Each year, medicine and technology get more and more advanced, leading to improvements in the quality and delivery of health care across the country. Despite these improvements, however, errors still occur in health care delivery, particularly regarding pharmacy and medication. In fact, Maryland pharmacy errors occur frequently, jeopardizing the health and well-being of patients. The Institute for Safe Medication Practices (ISMP) is a nonprofit organization that works closely with health care practitioners, institutions, regulatory agencies, professional organizations, and the pharmaceutical industry to create awareness of and provide education about medication errors and how to prevent them.

Every other week, ISMP produces a newsletter with timely information related to pharmacy error prevention. Looking at the newsletters from January 2020 through December 2020 provides important insight into the trends seen in pharmacy errors last year. Pharmacy Practice News recently provided a summary of these newsletters on their website.

In the Pharmacy Practice News summary, several key problem areas were identified. One was safety issues related to labeling, packaging, and nomenclature. For example, a pharmacist might mix-up two different medications that have similar labeling or names, giving the wrong one to the patient. Another area of concern was safety issues associated with order communication and documentation. For example, health officials searching for drugs by generic names and accidentally substituting non-substitutable drugs. Finally, there are problems involving drug information, patient information, patient education, and staff education. For example, two patients mixed up their insulin pens which looked alike but with different labels and manufacturers, meaning they gave themselves the wrong insulin, leading to hyperglycemia.

Victims of Maryland medication errors may be dealing with the stress of the injury, medical bills, and wage losses—and filing a Maryland medication error lawsuit may not be at the forefront of their minds. However, victims have to be careful not to wait too long, because it could be too late.

The statute of limitations dictates the time in which any claim must be filed in Maryland. Failure to file a lawsuit within the applicable statute of limitations generally will result in the claim being dismissed, though there are some exceptions. Generally, the statute of limitations for a medication error claim in Maryland (and other personal injury claims) is three years. Wrongful death claims also have a statute of limitations of three years. The statute of limitations varies depending on the type of case and there may be exceptions in some cases. The statutes of limitations also can change if there is a change in the law so it is important to meet with an experienced medication error attorney who understands the statute of limitations that applies in a specific case.

The statute of limitations generally begins to run when an injury occurs, though it may start to run later in some cases. An experienced medication error attorney can help medication error victims properly file a claim within the applicable statute of limitations.

While the COVID-19 pandemic was understandably the most reported and challenging topic in medicine and healthcare during 2020 (and maybe for 2021, as well), it is important to remember that Maryland pharmacy errors—both COVID-19 related and not—have continued to occur with alarming rates.

Pharmacy errors occur when some mistake is made between the time a prescription is written and the time a patient takes the medication. These errors can come in many different forms. For example, the pharmacist may provide a patient with the wrong medicine or the incorrect dose.

Now that 2020 has come to an end, reflection on the mistakes of the past year is possible. The Institute for Safe Medication Practices (ISMP) recently released a list of the Top 10 medication errors and hazards that occurred in 2020. Factors influencing the list include frequency of problems, the significance of the consequences to patients, and the potential for the errors to be avoided or minimized. ISMP recommends that these ten errors be top priorities in the new year.

In the tragic event of a death after a medication error, the family of a Maryland medication error victim may be able to file a wrongful death claim against those responsible. Maryland’s wrongful death statute generally allows for a claim to be filed by a spouse, parent, or child of the victim. If no spouse, parent, or child exists who may file a wrongful death claim, another person may file who was related to the victim by blood or marriage “who was substantially dependent upon the deceased.” Maryland’s Wrongful Death Act is intended to provide an avenue for family members of the victim to recover compensation for their losses by allowing them to recover for acts that would have entitled the victim to recover compensation if the victim had not died.

In wrongful death claims, the defendant or defendants may blame the victim or argue that the medication error did not cause the death. Just as in Maryland negligence cases, if the victim survives, a wrongful death claim can be barred if the decedent is found to be partially at fault for the error. A defendant may also argue that another medical condition or factor caused the person’s death. The plaintiff has the burden of proving all the elements of the case by a preponderance of the evidence. A wrongful death claim generally must be filed in Maryland within three years of the victim’s death.

Cases Reported of Drug Mix-ups During Spinal Injections

Three cases of accidental spinal injection of tranexamic acid were recently reported on by one news source. The tranexamic acid was reportedly used instead of a local anesthetic because the wrong container was used by accident. In one case, an anesthesiologist used tranexamic acid instead of bupivacaine and recognized the error right away, but the patient had already begun to experience seizures. In another case, the patient again received tranexamic acid instead of bupivacaine and experienced seizures, and was placed into an induced coma for several days. In the last case, the patient received tranexamic acid instead of a local anesthetic but also experienced seizures and extreme pain. Tranexamic acid given in the spine in place of anesthetic can be extremely harmful and has a mortality rate of about 50%. Survivors may experience paraplegia, seizures, ventricular fibrillation, and permanent neurological injury.

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Vaccines are life-saving substances that can provide children and adults with protection against many serious diseases and illnesses. However, in some cases, errors or unintended side-effects can occur, leaving individuals with injuries or illnesses. If an adult or child suffers an injury following medication or vaccine, they may file a Maryland pharmaceutical error lawsuit.

The United States generally maintains the most effective and safe supply of vaccines and medications. In most cases, side effects of a vaccine are temporary and mild; however, patients may develop serious side effects in some cases. Some common vaccine injuries are severe allergic reactions, drug interaction injuries, unlisted side effects, seizures, and wrongful death. Proving that the actual vaccine caused an injury can be complicated; however, there are situations where administration or dosage may cause the victim’s injuries.

For example, recently, national news reports revealed that health officials inadvertently gave 42 people the Regeneron IV Covid treatment, instead of the Covid-19 immunization. The National Guard stated that the individuals were given the treatment intravenously at a vaccination clinic. All of the individuals who received the antibody treatment instead of the immunization have been contacted. Health officials explained that they do not believe that the patients face any risk of harm from the error. However, the Health Department is working with the National Guard to review its policies and procedures.

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.

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