Articles Posted in Common Errors

Pharmacists have a great deal of responsibility in that they are responsible for accurately providing patients with physician-prescribed medication, double-checking that their prescribed medication does not negatively interact with other medications, and advising patients with medication-related advice. There can be little doubt that pharmacists have their hands full. This is especially the case when pharmacies are understaffed or during unusually busy hours.

Pills in HandAccording to a recent news report, the long hours and stressful work conditions present in many pharmacies across the country result in an increased risk of potentially serious errors. The article interviews several retired pharmacists, who relay their concerns about how the industry has become more demanding on pharmacists, often requiring that they work 14-hour shifts with only a few short breaks.

With drive-thru windows becoming more common over the years and the pressure to keep the pharmacy’s bottom line in mind, pharmacists not only are working long hours but are highly stressed while on the job. By some estimates, pharmacies are filling up to 800 prescriptions per day. These factors, according to the pharmacists interviewed in the article, have contributed to an increase in errors over the past several years. However, due to a lack of regulations, pharmacies are not required to report most of these errors, resulting in a dearth of accurate official statistics.

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In some ways, the pharmaceutical industry is heavily regulated. Medications must undergo years of testing before they are released and available for prescription. Similarly, pharmacists themselves must obtain a specialized advanced degree and have a certain amount of on-the-job training before they are certified. However, pharmacy technicians require less training and are often permitted to fill prescriptions on their own, requiring only a brief glance by the overseeing pharmacist before being provided to the patient.

Random PillsAccording to a recent news report, a lack of regulations inside the pharmacy may be responsible for the increase in pharmacy error rates across the country. The report details one woman’s experiences after being prescribed a dose of a prescribed medication. The report notes that lawmakers in many states have not enacted rules limiting the number of prescriptions a pharmacist can fill per hour or per day. This means that, rather than being permitted to focus on assuring that each prescription is properly filled, a pharmacist may be pressured by management to fill large amounts of prescriptions. This emphasis on quantity over quality can have disastrous results.

Prescription Error Results in Patient’s Skin “Melting Off”

Earlier this month, a local news report documented one woman’s struggles after being prescribed the wrong dose of the medication lamotrigine. According to the report, the woman went to the doctor because she felt depressed. The doctor wrote a prescription for lamotrigine, and the woman took it to her local pharmacy. However, the pharmacist on duty incorrectly filled the woman’s prescription at the wrong dose.

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The dangers of prescription drugs have been well-documented over the past several decades. In most cases, a medication is made available only by prescription because it presents an increased risk of causing harm to a patient who should not be taking it. This can be due to an increased risk of negative interaction with other medications, an increased risk of abuse, potential side effects, or the ease with which a patient could accidentally overdose.

Blister PacksPrescription errors can occur any time a patient is given medication. While many of these errors occur at local retail pharmacies, a large percentage of prescription drug errors occur in long-term care facilities. Once a patient is discharged from the hospital, their medical records are supposed to follow them. However, the reality is that many of the prescription errors that occur in long-term care facilities occur shortly after a resident is discharged from the hospital. This is most often due to a miscommunication between the hospital and the long-term care facility.

A recent report discusses how the period of transition from hospital to long-term care facility is one of the most dangerous times for patients. The report notes that in many cases, patients in transition are in “crisis mode,” after having recently been admitted to the hospital. The patient most likely has seen several medical professionals, and they may be taking multiple prescription medications that they are not accustomed to taking. Thus, the patient is less likely to be able to catch an error before it occurs.

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When most hear that a pharmacy error was made, they assume that a busy pharmacist grabbed the wrong prescription, got the dosage information incorrect, or printed the wrong instructions. However, according to a recent industry news report, a large portion of pharmacy errors list information technology as a contributing factor to the error.

Assorted PillsAs health care technology advances, pharmacies are relying more and more on technology to fill in the gaps where humans are prone to making errors. These areas include patient records, dosage instructions, drug-interaction alerts, and receiving and inputting customer orders. In many cases, technology allows for fewer pharmacists to fill more prescriptions per day, which benefits both the pharmacy owner as well as the patient, who presumably will have reduced wait times.

As the report notes, however, technology is not perfect. According to the report, the most common errors involved the dosage of medication, including omitting the dose, including the wrong dose, or including an extra dose of medication in a patient’s prescription. While many of these errors will be caught before the patient ingests the medication, some of these errors will result in a patient’s injury.

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While pharmacists are certainly busy medical professionals, there is no excuse to cut corners or to engage in any shortcuts that could potentially put a patient’s life at risk. However, despite the importance of a pharmacist’s role in a patient’s overall medical care, there are often lapses in care or judgment that put recovering patients at an increased risk of re-admission to the hospital. Similarly, even patients picking up routine medications are put at risk of serious complications when pharmacy errors are made.

Doctor's GearLegally, pharmacists have a duty to ensure that they provide a certain level of acceptable care. To be sure, this does not mean that a pharmacist can be held liable for every adverse drug reaction; however, when there is evidence that a pharmacist did not provide the adequate level of care, patients who suffered as a result may be entitled to monetary compensation for their injuries.

Proving that a pharmacist’s actions were legally deficient is not difficult in many pharmacy error cases, especially when the case involves allegations of the pharmacist providing a patient with the wrong medication or the wrong dosage of the correct medication. However, one of the most common areas in which plaintiffs run into problems is in establishing causation. Causation is an element in almost all pharmacy error cases that requires the plaintiff to establish that the defendant’s negligent act resulted in their injuries. In pharmacy error cases, this often requires the testimony of one or more medical experts.

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By any account, pharmacists do not have an easy job. They often fill hundreds of prescriptions per shift, meet with dozens of clients for consultations, and must also maintain their internal inventory systems throughout the day. Pharmacists are human, and with these burdens being placed upon them day after day, it is no surprise that the rate of pharmacy errors is as high as it is.

Blister PackAccording to one news report that discussed a study it conducted of Chicago-area pharmacies, 52% of all pharmacies surveyed failed to warn patients about a dangerous drug interaction. This study didn’t take into account other types of pharmacy errors, such as providing the patient with the wrong dose of medication or the wrong type of medication altogether. The news agency looked mostly at both independent and national-chain pharmacies, discovering that CVS had a failure rate of 62%, Walgreen’s had a failure rate of 30%, and independent pharmacies had a failure rate of 72%.

Due to the concerns surrounding pharmacy errors, lawmakers have recently started to try to implement stricter guidelines for pharmacists. The proposed changes would limit a pharmacist’s workday to 8 hours, require pharmacists take two 15 minute breaks and an hour lunch, and limit the number of prescriptions filled per hour and per shift. Despite the undeniably high error rates, some pharmacies and pharmacists have opposed the newly proposed laws.

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The results of a recently published study emphasize the crucial role that registered nurses (RNs) play in maintaining accuracy in dispensing medications to patients receiving inpatient services at a hospital. The recently performed study discusses the most common medications that are subject to error, as well as the rates of harm to patients that occur as a result of errors made by RNs. Costly errors appear to encourage doctors, hospitals, insurance companies, and the medical industry as a whole to issue guidelines in the hope of preventing errors. However, whatever harm these errors cause to the medical professionals who make them, the harm caused to innocent patients is significantly worse.

Blood Pressure CuffThe Study Confirms the High Rates of Inpatient Errors Committed by RNs

An article in an industry news source (login required) discusses the recent study mentioned above. The study found that the majority of medication errors occurred in the medical-surgical units of the hospitals where they were conducted, followed by the intensive care units and intermediate care units.

Anticoagulant drugs were the most common type of medication to be associated with a medication error, and 10% of the total errors ultimately resulted in harm to a patient. Although 10% sounds like a low number, that still adds up to hundreds of thousands of patients each year who receive some type of medication error and thousands who suffer harm as a result.

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The Supreme Court of Alabama recently released an opinion granting the appellant’s request for the state’s high court to intervene in the case and compel the trial judge to dismiss the plaintiff’s claim as time-barred. The statute of limitations for the plaintiff’s claim had expired shortly before the defendant’s motion was filed, and the motion was ultimately granted because the plaintiff had originally sued the wrong entity after an oversight was made. After the error was discovered, the complaint was not amended to include the proper defendant until after the limitations period had expired. Since the court found that the requirements for an amended complaint to “relate back” to an original filing and toll the statute of limitations were not met, the plaintiff will be unable to recover damages for his pharmacy error claim.

Various PillsThe Plaintiff Alleges That a Dangerous Mistake Was Made

The plaintiff in the case of Ex Rel VEL, LLC is a former customer of a pharmacy owned and operated by the defendant. In the events leading to the filing of the lawsuit, the plaintiff was allegedly given an antipsychotic medicine, Risperidone, instead of his blood-pressure medicine, Ropinirole. After taking the wrong pills for four days, the plaintiff allegedly experienced an adverse health event and was hospitalized, at which point the error was ultimately discovered. Claiming that he suffered permanent and serious harm as a result of the mistake, he pursued a pharmacy error claim against the pharmacy that made the mistake.

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The Institute for Safe Medication Practices (ISMP) has released a report that discusses the most common pharmacy errors of 2016 and strategies to prevent these errors from harming patients in the future. The ISMP is an industry trade association containing pharmaceutical companies, doctors, pharmacists, and other medical professionals that regularly conducts observations and releases data related to prescription errors and the dangers these errors present to patients. According to the report, the most common type of pharmacy error committed in 2016 was dispensing the wrong medication to a patient, although other dangerous errors, including dosage and patient mix-ups, also ranked high on the list.

Assorted PillsThe Classes of Drugs Most Affected by Medication Errors

The ISMP study concluded that certain classes of drugs are more commonly associated with medication errors than others. According to a recent report discussing the results of the study, medication errors are most commonly associated with opioid narcotics, antibiotics, antipsychotics, and insulins.

More errors are committed in dispensing the correct dosage of opioid narcotic medicines than any other type of medicine. This is in large part due to the significant variance in tolerance and dosage from patient to patient. For example, a dose that is appropriate for one patient could cause an overdose in another, and pharmacists must ensure that they have the correct prescription information when filling these prescriptions. If something looks wrong, the pharmacist should contact the patient’s doctor directly rather than fill the prescription and provide it to the patient.

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A recently published news report details an extensive study that was performed by the Chicago Tribune last year to evaluate and compare pharmacies’ ability to detect dangerous drug combinations being prescribed to the same patient and filled at the same time. The study involved researchers visiting over 250 Chicago-area pharmacies and filling five various prescriptions, including one “dangerous combination” of drugs. The researchers intentionally chose combinations of drugs that could cause a serious illness or death if taken together and that should not have been dispensed together.

Random PillsOver Half of Pharmacies Missed the Deadly Combinations

Considering their decision to undertake such a large study, the researchers probably expected that a significant number of pharmacies would overlook the dangerous interactions and dispense the selected combinations to the undercover patient.  However, the final results were stunning. Over half of the prescriptions containing deadly combinations with instructions for concurrent use were filled by the pharmacist with no discussion or objection.

There are measures in place and mandatory safety checks to prevent these dangerous drugs from being dispensed together, but the pressure to perform quickly discourages pharmacists from taking important safety measures.

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