Prescription errors occur more often than many people would think. And the health professionals more likely to commit prescription errors may be surprising. A lot of attention has been given lately to overworked pharmacists who may be rushing to fill prescriptions. Yet, a new study reported an interesting finding that may have implications for Maryland patients and the Maryland prescription error victims.

According to an analysis in the European Journal of Hospital Pharmacy, the study found that doctors make more errors than pharmacy technicians in transcribing discharge medicines. One source reported that an audit was completed to compare the transcription of discharge medicines. The analysis found that pharmacy technicians had a 3.8 percent error rate, while doctors had an 18.7 percent error rate. The doctors included in the analysis made 127 errors in transcribing 678 items, including 62 errors that were considered “significant,” and one that was considered “serious.” In comparison, pharmacy technicians only made 25 errors in transcribing 654 items, none of which were considered serious, and 16 of which were considered significant.

The pharmacy technicians reportedly received training at the hospital in transcribing medications from paper-based inpatient notes to an electronic discharge system, while the doctors did not receive the same training. Pharmacy technicians were also taught to seek additional clarification of any medical issues. One of the study’s authors speculated that pharmacy technicians were approaching the task with more focus. He also said that pharmacy technicians are generally trained to clarify any issues with the doctor and another pharmacist. However, experts noted that additional research was needed.

Prescription errors made by pharmacies or medical institutions may be grounds for a lawsuit if the patient was injured as a result of the prescription error. A lawsuit may be filed against a pharmacist and the pharmacy for Maryland prescription errors in instances of negligent or willful conduct by the individual or the organization. In a negligence claim, a patient must show that the individual or organization failed to meet the relevant standard of care by giving the patient medication with the incorrect dosage or drug. A plaintiff must demonstrate that it was more probable than not that the pharmacist’s wrongful conduct caused the injury the patient suffered. In some instances, the wrongful conduct may be so serious as to warrant punitive damages against the individual or the organization.

In Maryland, normally, plaintiffs can recover damages for economic damages, such as medical bills, wage loss, and other losses and expenses, as well as non-economic damages, such as pain and suffering. These damages are referred to as compensatory damages, because they are meant to compensate the plaintiff.

In contrast, punitive damages are not concerned with compensating the plaintiff for their losses but rather to punish the defendant for bad conduct and to deter others from engaging in such conduct. Under Maryland law, in order to warrant punitive damages in a case, a plaintiff must show by clear and convincing evidence that the defendant acted with actual malice, or with knowing and deliberate wrongdoing.

Medical errors are estimated to the third leading cause of death in the United States. Even when they are not fatal, these errors often have a profound impact on a patient’s life. While there are many different types of medical mistakes, Maryland pharmacy errors can be among the most devastating, especially for the elderly and young children.

While there is a risk of error any time a pharmacist fills a prescription, certain situations present an increased risk. For example, according to a recent news report, the following are a few of the most common medication errors.

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Pharmacists in Maryland and across the nation have an incredibly important job. However, pharmacists are human, and they make mistakes. When they are stressed, tired, distracted, or spread too thin, they may make careless errors while filling prescriptions, or ignore safety procedures in the interest of time or convenience. A recent New York Times article shows that, while some of these errors are self-reported by employees, it turns out that Walgreens—a leading pharmacy used by many Maryland residents—had been covering up these errors and information about them.

According to the New York Times, pharmacy employees told consultants about the errors—how they were tied to stress, and sometimes involved ignoring safety procedures—but the senior leaders at Walgreens told consultants to keep that information out of their presentation. The director of pharmacy and retail operations, for example, had instructed them to delete a bullet point mentioning the issue. Another senior leader removed an entire slide from the presentation, which included various findings, including instances where pill bottles contained more than one medication.

This cover-up harms patients, who are routinely being harmed by pharmacy errors related to understaffed and chaotic workplaces. Pharmacists may very well be doing their best to fill prescriptions, give flu shots, answer the phone, and tend the drive-through during their shifts, but many pharmacies employ too few employees in an attempt to cut costs, meaning that in the hustle and bustle something gets lost. Adding to the problem are the corporate performance metrics pharmacists must try to meet, which incentivize speed over safety.

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.

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