Pharmacy Error Injury Lawyer Blog

According to recent news that our Washington D.C. pharmacy error injury attorneys have been following, the U.S. Food and Drug Administration (FDA) has committed to reduce medication mistakes by publishing a draft guidance by the end of this fiscal year. The FDA states that one third of medication errors, including 30% of errors ending in deaths that are reported to the Institute of Safe Medication Practices (ISMP), may occur as a result of drug labeling and packaging.

The FDA reportedly claimed that medication errors often happen as a result of names that look alike or sound alike, encoded numerals, failure to recognize active ingredients, dangerous medical abbreviations, and name length.

In a FDA workshop last month, Carol Holquist, RPh and director of FDA’s Division of Medication Error Prevention and Analysis reportedly claimed that guidance on these medication mistake issues is an important first step to developing a consensus to form new FDA regulations, which can take around 10-15 years.

The American Society of Health-System Pharmacists (ASHP)’s director of Medication Use Quality Improvement, Bona Benjamin, also reportedly told the workshop group that the ASHP’s 2007 recommendations for the FDA are still current—that human factoring should be applied scientifically to drug packaging and labeling, and barcode verification should be encouraged, as nearly 20% of hospitals are using barcode medication verification.

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A recent article from the Institute for Safe Medication Practices (ISMP) that our Maryland-based medication error attorneys have been reading reported that the order management scanning system (OMSS) technology that was created to improve the efficiency and safety of the drug ordering process for doctors and pharmacies, is now experiencing error-prone problems that are leading to medication errors, drug omissions and missed drug therapy in patients.

OMSS is a technology that was created to capture a digital image of a handwritten or printed prescription order and send it to the pharmacy—eliminating faxing, the use of a courier, or the use of pneumatic tubes to transport the information to the pharmacist. The idea behind OMSS was to accelerate the time the prescription hit the pharmacy, speed up the prescription filling process, with electronic filling, easy retrieval of scanned orders, and reduce the risk of transcription errors because the order can be magnified. Unfortunately, according to the article, these OMSS benefits are null and void if the pharmacy never receives the prescription orders.

The problem that is reportedly occurring is that multiple pages of orders are being pulled through the scanner at the same time, and the scanner is only reading a single page at a time—a problem that has also plagued pharmacies with faxing or copying orders in the past. When this problem occurs, staff may not be aware that only one page was scanned, and the pharmacist may not be aware that they should have received multiple pages of orders. As a result, drug omissions can take place, leading to medication mistakes or missed drug therapy.

In one documented case, a physician wrote three pages of admission orders for a patient suffering from lung cancer, as well as difficile colitis and fever. When the orders were scanned with OMSS, the pharmacy only received two pages of the orders, because one page was not pulled through. Neither the nurse who administered the medication the physician, nor the pharmacist noticed the prescription error and omission. The drugs prescribed on the missing page were seizure medications. By the forth day of receiving only a fraction of the medication, the patient was exhibiting behavior that lead the emergency response team to determine that the patient was having a seizure. The patient was transferred to critical care unit, where the doctor figured out the pharmacy mistake, and although the patient required intubation, he ultimately experienced a full recovery.

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Recently, our Maryland Medical Mistake Lawyers wrote about the use of electronic health records in hospitals and doctors' offices, and how computerized health records have the potential to improve the health care of patients, and reduce the risk of medical errors and personal injury.

In the blog, our pharmacy error attorneys wrote about how President Barack Obama’s economic stimulus included over $19 billion for health information technology, and has given many hospitals great incentive to add their own funds and invest in adopting electronic records to improve the quality, safety, and efficiency of health and medical care.

One example of this comes from an article in the New England Journal of Medicine from last month, where the Long Island North Shore Hospital System in New York stated publicly that it will pay an up to $40,000 incentive offer to each doctor who agrees go electronic with health records—paying 50 percent of the total cost to doctors who install the Electronic Health Record that will communicate directly with the hospital, and will pay 85 percent of the total cost if the doctor shares quality care data.

The payment would reportedly add to the $44,000 physician incentive offer, where the American Recovery and Reinvestment Act of 2009 gave authority to Medicare to compensate health care professionals eligible for the payment, who used electronic health records in a meaningful way. According to the article, ‘meaningful use” is not yet clear in definition, but the overall aim is to transform the health care delivery system by using electronic records, to improve communication, efficiency, and quality care and reduce the risk of personal injury through medical mistakes or pharmacy error.

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In a recent post, our Maryland Medical Error Attorneys discussed how computerized health records have been used by the Veterans Health Administration for the past decade, with great reported success. These electronic records have reportedly improved the health care and well being of nearly eight million veterans, by storing information electronically about the prescriptions, studies, laboratory tests, consultations, doctor’s notes and any reports about the patient in any Veterans Affairs hospital—reducing the potential for medical errors or personal injury.

Yesterday The New York Times published an article discussing the reported benefits of electronic records, and how President Obama’s economic stimulus that included $19.2 billion for health information technology, has given many hospitals incentive to invest in creating and using electronic records to improve the efficiency, quality, and safety of medical care. The goal according to the article is to integrate the various systems across the country with various hospitals and medical groups so medical records can be shared on a common platform within the different systems.

According to the article, the benefits of electronic health records are:

• If the doctor has immediate access to a patient’s record, it could reduce medical errors and personal injury within the hospital setting due to drug complications, pharmacy errors, drug allergies, or potential drug interactions, as well as drug recalls.

• Electronic records can eliminate duplicate tests, from M.R.I.’s to blood tests. If a patient is seeing multiple doctors, a new doctor can easily access their test results electronically within the same system, which can prove to be valuable in a life-threatening situation. If a test needs to be repeated, the doctor will have access to the results of the last test to compare.

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In a related blog from yesterday, our Maryland Pharmacy Misfill Lawyers discussed a recent article from USA Today, where the step-by-step process of how a prescription is filled was followed in two pharmacies—to uncover how pharmacy mistakes are taking place, and how to prevent them in the future.

The article revealed how the possible errors are made and also discussed what steps pharmacies are making to try and prevent these errors, and reduce the number of pharmacy mistakes and patient injuries that could happen in the future.

Pharmacies are trying to prevent errors by:

• Encouraging improved communications between doctors and pharmacies.

• Encouraging doctors to write the prescriptions in full length, instead of using medical codes or abbreviations.

• Trying to transition from prescriptions that are handwritten to electronic prescribing—where a doctor sends the prescription directly from the doctors’ offices to the pharmacy computers.

• Computers are being used to aid the prescribing process, with more alerts for drug interactions, allergies, or patient’s illnesses.

• Other computer safety features include popup boxes when a technician enters or confuses a drug name with similarly named drug. After the popup appears, the technician has to initial the box to show he checked the drug.

Continue reading "Steps for Preventing Prescription Errors in Pharmacies" »

In a post from earlier this year, our attorneys at Lebowitz & Mzhen, LLC discussed how computerized health records would help Maryland pharmacists and doctors to eliminate Maryland medication mistakes.

According to a recent article in the Wall Street Journal, on how to digitize the health-care industry, Veterans hospitals have proven to have paved the way——showing doctors and pharmacists important lessons on how to effectively make the digital transformation.

The U.S. Department of Veterans Affairs digitized their records years ago, with great results. Independent studies show that the VA outperformed the private sector and Medicare on preventative services and chronic care. VA officials have claimed that the digital technology has helped cut down on patient hospitalizations and has helped patients live longer.

The VA’s digital records system has been a blessing to patients, allowing doctors and nurses at more than 1,400 facilities to share the medical history of the patients—avoiding the unnecessary repetition of costly tests. As well as storing patient data, the system gives screening warnings and keeps an eye on patient levels, like blood pressure and weight—all safeguards for improved quality care.

In a digitized record for a 59-year old Maryland patient at the VA medical center, all of his health problems were listed, like diabetes and hypertension, as well as all of his data since he has been a patient at the center. The screen showed a list of all current medications, including insulin, the drug Furosemide for heart failure, and Oxycodone, the pain medication. The patient’s doctor can reorder a drug through the system, sent directly to the pharmacy—eliminating medication mistakes and pharmacy misfills. If the doctor orders a new prescription that conflicts with a drug the patient is already taking, there is a warning in the system.

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A recent American Pharmacists Association (APhA) survey, that our Maryland Pharmacy Error Injury Attorneys have been following, revealed that 1.5 million people are injured by medication-related errors every year. The APhA commissioned the consumer survey, led by Harris Interactive, to investigate how consumers interact with their pharmacists, and how building relationships with pharmacists can avoid patient error and reduce medication mistakes and pharmacy misfills.

The APhA always recommends that people carry an updated list of their current prescription medications, over-the-counter (OTC) drugs, herbal supplements and vitamins. The list should include the name of the medications, the dosage, as well as the conditions that the medications treat. Any patient allergies should also be included in the list.

The study reports that while a large percentage of Americans have an up-to-date list of medications, only 28% of consumers actually carry the list with them at all times—an act that could prevent personal injury and medication mistakes, by providing emergency personnel and pharmacists with lifesaving information regarding drug names, proper dosing, allergy information, and drug interactions and side effects.

According to Kristen Binaso, pharmacist and national APhA spokesperson, until electronic medical records are used as the standard in sharing patient information in the health care industry, consumers should protect themselves by keeping a current medication list with them at all times, to show the doctor and pharmacist—to avoid the risk of improper dosing, medication duplication, pharmacy misfill, and harmful drug side effects and interactions. In a recent post, our Maryland Mistake Attorneys further discussed how these electronic health records will help pharmacists and doctors to eliminate medication errors.

Next to doctors, pharmacists are the second most trusted health care providers and trained medication experts, yet the survey found that 77% of consumers do not know their pharmacists names, and only 40% of consumers have asked their pharmacists valuable questions about their medication needs.

Continue reading "Medication Error Injury Prevention—Study Recommends Knowing Your Pharmacist" »

In prior posts concerning Maryland medication mistakes, the attorneys at Lebowitz & Mzhen, LLC have discussed how computerized health records help doctors and pharmacists eliminate medication errors.

Today, Governor Martin O’Malley, signed a bill that is designed to increase the speed with which Maryland doctors implement electronic patient records. The new law hopes to reduce the high costs that doctors must pay to implement electronic patient records systems by requiring private insurance companies to give physicians financial incentives to implement electronic patient records. Under the law, after a doctor implements a computerized records system, insurance companies may offer the doctor increased reimbursements for procedures they perform, a lump sum payment, or some other monetary advance. Additionally, under the new law, the state will fine physicians who have not adopted a computerized records system by 2015.

Since 2003, Maryland has been on the cutting edge of the movement towards computerized patient records. In that year, The Montgomery County Health Information Exchange Collaborative began a pilot program that linked community hospitals, the county’s health department, and area health clinics. The link allowed participating health care providers to easily access patient records.

The program developers believed that their medical information network would have the greatest impact on the county’s poorer citizens and those without health insurance. These individuals generally receive care in a number of different locations, and often times, the facilities do not share vital patient information. The link allowed the facilities to share patient information and reduce the risk of medication errors.

Maryland medication mistake attorneys will review the impact this law has on patient safety, and the state’s progress towards completely computerized patient records.

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In prior posts, Maryland medication mistake attorneys have asked our readers to question their doctors before taking prescription medications. Proactive patients are better able to notice potential medication mistakes before they occur and are less likely to suffer injuries.

The Agency for Healthcare Research and Quality (“AHRQ”), a part of the U.S. Department of Health & Human Services, has noted the substantial impact medication mistakes have on patients and the country as a whole. On itswebsite, the AHRQ quotes a report from the Institute of Medicine (“IOM”) which found that medication mistakes kill from 44,000 to 98,000 people each year. The report also indicated that medical mistakes cost the country approximately $17 billion each year in increased health care costs.

In order to help reduce medication mistakes, the AHRQ has developed a national ad campaign to encourage Americans to take a more active role in their health care by asking critical questions of their doctors, nurses, and pharmacists. The program drives home the point that Americans typically ask more questions of a cellular phone salesperson than they do of their physicians. The campaign’s website provides a top ten list of critical questions patients should ask their health care providers during appointments. Additionally, the website also has a “Question Builder” that allows readers to develop their own personalized list of questions.

In a recent study, researchers found that improper dosages account for nearly 40% of medication errors. Additionally, researchers found that poor communication between health care professionals was the underlying cause of 15.8% of prescription errors. I read an article about an interesting piece of new technology that helps improve dose accuracy and communication between care providers.

The Intellidot Corporation has released the wireless IntelliDot Bedside Medication Administration (“IntelliDot BMA”) which will help eliminate hospital medication errors. The handheld device reads a barcode attached a patient’s wrist and provides the health care professional with all of the patient’s relevant health information. At an instant, a nurse or doctor will know all of the patient’s prescriptions, their required dosages, and the proper way to administer the medication. Additionally, in a hospital equipped with a computerized pharmacy, a doctor can electronically submit a prescription to the hospital’s pharmacy, and the pharmacy can transmit the prescription along with administration instructions to the IntelliDot BMA. Under this system, a hospital can eliminate the need for handwritten prescriptions and therefore greatly reduce the risk of errors caused by a physician’s poor handwriting or the use of improper medication abbreviations.

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The medication error attorneys at Lebowitz and Mzhen, LLC are proud to have represented members of this country’s armed forces and their families in a variety of legal matters. In addition to the stresses that come with being a member of the military, soldiers and their families also have to be concerned about the risk of injury from medication errors.

The United States Army is comprised of 675,000 active duty soldiers. Army health centers are responsible for providing medical care to active duty personnel, their dependants, and a substantial population of veterans and their families. As a result, busy Army health facilities, including pharmacies, face the same risk of committing medication errors as their civilian counterparts.

The DeWitt Health Care Network serves 150,000 people in the Fort Belvoir Army community and is taking steps to reduce the risk of injuries from medication errors. Major Lela C. King, Chief of Pharmacy, reported that the network has given its patients pocket-sized medication cards that contain patient allergies, prescriptions, and other vital health information. These cards will reduce the risk of dangerous a physician prescribing a medication that interacts with one the patient is already taking.

Additionally, Major King has overseen the installation of digital patient records software and hardware in Dewitt facilities. According to Major King, the Army has recognized that such electronic health information can “decrease the number of medication errors made at the pharmacy by 70 percent.”

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Recently, my father attempted to relive his glory days on the football field with unfortunate results. While attempting to imitate some of the great wide receivers of his day, he ruptured his Achilles tendon and required surgery. I accompanied him to one of his follow up visits to his doctor’s office and was surprised to see the level of technology the doctor used when treating patients. In prior posts, Maryland medication error attorneys have extolled the virtues of computerized prescription programs, but I was still surprised to see how efficient those systems are when used in the day to day operation of a busy doctor’s office.

The doctor who treated my father asked him a series of questions about how the surgical site was healing, his pain, and any other prescriptions he was taking, and examined my father’s range of motion. The doctor entered all of that information into a computer terminal in the examination room and returned, within minutes, with a print out that contained my father’s prescription. Additionally, the doctor’s office electronically sent the prescription ahead to a local pharmacy.

Last month, Medicare and certain private health care plans began paying doctors bonuses for using similar E-prescription software. The private health care plans provide doctors with extra payments for services along with free equipment, such as PDA’s, if they use computerized prescription software. Medicare’s bonus amounts to 2% of charges billed to Medicare for 2009 and 2010. This translates into approximately $1,700 to $3,500 a year per doctor. As a result of the new incentives, the number of doctors using E-prescription programs has doubled over the past year and, nationwide, nearly 70,000 doctors use these programs.

Electronic prescription programs not only reduce the risk of medication errors, but they also help lower patients’ health care costs by suggesting low cost generic alternatives to expensive name brand medications. In a recent study, researchers at a hospital in Milwaukee, Wisconsin discovered that E-prescription software saved patients a substantial amount of money by allowing more doctors to prescribe safe generic prescriptions.

Additionally, by reducing the time a patient has to wait in a pharmacy to receive a prescription, E-prescription programs ensures that more Americans will fill the prescriptions their doctor’s prescribe. Fortunately, nearly all big box pharmacies and many independent pharmacies accept electronic prescriptions. This allows doctors, like my fathers, to forward prescriptions ahead of the patient and reduce the amount of time a sick or injured patient has to wait in a pharmacy waiting area.

Under the stimulus package, the government plans to invest $ 50 billion dollars over the next five years in technological advancements in health care. The Maryland medication error attorneys at Lebowitz & Mzhen, LLC will carefully watch these advancements as they arise in the future.

External Resource

Wall Street Journal article

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