Articles Posted in Common Errors

blister packsThis blog has covered a number of the common causes of Maryland pharmacy errors in hopes of increasing patient awareness. One common cause of pharmacy errors that has not recently been discussed is when a patient’s prescription is filled multiple times.

Most often, these errors are the results of two different pharmacies each filling a prescription and providing it to the patient. These errors are more common in mail-order pharmacies than in retail pharmacies. More often than not, these errors involve elderly patients that are prescribed multiple medications and may have a difficult time reading or understanding the numerous directions they should follow.

Patient Dies after Taking Twice the Number of Pills That Were Prescribed by His Physician

Back in 2016, an older man died from what appeared to be a medication overdose. According to a local news report covering the tragic accident, the man was prescribed medication to control his heart, liver, and anxiety-related conditions. The medications were provided to the patient in blister packs containing 108 pills each. The patient’s prescription was supposed to include a total of four blister packs.

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healthcare blocksSome pharmacy errors can be difficult to prove because patients are often already sick and suffering before the error. In any Maryland medical negligence claim, a plaintiff must establish the following elements: 1.) a healthcare professional owed the plaintiff a duty of care; 2.) the healthcare professional failed to meet the relevant standard of care; 3.) the plaintiff was injured as a result of that failure; and 4.) the professional’s lack of care caused the plaintiff injuries.

Proving causation means showing that the plaintiff was injured as a result of the professional’s breach of the standard of care. Simply showing that a healthcare professional did something wrong is not enough—a plaintiff must also show that the act caused the plaintiff’s injury.

The plaintiff has to prove causation by showing that it is “more probable than not” that the professional’s negligent act caused the plaintiff’s injury. This can be tricky if the patient was already suffering from health issues, or if there may have been more than one cause of the injury, for example. In a medical error case, there is almost always an underlying issue that caused the patient to receive medication, and patients often have multiple issues and several care providers. A recent study discussed some common medication safety risks in health care.

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prescription medicationGiven the prevalence of smartphones in today’s society, as well as the fact that doctors entering the medical field today are much more likely to be tech-savvy than ever before, it is no surprise that some doctors are relying on text messaging to deliver prescriptions to pharmacies. However, some experts are concerned that prescriptions that are sent in by text message may result in a higher overall rate of pharmacy errors.

According to a recent industry news report, while texting provides some potential benefits to physicians and pharmacists alike, the medical field is not yet prepared to safely implement the practice. The article outlines several errors that are more likely to occur when a physician texts – rather than calls, faxes, or electronically submits – a prescription.

First, physicians who use text messaging to submit a prescription bypass all clinical decision-making support offered by electronic-prescribing systems. Electronic-prescribing systems show providers relevant portions of a patient’s medical record and alert prescribers to a potential adverse reaction as well as the possibility of a better-suited medication.

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pharmacyThe increasing number of Maryland pharmacy errors has drawn attention not just from within the industry but also more broadly from the media and lawmakers. As the population grows and pharmacies take on more patients, the number of prescriptions filled per day continues to grow exponentially. With limited space and the pressure to keep costs down, pharmacies often have a difficult time staffing enough pharmacists and technicians to safely fill patients’ prescriptions.

This is not to say that being busy is an excuse to commit an error. It isn’t. In fact, regardless of how busy a pharmacist is, how long they have been on a shift, or how many prescriptions they have filled in any given day, pharmacists always have a duty to ensure that the prescriptions they fill are accurate.

A recent industry news source discusses several common errors that are seen in pharmacies across the country. As is the case with most errors, these are based on a lack of communication, problems with data management, and issues with conveying important and technical information quickly.

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medical assessmentMedical errors routinely rate among of the most frequent causes of preventable death in the United States. One of the more common types of medical errors are pharmacy misfills or prescription errors. These errors occur when a pharmacist provides a patient with the wrong medication, wrong dose, or wrong instructions.

According to one industry news source, pharmacy errors are on the rise. Evidently, the National Pharmacy Association released its most recent data which showed a 64% increase in pharmacy errors between April and June of this year. The data showed that nearly half of all of the reported pharmacy errors were caused by “workload and time pressures.”

The types of errors reported varied, but the following were some of the more common error types:

  • providing the wrong medication to the patient based on medication with similar sounding or looking names;
  • mixing up patients’ names and addresses; and
  • attaching the wrong information slip to a patient’s prescription.

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prescription instructionsWhile there are many causes of Maryland pharmacy errors, one of the most frequently reported errors involves a patient receiving the wrong medication from their pharmacist. In many cases, the pharmacist provides a patient with a drug that has a name similar to the drug which they were prescribed.

The Institute for Safe Medication Practices (ISMP) has coined the term look-alike sound-alike (LASA) drug to describe a medication that is either spelled or pronounced similar to other medications. It is estimated that up to 35% of all medication errors involve LASA medications. The IMSP has also published a list of the most common LASA drugs.

For example, common LASA drugs include:

  • hydromorphone and morphine
  • vinblastine and vincristine
  • tramadol and trazodone

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Each year, it is estimated that there are approximately 700,000 medication errors resulting in over 100,000 patient hospitalizations. The pharmacy industry realizes that this is a major problem, and for decades has been taking steps to reduce the rate of prescription errors among retail and hospital pharmacists. Most recently, a representative from the Institute for Safe Medication Practices (ISMP) gave a lecture discussing common types of pharmacy errors and what pharmacists can and should do to guard against them.

Legal News GavelMedication errors occur due to a breakdown somewhere along the line; from when a physician writes a prescription to when the pharmacist provides it to the patient. According to a recent industry news report detailing the speaker’s comments, she claimed that pharmacy errors occur throughout various points in the process, and pharmacists should take precautions every step of the way.

The ISMP representative discussed that there are several situations in which an error was more likely to occur. For example, when a pharmacist is dealing with drug shortages, vaccines, improperly or unlabeled medication, and insufficient drug allergy alerts, the rate of error was highest. The pharmacist detailed three of the most alarming prescription errors that she was made aware of over the past year, including:

  • A patient who was prescribed 25 mg of hydralazine rather than the prescribed medication, hydroxyzine;
  • A child-patient who developed Parkinson-like symptoms after being provided with an improperly diluted dose of risperidone; and
  • An elderly Alzheimer’s patient who was given both a 5mg and 10 mg dose of donepezil at the same time rather than the prescribed 5mg dose for four weeks to be followed by the 10mg dose afterward.

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While the exact number of Maryland pharmacy errors is disputed, the U.S. Food and Drug Administration offers a conservative estimate of approximately 7,000 deaths per year due to medication errors. Due to lenient reporting requirements in the pharmacy industry and the industry’s interest in keeping errors out of the mainstream news, experts believe that the true number of errors is much higher. Some reports suggest that upwards of 1.3 million people are harmed each year by prescription errors.

Legal News GavelPrescription errors have a number of potential causes. However, like most mistakes, the most common cause is that the pharmacist filling the prescription overlooked something they shouldn’t have. Poor communication between health care professionals plays a role in many pharmacy errors. Along those lines, pharmacists will often misinterpret a physician’s abbreviations, either prescribing the wrong medication or the wrong dose. Mistakes are also commonly made involving drugs with similar-sounding names.

Each of these situations involves one common variable:  a negligent pharmacist. Undoubtedly, most of the pharmacists who are responsible for pharmacy errors are well-intentioned. However, given the everyday stress and steady workload, many pharmacists end up taking short cuts that can hurt their patients.

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The chances are that anyone who has dropped off a prescription or refill request to a retail pharmacy has had to wait a considerable amount of time for the pharmacist to fill the prescription. First, the patient must wait in line to drop off the prescription. Then, the pharmacist often tells a patient to come back in at least 30 minutes – sometimes even longer.

Legal News GavelWhile waiting 30 or 45 minutes for a prescription to be filled isn’t a problem for most patients, the fact that a pharmacy is so busy raises some concerns for pharmacy experts. According to a recent news report discussing the prevalence of errors and what can be done to curb them in the future, it is estimated that there are approximately 100,000 deaths caused by pharmacy errors each year. The leading cause of Maryland pharmacy errors is commonly understood to be an overworked pharmacist.

The article details the startling account of a woman who was provided the wrong medication by her local pharmacy. The woman was prescribed the pain medication Gabapentin. Her physician instructed the woman to take the medication three times a day, taking two pills for each dose.

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Prescription errors can have devastating consequences for people of any age. The wrong dosage or medication can have long-lasting consequences and, in some cases, can be fatal. A recent article shows how children may be at greater risk for prescription errors in some circumstances. Since some medication is produced at dosages that are too high for children, they have to be reduced. The process of creating a smaller dosage is another opportunity for prescribers and pharmacists to make mistakes and for miscommunications to occur.

Legal News GavelIn the case of a Maryland prescription error, a plaintiff must demonstrate that the defendant was negligent by failing to meet the relevant standard of care. An example of this might be a pharmacist’s failure to administer the prescribed dosage. In these cases, a plaintiff may be entitled to compensation for their injuries.

Article Reveals Life-Threatening Errors in Administration of Flecainide to Children

Flecainide, an oral antiarrythmic drug, can be prescribed to treat supraventricular tachycardia or atrial fibrillation. However, it is only available commercially in doses of 50 mg, 100 mg, and 150 mg, so when given to infants and small children, who require smaller doses, it has to be given in the form of a suspension. A recent article discusses how there have been life-threatening errors during the preparation of the suspension, resulting in serious overdoses.

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