Articles Posted in COVID-19

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.

The COVID-19 pandemic has put added pressure and stress and healthcare professionals, especially as some hospitals have seen an influx of hospitalizations due to COVID-19, including the increased risk for medication errors for Maryland patients. A recent report from the Institute for Safe Medication Practices highlights the issue of medication errors related to the pandemic. There has been at least one lethal drug error in a hospital that struggled to cope with a surge in coronavirus cases. According to the report, a nurse who worked at the hospital where the death occurred worked in a busy intensive care unit that was treating about 20 COVID-19 patients each day. The nurse reported that they were overwhelmed with patients and under-resourced, and had stashes of medication left in patients’ closets and drawers. One researcher said a “rushed and hectic environment” can lead to a relaxation of safety measures and double-checks to avoid errors.

The report highlighted the University of Maryland Medical Center in Baltimore, which established a process to review workflow changes and patient safety events at the beginning of the pandemic in order to minimize potential medication errors. The Center made it standard practice to use a single concentration for high-alert medication whenever it was possible. On the other hand, the University of Maryland decided to eliminate a previous requirement that two nurses had to sign off on the administration of all medications. It now allows nurses to administer non-high alert medication without having witnesses present. The Institute provided several suggestions for avoiding prescription errors during the COVID-19 pandemic, including establishing a process for carrying out independent double checks before certain critical infusions are administered and affixing bold auxiliary labels to critical care infusions when dispensing a nonstandard concentration or a neuromuscular blocking agent.

Maryland Medication Error Victims May Be Entitled to Compensation

Maryland pharmacy errors can take many forms—an incorrect dosage, for example, or even the incorrect medicine. Perhaps the pharmacist accidentally prints instructions telling the patient to take the medicine twice a day instead of twice a week, or misreads a doctor’s written prescription. Whatever the error, pharmacy errors have one important thing in common: they are more likely to happen when pharmacists are stressed, overworked, and distracted—three things they have been known to be since the beginning of the COVID-19 pandemic.

With pharmacists and pharmacy technicians overworked and operating in stressful and hectic work environments, it may come as a surprise to many that there has been a significant decrease in the number of pharmacy errors and patient safety incidents being reported since March. According to a Pharmacy Business article, there was a 44.5% decrease in the number of incidents reported during the second quarter of 2020, compared to the first. Additionally, there was a 40.6% decrease in the number of incidents reported compared to the same quarter in 2019. While this may seem like good news, experts say it’s not. In fact, the National Pharmacy Association (NPA) has asked community pharmacies to report all safety incidents—believing that they are currently not doing so. In a recent update, NPA said that the significant reduction in the number of incidents being reported “may be due to the increased workload and pressure on pharmacy teams due to the COVID-19 pandemic, whereby pharmacy teams may not be prioritizing reporting of patient safety incidents.”

It is thus important that Maryland residents understand that a decrease in reported errors probably does not mean an actual decrease in errors—if anything, pharmacy errors are expected to be increasing during this stressful time. Pharmacists are working frantically to fill prescriptions, maintain a safe and clean working environment, and respond to patient requests, with the stress of COVID-19 constantly looming. As such, they are likely to be distracted and hurried, perhaps missing pharmacy errors that could cause significant harm to patients. Maryland residents are encouraged to double-check every prescription and refill to make sure the drug inside the bottle matches the description and the instructions match their doctor’s instructions. If a pharmacy error does occur, they should immediately call their doctor to mitigate any harm. Additionally, in cases causing serious illness or injury, Maryland patients always have the option of filing a personal injury suit against a negligent pharmacy or pharmacist. These suits can help hold the pharmacist responsible and provide monetary compensation for the injured victim, allowing them to pay off their medical bills or cover costs incurred due to the error.

It’s no secret that the COVID-19 pandemic has overwhelmed the health care system. High rates of infection and death have sent thousands of Americans to hospitals and health care clinics, most of which were already busy treating patients before the pandemic. The country’s medical providers and health care workers are working hard every single day to try and help people and combat the virus, but the sheer amount of work and stress they are under may take a serious toll on their mental health and their ability to perform the job effectively. Recently, a hospital nurse spoke to the Institute for Safe Medical Practices (ISMP) about the impact that COVID-19 is having, and what he said has implications for how the pandemic may increase Maryland pharmacy errors.

According to an article detailing his experiences and report, medication errors have been increasing in his hospital. Because nurses are working long hours with critically ill patients in a stressful, hectic, and overwhelming work environment, medication errors are more common. However, it is likely that this pattern is not isolated to just hospitals. The entire health care system is overwhelmed right now that it is likely that the rise of medication errors is also occurring in other settings, including pharmacies.

Pharmaceutical errors can be just as dangerous as errors occurring in hospitals. Many Maryland residents rely on their local pharmacy for their medications, but when pharmacists and pharmacy technicians are stressed out and overwhelmed they may make significant errors, such as providing the wrong dosage of a medication, or even the wrong medication altogether. With the COVID-19 pandemic, pharmacies may be overwhelmed by more calls from patients than usual, or requests for more prescriptions as individuals stock up. They may also be short-staffed if a pharmacist or technician gets sick or needs to stay home to take care of a family member. All of this can negatively affect Maryland residents, who rely on pharmacists to fill their prescriptions correctly and likely to not expect to be injured from taking prescribed medicine.

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