It’s no secret that the COVID-19 pandemic has overwhelmed the health care system. High rates of infection and death have sent thousands of Americans to hospitals and health care clinics, most of which were already busy treating patients before the pandemic. The country’s medical providers and health care workers are working hard every single day to try and help people and combat the virus, but the sheer amount of work and stress they are under may take a serious toll on their mental health and their ability to perform the job effectively. Recently, a hospital nurse spoke to the Institute for Safe Medical Practices (ISMP) about the impact that COVID-19 is having, and what he said has implications for how the pandemic may increase Maryland pharmacy errors.

According to an article detailing his experiences and report, medication errors have been increasing in his hospital. Because nurses are working long hours with critically ill patients in a stressful, hectic, and overwhelming work environment, medication errors are more common. However, it is likely that this pattern is not isolated to just hospitals. The entire health care system is overwhelmed right now that it is likely that the rise of medication errors is also occurring in other settings, including pharmacies.

Pharmaceutical errors can be just as dangerous as errors occurring in hospitals. Many Maryland residents rely on their local pharmacy for their medications, but when pharmacists and pharmacy technicians are stressed out and overwhelmed they may make significant errors, such as providing the wrong dosage of a medication, or even the wrong medication altogether. With the COVID-19 pandemic, pharmacies may be overwhelmed by more calls from patients than usual, or requests for more prescriptions as individuals stock up. They may also be short-staffed if a pharmacist or technician gets sick or needs to stay home to take care of a family member. All of this can negatively affect Maryland residents, who rely on pharmacists to fill their prescriptions correctly and likely to not expect to be injured from taking prescribed medicine.

The COVID-19 pandemic had changed the lives of almost every American in too many ways to count. Among those who have been the most impacted by the pandemic are medical workers, including pharmacists. Pharmacies have seen surges in volume as more people are more frequently visiting doctors and obtaining prescriptions for all types of health conditions. As the demand on pharmacists increases, so does the risk of a Maryland pharmacy error.

The Institute of Safe Medication Practices has released a list of tips that pharmacists should follow to decrease the risk of error during these challenging times. The tips are broken down into three categories:

Preventing Pharmacy Errors

When it comes to preventing Maryland medication errors, the Institute of Safe Medication Practices recommends pharmacists take the following steps:

  • Keep certain IV infusions standardized to a single concentration or dose, when possible.
  • Use visually identifiable premixed solutions for common infusions.
  • When dispensing a nonstandard concentration or a paralyzing agent, be sure to clearly label these infusions.
  • Implement frequent safety meetings and create processes for pharmacy members to double-check solutions before administering infusions.

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Many people will admit that they occasionally get distracted while at work. It’s human nature to get distracted occasionally, and even to occasionally make mistakes. However, in some lines of work, the costs of distractions and mistakes are much higher than others, and employees need to be particularly careful to ensure they are not harming others. This is true, for instance, in pharmacies. Maryland pharmacy errors cause harm and injuries to patients every year. Part of the reason is that pharmacists and pharmacies have recently been expected to handle more and more tasks faster and faster, making it easy for mistakes to occur and not get caught until it is too late.

Recently, an industry news source published a piece discussing the importance of minimizing distractions whilst working in a pharmacy. The post shed light on the fast-paced pharmacy work environment, and how often pharmacists are interrupted while doing important tasks, like filling prescriptions, checking dosages and instructions, and communicating with patients.

According to the post, a recent study found that those working in pharmacies were interrupted an average of seven to thirteen times each hour. The interruptions could be categorized into five major categories: (1) patients walking up to the counter or calling in refills; (2) technicians interrupting pharmacists, usually for assistance on something they are unauthorized to do; (3) pharmacists self-initiated distractions, such as calling a prescriber’s office or initiating a non-work conversation; (4) technological distractions, such as a phone ringing or an announcement over the store’s loudspeaker; and (5) other pharmacists having questions.

COVID-19 tests are now available for free at many Maryland pharmacies throughout the state. Maryland pharmacies conducting COVID-19 testing include CVS, Rite Aid, Walgreens, and Walmart, as well as some local independent pharmacies. However, the use of testing at these pharmacies raises questions about adequate staffing, particularly after such issues were raised prior to the pandemic.

According to a recent news source, Walgreens Pharmacy reported a coding error that resulted in incorrect COVID-19 testing data. The error meant that around 59,000 COVID-19 test results would be added to the state’s statistics that were not previously reported. It was not clear how many of those tests were positive and what brought about the error. According to the Department of State Health Services, there were previous issues with reporting that have caused additional issues with the state’s statistics. The state said that additional data was being reported from July when a private testing lab did not correctly report about 250,000 positive tests. The state was trying to separate the data and send the information to the appropriate county. The state reported a delay in reporting due to the errors.

The report of the pharmacy error comes just a month after CVS was fined for medication errors and under staffing. The Oklahoma State Board of Pharmacy fined the company last month after a report earlier this year that the company understaffed its pharmacies, putting patients at risk. The state pharmacy board subsequently launched an investigation and imposed $125,000 in fines. The COVID-19 testing being carried out by the pharmacies may be further burdening pharmacies and overworked pharmacists, potentially leading to medication errors and putting patients at greater risk.

Testing for COVID-19 has ramped up in recent months. While initially, tests were hard to come by, today most Maryland pharmacies are conducting tests, making them widely available. However, the surge in testing has resulted in a corresponding increase in the number of experts who are concerned that tests are providing people with false-negative results. Given the highly contagious nature of COVID-19, false negatives have the potential to cause a resurgence in the virus, putting everyone at risk.

According to a recent news report, 12 people who were tested at a Walgreen’s pharmacy were initially told that they were negative for COVID-19, only to learn later that was not the case. Evidently, the erroneous results came out of Delaware, where the local government had an agreement with Walgreen’s. In all, Walgreen’s collected over 2,900 samples at drive-up testing sites.

The tests appeared to be accurate, and the problem was not with the reliability of the test. In fact, the state Department of Health reviewed each of the Walgreen’s tests for accuracy and confirmed that “no patients who tested negative were given incorrect results.” However, 12 patients were called and told that they tested negative when, in fact, they had tested positive. The report notes that the error did not occur at the local Walgreen’s stores, implying that the lab may have been responsible for the errors.

Maryland residents may rush to get a COVID-19 vaccine when it becomes available. Yet, as companies race to develop a COVID-19 vaccine, questions about the risks of a vaccine have been raised. All vaccines carry some risk for residents of a Maryland medication error, and according to a recent news report, many experts have speculated on the heightened risks of a COVID-19 vaccine in light of a condensed development timeline.

Experts in the public health field worry that a condensed timeline for developing and testing the vaccine might mean that it is approved without proper data and analysis. Some of those fears appear to have merit. One vaccine testing candidate did not test in animals. Another experimental vaccine was approved for China’s military before trials were even completed. A significant number of people in one vaccine trial experienced a “medically significant” adverse event. Creating a vaccine in the span of a year is “unprecedented,” according to one expert working to develop a new vaccine platform.

Some experts worry that the vaccine will not be safe or effective. A vaccine might produce unintended side effects, for example. One adverse event that had been seen with vaccines for other viruses is an antibody-dependent enhancement (ADE). An ADE is an immune reaction to the vaccine that makes subsequent exposure to the virus more dangerous by generating antibodies that encourage the virus to replicate instead of neutralizing it. One scientist said that the rare side effects of a vaccine likely will not be discovered until after the vaccine is approved.

In this blog, we write a lot about Maryland pharmacy errors and the harms that can result from them. A lot of the time, Maryland pharmacy errors might not even be caught right away, and when they are, the individual affected may just decide to go deal with it individually with the pharmacy. Even if they decide to file a personal injury lawsuit due to the injuries they suffered, the case might not make the news or raise public awareness because the plaintiff is just focused on receiving compensation for their own individual injuries. Because of this, it is rare that there are public discussions about the errors that pharmacies make, and even rarer still that large retail pharmacy chains face consequences.

However, according to a recent news report, state regulators cited and fined CVS—the nation’s largest retail pharmacy chain—for conditions found at four of its pharmacies, including inadequate staffing and prescription filling errors. CVS was fined $125,000, a relatively small amount for the multi-billion dollar company. The fine, however, validated concerns that pharmacists and pharmacy technicians have about the risks of understaffing and pharmacy errors.

One of the errors found at a CVS pharmacy in the past year occurred when a developmentally disabled teenager received only one-fourth of his prescribed dose of an anti-convulsant medication. He ended up taking this incorrect dose for 18 days, during which he had uncontrollable and violent seizures. In fact, the seizures were so bad that he fell down and hit his head.

Recently, the Pharmacy Times published an article detailing how pharmacy technicians can play a critical role in preventing pharmacy errors. Maryland pharmacy errors can cause serious injuries or illness, leaving those affected with potentially lifelong medical issues. According to the article, the role of pharmacists continues to expand to include more and more duties, meaning that pharmacy technicians are needed more than ever to fill in the gaps. Every year, there are approximately 7 million preventable medication errors. One of the most common errors is incorrect dosing—the Pharmacy Times writes that they make up about 37% of errors each year.

So how can pharmacy technicians help? The technicians are often the first line of defense and best suited to catch errors and prevent them from happening. They are often the ones who type up the prescription, and the ones who take prescriptions from the patient at the counter. They are uniquely situated to prevent pharmacy errors before they happen by double-checking medications.

One experienced pharmacy technician says that all technicians should use a set of “patient rights” while checking medications. Her five steps are designed to help pharmacy technicians systematically check for errors. First, a technician should ensure they have the right patient and ask them to identify themselves. Second, the technician should ensure they have the right medication. Third, the technician should make sure they have the right dose and instructions for how to take the medication. And finally, the technician should confirm the time of the last dose and frequency.

Drug recalls have been on the rise over recent years, affecting an estimated 81% of consumers in the United States. But when the federal Food and Drug Administration (FDA) finds a problem with a drug, what happens when a drug is recalled? And what does it mean for victims who want to file a Maryland product liability claim? A recent industry news source outlined the drug-recall process, which provides a good overview for those unfamiliar with the process.

A drug recall is an action by the manufacturer of the drug to remove a defective or harmful product from the market after the drug is found to be in violation by FDA laws or regulations. The FDA cannot pull a product from the market. It can only request that a drug be recalled, but ultimately the pharmaceutical company must decide whether to pull the drug.

The FDA then assesses whether the recall was appropriate, classifies the recalls, and oversees the recall strategy. A recall is classified by the FDA as a class I, II, or III recall. Class I recalls are the most serious, as they are for products that could cause serious harm or death. Class II recalls are for products that pose a notable risk and threat. Class III recalls are for products that violate the agency’s labeling or manufacturing laws but are not likely to cause adverse health consequences. Once a drug recall has been issued, officials from state health departments and pharmacy boards, drug manufacturers, and others may contact pharmacies to let them know about the drug recall. The pharmacies are then responsible for making sure that the recalled product is removed and dispensed of properly. They also have to help patients by counseling them on their options in light of the recall.

Most cases of pharmacy error involve negligent conduct and generally include careless mistakes. For this reason, punitive damages are rare in Maryland pharmacy error claims. Punitive damages are typically imposed to punish a defendant for their wrongful conduct and serve as a warning sign for others to dissuade them from engaging in such behavior.

In Maryland courts, to award punitive damages, a plaintiff has to show that a defendant acted with knowing and deliberate wrongdoing. A plaintiff must prove this by clear and convincing evidence—a higher standard than the preponderance of the evidence standard, which is generally applicable in civil cases. Thus, in many pharmacy error cases, punitive damages are not awarded because a plaintiff is unable to establish the defendant’s knowing and deliberate wrongdoing. The deliberate or intentional administration of the wrong drug is not a common occurrence. However, as a recent news report illustrates, it does occur.

Pharmacist Suspended After Purposely Giving Patient Wrong Drug

A pharmacist was recently suspended from practicing and fined after she purposely gave a patient the incorrect drug, according to one news source. Evidently, the pharmacist was working alone on a Saturday night, and a customer came in to fill a prescription for Suboxone for the patient’s opioid addiction. The pharmacist had already closed the safe where the drug was held and could not open it. The patient reportedly did not want to wait, and threatened to call the police. According to a report, the pharmacist became stressed and took some Apo-Prednisone pills and crushed them. Apo-Prednisone is commonly used to treat allergic reactions, arthritis, and severe asthma, among other conditions.

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