Medication Errors in Nursing Homes

Medication Mistakes

As your parents have aged, it has become harder and harder for them to manage their basic care. You did your best to care for them, working with them to get them to doctors’ appointments, arranging to have their home cleaned, and stocking their cupboards. However, as much effort as you put into ensuring their care, it was becoming increasingly difficult to keep up with their needs. After many discussions with them, you all decided that a nursing home provided the best option for their health and community requirements. Selecting the best place for them took careful consideration, but you finally found a place that offered high-quality medical care and a friendly environment, or so you believed.

Discovering that your parent suffered as a result of a medication error is a devastating experience. Learning that it resulted because of the negligence of the staff is even worse. Unfortunately, there are many instances of medication errors in nursing homes, including administering the wrong drugs, providing the patient with the wrong dose, or giving the medication at the incorrect interval. Regardless of how the medication error occurred, the consequences are devastating. You need the assistance of Stern Law, PLLC to fight for the interests of your parent and ensure that this does not happen to anyone else.

Medication Errors are Common in Nursing Homes

There are numerous reasons why there are so many medication mistakes in nursing homes. Often, the error does not lead to serious or permanent injury, so it goes unreported. Despite the fact that most instances of medication mistakes are not reported, the Food and Drug Administration (FDA) has received nearly 100,000 reports of medication mistakes since 2000. These mistakes may be the result of reading the doctor’s instructions improperly, untrained staff, careless or overworked staff, unsupervised nurses, or lack of adequate employees for the number of residents.

The common types of medication errors are:

• Administering the wrong medication or giving the patient the wrong dose;
• Failing to observe the patient for any side-effects of the medication. Certain medications require regular blood testing in order to monitor impacts on the body;
• Improperly administering a drug to a patient who is allergic; and
• Delaying or missing the administration of medication.

In order to avoid problems, medications should be administered under a physician’s prescription and the drugs should be provided by a qualified nurse directly to the patient. The standard of care that applies is that a qualified nurse must verify that the correct medication, which has been prescribed by the patient’s doctor, is prepared in the correct dosage and administered in the appropriate manner. Unfortunately, this does not happen in understaffed or poorly run facilities. There also are situations where the nurse or other staff intentionally diverts, or steals, medication intended for the patient. These intentional acts may have been avoided if the nursing home had conducted the appropriate background check.

Medication errors are so prevalent that there are acceptable levels of problems with the administration of drugs, including percentages and severity of mistakes allowable under Medicare and Medicaid regulations. Federal regulations require that nursing home facilities have less than five percent (5%) of medication errors and that there are no significant mistakes. Significant errors are those that lead to measurable discomfort in the patient or jeopardize the health or safety of the individual.

There are some guidelines to judge whether the mistake is deemed significant or not, including:

• The condition of the patient – Some medications may have serious consequences for one patient, while the impact on another would be minimal. A patient who is already dehydrated may suffer severe harm if improperly administered a drug to eliminate fluids from the body.
• The classification of the drug that was erroneously administered. – Certain drugs may lead to toxicity after only one dose if given to the wrong patient or administered in the wrong dose. This is especially true with pharmaceuticals with a Narrow Therapeutic Index (NTI), where the proper dose is extremely close to a dose that will cause toxicity.
• Repeated errors – Where the frequency of the mistake increases, it may be classified as significant even if it would not have been deemed significant if it only occurred once or twice. The condition of the patient and the type of drug mistake will be considered in evaluating this type of error.

The error rate is established by the observed medication errors divided by the number of opportunities for an error to occur. These mistakes may be deemed significant or non-significant. If the error rate is less than 5% then the facility will not be cited. How this works is that nursing home inspectors complete annual reports detailing the frequency and severity of errors and only issue citations if the error rate is 5% or greater, or if there are significant error events, indicating that the current system of medication administration needs an overhaul. Further, this means that it is difficult for perspective residents to learn about some of the problems at a nursing home because of the lack of documentation.

Typically, medications are distributed to patients during a “med pass” at established times by way of a cart pushed from room to room. Depending upon the law of the state, this either is done by a nurse or under the supervision of a licensed nurse. Regardless of how it is done, the procedure for the administration of medications must be carefully established and written up. In following the protocol, it may take many hours to dispense all of the medications, depending upon the size of the nursing home. In addition, all of the drugs have to be acquired, organized, properly stored, and protected. This takes a significant amount of time and requires knowledge and skill. There are many things that can go wrong at different stages of the process.

Some common types of specific medication errors are:

• Failing to shake medications that need to be shaken properly before being dispensed result in the wrong dose being administered;
• Improperly mixing suspensions, such as insulin, can lead to air bubbles or unmixed solution;
• Delivering the drug via the wrong administration route;
• Administering an expired medication;
• Crushing or otherwise altering medication in a way that changes the efficacy of the drug;
• Failing to administer the medication with the necessary fluids;
• Failing to provide food with drugs that must be taken with food;
• Not achieving the proper technique with medications that must be instilled into the eye;
• Neglecting to ensure that a patient gets the proper dose from a metered inhalation device;
• Failing to continue the administration treatment for a sufficient length of time for the proper dose to be administered, which may result when a nebulizer treatment is cut short; and
• Failing to prevent patients from swallowing medications that must be dissolved under the tongue, such as nitroglycerine tablets.

Different situations that exist in the nursing home can lead to the occurrence of medication errors. These include:

• Simple human error;
• A transcription error in the directions for a specific patient;
• Numerous changes in the caregivers;
• Frequent distractions or other demands from patients and staff;
• Dispensing errors in the pharmacy;
• Ineffective or incomplete communication;
• Unavailability of the proper medication;
• A mix-up in the delivery of medication due to name confusion, either of the drug or the patient;
• A failure to follow the written drug administration protocol;
• Errors caused by overworked and overtired staff;
• Shift changes during medication delivery;
• Medication packaging problems;
• Insufficient staff training; and
• Illegible writing on the prescription or other critical documents.

There are circumstances where the patient does not get the proper medication where it is not classified as a medication error. For example, if the patient has dementia or another form cognitive impairment where administering the prescribed drug in the correct manner is made impossible as a result of the behavior of the patient, then it is not a medication error, but steps must be taken to come up with an appropriate solution. However, in many of the instances where the patient does not get the medication necessary to treat a diagnosed condition or receives a drug or dose that has not been prescribed, it is because of medication error. These mistakes can lead to serious consequences for the patient and may result in death. As the child of a parent who suffered serious harm as the result of a medication at a nursing home, it is crucial to get help on behalf of your loved one.

Stern Law, PLLC: Our Lawyers Make a Difference

Advances in medicine have resulted in numerous drugs that can help make the lives of your parents much better as they age. However, being certain that they get the right medication at the right time and in the prescribed dose was one of the main motivators in deciding to find a nursing home for them. You wanted to be confident that qualified medical personnel and dedicated staff were taking care of the details that were critical for the well-being of your parents. Discovering that a mistake was made that caused suffering and may impact future quality of life was devastating. Now, you need answers about how this could have happened and assurances that this never will happen again. Nursing home negligence always is a difficult reality to face, but learning that it was so easily preventable if the facility had followed the proper protocol is particularly devastating. Stern Law, PLLC was founded on the principles of getting answers in situations like this and then getting compensation for the wrong that was done to your parent. The medication error caused pain and suffering, but it also may have lead to a permanent medical condition that is going to require additional, specialized care for the remainder of your mom or dad’s life. The attorneys at Stern Law, PLLC understand how expensive this will become and will work to get the money to ensure that the remainder of his or her life is comfortable and free from the constant worry that this will happen again.

When I, Ken Stern, founded Stern Law, PLLC it was to fight for the rights of vulnerable members of our society. Nursing homes must be held accountable when their negligent practices lead to the suffering of one of their residents. Stern Law, PLLC will work with you to investigate the problems that existed at your parents’ home and get justice for the wrongs that were done to them. You can call our team at 1-877-469-7273 (1-877-4MYPARENT), at any time of the day or night, and we will answer your questions and offer solutions, without charge.