuit alleges that the staff at Chateau De Notre Dame (Louisiana nursing home) ignored the orders by withholding the medications for two days following his initial admission.  As a result of the lack of proper medication, Mr. Aucoin suffered a subsequent stroke which contributed to his death.

medication errrorsA recently reported episode of of nursing home negligence at a Minnesota nursing home clearly demonstrates that some facilities need to re-evaluate the way that they handle the dispensation of medications at their facility.

As reported in the Star Tribune article, “State nursing home resident given overdose just hours before he died” a tragic series of unexplainable errors may be to blame for a patients drug-induced death.

Citing an investigation into the incident by the state Health Department, the staff at Owatonna Care Center completely botched (how’s that for diplomacy) the administration of Lorazepam, an anti-anxiety medication, for an 84-year-old patient at the facility.

Medication Must Be Properly MonitoredI highly suggest taking a look at the New York Time’s recent “Well” column, Four Drugs Cause Most Hospitalizations in Older Adults, as a real wake up call for medical facilities— such as nursing homes— to do a better job monitoring the effectiveness in their patients.

The article has some interesting / concerning information concerning commonly prescribed medications that account for a staggering number of hospitalizations in the elderly every year.  An amazing 66% of emergency hospitalizations in the elderly are related to adverse reactions such as accidental overdoses of:

  • Warfarin / Coumadin- a blood thinner

potassium.jpgPoor communication appears to be to blame for the death of a woman at a Minnesota nursing home who was administered a dose of medication ten times higher than prescribed by her doctor.

According to news reports concerning this incident, a transcription error is likely to blame for the patient receiving 80-milliequivalent doses of potassium over an eight day period while she was a patient at Bethany Home of Alexandria.  A state investigation determined that the improper potassium dose was to blame for her cardiac arrest.

Making this tragedy even more concerning is the fact that the exceedingly high dose was recognized by a pharmacist who was filling the woman’s prescription who brought the unusually high dose to the attention of staff at the facility— only to be discounted.

Screen shot 2011-10-17 at 6.56.50 PM.pngWith a criminal trial set to begin, a former nurse has pleaded guilty to criminal neglect charges as opposed to letting a jury decide her fate.

The nurse identified as Marty Himebaugh and her supervisor Penny Whitlock faced multiple criminal counts for their roles in a series of suspicious patients deaths at Woodstock Care Center (Illinois).

Authorities quickly ascended on the nursing home after they received reports of six suspect deaths of patients at the facility from an overdose of the painkiller, morphine.

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After I read Jonathan’s Nursing Home Blog, I decided to hire him to look into my wife’s treatment at a local nursing home. Jonathan did a great job explaining the process and the laws that apply to nursing homes. I immediately felt at ease and was glad to have him on my side. Though the lawsuit process was at times frustrating, Jonathan reassured me, particularly at my deposition. I really felt like Jonathan cared about my wife’s best interests, and I think that came across to the lawyers for the nursing home. Eric