Nursing Homes Abuse Blog - By Jonathan Rosenfeld

Like 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.

Apparently medication errors were not a new issue for Chateau De Notre Dame as the facility had been cited by surveyors from the Department of Health and Human Services found higher than average medication error rates at the facility over an extended period.

Despite their reputation as facilities that care for the elderly on a long-term basis, nursing homes are medical facilities that provide skilled nursing for patients with both long-term and acute care needs.  Regardless of the underlying reason for admission, nursing homes have a responsibility to follow the orders of the patients attending physicians.

A medication plan remains one of the most primary responsibilities that skilled nursing facilities are responsible for complying with.  In addition to providing patients with the specific medications (and dosage), facilities must comply with the schedule for each medication. Unfortunately, when the accurate administration of medications is not made a priority we can see the devastating results.

Related Nursing Homes Abuse Blog Entries:

Common Medications Used By The Elderly Must Be Properly Monitored To Keep Patients Safe

Nursing Home Patient Dies After Receiving 'Toxic' Medication Overdose

State Surveyors Discover Medications Continually Withheld At Conn. Nursing Home

Medication Errors To Blame For Death Of Nursing Home Patient

I 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
• Insulin injections- to control blood sugar
• Aspirin and other anti-platelet drugs
• Oral diabetes drugs

The primary reason behind the high rate of complications is believed to be due to the fact that the medications have a specific therapeutic index-- a range in which the drug is effective, yet not hazardous. 

Medical professionals caring for elderly patients on these medications need to be mindful of these complications and incorporate safeguards such as getting feedback from the patient as to how they are feeling as well as getting regular blood work done to determine the drugs effectiveness.

As this article points out, most of these drugs are considered relatively 'safe' compared to drugs like narcotics--- yet they have a much higher rate of hospitalizations.

Hopefully this information will make its way to the medical professionals caring for elderly patients in nursing homes and hospitals and facilities will re-dedicate themselves to safely administering these drugs at their facilities. 

Related:

Family Alleges Nursing Home's Failure To Control Diabetes Resulted In Death Of Patient

Diabetic Ketoacidosis Is An Under-Appreciated Danger Facing Many Nursing Home Patients

Failure To Provide Medication Is A Common Error In Nursing Homes

Blood Thinning Medications, Such As Coumadin, Pose Substantial Danger To Nursing Home Patients Involved In Falls

With 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. 

Though there was insufficient evidence to establish the patients died from morphine intoxication (overdose), the investigation did reveal that Himebaugh and her peers consistently administered medications to patients without doctors order and the facility improperly kept patient records.

The sole criminal charge that Ms. Himebaugh admits to, stems from an incident where she administered Ativan (an anti-anxiety drug) to a patient several hours before he suffered a fatal head injury in a fall.

Woodstock Care Center garnered national attention several years ago when the investigating agencies revealed that Ms. Whitlock referred to Himebaugh as the “angel of death” in connection to a peculiar pattern of patients who died after her care. 

As a lawyer who has prosecuted medication error and medication overdose cases before, I am glad that Ms. Himebaugh has stepped up and acknowledged her poor decisions.  Nonetheless, I still find her actions especially disturbing.  As a nurse, Ms. Himbaugh has no authority to medicate her patients with any drugs other than those prescribed by the patients’ physicians. 

With respect to her sentence, The Chicago Sun Times recently reported that Marty Himebaugh a judge will decide her fate in December. 

Related Nursing Homes Abuse Blog Entries:

McHenry Nursing Home Hit With $360,000 In Fines

Lawsuit Filed Against Nurse Who Intentionally Gave Too Much Morphine

Morphine Overdose Of Patient Initiates A Lawsuit Against Doctor & Nursing Home

Morphine Intoxication Of Nursing Home Patient Results In Significant Jury Verdict

While it is the responsibility of a doctor to prescribe medications for nursing home patients, the daily task of administering the medication falls squarely on the shoulders of the nursing home staff.  Nursing home staff have a duty to both administer the proper medication-- at the interval prescribed--- to each patient.

Not surprisingly when patients get the wrong medication or it is not timely given the results can be catastrophic.  As a nursing home lawyer, I was disturbed to hear of a Connecticut nursing home where the staff withheld medications from a broad cross-section of patients at the large skilled nursing facility.

As reported in the New Haven Independent, surveyors from the Connecticut Department of Health found 18 cases where patients were not given the proper medication to patients at Regency Heights of Danielson.  Most of the identified problems involved patients with serious conditions such as congestive heart failure, seizures and hypertension.

In one case involving a diabetic patient, staff at Regency Heights failed to provide the patient with Glucophage (a medication used to control blood glucose levels) at least 72 times over a seven month period.

While no serious patient injuries or death were directly attributed to these medication errors, the facility has taken corrective actions to help reduce the chances of these events occurring again.  In addition, the Regency Heights facility has been fined $3,000.

Monitoring Diabetic Nursing Home Patients

Nursing home patients with diabetes must be monitored on a regular basis to ensure that their blood sugar levels remain safe. Proper monitoring of diabetics should consist of not only monitoring their blood sugar levels and diet, but the medical staff must also keep track of how the residents look and behave. Special attention should be paid to residents who experience: frequent urination, weight loss, fatigue, unusual aches or vision problems. 

However for patients who are on diabetic medication, such as Glucophage, must be given their medication as prescribed in order to prevent serious complications such as: Hyperglycemia or Hypoglycemia

Hyperglycemia

Hyperglycemia develops when there is too much sugar in the blood (glucose > 180mg/dl). Hyperglycemia may be caused by skipping insulin does, infection or illness. Prolonged hyperglycemia can result in infection, slow-healing cuts and sores, vision problems, nerve damage in arms and legs, chronic constipation and death.

Hypoglycemia

Hypoglycemia develops when blood sugar levels fall (glucose < 70mg/dl). Like hyperglycemia, hypoglycemia may develop when insulin is not timely administered or if the dosage is too high. Hypoglycemia may lead to serious medical complications such as coma or death.

Related Nursing Homes Abuse Blog Entries:

Never Event #3: Poorly Controlled Blood Sugar, Hyperglycemia & Hypoglycemia

Nursing Homes Not Prepared To Handle Diabetic Residents

Family Alleges Nursing Home's Failure To Control Diabetes Resulted In Death Of Patient

Dirty Needles May Be Cause Of Hepatitis B Outbreak In Nursing Home

Very disturbing allegations have surfaced in a nursing home negligence lawsuit filed against a California nursing home by a former patient at the facility.  Marsha Davis has filed a lawsuit against Country Villa of Seal Beach alleging that the facility improperly gave her psychotropic medications (Ativan) without a prescription in order to take over her social security payments.

If proved to be true, this is undoubtedly a form of elder abuse both in terms of the inappropriate drugging as well as the misappropriation of the woman's finances.  

According to Medicare regulations applicable to nursing homes: each resident’s drug regimen must be free from unnecessary drugs and define what is considered an unnecessary drug. An unnecessary drug is any drug used:

• In excessive dose
• For excessive duration
• Without adequate monitoring or without adequate indications for its use
• In the presence of adverse consequences, which indicate the dosage should be reduced or discontinued
• Without specific target symptoms

When nursing home surveyors conduct their inspections of facilities and confirm unnecessary psychotropic drug usage they may issue one (or more) of the following F-tags that are used to confirm care violations in survey reports:

• F-Tag 329 is cited for all unnecessary drugs including: anti-anxiety, anti-depressant, anti-psychotic, and hypnotic drug use. 
• F-Tag 330 is specific to anti-psychotic drug use in residents who do not have a specific condition as diagnosed and documented in the medical record
• F-Tag 222 is cited for inappropriate chemical restraints

With respect to the misappropriation of personal funds, similar the federal government has enacted similar safeguards with respect to protection of patient funds.

F-Tag 158

§483.10(c)(1) Protection of Resident Funds

The resident has the right to manage his or her financial affairs, and the facility may not require residents to deposit their personal funds with the facility.

F-Tag 159

§483.10(c)(2) Management of Personal Funds

Upon written authorization of a resident, the facility must hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility, as specified in paragraphs (c)(3)-(8) of this section.

§483.10(c)(3) Deposit of Funds

(i) Funds in excess of $50. The facility must deposit any residents’ personal funds in excess of $50 in an interest bearing account (or accounts) that is separate from any of the facility’s operating accounts, and that credits all interest earned on resident’s funds to that account. (In pooled accounts, there must be a separate accounting for each resident’s share.)

(ii) Funds less than $50. The facility must maintain a resident’s personal funds that do not exceed $50 in a non-interest bearing account, interest-bearing account, or petty cash fund.

Use of f-Tags in nursing home litigation

As a nursing home lawyer, I frequently use the compilation of 'f-tags' to help in the prosecution of my nursing home abuse cases.  While the regulations may appear to be fairly complex-- and they can be--- they can be especially helpful in establishing the standard of care with respect to different aspects of case provided at nursing homes.

Related Nursing Homes Abuse Blog Entries:

Study Demonstrates Correlation Between Under-Staffing & Incidence Of Infections In Nursing Homes

Medicare Standards Require Nursing Home Patients To Be Transported Safely

Are there any federal regulations that apply to the prevention of bed sores?

Some of the most tragic cases of nursing home negligence involve medication errors.  Not just because the error results in a severe injury or death of a patient, but because the errors were indeed so needless.  Somewhere along the line from the time the doctors order was written to the time the medication was dispensed--- or perhaps not-- we frequently see errors made with respect to how medications are handled in nursing homes.  Even innocent errors made by nursing home staff can wreck havoc on fragile patients who require strict adherence to their doctors medication orders.

For some reason, there seems to be a caviler attitude amongst some nurse some staff when it comes to dispensing medication to patients.  Perhaps it's the brightly colored pills or the fact that many staff members have become so accustomed to seeing a large percentage of patients taking the same medications? Regardless of the underlying reasoning, staff must be as diligent in their approach to medication dispensation as they are with providing other types of medical care for patients.

A prime example of the sloppy attitude towards the the dispensation of medication occurred recently at a Minnesota nursing home.  After an investigation completed by state investigators, it was determined that a patient at Lake ridge Care Center missed 26 doses of a potassium replacement medication over a nine-day period. 

After nine days without the potassium, she was admitted to a local hospital due to unresponsiveness.  Shortly after her admission, doctors determined that her condition was related to a severely abnormal heart rhythm which was attributed to an extremely low level of potassium.  Despite efforts to increase her potassium levels, the woman died from cardiac arrest.

Like many cases involving nursing home injury, this incident occurred during the initial time the woman was admitted to the facility.  As a nursing home lawyer, I find that the initial period following an admission to a nursing home can be particularly troublesome for both patients and staff as both parties work to get acquainted. 

Knowing the unfamiliarity with each other it is incumbent that patients and their families work with the facility to inform them of their needs and review conditions.  Would such intervention have prevented this mix-up?  Perhaps?  Yet, when the basic needs of patients go ignored, such errors are probably representative of a larger underlying problem at the facility.

Related:

Medication errors tied to Buffalo nursing home death, Star Tribune, June 24, 2011, by Paul Walsh

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

Who Should Manage Administration Of Medication?

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

A Minnesota nursing home has been cited by the state's Department of Health after investigators determined that staff at the facility failed to provide prescription medication to a patient who was admitted to the facility for short-term rehabilitation.  

The investigation was triggered in response to a complaint following the stroke-related death of an elderly woman who was admitted to Lakeshore, Inc. for short-term rehabilitation.  The woman was admitted to the nursing home in order to gain enough strength so she could return back to the assisted living facility where she lived.

Despite the fact that that the facility knew the woman had a history of strokes and was prescribed Coumadin for approximately 10 years prior, staff at Lakeshore never administered the Coumadin, nor did they administer the necessary blood tests to test the drugs effectiveness.

Health Department officials elected to cite the nursing home for failing to provide the necessary medication, but elected not to impose any fines primarily because the facility voluntarily changed its policies regarding administration of prescriptions prior to any strong-arming on the part of the state.

Situations such as this provide a reminder of the importance of reporting suspected errors to the Department of Health following a suspicious event.  In this case, officials were able to examine the patients medical chart and determine where the facility went awry.  While it may disappoint some that no fine was imposed, the fact that this incident was made public should hopefully provide enough motivation for the facility to change its ways.

Related:

Nursing home found at fault after woman dies, Duluth News Tribune, September 16, 2010

Medication Errors, Nursing Home Injury Laws

Fixed Minidose Warfarin and Aspirin Alone and in Combination vs Adjusted-Dose Warfarin for Stroke Prevention in Atrial Fibrillation (PDF) by Annette Lemche Gulløv, MD; Birgitte Gade Koefoed, MD; Palle Petersen, MD, DMSc; Trine Sander Pedersen, MD; Ellen Damgaard Andersen, MD; John Godtfredsen, MD, DMSc; Gudrun Boysen, MD, DMSc, Archives of Internal Medicine

Blood Thinning Medications, Such As Coumadin, Pose Substantial Danger To Nursing Home Patients Involved In Falls Nursing Homes Abuse Blog, November 30, 2009

Sometimes I see nursing home negligence cases where a facilities errors stem from the fact that staff fail to pay attention to an initial physician order or care plans developed by the facility for a patients care.  Perhaps the order itself was ambiguous, or perhaps the writing was illegible?  But what happens if a physicians order is just plain wrong?

Certainly, in cases where orders are ambiguous, illegible or downright suspect, it is up to the nursing home staff to clarify the orders with a supervisor at the facility or to take it upon themselves to confirm the order with the patient's physician.  Put another way-- staff can not leave their common sense at the door when implementing patient care.

Frankly, I was pleased to see a recent jury verdict in a case where the jury acknowledged that that nursing home staff can not pass the buck in all situations-- even when the physician is partially at fault. 

A California jury recently awarded a brain damaged woman $3.1 million in a case where the staff at St. Edna Subacute & Rehabilitation Center administered an overdose of morphine to a rehab patient who was recovering from a foot surgery.  The 57-year-old woman's podiatrist has mistakenly prescribed 50 mg of morphine instead of the 30 mg of Demerol that he intended.

Even though the morphine dosage was unusually high and staff were similarly warned of the excessive dosage by a pharmacist, the staff at St. Edna took it upon themselves to administer the mistakenly prescribed drug.

Even after the woman became visibly ill from the morphine, the facility still made errors in delaying the implementation of medical care and taking the woman to a hospital.  The combination of the excessive morphine dosage was well as the delay in care resulted in the woman sustaining a brain injury.

The $3.1 million award was composed of $2.0 million for pain and suffering and $1.1 million in medical costs.  The jury furhter apportioned the nursing home 90% responsible and the prescribing physician 10% at fault. 

In addition to the compensatory damages awarded above, the jury will also determine if punitive damages should be awarded based on the nursing home's conduct.

St. Edna Subacute & Rehabilitation Center is part of Covenant Care, a large nursing home operator with 25 facilities throughout California.

Related:

Woman injured at O.C. nursing home gets $3.1 million O.C. Watchdog, August 19, 2010

Insulin Overdose Kills Nursing Home Resident

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Morphine Intoxication Of Nursing Home Patient Results In Significant Jury Verdict

Loopholes in a reciprocity program amongst 24 states that allows nurses from one state to transfer to another may be putting a tremendous number of nursing home and hospital patients at risk for receiving poor care-- or perhaps more accurately downright dangerous care.

A recent USA Today article "Bad nurses able to keep working in other states" highlights the problems associated with the lack of a national database to keep track of nurses with blemishes on their records.  The article chronicles how some nurses legally obtain work in one state when they may have been disciplined for poor care in another.

The 24-state pact was originally intended help under-utilized areas of the county get the nurses when they need them--- without the nurses having to obtain licensing from the state board.  However, it seems like the dangers associated with states almost blindly allowing nurses to transfer into their state are alarming. 

In particular, there are multiple episodes where nurses have admitted and/or been disciplined in the following circumstances:

• Stealing patients medicine
• Medication errors
• Providing negligent medical care
• Neglected patient needs
• Physically abusing patients
• Failing to register as a convicted sex offender

Certainly, after reading this article, you will likely be left with a similar impression to myself that there needs to be a national tracking system for nurses and all health professionals who may have reciprocity rights that allow them to transfer from one state to another. 

However, until such a system is put into place, I firmly believe it is the responsibility of individual facilities (and staffing agencies) to provide qualified staff at their facilities to assure proper care and patient safety.  In my opinion, these responsibilities are non-delegable and when a facility fails to uphold their end of the bargain and a patient suffers harm they certainly expose themselves to civil responsibility.

Related Nursing Homes Abuse Blog Entries:

Temp Workers Becoming An Increasing Threat To Nursing Home Patients' Safety

Failure To Conduct Adequate Pre-Employment Criminal Background Search Costs Assisted Living Facility $750,000

'Significant Medication Errors' Discovered In Nursing Home Following Investigation Related To Patient Injury & Death

Why Would Anyone Want To Work In A Nursing Home?

Following a three week trial, jurors in Michigan awarded the family of a deceased nursing home patient $4.85 million. 

The nursing home negligence lawsuit alleged Mercy Memorial Nursing Center was negligent in administering morphine, a commonly prescribed pain medication, to a man who was admitted to the facility for physical therapy following a non-displaced hip fracture. 

A coroner's report concluded that the man died from 'morphine intoxication'-- essentially an overdose of the medicine.

According to the lawyer representing the nursing home patient's family, the facilities poor charting was probably to blame for the man's morphine overdose.  "The document stuck out like a sore thumb.  It clearly shows morphine was unaccounted for on his chart," the lawyer added.

Like many nursing home negligence cases, this case has a long history.  The lawsuit was originally filed in 2005 only to be dismissed and reinstated by the Michigan Appellate Court.  Further, the man's wife died during the pendency of the matter-- making the juries decision even more impressive.

Morphine Intoxication

Morphine is an opiate pain medication commonly used for nursing home and hospital patients recovering from trauma or to alleviate chronic pain.  Morphine requires a doctors prescription.  Due to the strength of the medication, it generally is taken under medical supervision.

Indications of a morphine overdose or morphine intoxication that require medical attention include:

• Fixed pupils
• Nausea, vomiting
• Severe constipation
• Low blood pressure
• Muted pulse
• Discolored fingers and lips
• Shallow breathing

Nursing homes that administer morphine and other drugs to patients must do so in a safe manner.  This means administering the specific medications according to the dosages and frequency prescribed by a physician.  Further, facilities must keep an accurate accounting of every dose given to a patient.

Unfortunately, many medications look very similar and some staff administering the medications are not familiar with the patients.  Many times this results in serious injury or death of the patient. 

If you believe your loved one was harmed due to a medication error in a nursing home, assisted living facility or hospital, we would be honored to speak with you regarding your legal options.  As always, there a never a charge to speak to our lawyers and we only earn a fee if there is a recovery for you. (888) 424-5757

Related:

Family wines $4.85 million for nursing home death, Toledoblade.com, June 29, 2010

Medication Errors, Nursinghomeinjurylaws.com

Authorities Investigate North Carolina Nursing Home After Lab Test Determines Patient's Death Related To Morphine Overdose

Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

Officials at the North Carolina Bureau of Investigation are looking into the nursing care provided to patients at the Britthaven of Chapel Hill nursing home after laboratory tests confirmed that the death of an Alzheimer's patient may have been related to a morphine overdose.

The investigation was triggered after the blood lab results determined that an 84-year-old patient at the facility had 'toxic' levels of morphine in her body at the time of her death. 

Lab results revealed that the nursing home patient had morphine levels of more than 50,000 nanograms per milliliter at the time of her death.  Putting that number in perspective, federal regulations concerning employment screenings categorize lab result over 2,000 nanograms per milliliter as 'positive'.

What makes this matter particularly alarming is the fact that no physician ever ordered morphine for this patient and other patients in the Alzehimer's units at Britthaven similarly tested positive for morphine without any physician orders.

This incident is not the first time investigators have questioned the care provided to patients at the Chapel Hill, NC nursing home.  Britthaven has the dubious distinction of earning a spot on the government's 'Special Focus Facility' list after regulators found multiple safety violations in 2008 and 2009.

Morphine Use In Nursing Homes

Morphine is a powerful narcotic pain reliever that is made from opium.  Like most powerful narcotics, morphine can only be prescribed by a physician and must be carefully dispensed in order to avoid addiction and overdose.

Particularly in the elderly, morphine dosages must be strictly adhered to in order to prevent overdoses which can easily kill a patient due to the cellular changes the drug brings about in the body that alter breathing patterns.

Britthaven operates many nursing homes, assisted living facilities and rehabilitation centers in North Carolina, Kentucky and Virginia. 

Related:

Medication Errors: Nursing Home Injury Laws

'Significant Medication Errors' Discovered In Nursing Home Following Investigation Related To Patient Injury & Death

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

Nursing Home Patients Continue To Receive Drugs Associated With Known Dangers

Following a medication-error related death and other medication-related problems that resulted in patient injuries, Minnesota Department of Heath investigators concluded that Fair Oaks Lodge in Wadena, MN was guilty of neglect and other federally mandated nursing home standards.

The 'major medication errors' occurred within 16 days of one another.  According to the State's investigative report:

• A medication aide mistakenly gave an Alzheimer's patient drugs for her central nervous system, the heart and anti-psychotic medication all of which resulted in an immediate drop of her blood pressure.  Despite being rushed to the emergency room, the elderly woman died three days later.
• A patient was hospitalized after receiving two does of Tylenol within two hours and an improper medication related to hypertension
• A third nursing home patient was hospitalized after a nurse administered medications a medication aide had intended for another patient.

Despite the serious medication-related problems at Fair Oaks, state investigators still found a medication error rate of 18% 2 1/2 months later.  Read more about these medication errors in a nursing home here.

Medication Errors

In the nursing home setting, some of the more common medication errors include:

Administering The Incorrect Prescription

Medication errors can result when there is a mis-communication or misunderstanding of drug orders. These errors may be due to: poor handwriting, confusion between drugs with similar names, misuse of zeroes and decimal points, confusion of metric and other dosing units, and inappropriate abbreviations. Doctors must take reasonable care in correctly and accurately writing prescriptions and staff must similarly confirm medication types and dosages when in doubt.

Medication errors can also occur when doctors take an incomplete medical history from a patient. For example, the doctor might not know about the patient’s allergies, any other medications the patient is taking, previous diagnoses, and lab results. Nursing homes should help treating physicians by ensuring that they provide the physician with accurate medical charts.

Failure to Consider Adverse Side Effects of Drugs

Many prescription (and over-the-counter) 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. Similarly, the staff in a nursing home, should monitor patients to help detect adverse reactions as quickly as feasible.

Incorrect Medication Dosage

Prescription medications have more serious dangers associated with them than over the counter (OTC) drugs. Therefore, it is important that nursing home staff issue the correct drug (the one the doctor prescribed) at the correct dose. At many nursing homes and medical facilities, medications are administered via a ‘medication cart’ where many similar-looking pills are stored. Consequently, staff in nursing homes must check and re-check before administering medication to assure the patient receives the proper dosage.

Medical complications may arise when patients are administered too much or too little of a drug. Many prescription medications require must be taken at a specific time, staff must be aware of these administration parameters and dispense the medication accordingly.

Adverse Drug Interactions

Many 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.

Nursing Home Liability for Medication Errors

Medication error cases can frequently be some of the more complex cases due to the fact that a variety of parties may be responsible for the error(s). In some cases, liability may be imposed on the physician, nursing home and pharmacy involved in the incident. Consequently, in order to fully investigate each parties culpability, it is important to speak with a lawyer experienced in handling cases involving medication errors as soon as feasible after the event.

Related Nursing Homes Abuse Blog Entries:

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

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

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

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

Continue Reading

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.

• MRI Danger: Gadolinium Liquid May Cause Severe Reactions Such As Nephrogenic Systemic Fibrosis

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:

• Have You Suffered An Injury After Taking Avandia?

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.

• Fentanyl Overdose Leads To 1.6M Nursing Home Settlement

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.

• 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.

• Medications Such As: Visocol, OsmoPrep, or Fleet Phoso-Soda May Cause Kidney Failure Or Death In The Elderly

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.

• Use Of Reglan Has Been Linked To Development Of Tardive Dyskinesia Or Abnormal Muscle Spasms

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 Rosenfeld Injury Lawyers 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

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

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

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.

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

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

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. 

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.

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.

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. 

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.

Nursing Home Injury Laws: Kansas

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.

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.