Medication Errors

Case Types

Nursing home residents are at high risk for suffering medication errors. The average nursing home resident takes between 7 and 8 medications daily. That means that for the average nursing home resident, there are at least 7 opportunities for medication errors every day.

How Common Are Medication Errors in Nursing Homes?

Because medication errors can be deadly, nursing homes must take every measure to ensure they don’t occur. Unfortunately, an estimated 800,000 preventable medication errors occur in long-term care facilities every year in the United States.

Are Medication Errors A Sign of Abuse and Neglect?

Serious medication errors at nursing homes are considered neglect and abuse. Serious medication errors occur when a medication error causes a severe injury, or even death. It is important to remember that with appropriate systems and planning, medication errors are preventable.

Medication errors at nursing homes do not need to be intentional to be considered abuse and neglect. Accidental medication errors at nursing homes are also a sign of negligence.

What Are The Most Common Types of Medication Errors?

Medication errors can take almost any form, but some medication errors are more likely to occur in nursing homes than others. The following list includes some of the most common nursing home medication errors.

Prescribing Errors

Prescribing errors occur when a medication is ordered for a patient but should not be given or should not be given in the dosage ordered. Medication may be unsafe for elderly patients for a number of reasons.

Some medications are considered generally unsafe for the elderly. Many of these medications are considered dangerous according to the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. The American Geriatrics Society revises the list every three years. The Beers Criteria is a list of potentially harmful medications or medications with side effects that outweigh the benefit of taking the medication for the elderly population. Nursing homes should avoid prescribing medications on the Beers Criteria.

Other medications may be dangerous because they interact with other medications the person is taking. Dangerous drug interactions are common in the elderly. For example, a certain blood thinning medication called Warfarin is dangerous when combined with nonsteroidal antiinflammatory medications like ibuprofen and ACE inhibitors used to control blood pressure are potentially deadly when combined with potassium supplements.

Nursing homes are required to cross-check medications to prevent harmful drug interactions. Sadly, nursing homes often neglect this crucial step.

With nursing home residents taking so many medications daily, 7 to 8 on average, nursing home’s are responsible for preventing prescribing medication errors.

Medication Overdose

An overdose occurs when toxic and potentially lethal doses of medication are given. Medication overdoses can be unintentional, for example, when a nurse adds a fentanyl patch to a patient before removing an old one resulting in a potentially fatal dose of opioid medication. This may also occur when the wrong dose of a prescribed medication or another patient’s medication is accidentally given.

Other medication overdoses may be intentional and used to intentionally or unintentionally restrain a patient. This is an illegal practice called “chemically restraining” a resident.

Most troubling, on rare occasions, nurses or other staff have deliberately overdosed patients in an effort to take their lives. A nursing home must have appropriate systems in place, including background checks and ongoing monitoring of medication usage, to ensure this never happens.

Medication Underdose

An underdose occurs when a patient is given the correct medication, but not enough of the medication is given. It is an often underreported and underappreciated medication error. Underdosing usually does not result in immediate life-threatening issues. It does limit the therapeutic effect of a medication and overtime can result in serious long-term consequences.

Failure to Consider Drug Interactions

There are several different kinds of drug interactions that nursing homes must consider.

One of those potential medication errors is called drug-drug interactions. This is when one or more medications interact with one another causing a harmful effect. For example, taking a drug to help you sleep, called a sedative, and a cough medicine, called an antitussive, could cause the two medications to dangerously interact with one another resulting in respiratory depression or death. Another example is if a nursing home resident is taking a medication to control blood pressure and is given another medication that negates the effects of that medication, it can result in cardiac issues, stroke, or death. Nursing homes are required to carefully review resident’s medications to eliminate harmful drug-drug interactions.

Another dangerous drug interaction is called drug-food interaction. Drugs taken by mouth have to be absorbed into the stomach. Certain foods, like the acidity of certain fruits and fruit juices, can decrease the effects of some antibiotics. Green leafy vegetables, generally considered a very healthy food, can cancel out the effects of a blood thinning medication called Warfarin (coumadin) causing strokes.

Other potentially dangerous drug interactions are called drug-condition interactions. This is when a medical condition makes it dangerous to take certain medications. For example, if a resident has high blood pressure, taking a decongestant can dangerously raise their blood pressure.

Nursing homes must carefully review all potential drug interactions and monitor residents for any signs of adverse drug interactions.

Medication Omission

A medication omission occurs when a medication that was prescribed was not given. A medication omission can happen on one or a small number of occasions when doses are missed. It can also happen when a medication is prescribed but never makes it onto the patient’s medication order sheet at the nursing home. This often happens when a patient is admitted to a nursing home from a hospital or other facility, and the nursing fails to ensure that all medications ordered are added to the patient’s medication sheet. Depending on the medication, medication omissions can be as deadly as an overdose.

For example, if cardiac or blood thinning medication is not given on time, the resident can have cardiac issues or stroke leading to permanent injuries or death. If anti anxiety or similar medications are not given, patients can become restless or agitated resulting in falls and serious injuries. If Parkinson’s medications are withheld, residents can have accelerated symptoms of muscle rigidity and involuntary movements leading to falls and choking hazards.

Wrong Patient

A wrong patient error occurs when a medication intended for one patient is given to a different patient. For some over-the-counter medications, this may be a minor inconvenience. Other medications, even those that seem mild, may have devastating consequences because the resident may not be able to tolerate the medication because of underlying physical conditions or the medication may dangerously interact with a medication the patient is currently taking.

Wrong Medication

A wrong medication error occurs when a patient is given a medication that was never ordered from them. This type of medication error may occur when a rushed nurse loads the wrong medications on the medication cart before passing them to the residents. A wrong medication error may also occur when a nurse becomes distracted and hands a resident another resident’s medication. Whatever the reason, wrong medication errors in nursing homes are always a sign of negligence.

Wrong Route

Wrong route medications occur when a medication is given orally when it should be given intravenously or vice versa or when ear drops are given as eye drops. There are several potential causes of this error. One cause is that the pharmacist ordered or the pharmacy mistakenly prescribed the medication in the wrong way. Another potential cause is that the nurse is rushed or distracted and administers the medication in the wrong route of transmission, for example injecting an oral medication into an IV.

When administered in the incorrect route, a medication that is generally safe can have deadly consequences.

Failure to Obtain or Consider Allergy History

Some studies suggest that 12% of all medication errors are caused by a failure to obtain a patient’s allergy history. When obtaining a resident’s allergy history, the nursing home must identify the drug that caused the reaction, the nature of the reaction, the treatment for the reaction, and the time since the reaction. Nursing home residents are often unable to provide their own history due to difficulties with memory and recall. In that case, nursing homes must get a comprehensive medical history both from the resident’s records and the resident’s family members.

Administering a drug when a patient has a known allergy, or when the nursing home could learn about the allergy with due diligence, is negligence.

Failure to Consider Kidney or Liver Function

Another widespread medication error is when nursing homes fail to consider a patient’s liver or kidney functioning. Medications are often metabolized and filtered through the bloodstream by the kidney and liver. Patients with liver and kidney dysfunction need lower doses of medication. What are considered “normal” doses can result in toxicity because of the failure to breakdown or excrete the medication.

Unauthorized Prescribing of Medication

Although all medication errors are concerning, one of the most egregious forms of medication errors occurs when nursing staff take it upon themselves to prescribe medications without a physician’s authorization. Only a physician or a certified nurse practitioner can prescribe medications. However, there have been numerous instances where nurses have intentionally given patients medications without physician authorization.

Nursing homes must have checks and balances in place to present unauthorized medication administration.

How Are Medication Errors Prevented in Nursing Homes?

Medication administration is a multiple step process in nursing homes. The process begins with a physician prescribing the medication, the pharmacists preparing the medication, to the healthcare team collecting and administering the medication. An error can occur any step along the way.

The most tried and true way of preventing medication errors is to ensure the 5 rights of medication are met.

Right patient
Right drug
Right time
Right dose
Right route

Nursing homes must have appropriate documentation systems to ensure that these rights are met.

Why do Medication Errors Occur at Nursing Homes?

Understaffing is a common cause of medication errors. Understaffed facilities lack the resources needed to maintain systems needed to safely care for residents. When a nurse is administering medications, they should be able to devote their attention fully to doing so. That includes loading the cart with medications and ensuring that the patient is given the right medication in the right dose. Understaffed workers are often distracted and forced to do more than one job at once. The result is that the wrong medication, or the wrong dose of a medication, may be given with disastrous consequences.

When staff are overworked and asked to do more than they are capable of doing, they are also often prevented from giving medications at the correct time. Some medications are highly time dependent. While many medications are alright to give over a range of time, other medications, like seizure and Parkinson’s medications, must be given at regimented times. When a facility is understaffed, nurses are prevented from giving medications at the correct time.

Another significant cause of medication errors is staff who are poorly trained on drug interactions and drug reactions. All medications have a risk of side effects, especially when a patient is on multiple medications that can negatively interact with one another.

Training staff costs money and lost money is lost profits. The vast majority of nursing homes are for-profit facilities–meaning that their overall goal is to earn a profit for their owners and shareholders. When nursing staff are in training, they are being paid when not providing care. This results in overtime and lost profits. As a result, few nursing homes truly have well-trained staff.

Chemically Restraining Residents

The days of physically restraining residents is for the most part over. However, straps, tie downs, and straight jackets have largely been replaced with sedating medications. These medications are usually in either a class of medications called benzodiazepines or antipsychotics. Both of these are potentially deadly in the elderly.

The most common medications to be abused by nursing homes and their staff are:

Abilify (aripiprazole)
Clozaril (clozapine)
Haldol (haloperidol)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Risperdal (risperidone)
Geodon (ziprasidone)

These drugs are known to cause difficulty functioning, increased risk of falling, dehydration, malnutrition, choking, and a general overall decline in health. These sedating medications can also cause severe, lethal side effects, including wandering because of confusion, cardiac issues, and increased risk of stroke.

It is illegal to chemically restrain residents. It is prohibited by the Federal Nursing Home Resident Rights Laws, many state resident right laws, and is considered abuse and neglect.

Representative Cases

Phil

Phil was an 81-year-old man with a history of Parkinson’s disease. He entered a nursing facility outside of Cleveland, Ohio for a temporary stay while his wife sold his home and they resumed living together. Phil’s wife received a call that he was acting strangely and the doctor had ordered a medication for anxiety. When Phil’s wife came to visit him days later, he could no longer walk, speak, eat, or even respond. He was taken to the hospital where it was determined that a nurse had given him risperidone, which is an antipsychotic medication. No physician had ever prescribed this medication. In addition to the fact that no doctor ever prescribed this medication it should never be given to Parkinson’s patients because it accelerates Parkinson’s disorder. Phil lost the ability to swallow and eventually died from the effects of aspiration pneumonia. The lawsuit settled for $2,300,000.

Jacob

Jacob was a nursing home resident in East Palestine, Ohio. Jacob was taking an antipsychotic medication. Many antipsychotic medications are known to cause weight gain. Jacob gained approximately 100 pounds during his stay at the nursing home. Rather than address his weight gain from antipsychotic medication, the nurse practitioner ordered large doses of lasix. Lasix is a diuretic medication used to treat excess fluid caused by congestive heart failure. Jacob did not have congestive heart failure, and his weight gain was not because of increased fluid. The diuretic medication caused him to suffer a severe physical decline, become dehydrated, and die. The lawsuit is currently pending in Columbiana County, Ohio.

Jane

A 76-year-old Michigan woman died after being given a fatal dose of morphine. She had been recovering from a fractured hip at a nursing home just north of the Ohio border. None of the staff were charged with a crime, but a jury returned a verdict of $4,850,000.

Nora

Nora was a 75-year-old woman who entered a nursing home in Delaware, Ohio to recover after elective back surgery. She had a history of mental health concerns, but was doing well with a well-established medication regimen. Without explanation, the nursing home physician removed her psychiatric medication and replaced it with a medication called dronabinol (Marinol). Dronabinol is a man-made form of THC, which is the psychoactive chemical in marijuana. It should not be given to patients with psychiatric conditions. She fell numerous times at the nursing home after her medications were negligently changed causing her to suffer multiple spinal fractures, the hardware in her spine to break and move, break her pelvis, and die prematurely. The case is currently pending in Knox County, Ohio.

Heather

Heather Presdee is a nurse in Western Pennsylvania outside of Pittsburgh who has confessed to trying to kill 19 patients by administering excessive amounts of insulin. She has been linked to 17 nursing home resident deaths at multiple nursing homes. We are currently investigating those cases.

Joan

Joan was a 85-year-old woman who entered a nursing home in northeast Ohio after being hospitalized for an illness. The hospital sent orders for her warfarin–a blood thinner used to prevent blood clots. The nursing home did not restart the medication, and she developed a blood clot and died. The nursing home settled the case for $1,000,000.

How Much is My Nursing Home Medication Error Case Worth?

Every case is unique and has to be evaluated on its specific facts. The only way to determine the value of your nursing home medication error case is to begin an investigation.