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Although they pose a risk to Maryland residents, most individuals do not know what a compounding pharmacy is. Compounding pharmacies mix, tailor, and create drugs on their own, to meet specific patients’ needs. These drugs may be helpful to individual patients, but often they are not approved by the FDA and, like any drug, can be dangerous to patients and are subject to pharmaceutical error. According to the International Academy of Compounding Pharmacists, there are over 55,000 compounding pharmacies in the U.S., with roughly 27,000 serving local patients and doctors directly.

Recently, a story of a compounding pharmacy error made headlines when it resulted in severe injuries to a healthy 54-year-old man, who ultimately lost his leg due to the error. According to a local news report covering the incident, the patient was regularly active, working out regularly and playing sports. To help his muscles recover from his workouts, he took injections of an amino acid drug from a compounding pharmacy. After ten months of taking the injections with no problem, he woke up one day drenched in sweat, with a raging fever and swollen leg. It turned out that he had mycobacterium abscesses growing in his leg, which is very rare and hard to treat.

The patient had to undergo 23 different surgeries over five months and was put on five different antibiotics, which caused rashes and nausea. He also began to experience a ringing in his ear, and was told by his doctor that he had to choose between saving his leg and saving his hearing, because he needed the antibiotic causing the ringing to save his leg. He decided to save his leg, because he wanted to continue to be active, but now lives with impaired hearing.

Pharmacists at the country’s biggest retail chains have written letters to state regulatory boards in recent months alerting them to what they claim are chaotic workplaces that put patients at risk, according to a recent article. The pharmacists say that the pressures put on them require that they give shots, answer phones, mange drive-throughs, take payments, and make calls in addition to filling prescriptions and counseling patients. They say that these demands in addition to meeting corporate metrics are making their jobs unsafe for patients. According to the article, surveys of pharmacists in Maryland and other states reveal that they “feel pressured or intimidated to meet standards or metrics that may interfere with safe patient care.”

For example, internal documents from CVS showed that staff members were supposed to persuade 65 percent of patients that were picking up prescriptions to sign up for automatic refills, 75 percent to have their doctor contacted for a proactive refill request, and 55 percent to switch from a 30-day supply to a 90-day supply.

One pharmacist wrote that they were  a “danger to the public” in a letter to the Texas State Board of Pharmacy. Another said the situation is “absolutely dangerous” to patients. Such pressures have led to mistakes they say, including misfills. Some mistakes have led to devastating results, including dispensing a cancer drug instead of an antidepressant, leading to the woman’s death after six days of taking the medication, which allegedly led to organ failure. The family was offered a settlement in that case.

When a Maryland patient receives a prescription from a pharmacist, they typically trust that the pharmacist has given them the correct medication and the correct dosage. Unfortunately, this is not always true. Pharmacists make mistakes far too often while filling patients’ prescriptions, and these mistakes can have long-lasting consequences and lead to illness, injury, or even sometimes death. Fortunately, however, there are things Maryland residents can do to protect themselves from pharmacy errors. The New York Times recently published an article detailing five things patients should do when getting a prescription from a pharmacy.

First, patients should talk to the pharmacist dispensing their drugs. Pharmacists are knowledgeable about drugs, common issues with drugs, and how they may interact with other medications someone is already taking. Talking to the pharmacist also increases the chance that they will take a second look at a patient’s prescription, hopefully catching any errors. This precautionary step is especially useful if it is a new medication, since patients may not know what the pill is supposed to look like and won’t immediately notice errors.

Second, patients can protect themselves by taking a few seconds right inside of the pharmacy to open the bag. According to Institute for Safe Medication Practices, one of the most common pharmacy errors is dispensing a prescription to the wrong patient. Take time to check that the correct name of the patient is on the bag as well as on the box or bottle inside the bag. In this instance, patients may be able to fix a pharmacy error before it even leaves the pharmacy.

Maryland medication and pharmacy errors of any type are concerning, but they are of particular worry when they affect children. Children’s immune systems are more vulnerable than adults, and they may lack the ability to articulate and explain what is wrong or what is happening to them, making errors more difficult to detect. Because children’s bodies are still growing, certain errors can also inhibit growth and have serious long-term consequences. While relatively rare, all parents should be on the lookout for pharmacy errors when it comes to their children.

To make this easier for parents, The Pharmaceutical Journal recently announced a new initiative focused solely on this problem: inviting researchers to submit articles on the subject to be published, increasing the availability of information on prevention and common errors. The Journal hopes to publish articles on how pharmaceuticals can improve the health of children, new policies that may prevent errors of this kind, and evidence-based best practices across all sectors.

The Pharmaceutical Journal explained in depth why this initiative matters. Most research on pharmaceuticals and drug administration focuses on adults, who can be studied more easily with less ethical concerns. However, children are not simply small adults, and the data collected on adult subjects cannot necessarily be translated to children, whose bodies, physiology, are remarkably different. For instance, drug doses, which are generally standardized across all adults, perhaps only differing due to weight or sex, have to be individually calculated for every child receiving the drug, based on their age, weight, body surface area, and clinical condition. This individualized calculation may lead to more errors. Additionally, the physiology of children is changing, meaning that old processes and procedures for calculating dose calculations may now be incorrect. Specifically, obesity is on the rise, with the number of overweight or obese children increasing globally. Because of this, pharmacists should be particularly cautious when treating children, and more information on the subject could help them do just that.

E-prescribing or electronic prescribing has become increasingly common in recent years in Maryland and throughout the country. The practice allows the direct transmission of prescription information from a provider to a pharmacy. Many people hail the benefits of electronic prescribing, as handwritten prescriptions are inefficient and carry risks of error. The Maryland Senate introduced a bill earlier this month to allow health practitioners to issue prescriptions for certain controlled substances electronically. However, electronic prescribing carries its own set of risks. A study by the National Institutes of Health found that serious adverse effects, including deaths, have been caused by electronic prescriptions. Such errors can include entry errors, dispensing errors, and transcription errors that are unique to electronic prescribing. Electronic prescriptions require that medical professionals make particular precautions to detect and avoid mistakes. Maryland pharmacy error victims may be able to recover financial compensation in the event of an error.

One woman’s recent death was determined to be caused by an electronic prescription error, according to a news source. The woman was prescribed the drug trimethoprim for a urine infection when she was seen at a hospital. On the same day, her doctors saw test results from an earlier test that showed that an infection would not have responded to trimethoprim, and instead prescribed the woman Amoxicillin. The prescription was transmitted electronically, but by amending the prescription, the prescription for Amoxycillin was not available for the pharmacist to download. The prescription for the patient only reflected the prescription for trimethoprim.

The patient took the medication, and, four days later, was admitted to the hospital with worsening symptoms. The error was recognized, and she was treated, but the woman’s condition deteriorated and she died the following day. A coroner determined that the woman would not have died if she had taken the Amoxycillin she had been prescribed.

Maryland medication errors occur all too frequently and can have dire consequences for patients. The most recent study conducted by the Institute of Medicine found in 2013 that medical errors caused between 210,000 to 440,000 deaths per year. Of course, an exact number is difficult to determine because medical records are not always complete, and providers can be reluctant to disclose mistakes. In 2014, one study found adverse drug events were one of the most common medical errors in the country.

Errors involving what are known as “look alike, sound alike” (LASA) medications involve medications that sound similar or look similar in appearance, packaging, or in the names of the medications. Such drugs pose a higher risk of medication errors. As one recent article found, “Depo-” medications are often the subject of medication errors. There are several medications on the market today that begin with the prefix “Depo-.” The prefix means that the medication is administered via a depot injection that deposits the drug into tissue. However, people have consistently mixed up different “Depo-” medications with one another. Some of the most common errors are: “Depo-Provera,” “Depo-Subq-provera 104,” and “Depo-Provera Contraceptive Injection”; with “Depo-Medrol,” and with “Depo-Testosterone.”

For example, according to a recent news report, a physician mistakenly injected a patient with Depo-Provera instead of Depo-Medrol in 2015, after the medication had been inadvertently stored in a bin where Depo-Medrol was normally kept. In another case, a patient was injected with Depo-Medrol instead of Depo-Provera, which she was being given for contraception. The patient became pregnant as a result of the mistake. In that case, the staff person had mistakenly taken a vial of the drug where both drugs were stored next to each other.

All Maryland personal injury claims, including pharmaceutical claims, are subject to a statute of limitations, which indicates how long after an accident or injury a plaintiff has to file suit against the responsible party. In most cases, the statute of limitations is three years. Waiting too long to file a suit can bar Maryland plaintiffs from recovering, so it is important to be aware of the relevant statute of limitations and file suit in a timely manner when injured.

In cases where the injury was caused by a medication, knowing when the statute of limitations begins can be difficult. Plaintiffs want to push the start point forward, saying the clock did not begin until they knew about their injury, even if it technically happened weeks, months, or years, later. On the other hand, pharmaceutical companies will likely argue that the statute of limitations began to run before the plaintiff even knew about the issue. Oftentimes, the outcome of this disagreement determines whether or not the plaintiff recovers for their injuries.

Take a recent state supreme court case as an example. According to the court’s written opinion, the two plaintiffs, young men, were both prescribed Risperdal for mental health issues in 1997 and 1998. The first plaintiff started experiencing increased breast size, extreme weight gain, and psychological distress in 2001. The second plaintiff suffered from weight gain and diabetes as well, and in 1998 also perceived breast development and psychological distress. The two filed suit against the drug manufacturer and pharmaceutical company, claiming that they failed to warn plaintiffs about the potential of developing Gynecomastia, an endocrine disorder that causes the growth and swelling of the breast tissue in males. The defendants responded by filing a motion for summary judgment, arguing that the statute of limitations had passed. According to the defendants, the statute of limitations had begun almost eight years before the plaintiffs filed suit. The plaintiffs, on the other hand, argued that they did not know about their condition and thus could not have filed suit during that time, and that the statute of limitations did not actually begin until much later.

A recent tragic case of a wrong prescription given to a patient illustrates the potential dangers and long-term consequences of Maryland pharmacy errors. According to a local news report covering the incident, the patient was suffering from an eye infection in November 2018, and he was prescribed Tobramycin-Dexamethasone, which are eye drops to treat infections. However, after five days of putting the drops into his eyes, the patient realized that it was not the right medication.

Looking at the back of the box given to him, he noticed that it said “for ears only.” As it turns out, the pharmacy had given him Neomycin and Polymyxin B Sulfates and Hydrocortisone Otic Solution, which are ear drops, used to treat ear infections. These drops should never be put into eyes and can have long-term consequences.

After discovering the mistake, the patient went to the emergency room and saw an emergency ophthalmologist. At this point, his eyes were swelling severely and were bright red. Unfortunately, almost a year later, the patient is still suffering from the error. The glands behind his eyelids are clogged up, forming pimples and causing him pain. He has been taking medication to treat this condition and may require surgery in the future.

After a patient is prescribed a medication by their doctor, they assume that the medication provided by the pharmacy will help their condition. However, statistics show that there are a frightening number of pharmacy errors each year. Indeed, according to the World Health Organization, it is estimated that nearly 50 percent of all patients will experience a pharmacy error at some point in their life.

As is the case with most accidents, there are several causes of pharmacy errors. One cause that has garnered significant attention over the past few years is the lax reporting requirements following a pharmacy error. In most states, including Maryland, a pharmacist who discovers that he made an error is not required to report the error. It is only in certain, limited situations that the error must be reported. Experts believe that implementing stricter reporting requirements may bring to light common errors, as well as ways to improve patient safety.

Some states are working to create stricter pharmacy error reporting requirements. According to a recent news report, Ohio lawmakers recently passed a law requiring pharmacists to report prescription errors that harm or kill patients because of reckless behavior or unprofessional conduct. In determining whether to pass the law, lawmakers reviewed data suggesting that there were two deaths and 31 cases of serious injuries in the state over just the past four years. Under the new law, a pharmacist’s failure to report an error could result in disciplinary action, a suspension of their license, required additional coursework, monetary fines, and potentially the revocation of the pharmacist’s license.

The Institute for Safe Medication Practices (ISMP) is warning pharmacists and medical practitioners about the potentially severe consequences of using abbreviations for drug names. Their recent report, submitted to the National Medication Errors Reporting Program, sheds crucial light onto one way in which patients could be injured by a Maryland pharmacy error—through miscommunications and mix-ups based on drug abbreviations.

For example, according to an article discussing the ISMP’s report, one commonly confusing abbreviation is “tPA,” which refers to “tissue plasminogen activator alteplase (Activase).” In one situation, an urgent order for alteplase for a patient in an intensive care unit (ICU) was sent to the pharmacy. A nurse from the ICU called the pharmacy to ask if the “tPA” was ready, but the pharmacist, who was newly hired and unfamiliar with the abbreviation tPA, thought the request was for “TPN,” or “total parenteral nutrition.” The pharmacist then told the nurse that the drug would be there in a few minutes, since they were currently mixing parenteral nutrition solutions.

Later that day, when the needed alteplase did not arrive, the ICU nurse called the pharmacy again. Another pharmacist answered, saw the urgent order in the database, and began to dispense a dosage of the drug. Unfortunately, in her rush, she forgot to mix the drug according to the protocol for inpatient use and was delayed while re-dispensing and mixing the drug. This delay, since the drug was already delayed due to the abbreviation mix-up earlier, led to the hospital calling a rapid response team for the patient in question.

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