The COVID-19 pandemic has disrupted millions of lives across the world, nation, and the state of Maryland, but fortunately, vaccines are currently being distributed. As of January 15th of this year, approximately 12.2 million individuals have received the first dose of the COVID-19 vaccine. While the vaccine is a good thing and a sign of hope to many, its distribution is vulnerable to errors, just like any medication or drug. Pharmacy and medication errors do happen in Maryland, and so there is potential for vaccine errors as the state rolls out the vaccine as well.

Fortunately, the Institute for Safe Medication Practices (ISMP) recently provided safe practice recommendations for administering COVID-19 vaccines, following several reports of errors. There are two main types of reported errors that affect patients: dilution errors and mix-ups with look-alike products. First, the Pfizer vaccine must be diluted with a preservative-free sodium chloride injection. Unfortunately, multiple errors have occurred in the dilution, with too little diluent added and patients having too much of the vaccine administered. These errors can potentially lead to potentially stronger adverse effects for patients. Second, Moderna’s vaccine has been confused by some with the new Regeneron monoclonal antibody casirivimab, likely due to labeling issues and the fact that they look alike. It is reported that two versions of vial and carton labels for the Regeneron antibody exist, but neither includes the name of the specific antibody or has a functioning barcode. These mix-ups could result in patients receiving the wrong drug.

To reduce the risk of errors, ISMP offered several recommendations for health care organizations. These recommendations include safely selecting vaccination sites, verifying the competency of the vaccinators, dispensing pharmacy-prepared syringes, identifying and differentiating monoclonal antibodies, separating different vaccines when storing them, and preparing for allergic reactions. Hopefully, these recommendations can prevent future vaccinations from occurring. However, recommendations have been made in the past to prevent common pharmacy errors that occur in Maryland every day, and yet they unfortunately still happen. It is important that those who may be injured as a result of those errors understand that state law may provide them a remedy through a personal injury lawsuit. If they are interested in filing one, they should begin by reaching out to a pharmacy error attorney who handles these matters.

Although the COVID-19 is generally accepted to be safe, some people may still have adverse reactions to the vaccine. Like all vaccines, the vaccine still carries some risk of a Maryland medication error. The vaccine may have adverse side effects. It also will not be 100% effective for everyone, and it is unclear how long immunity will last.

The federal government granted companies immunity from liability for the development and administration of vaccines unless there is “willful misconduct” on the part of the companies making and distributing the vaccines. Pharmacists in Maryland are allowed to administer vaccines, and the federal government has declared pharmacists as covered under the emergency preparedness act allowing them to administer the vaccine without risk of liability. Yet pharmacists must also follow the federal government’s guidance to qualify for protection. Pharmacists must complete required training, administer an FDA-approved vaccine, administer according to the vaccination schedule, and follow record-keeping and reporting requirements.

Thus, in limited circumstances, injured patients may be able to recover compensation for their injuries. Victims of medical malpractice may be able to recover compensation if they prove that a healthcare professional failed to meet the standard of care in providing care to the patient by negligently acting or failing to act in some way.

While Maryland patients often trust their pharmacies to give them the correct prescription medication and dosage, pharmacy errors, unfortunately, do occur consistently throughout the state. These errors can take various forms—such as incorrect dosage or incorrect medication—can be harmless or cause severe injuries and illness. Currently, there are three known pharmacy errors repeatedly happening across the country, reported by the Pharmacy Times. Maryland patients should be on alert for these errors that may affect themselves or their family members.

The first is an error occurring with rapid-acting insulins. According to the Pharmacy Times, errors have been reported due to searching for rapid-acting insulins by generic name, which has caused mix-ups between two insulins that pharmacists may think are the same but are not. The authorized generic version of a new type of insulin has a different onset of action after the injection, and some different ingredients. It cannot be used as an exact substitution for the brand name, although some are prescribing it that way, which may cause issues as patients use it.

The second error is a dispensing error in fentanyl. Transdermal fentanyl patches are placed on the skin. Sometimes, when writing the prescription, there can be multiple confusing numbers that lead to mix-ups. For example, one prescription read “fentanyl patch 72-hour 50 mcg/hour,” with mcg/hour being the dosage or strength of the patch. But the pharmacy employee who entered this prescription into the computer read “fentanyl patch 72,” which led him to mistakenly select a 75 mcg per hour patch instead of 50. This dispensing error can lead to stronger dosages of fentanyl being given to patients.

Maryland is receiving nearly 200,000 vaccine doses that will go to front-line hospital workers, first responders, and long-term care facility residents and staff in the state. Some Maryland pharmacies are receiving shipments of the vaccine to administer to nursing home residents and staff through the CDC’s Pharmacy Partnership for Long-Term Care Program.

To date, two vaccines have received approval from the Food and Drug Administration for emergency use: Pfizer-BioNTech’s COVID-19 vaccine and Moderna’s COVID-19 vaccine. Both are now being distributed in Maryland. Both Pfizer-BioNTech’s and Moderna’s vaccines have been shown to be about 95% effective in preventing symptoms and decreasing severe COVID-19 infection.

The two approved vaccines require two doses of the vaccine. Pfizer’s is administered three weeks apart, and Moderna’s is administered four weeks apart. Both vaccines have shown some minor-to-moderate side effects, including pain, fatigue, headaches, chills, and joint pain. Both approved vaccines are mRNA vaccines, which means that those vaccines work by teaching one’s body to create an immune response to the virus without getting sick with the virus and without putting a weakened or inactivated virus in people’s bodies. The mRNA vaccines do not use the live virus that causes COVID-19, and someone who gets vaccinated cannot get infected with COVID-19 from the vaccination.

Each year, between 7,000 and 9,000 people die in the United States because of a medication error. Many more experience adverse reactions that are not reported. Maryland medication error victims often suffer from physical pain as well as psychological pain because of the error. The problem of medication errors, which are often due to human error, has pushed many pharmacies to begin implemented pharmacy automation. Pharmacy automation is a process that includes the handling and distribution of medications in pharmacies and hospitals.

Automation can include counting medicines as well as maintaining and updating patient information. The global pharmacy automation market is expected to continue to grow. The reasons for which growth is expected include a shift towards digitization and a rise in investment in healthcare development in certain countries, leading to an increase in opportunities for growth. Some see automation as a way to avoid medication errors, although it may also bring about risks and new opportunities for errors to be made.

If someone is injured due to a medication error, they may be able to file a negligence claim against the pharmacist, doctor, or other provider, in order to hold them responsible for the error and seek financial compensation. In a Maryland medication error negligence case, a victim generally has to show that the defendant owed the victim a duty, the defendant failed to meet the standard of care required, the victim was injured because of the defendant’s negligent conduct, and the defendant’s conduct caused the victim injuries. A medication error victim has to prove it was more probable than not that the injury the victim suffered was caused by the healthcare professional’s negligent conduct. In the tragic event of a death caused by a medication error, certain members of the decedent’s family may be able to pursue a wrongful death claim against the responsible parties.

Amazon is one of the most valuable companies in the United States, and is getting even more and more utilization during the COVID-19 pandemic, as Americans order an increasing amount of things online, from groceries to pet supplies, books, and décor. Now, Maryland shoppers may be able to get one more thing from this giant retailer: their prescriptions. Last month, Amazon announced the launch of Amazon Pharmacy, a delivery service for prescription medications. The service would allow Amazon customers to purchase prescription drugs with or without health insurance, which Amazon claims will save them money, up to “80 percent off generic and 40 percent off brand name medications when paying without insurance.” Is is unclear, however, how Amazon Pharmacy could impact the prevalence of Maryland pharmacy errors.

While the potential savings on drug prices sound great, experts say that Amazon Pharmacy is likely not going to be a game-changer when it comes to the high cost of prescription medications.  Customers may enjoy some savings, but this online option is likely to work similarly to other online pharmacies and cannot solve the large and complicated problem of U.S. drug pricing. Still, professionals are watching to see what impact Amazon Pharmacy has and how many Americans utilize it for their medications.

Maryland pharmacy errors are a persistent problem, sometimes causing severe injury or illness. And, unfortunately, anyone who has ever ordered something online can tell you that online shopping does not always go off without a hitch—sometimes the wrong product or item can be sent, items can be swapped with others, or a package could get lost or never arrived. Pharmacy safety advocates should watch closely to see whether or not Amazon Pharmacy falls prey to the same errors that occur in pharmacies every day. It’s very possible that pharmacy errors continue to plague Maryland patients, regardless of where they get their prescription.

In this blog, we write about Maryland pharmacy errors, which occur when any mistake is made between the doctor writing the prescription and the patient taking it. Some of these errors include dispensing errors—when a pharmacist makes a mistake dispensing the medication based on the written prescription. These errors can come in a few different forms—maybe the dosage or strength is mistaken, for example—but one of the most dangerous errors is when the wrong medications are dispensed. Usually, we write about instances where this happens on an individual level—when a patient is given the wrong medication—but occasionally, this can happen on a much wider level as well, affecting many patients.

For example, recently, one health clinic experienced a widespread dispensing error thought to have stemmed from a pharmacy machine malfunction. According to a news report covering the story, the wrong medications were mixed in with some prescriptions dispensed between November 9th and 16th at the health clinic. Officials are now reaching out to all those who picked up prescriptions during that time frame to try and make sure they do not accidentally take the wrong medication, which could potentially cause serious injury or illness. But it may be hard to find everyone who picked up prescriptions. For example, officials believe that some individuals had their phone numbers changed since they first entered them into the system—meaning that they cannot find them at the moment.

So far, no serious adverse health outcomes have occurred. But the situation is being monitored closely—it is possible some adverse health outcomes may not be experienced right away. This situation shines a light on how dispensing errors could happen and not be caught. If it’s a new prescription, or one that looks similar to another, individuals might not even realize that there’s a problem and take the medication. If they begin to feel negative symptoms, it may take them a while to figure out that a pharmacy error was the cause, especially since most people expect pharmacists and prescriptions to be accurate.

In this blog, we often write about Maryland pharmacy errors, their potential negative consequences, and how to recover against negligent pharmacies. However, it can sometimes be difficult to understand exactly how Maryland pharmacy errors occur. Today, we focus specifically on dispensing errors—errors that occur as pharmacists dispense medication, which is one of their key responsibilities and a large part of their job.

Dispensing errors are one type of Maryland pharmacy errors that occur when the medication is dispensed into the pill bottle or other package for patients to take home. In this case, the prescription is written correctly by the doctor, but an error occurs when it comes to actually filling it. There are a few ways dispensing errors could occur—a pharmacist could dispense the wrong formulation of a medication, for example, or could put an incorrect label on it. Some research suggests that the most common dispensing errors are prescriptions given with the wrong dosage or strength of the medicine and prescriptions with the wrong medicine altogether.

One of the reasons dispensing errors occur is so simple it might be missed: humans make mistakes. Despite their specialized knowledge and experience, pharmacists are human, and they are prone to mistakes just like everyone else, especially in busy, stressful, and overwhelming work environments. With the current COVID-19 pandemic, unfortunately, these work environments have become the norm, which can exacerbate an already existing problem.

The COVID-19 pandemic has put added pressure and stress and healthcare professionals, especially as some hospitals have seen an influx of hospitalizations due to COVID-19, including the increased risk for medication errors for Maryland patients. A recent report from the Institute for Safe Medication Practices highlights the issue of medication errors related to the pandemic. There has been at least one lethal drug error in a hospital that struggled to cope with a surge in coronavirus cases. According to the report, a nurse who worked at the hospital where the death occurred worked in a busy intensive care unit that was treating about 20 COVID-19 patients each day. The nurse reported that they were overwhelmed with patients and under-resourced, and had stashes of medication left in patients’ closets and drawers. One researcher said a “rushed and hectic environment” can lead to a relaxation of safety measures and double-checks to avoid errors.

The report highlighted the University of Maryland Medical Center in Baltimore, which established a process to review workflow changes and patient safety events at the beginning of the pandemic in order to minimize potential medication errors. The Center made it standard practice to use a single concentration for high-alert medication whenever it was possible. On the other hand, the University of Maryland decided to eliminate a previous requirement that two nurses had to sign off on the administration of all medications. It now allows nurses to administer non-high alert medication without having witnesses present. The Institute provided several suggestions for avoiding prescription errors during the COVID-19 pandemic, including establishing a process for carrying out independent double checks before certain critical infusions are administered and affixing bold auxiliary labels to critical care infusions when dispensing a nonstandard concentration or a neuromuscular blocking agent.

Maryland Medication Error Victims May Be Entitled to Compensation

Laws vary from state to state regarding the authority of certain persons to dispense medication. In Maryland, physicians are permitted to dispense medication subject to certain regulations. Maryland physicians who are permitted to dispense medication must obtain a dispensing permit from the Maryland Board of Physicians. But the ability to dispense medication poses additional avenues of liability for physicians and raise concerns among some and may pose additional risks for Maryland patients, as one recent article showed.

The article raised the issue of whether physicians should be permitted to dispense medications. In an editorial in another paper, a writer had suggested that it is a good idea to have doctors dispense medications directly to patients, because it may be easier and cheaper for patients. Three doctors in Montana recently filed a lawsuit seeking to be allowed to dispense medications directly to their patients. Dispensing medication directly to patients is prohibited in that state. However, critics say that dispensing medication directly to patients raises serious medication safety concerns. In particular, there is a concern that there would not be a second review by a pharmacist of the prescription. There is also a concern about the lack of regulatory oversight, such as labeling, supervision, and storage.

Pharmacy errors can occur at different stages in the process. Having a pharmacist dispense and administer the medication means that the pharmacist can act as a check on errors that can occur when prescribing medication. Allowing a doctor to prescribe and dispense a medication means that there would likely be no second person reviewing and checking for errors before the medication reaches a patient. Prescribing errors can, of course, cause significant harm to patients.

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