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Anyone who takes prescription medication on a regular basis understands the importance of consistency and accuracy. Whether you pick up one or several medications on a regular basis at the pharmacy, every patient deserves to have peace of mind when they receive their prescription. After all, if a medication error were to take place, the consequences could result in injury, or in extreme cases, even death.

Improper dispensing of medications is more common than you may think—in fact, one in five Americans has experienced a medical error while receiving health care. The issue was given even greater attention more than four years ago, when a nurse typed two letters into a hospital’s computerized medication cabinet, selected the wrong drug from the results, and then administered a fatal dose to a patient. Because most hospital systems or pharmacies have computerized medicine cabinets, such technological vulnerability is not uncommon—and Maryland is no exception.

How can medication and pharmacy errors be prevented?

According to a recent news report, pharmaceutical safety experts are recommending a new method for medical practitioners to avoid pharmacy errors. With a new software update that requires drug names to be searched with five letters rather than three, experts are hoping that the fix will rectify issues surrounding withdrawing the incorrect drugs. Currently, most computerized medicine cabinet software programs require practitioners to type only three letters to search up a drug. For example, when a nurse types “M-E-T,” the search results could bring up anything from metronidazole to metformin. One of these drugs is an antibiotic—the other is for diabetes. Administering the wrong drug could yield disastrous results.

A common theme of the last two years has been the burnout suffered by pharmacy employees, and the increase in patient risk that results from the lack of skilled, motivated, and healthy pharmacy staff. Although some symptoms of burnout, such as increased overtime, lack of retention, and mental health issues among employees are easily measurable, the actual number of error claims may not always be. A recently published investigative report demonstrates that a large increase in pharmacy error claims in the last two years has been obscured by lenient reporting requirements that keep such claims out of the public view. The pattern appears to apply nationwide.

According to the investigative report, several public records requests were used to discover that a large increase in pharmacy error claims corresponded with the labor issues related to the pandemic. The correlation serves as further evidence that the pharmacy industry is unable or unwilling to meet the industry standard of care that patients are entitled to and have come to expect. Pharmacies have little incentive to report instances of error when they are not required to, as public dissemination of such information may hurt the pharmacy’s bottom line. A pharmacy is a business after all.

Patients who are victims of pharmacy error and are hurt or killed as a result may have a significant claim for damages against the pharmacy or employees. Pharmacies are accountable for the conduct and mistakes of their employees, and if they are unable to safely staff their businesses, then they should not be operating under dangerous conditions. While the solutions to this problem may vary, the most important matter is that patient health and safety must come first. Maybe pharmacies need to pay more, maybe they need better training, maybe they need more safeguards, or maybe they need to temporarily close until the adequate standards can be met. Regardless of this, patients can expect adequate care and take legal action in the event of an error or mistake.

Economic factors have combined with the Covid-19 pandemic to make employment shortages in Maryland and Virginia a reality in many industries today. The medical industry is likely the most affected industry by these staffing issues, as the pandemic-related risks and responsibilities have made jobs in the medical field less desirable. Pharmacists and other pharmacy employees have been suffering from increased symptoms of burnout, as the stress and responsibility of a job in a pharmacy can be too much to handle in these times.

A recently-published article in a national pharmacy trade journal discusses the effects that staff burnout and understaffing have had on the industry, as well as the risks to patient health that will be assumed if nothing is done to address the shortages soon. According to the article, pharmacies were facing staffing issues even before the pandemic hit, and the effects of the pandemic and the broader economy have exacerbated the problems, with dangerous results. Throughout the Covid-19 pandemic, pharmacies have been a primary site for testing people for the virus. The surge in demand for pharmacists and pharmacy technicians was never quite met, and pharmacists have had a difficult time staffing their locations adequately.

With pharmacies understaffed, and remaining staff facing increased stress, hours, and workload; it is the patients who ultimately suffer. Overworked pharmaceutical assistants and technicians have been unable to spend enough time with the pharmacy customers to address their concerns with medication and screen for possible mistakes. As time moves forward and the staffing shortages continue, it is becoming even more difficult to retain employees, as many are leaving the industry entirely to seek out better opportunities.

Prescription and pharmacy errors are more common than many patients and consumers may think. The vast majority of prescription errors result in little or no consequence, and many mistakes are never even caught as a result of this. In some instances, a prescription error can be catastrophic. A recently published national news report discusses the decision by a Tennessee jury to convict a nurse of negligent homicide after the death of a patient was found to be the result of a medication mix-up that the nurse was responsible for.

According to the facts discussed in the recently published news report, the 37-year-old nurse was arrested and charged with negligent homicide after one of her patients died. The patient at issue was prescribed an anti-anxiety medication called Versed but was given a paralytic agent, vecuronium, instead. At trial, the prosecution argued that the nurse improperly used an automated medication dispensing system at the nursing home, opening up the medicine cabinet manually and taking the wrong drug for her patient.

After administering the incorrect medication to the patient, the nurse did not remain with the patient to notice any harmful interactions with the drug. When a nursing home employee eventually found the patient, she had died. Medical examiners determined that vecuronium intoxication led to the patient’s death. Based on this evidence, the jury decided to convict the nurse of the charges against her. The nurse has yet to be sentenced, but she could face up to 20 years in prison for the charge.

Prescription drug side effects and drug interactions may be minor and unnoticeable, though some drug effects can be severe, and even fatal. Doctors and pharmacists are responsible for the drugs they prescribe and dispense, and harmful side effects and drug interactions should be considered when giving a drug to a certain patient. Because some drugs are more prone to causing serious side effects and harmful interactions, a nonprofit organization known as the Institute for Safe Medical Practices (ISMP) has been compiling a database of the medications that carry an increased risk of resulting in patient harm when they are used or prescribed incorrectly. This database is part of the ISMP’s division known as the National Medication Errors Reporting Program (MERP). An article recently published by a pharmaceutical trade industry journal discusses some recent revisions that have been made to the ISMP database.

According to the recently published article, the medications in the database are not necessarily more likely to cause side effects or drug interactions, but the effects and interactions that do occur with the listed medications are more likely to be serious and result in patient harm. The article notes that the use of the MERP medication database is only a small part of an effective risk reduction strategy that should be employed by pharmacies to protect their patients. Medication errors will probably never be completely eliminated, and because of that, it is especially important for pharmacies and their employees to utilize a multi-faceted approach to preventing and catching medication errors.

What Is the Most Common Cause of Prescription Errors?

Human error is the most common cause of harmful medication mistakes. Because pharmacists and their employees are often overworked and understaffed, it is not prudent to place all of the responsibility for catching an error with a single person. The great advances in machine learning algorithms and automation technology have enabled pharmacies to automatically catch many errors that may have gone unnoticed before. Even with the technological advances, the ISMP recommendations are not always eagerly followed by pharmacies. Corporate greed, cost-cutting measures, and stubborn decision-makers who are resistant to change can all prevent improvements in the industry. When pharmacies refuse to listen to sound advice like that given by the ISMP, patients can be put at risk. Because of this, patients are still in danger of serious harm from medication errors anytime they visit a pharmacy.

The Covid-19 pandemic has strained nearly every industry worldwide, however, healthcare workers remain one of the most affected groups by the public health crisis. Pharmacists in particular are especially burdened with extra duties related to vaccination and testing, as well as the staffing shortages and worker burnout that are affecting industries nationwide. Because pharmacists and pharmacy workers are so strained, the risks associated with burnout are real. Strained and stressed out pharmacists and other medical workers are more likely to make mistakes in their work, which may put patients at risk. A recently published news report discusses measures that one pharmacy chain is taking to address the risk of burnout among pharmacists and other employees.

According to the local news report, a major national pharmacy chain is enacting a new policy to close down their pharmacies for a 30-minute lunch break where every pharmacy employee will be given uninterrupted time to themselves to prevent the effects of burnout from affecting their work. According to company sources quoted in the news report, pharmacists and other employees have been complaining about unsustainable levels of stress and the lack of adequate breaks. The company hopes that the new policy will help their workers’ psychological wellbeing while also protecting patients from pharmacy errors.

Can Pharmacists Be Responsible for a Doctor's Prescription Error?

Yes, in some cases, pharmacists can be legally responsible for a mistake that originated with the prescribing physician. Pharmacists and their assistants play an important role in checking of the drugs that were prescribed by a medical provider to a patient are being dispensed properly. Doctors can make mistakes in choosing drugs or dosage amounts, and harmful drug interactions may not be noticed until it is too late. Because of this, it is important for pharmacy employees to be attentive and vigilant in protecting their patients.

While technological advances have reduced the likelihood of most Maryland age-related vaccine errors, the COVID-19 vaccine has reignited some of these issues. Research indicates administration errors are more likely to occur to those: receiving an injection at an uncommon age, with vaccines that have age-specific dosing, and with vaccines given less frequently. The findings suggest that those receiving a vaccine off-schedule may be more likely to experience an administration error.

A typical example of this error involves the COVID-19 vaccine. The Centers for Disease Control indicates that the COVID-19 are safe and effective against severe disease. However, the public must receive the appropriate dosage at the correct time. For example, the Pharmacy Times advises the public to be aware of the rising rate of age-related COVID-19 vaccine mix-ups.

On October 28, 2021, the U.S. Food and Drug Administration (FDA) authorized emergency use of certain COVID-19 vaccines for youth between the ages of 5-11 years old. Since that time, the Institute for Safe Medication Practices (ISMP) reports receiving hundreds of mix-up reports involving the formulation for those over 12 years old and the pediatric formulation. The majority of the mix-ups occurred at physician offices, public health clinics, community pharmacies, and outpatient clinics. The reports indicate that children between 5 to 11 years old received under or overdoses, and children 12 years or older received underdoses.

Whether you only take medicine when you are sick or you have several medications to keep track of on a daily basis, we expect prescriptions to be filled by the pharmacy accurately. Medication errors, which take place when the type, dosage, or instructions associated with a prescription are incorrect, can have injurious or even deadly consequences.

Although medication errors took place before the pandemic, COVID-19 has exacerbated many previously existing issues. Many pharmacists, like other front-line health care providers, are overworked, exhausted, and burnt out with no reprieve or end to the pandemic in sight.

Before the pandemic, pharmacists already had dozens of responsibilities. From filling prescriptions, organizing various scripts, communicating back and forth with providers and patients, operating the drive-through, coordinating pickup and drop off of prescriptions, and conducting consultations, pharmacists are no stranger to busy and long days. The pandemic, however, increased the number of existing responsibilities. Now, in addition to previous obligations, pharmacists are also administering COVID-19 vaccines and tests while also frequently working with smaller numbers of staff because of people getting sick or social distancing requirements.

Medication errors are an unfortunate yet common occurrence throughout the United States. While these errors can have deadly consequences, they are most dangerous to vulnerable populations such as older adults, pregnant women, and children. In Maryland, those who suffer a medication error may hold the responsible party liable for their losses. Children are a unique population in that they have little to no control over the medication they consume yet can face the most consequences after a medication error. Statistics indicate that over 50% of American children consume one medication or more every week, and one study revealed that almost half of caregivers gave an incorrect dose.

While a single dosing error of a common medication may not result in a significant injury, persistent errors can raise the likelihood of serious harm. In light of the growing concern surrounding pediatric medication errors, the American Academy of Pediatrics (AAP) published a piece on preventing home medication errors. The authors acknowledged that home medication errors commonly occur with liquid medications requiring preparations. Caregivers with reduced health literacy or limited English proficiency are at an increased risk for making an administration error.

In addition to home caregivers, health care providers may also be responsible for pediatric medication errors. Many health care provider practices enhance the occurrence of errors. Providers who do not include complete information related to indication, frequency, or duration, can affect how the caregiver administers the medication. Further, providers who fail to include a consistent dosage or conduct a thorough medication review may inappropriately prescribe medication.

From March 2020 until now, the COVID-19 global pandemic has taken a toll on everyone—but especially healthcare workers. Less discussed, however, are pharmacists and the burnout they have experienced as healthcare providers, since many may assume that other frontline workers, such as physicians or nurses, are bearing the brunt of the pandemic’s impacts. Pharmacists, however, have experienced similar record numbers of burnout and exhaustion during the course of the pandemic, and mistakes resulting from being overworked could injure or even kill patients.

According to a recent news report, the COVID-19 global pandemic has taken a significant toll on pharmacists, particularly as new variations of the virus continue to emerge and mutate with no signs of slowing down. For many who work in pharmacies, the work was a great fit initially because of the drive to give back and help people. Now, many pharmacists report being burnt out and exhausted from the daily demands of work, which have been exacerbated by pandemic specific tasks that added more work to each pharmacist’s already busy schedule.

Before the pandemic, for example, pharmacists mostly focused on filling prescriptions and providing a limited number of vaccines, such as the flu vaccine. Now, many pharmacists are struggling to fill up to 250 prescriptions a day while administering COVID-19 vaccines, COVID-19 tests, and manning the phones and other customers with limited staff available.

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