Pharmacy Error Injury Lawyer Blog

Earlier last week in Tennessee, a firefighter went to pick up a prescription for an anti-inflammatory medication for shoulder pain and was instead provided Adderall, a medication used to treat the symptoms of Attention Deficit Disorder. According to one local news report, the firefighter immediately noticed that his heart started racing and he was feeling light-headed.

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After a few days, he could tell something was not right with the medication. He told reporters that “I started noticing I was real jittery and even throughout the day I was just a bit jittery. I started having hallucinations, shortness of breath and I just really wasn’t feeling myself.”

He ended up calling the Walgreen’s that filled the prescription at 4:00 a.m. to ask if something was wrong with the prescription. As it turns out, he had been given another patient’s medication and had been taking 30g of Adderall twice a day for several days. The firefighter was admitted into the emergency room twice in two days and was given medication to slow down his heart rate.

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Earlier this month in Michigan, a teenager’s family discovered that he had been taking the wrong prescription for almost a whole month after they noticed that his mood was off and his schoolwork declining. According to a report by one local news source, the teen was prescribed medication for his ADHD that he was to take daily. However, when he went to fill the prescription, he was instead provided a generic version of Singulair, an asthma medication.

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The teen’s parents noticed that he was acting off once he started taking the medication. He was “extremely feisty and bitey and moody, extremely moody, and his school work just went downhill, everything went downhill.” But the parents didn’t know what was wrong. At first, they thought that he was not getting enough of the medication, and that his dosage was off because he had grown since the dosage was last adjusted. It wasn’t until the teen’s mom looked at the bottle when she took it to get refilled that she noticed a problem.

Evidently, the bottle had the teen’s first name on it and his last initial, but it was for an entirely different patient. Making matters even more confusing, the correct address and prescription label was on the bottle. When they first filled the prescription, the teen’s mom trusted her son to take his medication as he should. In fact, he was doing fine taking it as needed until this setback.

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In a newly released study by Pediatrics, it is reported that there are an astronomical amount of child medication errors that are occurring outside the hospital setting. According to one article that summarized the report, there are almost 64,000 medication errors annually in the United States involving children under the age of six. Twenty-five percent of these errors occur in infants under the age of one.

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The report explains that each year, there are about 200,000 medication errors that occur outside of hospitals, and about 30% of these errors involve children under six. This comes to one medication error every eight minutes. Of course, the study can only deal with reported medication errors. The actual number of errors is expected to be much higher, since only a fraction of errors are reported.

Liquid medications are by far the biggest culprit when it comes to medication errors, resulting in a whopping 89% of all errors. As far as what was causing the error, the breakdown is as follows:

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In a frightening case out of British Columbia, a 76-year-old, otherwise healthy woman died when she was prescribed two drugs that were known to have dangerous interactions. According to a report by one local news source, the error slipped past the physician, two pharmacists, and the computer system that tracks drug interactions.

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Evidently, the woman was on maintenance therapy for her colitis with a drug called mercaptopurine, an immunosuppressant. When the woman developed a case of gout, her prescribing doctor sent her to the pharmacy with a prescription for another drug. The two drugs were prescribed by the same doctor.

When she went to the pharmacy to fill her prescription for the new medication, no one at the pharmacy told her that the two drugs could be dangerous if taken together. The woman went home, continued taking her mercaptopurine, and started with the new drug as well.

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In a frightening case earlier last month out of New Zealand, a man needed to be hospitalized after he started to cough up blood due to a pharmacist’s error. The pharmacist responsible was actually hired from a temp agency that staffs short-term employees.
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According to one local news source, a 65-year-old man went to fill a prescription for warfarin, a blood-thinner and anti-coagulant used to treat blood clots. Instead of providing him the required dose of a single 1 mg pill, the pharmacist filled the prescription for five 1 mg pills.

The man took the medication as instructed and six weeks later was complaining of extreme abdominal pain and constipation. He was hospitalized when he started coughing up blood and urinating blood. The man was taken off warfarin and placed on vitamin K instead. After five days in the hospital, doctors felt that he was okay to return back home. There is no indication as to what, if any, long-term effects the man may experience as a result of the overdose.

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Pharmacists are charged with a very important duty in our society: to verify and fill prescriptions issued by physicians and to answer any patient questions that may arise. In addition, pharmacists are a second line of defense against physician error, checking prescriptions against other medications that the patient is taking.

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However, with the burden on pharmacists increasing as more and more people obtain healthcare, it seems that corners are being cut, potentially increasing the risk of a pharmacy error.

In fact, one report recently released by Pharmaceutical Journal discusses a recommendation that pharmacists keep similarly named medications physically apart from one another to reduce the chance of confusion.

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Earlier this month in Portage, Michigan, one local woman caught on to an error by her pharmacist that may have saved her life. According to a report by a local news source, the woman was provided a prescription by a local Wal-Mart pharmacy that belonged to another patient not once, but twice.

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Evidently, the woman takes an unknown medication daily and has her prescriptions filled at the local Wal-Mart pharmacy. However, last month she noticed that her daily pill looked a little larger than normal. She checked the label and saw that there was another patient’s name on it.

The woman did not disclose what medication she was supposed to be taking, but it is known that the prescription she was given was for a 78-year-old woman’s heart condition. There is no indication that the 78-year-old woman was provided any medication other than what she was prescribed. It’s possible she had not yet picked up her prescription.

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According to a study that was recently conducted in the United Kingdom, pharmacists miss errors in prescriptions in a frightening number of cases. According to a report by the Pharmaceutical Journal, the study results were unveiled at the Royal Pharmaceutical Society Annual Conference earlier this month.

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The study took 103 local pharmacists and had them fill 50 prescriptions in 25 minutes, which is generally considered a normal, if slightly heavy, workload for that amount of time. Five of the 50 prescriptions intentionally contained errors. There were also a few distractions that were thrown at the pharmacists while they were filling the test prescriptions, but nothing out of the ordinary for the profession.

The idea of the study was to see how many of the pharmacists would catch all five of the errors. The results were frightening. Below is a summary of the results:

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Not too long ago, two sons lost their mother during what was supposed to be a routine two-hour surgery to help deliver soothing medication to her aching muscles and bones. According to a report by the Boston Globe, the woman fell last summer and broke several of her vertebrae. Doctors fused several of the bones together to prevent them from moving, but her persistent pain continued.

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Eventually, doctors recommended a routine surgery to put a small pump under her skin to more quickly deliver medication to her spine and the surrounding muscles. As a part of the surgery, the surgeon needed to use a certain type of dye that is to be injected into the spine. However, when he asked the hospital’s pharmacist for the dye, the pharmacist replied that they didn’t carry that dye and provided an alternative.

Not looking at what the dye was, and assuming it was a replacement for the requested dye, the doctor injected the dye into the woman’s spine. After the surgery, the doctor told the woman’s sons that the surgery didn’t go as well as expected, but that the pump should still work.

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Earlier this month in New Zealand, a man died from a preventable and accidental overdose of rheumatoid arthritis medication, a doctor’s error that went undetected by the pharmacist who filled the prescription. According to a report by a local New Zealand news source, the man had been diagnosed with rheumatoid arthritis for 20 years and had been on this exact medication previously. However, he had to be taken off the medication when his liver function started to decrease. Since then, he had been re-prescribed the medication after his liver function returned to normal.

medicaments-2-234571-m.jpg Evidently, the prescribing doctor made the first mistake, prescribing the medication to be taken daily rather than weekly as it should have been prescribed. When the man took the prescription to his local pharmacy, the pharmacist transcribed the prescription exactly as the doctor wrote it, instructing the man to take the medication daily.

Shortly after he began taking the medication, he noticed severe adverse side effects, such as mouth ulcers, a sore throat, and an abnormal blood count. When he went to have his symptoms checked out, he was diagnosed with methotrexate toxicity, a result of an overdose of the rheumatoid arthritis medication.

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