Improper Drug Dosage, Wrong Medication, Interactions With Other Drugs.... May Be The Result Of Pharmacutical Malpractice

Prescription drugs are invaluable tools in the practice of medicine, used to treat numerous illnesses and diseases. However, prescription errors can result in serious injury and death. In the United States, about 1.5 million preventable adverse drug events occur every year.

Pharmaceutical malpractice can occur when a doctor prescribes the wrong medication or incorrect dose or when a pharmacist fills the wrong medication or dosage. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as:

"A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use."

These pharmaceutical errors can result in serious health complications including allergic reactions, organ damage caused by an overdose, infection, stroke, heart failure, and even death. Doctors and pharmacists must follow strict regulations in order to prevent mistakes. In Illinois, the Pharmacy Practice Act (225 ILCS 85) regulates the practice of pharmacy in Illinois. 

Types of Pharmaceutical Errors

  • Adverse Drug Side Effects
  • Incorrectly Filling A Prescription
  • Incorrect Labeling
  • Incorrect Dosage
  • Drug Interactions
  • Incorrect instructions regarding usage

Drug Side Effects

Many prescription medications have serious side effects that should be considered before taking them. Some serious and common side effects include: allergic reactions, heart problems, liver and kidney failure, weight gain/loss, and psychological effects. The doctor prescribing your medication should consider the pros and cons of prescribing the medication as opposed to leaving the condition untreated or prescribing a different medication. 

When considering whether to prescribe a drug with serious side effects, the doctor should consider your full medical history and information to determine whether you can handle the side effects. Also, when filling a prescription order, pharmacists have a duty to advise you about any side effects that might accompany the use of the prescription medication. 

Incorrect Prescription

Medication errors can result when there is a miscommunication of drug orders. This can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations. As many people know, doctor’s handwriting is often times little more than a scrawl or scribble. 

Doctors must take reasonable care in correctly and accurately writing prescriptions. One way to reduce the chance of prescription errors is to use electronic prescriptions, removing the risk of errors associated with poor handwriting. However, mistakes can still occur when a doctor types in the wrong prescription order. Therefore, doctors should take extra care when prescribing medications to ensure that no transcribing errors have occurred. 

Medication errors can also occur when doctors take incomplete patient information. For example, the doctor might not know about the patient’s allergies, any other medications the patient is taking, previous diagnoses, and lab results. Doctors perform best when fully informed about the patient’s history and information. Doctors should ensure that they have a patient’s complete and up to date information before prescribing medication, in order to cut down on medication errors. 

Incorrect Labeling

Pharmacists must ensure that medications have correct labels before selling them to patients. Prescription medication labels should include the name of the drug it contains, the amount to be taken, the time of day to take the medication, and any warnings while taking the drug. When prescription medications are labeled incorrectly, you may end up taking the wrong drug, the wrong dose, the wrong time, or be unaware of warnings about what foods, beverages, or activities to avoid while taking the drug. 

These mistakes can result in serious complications including liver or kidney damage or death or not receiving the full benefit of the drug’s intended purpose. Even when pharmacists include the correct information on the label, they should go over the recommended dosage, procedures, and warnings to ensure that you understand how to safely and correctly take the medication. This is especially important with older adults who may be unable to read the label.  

Incorrect Dosage

Prescription medications have more serious dangers associated with them than over the counter (OTC) drugs. Therefore, it is important that pharmacists issue the correct drug (the one the doctor prescribed) at the correct dose. Errors in filling prescriptions can result from similar-looking pills, difficult to read physician handwriting, and rushed work at pharmacies. Pharmacists must exercise reasonable care when filling each and every prescription order to ensure that you receive the highest standard of care and avoid injury. 

In Illinois, registered pharmacy technicians may, under the supervision of a pharmacist, assist in the dispensing process, offer counseling, and receive new verbal prescription orders (225 ILCS 85/9 – Registration as pharmacy technician). Depending on the pace of business at the pharmacy, these pharmacy technicians might not receive proper supervision to ensure the highest standard of care. 

These mistakes can also cause serious medical complications, either because you take too much or too little of a drug or even taking the wrong drug. Many prescription medications treat serious illness and disease, and besides the risks associated with taking the wrong drug or the wrong dose, are the risks associated with not treating the illness or disease that prompted your doctor to give you a prescription in the first place. 

Adverse Drug Interactions

Many people, especially older adults, take multiple prescription medications, which are commonly prescribed my multiple doctors. However, problems can occur because the doctors prescribing these medications might not know about the other drugs you are taking. 

This can lead to serious complications stemming from drug interactions. Drug-drug interactions are not the only type of potentially dangerous drug interactions; there can also be drug interactions with foods, beverages, and dietary supplements. 

There are three main types of drug interactions:

  • Drugs with food and beverages
  • Drugs with dietary supplements
  • Drugs with other drugs

Drug interactions can reduce the effectiveness of drugs, cause unexpected side effects, or increase the action of a particular drug. Drug interactions with food and beverages might result in delayed, decreased, or enhanced absorption of a medication. Dietary supplements can also cause a variety of drug interactions, and with fifty percent of American adults using dietary supplements (vitamins, minerals, amino acids, herbs or botanicals) on a regular basis, the risk of negative drug interactions is high. 

For example, St. John’s Wort can reduce the concentration of medications in the blood; Vitamin E can increase anti-clotting activity and cause increased risk of bleeding when taken with blood-thinning medication; Ginseng can enhance the bleeding effects of aspirin and ibuprofen; and Ginkgo Biloba can decrease the effectiveness of anticonvulsant therapy. Drug-drug interactions can cause adverse drug reactions. 

The rate of adverse drug reactions increases significantly when a patient is on four or more medications. This is especially worrisome because almost 40% of Americans receive prescriptions for four or more medications. 

Because pharmacists fill prescriptions issued by multiple doctors, they are in the best position to catch potentially harmful drug interactions. However, some people use more than one pharmacy for their drug needs. Therefore, in order to avoid problems with drug interactions, you should use one pharmacy for all of your medications and keep a record of all prescription drugs, over the counter (OTC) drugs, and dietary supplements that you take. 

Nursing home staff must take extra precautions when distributing new prescription medications to nursing home residents. Many nursing home residents are on multiple medications for a variety of physical and mental conditions that are best treated with prescription drugs. These residents might be under the supervision of multiple doctors, and it is the nursing home’s responsibility to ensure that the doctors are aware of all the resident’s medications and changes in condition in order to avoid serious medical complications. 

Physician & Pharmacists Duty To Use Reasonable Care

Pharmacists and doctors have a duty to exercise reasonable care in prescribing and filling prescription drugs. When this duty is breached, serious injuries and even death can occur. Elderly adults are particularly susceptible to injuries stemming from pharmaceutical medication errors because many older adults take multiple medications. Furthermore, many older adults see multiple doctors for specialized care to treat specific injuries or illnesses. 

The increased number of prescription drugs and multiple drug providers can increase the likelihood for a pharmaceutical error. Older adults are also less able to prevent pharmaceutical errors because they might be less able to read the labels and warnings, be less able to understand the medication labels, and might be unable to provide doctors with a complete list of medications or medical information. Many older adults, especially those in nursing homes, rely on other people to fulfill their prescription needs. Therefore, additional care and caution must be taken when prescribing medications to older adults, especially those who rely on nursing home staff for medications and activities of daily living. 

If you or a member of your family has suffered injury because of a pharmaceutical error, you can bring a pharmaceutical malpractice or negligence action. In addition, if the worst occurs and the pharmaceutical malpractice results in the death of a loved one, you may also be entitled to bring a wrongful death action. 

Speak to our experienced pharmaceutical error lawyers about your case for free today.  Nationwide service.  (888) 424-5757

Resources:

FDA: Avoiding Drug Interactions

National Coordinating Council for Medication Error Reporting and Prevention

Adverse Drug Event Reporting: The Roles of Consumers and Health-Care Professionals

Illinois General Assembly – 225 ILCS 85/9 Registration as pharmacy technician

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Now That We Rate Nursing Homes, Is It Time To Rate Other Adult-Care Facilities?

Families looking for facilities to care for their loved ones in North Carolina may begin having an easier time selecting an adequate adult day care or assisted living facility after the state implements a new rating system.  Similar to the well-publicized Medicare-rating system for nursing homes, North Carolina will rate assisted living centers and adult group homes on a four star system.

Unlike a current three-star system currently in place, the four-star system is intended to more accurately categorize facilities according to the quality of the care they provide.  Additionally, the newer rating system is intended to penalize facilities for providing inadequate care for stemming from problems such as medication errors and patient wandering.

Not surprisingly, some industry groups believe the new rating system may not provide a complete picture of each facility.  In this respect, I could not agree more.  No rating system-- no matter how well conceived-- can take the place of an in person visits (and preferably visits).  

Nonetheless, I certainly am a fan of any system that can help families with the difficult decision of what facility to select for a loved one.  As a lawyer who handles cases involving abuse and neglect in a group home setting, I wish other states would implement more intensive regulations of these facilities to protect our elderly population.

Read more about the new rating system for group homes here.

Related:

Are Group Homes A Viable Alternative To Nursing Homes?

Nursing Home Rating System Reveals Inferior Care Provided At For-Profit Facilities

What Is It Like To Live In A 1-Starred Nursing Home?

One year after the implementation of the Medicare nursing home rating system, where do we stand?

Nursing Home Patients Continue To Receive Drugs Associated With Known Dangers

Through no fault of their own, many nursing home patients continue to receive medications known to potentially cause serious injury or death.  Many of these situations involve claims for damage against the drug manufacturers themselves.  In other cases, the prescribing physician may be partially responsible for failing to monitor the patient.

In 1988 the FDA approved the use of Gadolinium for use as a contrast agent in MRI's. Contrast agents help in enhancing the clarity of MRI images. Gadolinium bonds with damaged or diseased tissues giving doctors a much clearer picture of organs that they would without.

On June 8, 2006 the FDA issued a warning that Gadolinium may be linked to Nephrogenic Systemic Fibrosis (NSF) or Nephrogenic Fibrosing Dermopathy (NFD). NSF & NFD patients may have one or more of the follow conditions:

Avandia is the most commonly prescribed diabetes drug in the United States. Avandia (rosiglitazone) is used to treat type 2, non-insulin dependent diabetes by increasing the bodies sensitivity to insulin. Avandia is manufactured by pharmaceutical giant GlaxoSmithKline and has been on the market since 1999. If you have type 2, diabetes there is a strong likelihood you may have taken Avandia at some time.

Ruth Lomeo, a 44-year-old disabled person, will receive $1.6 million from the California nursing home responsible for her care. In July, 2005 Lomeo was admitted to Edgemoor Geriatric Hospital for treatment of Lupus, a chronic inflammatory disease. The nursing home staff was responsible for properly administering Fentanyl skin patches to help Lomeo cope with chronic pain. Physician orders directed the nursing home staff to put the pain patches on alternating arms every 48 hours.

Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction. SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes. These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death. Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

We've all gone through the unpleasant task of preparing for a colonoscopy. Drinking an unpleasant liquid or popping pills for the purpose of giving the doctor a better view of our colon's contents is.... anything but pleasant. Now, news has surfaced that, depending on the product you used to prepare for the procedure, the experience may not have been merely unpleasant-- but downright dangerous.

On December 11, 2008, the FDA ordered the makers of Visicol and OsmoPrep to put a black box warning on their products alerting consumers to the fact that the drugs can cause kidney damage or death. The warning came after the FDA confirmed more than 20 reports of a severe kidney injury called acute phosphate nephropathy after people consumed the products. Acute phosphate nephropathy may progress resulting in: kidney failure, long-term dialysis, the need for a kidney transplant or death.

Recently, we were contacted by the family of a lady who within several months of taking Reglan Tablets, began to develop severe muscle spasms in her face. We soon found out that the staff physician had prescribed Reglan several months before the spasms started.

Reglan (generic name – metoclopramide) speeds up the movement of the stomach muscles, which increases the rate at which the stomach empties into the intestines. This prescription drug is used to treat gastrointestinal disorders including heartburn caused by gastroesophageal reflux disorder (GERD), diabetic gastroparesis (stomach does not contract), and to prevent nausea and vomiting caused by cancer chemotherapy and surgery.

For more than 30 years Strellis & Field has championed the legal rights of the injured.  If you suffered believe a drug is responsible for the death or injury to a loved one, we welcome you to contact us for a free legal consultation to learn your rights.  (888) 424-5757

Wrongful Death Lawsuit Claims Nursing Home Negligently Administered Allergy Inducing Drugs To Patient

The Estate of a deceased nursing home patient has filed a wrongful death lawsuit against the facility where she died and other parties who allegedly contributed to her death.  The crux of the lawsuit alleges that the staff and physicians at the nursing home failed to note the woman's allergy to medications containing Sulfonamide, a common ingredient in antibiotic medications such as Bactrim.

After the the staff at the nursing home began administering Bactrim, the woman began to experience a severe reaction on her skin.  According to the lawsuit, 

"the plaintiff's decedent sustained a severe reaction to the administration of Bactrim, D.S., she developed multiple large open areas in the skin over large portions of her body, portions of her skin sloughed off; the skin over her entire body became 'tented' and she developed red blistering over the back of her neck and back and she developed toxic epidermal necroysis, causing her skin to slough off, she lost 55% of her active skin, she had a positive Nikolsky sign, she had whole body erythema, lesions, blistering and sloughing"

The lawsuit has been filed against 17 different defendants, including Atrium Health Care and Rehabilitation Center in St. Clair County Circuit Court.  The lawsuit seeks $1.9 million.

Toxic epidermal necroysis following the administration of Bactrim?

Sounds like this woman was suffering the effects of Stevens Johnson Syndrome.  Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction.

SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes. These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death. Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

Although at least from the allegations in the complaint, this facility failed to note this woman's allergies, I'm sure they also failed to monitor the severe skin reaction and notify the woman's physician about the change in her condition. 

Read more about this wrongful death lawsuit here.

Related:

Medications Commonly Prescribed To Nursing Home Patients May Cause Stevens Johnson Syndrome

Admissions Suspended At An Emeritus Assisted Living Facility Following The Discovery Of: Medication Errors, Bed Sores & Falsified Medical Records

After discovering multiple health and safety problems, Florida officials have suspended the admission of new residents to Emeritus at Crossing Pointe-- a Florida Assisted Living Facility.  

A September inspection of Emeritus revealed:

  • An 82-year-old patient who died after staff failed to provide her heart medication for four days
  • Inaccurate resident counts by facility managers
  • Residents with infected bed sores (also called decubitus ulcers, pressure ulcers or pressure sores)
  • Neglected patients-  some Alzheimer's patients had toe nails so long that they curved around their toes
  • Falsified medical records
  • Staff administering the wrong medications to patients that resulted in injury

The documented findings above, come on the heels of a suspected Norovirus outbreak in August at the facility.  The outbreak originated in the facilities cafeteria and sickened 19 residents and two staff members.

In response to the recent findings, management of Emeritus at Crossing Pointe recently held a meeting for residents and their families.  According to acting executive director, Pam Campbell, the identified conditions by inspectors are "not what Emeritus stands for" and calls findings "very sad for us."

Rest assured, once the state lifts the suspension on new admissions, Ms. Campbell says her facility is prepared.  "We're ready for them any day."  

Great.  

I find it difficult to believe the Ms. Campbell-- or any manager in her position-- is capable of turning around such a troubled facility so quickly.  The reason the state's inspection report listed such extensive violations is because Emeritus allowed a culture of poor patient care to exist.  My guess is that until management decides to delve deeply into these problems and evaluate each employees role in this neglect, it is only a matter of time before more problems surface.

Emeritus Corporation

Emeritus Senior Living is part of the Emeritus Corporations, a publicly traded company based in Seattle.  Emeritus Senior Living operates more than 300 assisted living, Alzheimer's care, and retirement communities across the country.

Resources:

Report: Patient at South Orange County assisted-living facility died after she wasn't given her medicine, Orlando Sentinel, November 15, 2009

We're fixing problems, assisted-living manager tells residents, Orlando Sentinel, November 17, 2009

Want Some Psychotropic Medication? Give This Nursing Home Psychatrist A Call.

In its seemingly endless series of well-done articles regarding the 'state of nursing homes' in Illinois and throughout the country, the Chicago Tribune, recently highlighted a well traveled Chicago psychiatrist-- Michael Reinstein.

Putting it mildly, Dr. Reinstein has a very unique style of practicing medicine-- one that commonly entails use of the powerful psychotropic medicine, clozapine.  Among Reinstein's unusual practice 'accomplishments':

  • In 2007, he prescribed medication to 4,141 Medicaid patients
  • According to an audit report, Reinstein sees 60 patients per day, 365 days per year
  • He is a the psychiatric medical director at 13 nursing homes in the Chicagoland-area
  • Reinstein personally write more prescriptions for clozapine than all the physicians in the state of Texas combined write for their patients.

The dangers of clozapine

Clozapine (the generic medication for Clozaril) is an anti-psychotic medication approved for use in schizophrenia and for reducing the risk of suicidal behavior in patients with schizophrenia or schizoaffective disorder.

Clozaril carries five black box warnings-- the FDA's strongest warning.  Consequently, Clozaril is only approved for use in limited circumstances and the FDA requires ongoing monitoring of the patients to minimize the risk of complications.

1) Agranulocytosis-  An abnormally low white blood cell count. Since white blood cells are necessary to fight diseases, this is a potentially fatal side effect. Patients being treated with Clozapine must have a baseline white blood cell (WBC) count and absolute neutrophil count (ANC) before initiation of treatment as well as regular WBC counts and ANCs during treatment.

2) Seizures- Seizures have been associated with the use of Clozapine.  Studies have conclusively demonstrated that the the incidence of seizures increases as the dosage increases. Additionally, patients taking Clozapine, should be advised not to engage in any activity where sudden loss of consciousness could cause serious risk to themselves or others.

3) Myocarditis- Inflammation of heart muscle.  The incidence of myocarditis has been demonstrated to substantially particularly in the first month of use.

4) Orthostatic hypotension- A large, sudden decrease in blood pressure upon standing that can result in fall.

5) Increased Mortality in Elderly Patients With Dementia- Elderly patients with dementia-related psychosis treated with atypical anti-psychotic drugs, such as Clozapine, are at an increased risk of death compared to placebo. 

Not surprisingly-- especially when medicating such a large group, many with high clozapine dosages-- some of Dr. Reinstein's patients have suffered adverse effects and even death related to clozapine intoxication.  Who is responsible, the drug itself or the man responsible for prescribing it? Would his patients be better served with another type of treatment?

Related Nursing Homes Abuse Blog Entries

Medication Aides In Nursing Homes: A Push To Save Money Or Improve Patient Care?

Nursing Home Employees Plead 'Not Guilty' To Charges Related To The Intentional Chemical-Sedation Of 22 Elderly Residents

Pile On The Medication

Administrator Charged With Elder Abuse After Intentionally Over-Medicating Nursing Home Patients

Administrator Charged With Elder Abuse After Intentionally Over-Medicating Nursing Home Patients

I was glad to see criminal charges have now been filed against Pamela Ott, the Administrator at Kern Valley Healthcare District, after several employees of the facility allegedly used psychotropic medications to control the behavior of patients with Alzheimer's and dementia.  Ott is now facing eight felony counts of elder abuse.

The instances of nursing home abuse allegedly occurred between August 2006 and January 2007 when the employees intentionally over-medicated residents with anti-psychotic drugs at Kern Valley Skilled Nursing Facility to keep them quiet and make them easier to handle. 

As the administrator of the Kern Valley Healthcare District, Ott was responsible for supervising the operation of a small community hospital and skilled nursing facility in Lake Isabella, CA.  

A Healthcare Ombudsman who witnessed a resident of Kern Valley being forcibly held down by nursing home staff and injected with drugs brought the situation to the attention of authorities. In total, 22 residents of the California nursing home were believed to be intentionally drugged by the threesome. Additionally, the deaths of three residents are also believed to be related to the improper drugging.

"As hospital administrator, Pamela Ott, was responsible for the safeguarding the welfare of her patients.  Instead, Ott abdicated her responsibility and allowed the staff of the Kern Valley Hospital to forcible sedate patients who questioned their care," said Attorney General, Edmund G. Brown Jr.

Among the three nursing home employees who have already been criminally charged:

  • Gwen Hughes, 55, the former director of nursing
  • Debbi Gayle Hayes, 51, the facilities former pharmacist
  • Dr. Hoshang M. Pormir, 48, a staff physician at Kern Valley Healthcare District who was the medical director at the skilled nursing facility

In situations involving dangerous patient care, it is important that elevated officials at the facilities be held responsible.  I am glad to see that this Attorney General did a thorough investigation and is moving forward with criminal charges for Ms. Ott's supervisory role in this situation.  

Read more about this case involving over-medication in a California nursing home here.

Related Nursing Homes Abuse Blog Entry

Nursing Home Employees Plead 'Not Guilty' To Charges Related To The Intentional Chemical-Sedation Of 22 Elderly Residents

Medications Commonly Prescribed To Nursing Home Patients May Cause Stevens Johnson Syndrome

Stevens-Johnson Syndrome (“SJS”) is a systemic disorder that affects the skin and mucous membranes, usually caused by a severe drug reaction.  SJS often begins with flu-like symptoms (fever, sore throat, cough, burning eyes), then progresses to red or purple rashes and blisters (photos), especially around the mouth, nose, eyes.  These symptoms eventually lead to skin sloughing (the shedding of the top layer of skin) because of cell death.  Some patients with extreme cases of SJS appear as though they were severely burned due to the extensive skin loss.

Stevens-Johnson syndrome is a hypersensitivity disorder usually caused by a reaction to a newly prescribed medication.  Although any drug can cause SJS, several drugs are often associated with SJS including: anti-gout medications, non-steroidal anti-inflammatory drugs, sulfonamides and penicillins, and anticonvulsants.

Some drugs which have been associated with SJS that are frequently prescribed to nursing home patients include:

  • Advil
  • Motrin
  • Vioxx
  • Celebrex
  • Bextra

Although Stevens-Johnson Syndrome is difficult to predict, there are several risk factors.  These include existing medical conditions (pre-existing infections) and genetics (carrying the HLA-B12 gene).  Still, there are no tests to help determine who is at risk for SJS.  To diagnose SJS, doctors conduct a physical exam and possibly a biopsy of the skin for further examination. 

Elderly patients in nursing homes are particularly susceptible to Stevens-Johnson syndrome because nursing home facilities fail to properly screen residents prior to administering potentially reactive drugs.  This is especially when a medication is prescribed by a physician who does not have ongoing contact with the patient.  Also, many nursing homes do not adequately train their staff to look for adverse reactions to drugs.

Treatment of Stevens-Johnson syndrome often requires hospitalization, especially because of possible complications.  These complications include a secondary skin infection, sepsis (bacteria entering the bloodstream, which can cause shock and even organ failure), eye problems (resulting from inflammation caused by any rash and blisters around the eyes), damaging lesions on internal organs, and permanent skin damage including abnormal coloring and scars.  The rash and blisters can take several weeks to heal, depending on the severity of the attack.  In more severe cases, where lesions cover about a third of the body, it is referred to as Toxic Epidermal Necrolysis (TEN). If SJS is left untreated, it can result in death.

The main treatment of SJS includes stopping the use of any medications that could be causing the Stevens-Johnson syndrome.  Further treatment includes fluid replacement and application of cool, wet compresses, accompanied by medication to ease itching and discomfort.  These supportive treatments are often performed in burn units. 

It is difficult to prevent Stevens-Johnson syndrome the first time because of how difficult it is to predict what will cause it; however, once a trigger is identified, that medication should be avoided in order to prevent further reactions.  Because recurrences of SJS are often more severe, it is important to properly identify SJS triggers. 

In the case of nursing home patients, we frequently see that staff physicians fail to alert staff to the fact that a new (and potentially dangerous drug) was introduced to patients.  This failure to communicate can lead nurses and other staff misinterpreting an allergic reaction to the medication as an general illness.  In some cases, the delay in diagnosis has resulted in irreversible injury or death.

Resources:

MayoClinic.com - Stevens-Johnson Syndrome

The Stevens-Johnson Syndrome Foundation

Photo Of Individual With Stevens Johnson Syndrome

Family Of Disabled Patients Accuse Chicago Nursing Home Of Physical Abuse & Medication Errors In Lawsuit

A nursing home negligence lawsuit was recently filed against Central Baptist Village, a Chicago-land assisted living facility, for the alleged mistreatment of a disabled husband and wife who were both residents in the facility..  The lawsuit, brought by the couples guardian, claims employees at Central Baptist Village physically assaulted the wife on several occasions between December, 2008 and February, 2009.  Additionally, the lawsuit claims the staff administered the wife's medication to the husband from October, 2008 through February, 2009 resulting in over-medication.  The lawsuit against Central Baptist Village seeks more than $200,000 in damages.

Central Baptist Village is a multi-need facility located at 4747 N. Cranfield Avenue in Norridge, IL. The facility has been providing care for more than 100 year and operates as a not-for-profit nursing facility. 

Read more about this lawsuit against this Chicago nursing home here.

Medication Aides In Nursing Homes: A Push To Save Money Or Improve Patient Care?

A bill in the Tennessee Legislature would create a new 'medication aide' position in nursing homes.  The bill would allow medication aides to administer medication under the supervision of licensed nurses as opposed to a registered nurse- a more advanced position.  Applicants for the new position would need a high school diploma, one year experience as a nurses aide in a nursing home and passage of a standardized exam.

An improvement to patient care or simply cutting corners?

Proponents of the bill claim the creation of a new group of medication aides will free up more experienced nurses to work directly with patients as opposed to dispensing routine medications.  According to bill sponsor, Debra Young Maggart (R-Hendersonville), the bill could eventually reduce medication errors caused by over-extended nurses.  The secondary benefit to some would be an inherent cost savings by hiring lesser credentialed employees.

The bills opponents worry that the credentialing requirements are insufficient for a job where a slight error could cost a life.  Not surprisingly, some of the bills most vocal opponents are nurses groups who are quick to point out that there are thousands of drugs available in the United States and medication aide with limited training is simply unable to have a mastery of all of them. 

Medication errors continue to climb each year.  By some accounts, 1.5 million people are injured on an annual basis due to medication errors.  In a study completed by The Institute of Medicine, 800,000 of the injuries occurred in the long-term care setting.

The Tennessee bill is currently in subcommittee.  If passed, Tennessee would join the majority of other states that allow medication aides to dispense medication in nursing homes and long-term care facilities.  Read more about this proposed nursing home legislation here.

I tend to think nurses aides can be a good idea in settings where common medications are dispensed on a regular basis.  The argument that a medication aide should have a mastery of every medication available is ridiculous!  Is it really fair (or necessary) to expect them to be intimately familiar with medications that would rarely be dispensed in a long-term care setting?

Resource

Preventing Medication Errors, Annals of Long-Term Care by Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Nursing Homes Abuse Posts On Medication Errors

Nursing Home Employees Plead 'Not Guilty' To Charges Related To The Intentional Chemical-Sedation Of 22 Elderly Residents

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Who Should Manage Administration Of Medication?

A Recipe For Danger: Nursing Shortage Could Reach 1M By 2020

An aging nursing population, the growing need for nursing services and an insufficient number of facilities to train new nurses are coming together to create a 'nursing crisis', according to a recent article in The Iowa Independent.  The congruence of factors will lead to dramatic shortages of nurses both in Iowa and on a national basis.  

The American Health Care Association estimates the the nursing shortage will explode in coming years.  Among the nursing shortage numbers predicted by the AHCA include:

  • July, 2009: 116,000 vacant nursing positions in hospitals and 19,000 vacant nursing positions in long-term care facilities.
  • 2010: 275,000 vacant nursing positions
  • 2020: an anticipated shortage of more than 1 million nurses in hospitals and long-term care settings

The shortage of qualified nursing educators is the crux of the issue according to Dr. Rita A. Frantz, of the University of Iowa College of Nursing.  "We have a national shortage of nurse faculty as well as a shortage of practicing nurses.  The two are intricately intertwined.  That is, without the appropriate number of nurse faculty, we can't admit all the qualified applicants to our nursing programs."

Unfortunately, the number of nurses in teaching positions is also expected to decline at a time when they are needed the most.  At the University of Iowa, the average age of the nursing faculty is 56 years-old, and the average age of professors at the school is 59.  "We're going to have large numbers of them leaving the academic environment to retire in a fairly short period of time," according to Frantz.

The final factor coming into play is the aging population and the inherent nursing demands placed upon it.  Along with the increase in aging population comes a larger proportion of the population turning to public health coverage to pay for their care.  In the case of Medicare or Medicaid, the reimbursement rates offered for many services do not cover the facilities expenses. How do facilities cope?  The only way they can, by keeping nursing staff to a bare minimum.

The article does not specifically address the nursing shortage in nursing homes or other long-term settings--in these situations the nursing shortage is likely even more dire as many nursing facilities pay substantially less and demand longer hours than hospital based nursing.  Read more about the looming 'nursing crisis' here.

Under-Staffing In Nursing Homes

Nurse shortages in nursing homes are believed to be a primary factor related to poor patient care. Although, federal regulations stipulate to minimum staffing levels, many of these requirements are insufficient for residents who may require substantial help for daily living needs.  Under-staffing in nursing homes is routinely blamed for: falls, medication errors, bed sores, elopement and general neglect.

Many nursing home experts believe the the number one predictor of patient care is the number of hours spent by staff tending to residents needs per day.  A great resource to find this information is the Medicare compare website where you can see how facilities rate in this area. 

There is no current federal standard for the ideal nursing home staffing levels in all facilities. Nonetheless, federal laws do require nursing home must have at least one RN for at least 8 straight hours a day, 7 days a week, and either an RN or LPN/LVN on duty 24 hours per day. Individual states may have additional staffing requirements.

Resources

U.S. healthcare system pinched by nursing shortage, Reuters.com, March 8, 2009

Nursing home 'understaffed' death results: damages awarded.(Nursing Law Case of the Month), Encyclopedia.com, June 1, 2005

Drug Dealing Nursing Home Worker To Serve 3 Years In Jail

The former assistant director of nursing of a Virginia Nursing Home will serve three years in prison for the illegal distribution and sale of drugs.  Linda Sloan Quick stole the drugs from the Rocky Mount Nursing Home during her tenure there.  The drugs Quick stole were either expired, prescribed for a deceased patient or belonged to a resident who was transferred to another facility.

An anonymous informant tipped off the sheriff's department that a person at the nursing home was selling prescription drugs.  During an investigation at the facility, an informant directed police to Quick.  Undercover police made multiple purchases from Quick during a 90-day period in 2008. 

Quick pleaded guilty to four charges of prescription drug distribution, including one count of Fentanyl (Schedule 2) and three counts of distributing Hyrocodone (Schedule 3).  Separate charges of distributing Lorazepam and Diazepam (Schedule 4) were dismissed according to Quick's plea agreement.

Should nursing home officials have been aware of the drug dealing that occurred at their facility?  "The drugs she was taking should have been destroyed according to procedure," according to Major Josh Carter of the Franklin County Sheriff's Department.  Read more about this case of drug dealing at a Virginia Nursing Home here.

Nursing Home Employees Plead 'Not Guilty' To Charges Related To The Intentional Chemical-Sedation Of 22 Elderly Residents

Three employees of the Kern Valley Healthcare District's skilled nursing facility have plead not guilty to multiple felony counts of elder abuse causing harm or death.  The instances of nursing home abuse allegedly occurred between August 2006 and January 2007 when the employees intentionally over-medicated residents with anti-psychotic drugs at Kern Valley to keep them quiet and make them easier to handle.

The situation was brought to authorities attention by an unnamed healthcare ombudsman who witnessed a resident of Kern Valley being forcibly held down by nursing home staff and injected with drugs.  In total, 22 residents of the California nursing home were believed to be intentionally drugged by the threesome.  Additionally, the deaths of three residents are also believed to be related to the improper drugging.

Among the three nursing home employees charged:

  • Gwen Hughes, 55, the former director of nursing
  • Debbi Gayle Hayes, 51, the facilities former pharmacist
  • Dr. Hoshang M. Pormir, 48, a staff physician at Kern Valley Healthcare District who was the medical director at the skilled nursing facility

Hughes and Hayes were charged with eight felony counts of causing harm or death to an elder or dependent adult and two felony charges of assault with a deadly weapon through over-medication.  Meanwhile Dr. Pormir faces eight felony counts of causing harm or death to an elder or dependent adult.

The California Attorney General filed a criminal complaint against the three workers following an investigation into the matter.  The investigation revealed:

  • The physician signed off on medication orders after the dosages were administered
  • Medications were administered without patient or family consent
  • Residents were forcibly injected with sedating medication
  • Psychotropic drugs were unknowingly sprinkled on residents food
  • The administration of medication without any medical examination or working diagnosis
  • Dehydration and malnutrition of residents due to over-medication

In the course of the Attorney General's investigation, nurses at the facility related how the over-drugging of residents began after Hughes was hired.  According to nurses at the facility, Hughes ordered the psychotropic medications (Depacote, Zyprexa, Resperidol and Seroquel ) be administered to residents who were 'acting up'.

Hughes has a track record of using medication to control the behavior of residents.  In 1999 she was fired from a Fresno, CA nursing home after the state cited the facility for over-medicating patients.

The nursing home workers are due back in criminal court on April 23.  If convicted, each face up to 11 years in prison.

Who is to blame for this situation?

Perhaps most disheartening part of this situation is the fact that this alleged mistreatment of residents at the facility over a fairly long period and in 'plain sight'.  Many nursing home employees and administrators likely witnessed the abuse of nursing home residents without any doing a thing.  The administrators should be ashamed of themselves for allowing a culture of abusive behavior to take place in the presence of health professionals.

Related Web Articles:

Reports detail fatal druggings at nursing facility, BY STACEY SHEPARD AND JAMES BURGER, Californian Feb 18 2009

Nursing home workers arrested in fatal druggings, Bakersfieldnow.com

Nursing Homes Abuse Blog Entries On Over-Medication

Pile On The Medication

McHenry Nursing Home Hit With $360,000 In Fines

Half Of Nursing Home Residents Wrongly Drugged

Nurses Caught Administering Insulin To Non-Diabetic Nursing Home Residents

New York Nursing Home inspectors were recently called to investigate, Hilltop Nursing Home, following two incidents where nurses at the facility gave insulin to non-diabetic residents.  The residents went into shock and were hospitalized.  According to a report from the  New York Department of Public Health, the two incidents were investigated following tips made on the telephone hot line.  One of the insulin errors involved an LPN who admitted to being under the influence of narcotic medications not prescribed to her. 

During the recent health department investigations, investigators also determined that nurses at the facility signed on narcotic medications for resident use, but there was no documentation that the medications were actually administered.  Upon discovering this situation, the findings were turned over to the Bureau of Narcotics Enforcement.

Hilltop Nursing Home is a short-term sub-acute facility certified for 110 residents and has a staff of 200.  It specializes in treatment of traumatic brain injury and pediatric care. Hilltop Nursing Home has been part of the government's nursing home watch list or "Special Focus Facility" since 2006 when an 11-month-old boy stopped breathing for 20 minutes following the displacement of his breathing tube.  The boy suffered brain damage from the incident.  An inspection of the incident confirmed the boy received improper medical care and the staff failed to timely respond to alarms signaling a problem.

The 'special focus facility' designation cases nursing home inspectors to visit the facility more frequently.  Nursing homes remain part of the 'special focus facility' watch list until they pass two consecutive surveys without major violations.  Well, after these incidents involving medication errors, Hilltop will remain on nursing home inspectors short list.

Read more about this medication error at a New York Nursing Home here.

High Staff Turnover Rates Plague Most Nursing Homes

This article from Hutchinson News Online, details the high rate of nursing home staff turnover at most facilities.  Most nursing homes have annual staff turnover rates that exceed 100%.  The lack of continuity of care is problematic for both the nursing home and residents.  For the nursing home it means an exertion of time and money to train and attract new employees.  For nursing home residents,  high staff likely has a direct impact on the quality of their care.  According to a 2006 University of Kansas study on nursing homes, employee turnover is "the most important factor in predicting nursing home deficiency scores."

In our nursing home liability practice, it is common to see cases involving medication errors, dietary errors and general medical mistakes occurring at a disproportionate rate among new nursing home staff.  In a pending matter, a CNA at a Chicago Nursing Home mistakenly served a resident a steak dinner when the resident was on a strict 'soft foods' diet.  The resident chocked on the steak and suffered a brain injury from lack of oxygen.  Barely 24-hours on the job, the nurse was unaware of the resident's dietary restrictions. 

Never Event #2: Infection In Central Venous Catheters

 The second most frequently encountered 'never event' is an infection from a central venous catheter.  Infections due to improperly maintained and inplanted central venous catheters accounted for 29,536 cases in hospitals in 2007.  A central venous catheter is a tube usually inserted in an arm or chest and threaded through a vein until it reaches a large vein close to the heart.  Central venous catheters are used to administer medication, supply nutrition or blood products.  

There are three main types of central venous catheters:

  • PICC Line: A 'peripherally inserted central catheter.'  PICC's are the most common type of central venous catheter accounting for more than 50% of the vascular catherizations because it may be inserted relatively easily.  PICC's are inserted into a vein in the arm as opposed to the neck or chest.
  • Tunneled Catheter: A surgically inserted catheter in the neck or chest and is passed under the skin.  Only the end of the catheter is visible through the skin.  Passing the catheter under the skin allow people greater mobility and helps the catheter stay in place.
  • Inplanted Port Catheter: Similar to the tunneled catheter, but the entire catheter is left under the skin.  Medication must be injected through the skin and into the catheter.

More than 40% of bloodstream infections are accounted for in people with central venous catheters. An estimated 1% to 5% of people with central venous catheters who get an infections die from them. In order to reduce the likelihood of infection, the following should be done:

  • Use sterile technique when working with a person who has a central venous catheter.
  • Clean the exposed area of the catheter on a regular basis.
  • Dressings should be changed at a minimum of every week.
  • The catheter should be flushed regularly.
  • The exposed end of the catheter should be routinely check for inflammation and discoloration--the early signs of a potential infection.

Basic maintenance and observation should be part of all hospital and nursing home patients routine.  If you have acquired a blood infection during your hospital or nursing home stay, do not assume that your condition was inevitable.  For more information on infections of central vascular catheters this is a useful article.

Who Should Manage Administration Of Medication?

The discussion on administration of medication at assisted living facilities at Inside Assisted Living, caught my attention.  Inside Assisted Living is an extremely useful blog dedicated to helping residents and their families transition into assisted living facilities.  A reader of the blog asked:

'Ryan, my parents are now in an Assisted Living Community. I’ve been told that they must turn over administration of their meds to the Nurse. Problem is, that there is constantly problems with the meds given by the nurse, ie. meds from another patient, not given at proper time, cannot identify the pill, not all prescriptions given. They tell me that this is a Federally mandated law that my parents cannot self administer, is this true?'

Ryan, the blog administrator gives some excellent advice when addressing this frequently encountered situation dealing with medication errors.  If the resident of an assisted living facility is capable of administering medication, they should generally be able to do so.  I must agree, with Ryan that once a facility takes on an important responsibility, such as the administering medication they must do so in a safe manner. 

If an assisted living facility or nursing home is dispensing the wrong medication or is administering the doses at improper intervals, the situation should be brought to the attention of the facility administrator and / or the state department of public health.

Studies have shown that medication errors occur with up to 50% of nursing home and long-term care residents.  The following are important criteria to evaluate to assure your loved one is the the recipient of a medication error.

Review each medication with a physician to determine its necessity

  • Make sure the list of medications is complete
  • Identify the condition for which each medication is prescribed
  • Determine the potential for any drug vs. drug interactions
  • Determine potential for any drug vs. disease interactions
  • Can the drug regimen be simplified?
  • Are there any new, safer drugs available to substitute with current medication?
  • Is it possible to discontinue any medication? 

New medication tips

  • Is the diagnosis correct?
  • Can the condition be treated without medication?
  • Can a lower dosage be used?
  • Could the symptoms be related to another medication?
  • Can one drug be used to treat multiple conditions?

Inappropriate medication use

  • Don't try to treat every condition. It is impossible to treat every physical condition
  • Don't try to treat the side effects of medications
  • Try to have one physician prescribe all medications
  • Make sure each all physicians involved in a patients treatment are aware of each other

Bottom line is that given the frequency of medication errors and the serious medical complications that may arise from their complications it is best to speak up immediately if you suspect even a minor deviation from the physician prescribed medical protocol.

A First Hand Account Of Nursing Shortages

How real of a problem is under-staffing in nursing homes?  I came across this post from the Nursing Home Reality blog from a nurse who works at a 200 bed facility.

I am an RN in a nursing home licensed for just over 200 residents that offers skilled, intermediate and personal care. This facility has four nurses stations/units. I work on a unit with 38 residents. Many of these individuals have dementia.

My unit is allowed four nurses aides and an LPN on day shift, 3 nurses aides and an LPN on evenings, 1 - 2 aides and an LPN on nights.

While I try hard to understand the “budget” for staffing on my unit, my repeated requests for additional help has been ignored. In August I had eight (8) resident falls on my unit and they all happened on evening shift. My unit’s LPNs are frequently out of time compliance on distributing medications.

I would like to see mandatory staffing based not only on the number of residents, but also on their needs. This is especially important on a unit that has residents with many needs.

Nursing homes are required to have minimum staffing ratios that are controlled by Medicare.  However, when a facility has a combination of residents requiring 24-hour nursing, rehabilitation and personal care the lines of what is required get blurred.  As this nurse points out, some people simply require more care than others and general staffing guidelines will not always provide sufficient care.

If this nursing home fails to listen to its staff complaints of under-staffing, they should recognize the problems with patient safety.  If eight residents fell within one month, I bet at least several of of them sustained serious injuries requiring medical attention.  These are the type of inexcusable cases where the nursing home should be held fully accountable for their deliberate choice to cut corners on patient safety by under-staffing their nursing home.

Half Of Nursing Home Residents Wrongly Drugged

Ever go into a nursing home in the middle of the day?  While the rest if the world busy about their business, many nursing home residents are sound asleep or staring blankly at the ceiling.  Even may of the residents who appear to be awake have a dulled look in their eyes.

A new British Study suggests that many of the nursing home residents who appear to be in trances may be improperly medicated.  In a study of 22 nursing homes, 51% of residents were give inappropriate drugs including anti-psychotics, antidepressants and painkillers.  Frequently, anti-psychotic drugs are used to treat dementia and Alzheimer's patients even though the drugs were not intended for those residents.

The use of medications is not only inappropriate it may be downright dangerous.  Recently, evidence has come forward linking popular anti-psychotic medications such as: Clozaril, Risperdal, Abilify, Seroquil and Zyprexa to an increased risk of stroke.

At too many nursing homes and long-term care facilities over-medication of residents has become such an accepted part of the facilities culture that there may be little incentive to consider reducing or eliminating the medication all together.  Further, some facilities wish to keep their residents medication level high to reduce the amount of work the nursing home staff needs to do with the residents.  It may be easier to dish out pills than it is to interact with residents who may suffer from dementia or psychiatric problems.

If you believe your family member is inappropriately medicated or is over-medicated ask to speak with his or her physician.  Do not take it upon yourself to reduce medication without the input of medical expertise.

Read more about the over medication of nursing home residents here.

Insulin Overdose Kills Nursing Home Resident

A nursing home resident in England died after receiving 5 times the normal dosage by a nurse at the nursing home where she resided.  The woman who had Parkinson's was unable to communicate her physical needs or her insulin dosage to the nursing home employees.

An insulin overdose results in low blood sugar levels, or hypoglycemia. Symptoms of hypoglycemia include:

  • Anxiety
  • Confusion
  • Extreme hunger
  • Fatigue
  • Irritability
  • Sweating or clammy skin
  • Trembling hands

If sugar levels continue to fall during an insulin overdose, serious medical complications and even death.  Low blood sugar is defined as less than 70 mg/dL. Hypoglycemia is defined as a low blood sugar which leads to symptoms.

Nursing homes must properly monitor diabetics blood sugar levels.  Moreover, nursing homes must dispense medication in their proper dosage and at the proper times.  If a nursing home makes errors with respect to medication dosage they are guilty of nursing home neglect

Read more about this incident involving medication errors here.

Failure To Provide Medication Is A Common Error In Nursing Homes

Failure to provide medication is a common problem facing nursing home residents.  Many situations involving failure to provide medication result from problems with the transition of a resident's medical charts from a hospital or facility where they were prior to their admission to the nursing home.  Nonetheless, nursing homes have a responsibility to provide quality care to their residents.  This includes conducting an assessment upon admission to assure all medical needs are met.  

Yesterday's blog entry on the untimeliness of administration of medication reminded me of a case my office is working on.  In our case, a Chicago-area nursing home failed to provide insulin to our diabetic client for several months.  As a result of this nursing home neglect, our client went into Diabetic Ketoacidosis.  Diabetic Ketoacidosis, is a life-threatening condition that develops when diabetics do not get enough sugar into their cells.  The lack of sugar results in the development of fatty acids which cause chemical imbalance.  

Diabetic Ketoacidosis can be detected by monitoring the level of sugar in the blood and urinalysis. Diabetic Ketoacidosis may also be accompanied by:

  • Flushed, hot, dry skin
  • Blurred vision
  • Lack of interest in usual activities
  • Drowsiness
  • Rapid breathing
  • Breath smelling of vinegar or alcohol
  • Loss of appetite
  • Confusion

If the Diabetic Ketoacidosis is left untreated, the condition may cause brain damage or death.  Unlike other situations involving medication errors, injuries due to failure to administer medication are completely preventable and result from nursing home staff neglect

Study Shows Errors In Timing Of Administration Of Medication In Assisted Living Facilties

According to a new study published in the Journal of the American Geriatrics Society, the likelihood of a medication error is low.  The authors of the study looked at 12 long-term care facilities in 3 states.  The results of the study are surprising considering that many long-term care facilities use aides who no formal training in the administration of medication.  Among the studies findings are:

  • Overall error rate of 28.2%
  • Timing errors were the most common (70.8%).  The resident did not receive the medication within an hour of the scheduled time.
  • Wrong dosage 12.9% of the time
  • Skipped dosage 11.1% of the time
  • Extra dosage 3.5% of the time
  • Unauthorized drug 1.5% of the time
  • Wrong drug .2% of the time

None of the timing errors were related to medications where timing is critical to the health of the resident.  Medications such as insulin and warfarin must be administered very consistently in order to avoid serious physical injury to the individual. 

Once the 'time' factor was removed from the study, results show that medication errors were made 8.2% of the time. 

Where else would an 8.2% error rate be acceptable?  Can you imagine a bank teller with an 8.2% error rate in giving out cash.  How long would a bank keep a person like that around? 

Read more about medication errors in assisted living facilities here.

Bar Coding To Reduce Mistakes With Administration Of Medication

A Kansas hospital is using a bar coding system- the same technology that allows grocery clerks to quickly scan bags of groceries-- to help with verification when administering medication at the bedside.

Many hospitals, nursing homes and long-term care facilities are quickly seeking new ways to cut down on the number of mistakes involving medication errors.  Following the lead of many health insurers, new Medicare rules will deny payment for avoidable errors made by hospitals and nursing homes.

Experts estimate that 40 percent of medication errors are made with the physician's written order. But another 40 percent are made at the point at which medication is administered.  "We know medication errors occur in hospitals... we want to cut down on that."  Jim Garrelts, a pharmacy director.

Unlike errors with physician orders, which pharmacists and nursing staff can potentially catch, there is little that can be done to prevent errors associated with errors made in the administration of medication.  This is where the bar coding system will have the biggest impact.  The bar coding system is intended to reduce medication errors with administration of medication.

With a bar code system, the nurses will scan the hospital id bracelet on the patient and the medication.  If there is any error with the type of medication or the dosage, the system will notify the nurse immediately.  The system provides one more opportunity to prevent human errors before a patient receives medication.

Hospitals and nursing homes that implement this system should be commended for their commitment to patient safety.  The facilities will likely reap benefits in a reduction of the number of claims associated with medication errors.  The National Hospital Association estimates that medication errors cost facilities between $5,000 and $7,000 per mistake.

Read more about the use of bar codes to prevent medication errors here.

Medication Errors Caused By Patients On The Rise

A study published in the Achieves of Internal Medicine reveals an increase in the number of people who die at home from unsafe use of legal medications.  Most of the medications taken in peoples' homes have 'little or no  professional support'  according to Dr. Michael Negrete, a pharmacist and CEO of  the Pharmacy Foundation of  California.   The study further revealed that most Americans are aware of home medication error problems, but most assume that doctors and pharmacists are in possession of all their medications and are monitoring their use.  Read more about medication errors at home here.

The results of this study are particularly relevant to seniors who are in less structured programs or in long-term care facilities where there is relaxed supervision.  In those situations, it is important for seniors to make both the nursing staff and physicians aware of all medications they are on

Pile On The Medication

Old?  Weak? Tired? Have dementia?  The answer to these ailments in some nursing homes is to prescribe antipsychotic drugs to subdue any signs of energy and life left in residents suffering from Alzheimer's and other forms of dementia.  A whopping one-third of all nursing home residents are prescribed antipsychotic drugs such as: Risperdal, Seroquel and Zyprexa.

Prescription of antipsychotic drugs is big business for their makers.  Sales of Risperdal, Seroquel and Zyprexa have more than tripled from 2000 to 2007.  Dispensation of the drugs is also often profitable for the facilities where the patients reside.  Every time medication is given, it is an opportunity for a nursing home to charge.  Most often the charges are tacked onto the Medicare and Medicaid tab.

Use of antipsychotic drugs continues despite recent studies that have demonstrated their ineffectiveness in Alzheimer's patients with aggressiveness and delusions.  The wide spread use of antipsychotic drugs covers up the fact that most facilities are understaffed.  It is far easier to have a patient down a couple of pills than to provide skilled nurses, psychiatrists and therapists to treat their underlying needs.

Read the full New York Times article on overuse of medication in dementia here.

Preventing Medication Errors: The List

Recently, I discussed medication errors in nursing homes. Every nursing home resident I have seen is on some type of medication or vitamin supplement. The likelihood of suffering an injury due to a medication error is higher than almost any type of treatment rendered in a nursing home. How can you prevent the medication errors from occurring?

Jeffery Levine, M.D., author of, Medical-Legal Aspects of Long Term Care, has put together a list for preventing medication errors and adverse drug reactions. Dr. Levine provides the necessary information for a family member to evaluate potential errors in the administration of medication. I highly recommend this book. Inspired by Dr. Levine, here is a listing of recommendations applicable to every nursing home and hospital patient.

Review each medication to determine its necessity

  • Make sure the list of medications is complete
  • Identify the condition for which each medication is prescribed
  • Determine the potential for any drug vs. drug interactions
  • Determine potential for any drug vs. disease interactions
  • Can the drug regimen be simplified?
  • Are there any new, safer drugs available to substitute with current medication?
  • Is it possible to discontinue any medication? 
New medication tips
  • Is the diagnosis correct?
  • Can the condition be treated without medication?
  • Can a lower dosage be used?
  • Could the symptoms be related to another medication?
  • Can one drug be used to treat multiple conditions?
Inappropriate medication use
  • Don't try to treat every condition. It is impossible to treat every physical condition
  • Don't try to treat the side effects of medications
  • Try to have one physician prescribe all medications
  • Make sure each all physicians involved in a patients treatment are aware of each other
Clearly, the most important preventative measure is to take an active role in the care of your loved one. Making regular, unscheduled visits is suggested. Do not be afraid to ask questions from those who have a role in the dispensing of medications. A clarification may prevent an episode of injury down the road.

Medication / Pharmaceutical Errors

Medication errors are considered to be any preventable event that may cause or lead to inappropriate medication use or harm to a patient. Since 2000, the Food and Drug Administration (FDA) has received more than 95,000 reports of medication errors. FDA reviews reports that come to MedWatch, the agency's adverse event reporting program.  (Source: FDA website)

The FDA relies on a voluntary reporting for incidents involving medication errors.  The actual number of incidents involving errors in the misadministration of medication to be much higher. The term 'medication error' may describe situations involving: physician malpractice, inadequate facility policies and procedures, faulty charting, order miscommunication, inadequate product labeling, faulty packaging, under-staffing and failure of a nursing home or hospital to monitor residents.

The American Hospital Association lists the following as some common types of medication errors:

  • incomplete patient information (not knowing about patients' allergies, other medicines they are taking, previous diagnoses, and lab results, for example);
  • unavailable drug information (such as lack of up-to-date warnings);
  • miscommunication of drug orders, which can involve poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations;
  • lack of appropriate labeling as a drug is prepared and repackaged into smaller units; and
  • environmental factors, such as lighting, heat, noise, and interruptions, that can distract health professionals from their medical tasks.

Similarly, incidents of medication error may occur when nursing home staff withhold medication or over-medicate residents.  There are incidents where nursing homes intentionally over-medicate a large percentage of their residents in order to keep them complacent and quiet, rather than providing them with the necessary care.

Victims of medication errors have rights.  If you believe a family member or friend has suffered an injury due to a medication error contact the nursing home monitoring authorities in your area.