Medication Mistakes in Nursing Homes

Nursing Home ErrorsAs of June 2, 2014, there were 195 licensed nursing homes in South Carolina, with a total of 20,156 beds. Estimates are that about 40 percent of people over age 65 will spend time in a nursing home at some point – you or your parents or other loved ones could be among them. And it’s likely that you, or they, will be dependent upon prescription drugs to extend and improve the later years of life.

Medications are an important and integral part of the care provided to residents of assisted living centers and skilled nursing facilities. One study found that an average of 6.7 medications are ordered per elderly resident, with 27 percent of residents taking 9 or more. Medicaid data showed that in one state, during a 30-day period, 68% of long-term care patients had received 9 or more prescription drugs, and 32% had received 20 or more! Obviously, the more medications a patient is supposed to be given, the greater the risk that mistakes will be made. Patients who cannot, or are not allowed to, self-administer their medications are at the mercy of staff who may be overworked, underpaid or poorly screened.

How big is the problem of medication errors in nursing homes?

A study reported in the Journal of the American Medical Association assessed the incidence and preventability of ADEs (adverse drug events) among 27,617 Medicare enrollees aged 65 and older in an ambulatory clinical setting. Of 1,523 ADEs uncovered, 27.6% were considered preventable; 38% were described as serious, life-threatening, or fatal.

Medication mistakes are such a routine part of nursing home care that a certain number of them are considered “acceptable” within the industry. Only when the error rate is 5% or greater is it worthy of a deficiency citation by regulators.

What types of mistakes cause adverse drug events?

A 2007-08 study in North Carolina by the Medication Error Quality Initiative identified the most frequent medication errors to be the following:

  • Dose Omission
  • Overdose/multiple Dose
  • Under Dose
  • Wrong Product Strength
  • Expired Order
  • Wrong Documentation
  • Wrong Product
  • Wrong Time
  • Wrong Patient
  • Wrong Duration
  • Monitoring Error
  • Lab work Error
  • Wrong Technique
  • Wrong Form of Product
  • Expired Product
  • Wrong Rate of Administration
  • Wrong Route.

Some of these are self-explanatory, but you may wonder what is meant by “wrong technique” or “wrong route.” In addition to making sure that the proper drug is given at the proper time, nursing home nurses and certified medication aides must take the time to properly administer the drug. For example, some drugs are to be shaken well before being given, but rushed nurses may omit this preparatory step or just give the container a quick jiggle. Some medications should not be crushed, but nursing homes frequently give medications ground up in applesauce to make them easier to swallow. Many medications are meant to be taken before a meal, or with food, but this does not always fit the staff’s med pass schedule.

What is a med pass?

Med pass is the term given to the periodic dispensing of medications to nursing home residents. It is usually done from a cart by a licensed nurse or a certified medication aide under the supervision of a nurse.

If you’ve ever visited a resident of an ambulatory care center or assisted living facility at meal time, you’ve probably seen a large rolling cart stocked with various medications and supplies which are doled out to each patient in turn. At other times of the day or night, the nurse and her pharmacy on wheels delivers and administers medications ordered by numerous doctors. In fact, a significant amount of a nurse’s time in elder-care facilities is spent on medication-related matters.

According to an article in the Annals of Long-Term Care, a typical med pass in a long-term care facility exceeds 2 hours. If a medication nurse conducts two medication passes during his or her shift, caring for an average of 30 residents, many of whom take 10 or more medications, there is a potential to deliver and administer several hundred medications each day. And there’s an equal potential for error.

Why are medication mistakes made?

In addition to having a large number of drugs and doses to administer, nursing home personnel make medication errors for a number of other reasons, including being distracted or interrupted by other demands.

It is not unusual for a nursing home resident to be hospitalized, perhaps due to a fall or illness, where the doctor will make changes in his or her medication regimen. When the patient is released back to the residential facility, the revised orders may not be properly communicated. Sometimes there is confusion about whether a previously prescribed drug has been withdrawn or is to continue.

Lack of communication between nursing shifts also leads to the potential for incorrectly giving patients their medications, and busy nurses don’t always sufficiently note and describe patient complaints or observations that could indicate a problem with medication.

What happens when patients are given wrong meds or wrong doses?

Prescription drugs are ordered to stabilize or improve a patient’s comfort, quality of life, functional capacity, and length of life. Not only can medication errors deprive the patient of the full benefit of the ordered drug therapy, they can expose the patient to potentially harmful conditions, such as medication interactions, depression, confusion, immobility, falls, and related hip fractures.

The drugs most often associated with preventable adverse drug events are cardiovascular medications (24.5%), diuretics (22.1%), nonopioid pain meds (15.4%), hypoglycemics (10.9%), and anticoagulants (10.2%).

Some adverse reactions are considered significant but not serious — skin rash, a fall without associated fracture, hemorrhage not requiring transfusion or hospitalization, and oversedation. Examples of serious consequences are hives, a fall with an associated fracture, hemorrhage requiring transfusion or hospitalization but without hypotension, and delirium. Sometimes a medication error can be life-threatening and produce hemorrhage with associated hypotension, hypoglycemic encephalopathy, profound hyponatremia, and acute renal failure requiring hospitalization.

Wrong Drug? Right Response.

If you believe that a nursing home, assisted living facility, or skilled nursing facility harmed you or your loved one by failing to properly administer prescribed medication, you may be entitled to compensation for those injuries or your loss. At the Louthian Law Firm in Columbia, South Carolina, we have been securing justice for hardworking people and families since 1959. You should not have to pay the price – either in dollars and cents or in diminished quality of life – because of the negligence of a healthcare professional.

Not only are nursing homes required to meet certain standards of care, they are required to keep detailed records and are subject to inspection by state and federal regulators. The South Carolina nursing home malpractice lawyers of The Louthian Law Firm in Columbia will conduct a thorough investigation of the negligent elder-care facility and take every step necessary to see that justice is served.

Discipline. Diligence. Dedication. That’s what we offer families who are injured through the negligence of others. Call us at (803) 454-1200 or use our online contact form to arrange a free consultation.