Articles Posted in Pharmacy Errors and Children

Many pharmacy errors result in the wrong dose of the prescribed medication being given to a patient by mistake, or the dosage instructions being printed incorrectly on the bottle. Thus, even when taking their medicines as directed, some patients are receiving significantly more (or less) medication than their doctor prescribed. A recently published article from a local news source discusses a case in which a pharmacy accidentally dispensed 10 times the prescribed amount of an antipsychotic medication to a young boy, who took the drug for several months before the error was noticed.

Boy Receives Prescription for 0.3 mg of Risperidone to Treat Behavioral Issues

According to the report, the boy and his mother visited a psychiatrist for treatment of psychological and behavioral problems. The doctor prescribed the antipsychotic medication Risperidone to the boy with instructions to consume 0.3 mg of the drug per dose. For several months, the pharmacy failed to see the decimal point and dispensed medication with instructions for the boy to consume three mg for each dose.

For months, the boy was taking intoxicating and dangerous levels of the drug. His mother visited several doctors, trying to determine what was wrong. Eventually, doctors noticed that the boy was receiving 10 times the amount he was prescribed, and the mother visited the pharmacy for answers.

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Most people who are prescribed a medication by a physician are prescribed a ready-made form of that medication, whether it be a pill, liquid, powder, or cream. However, sometimes a need arises for a physician to prescribe a very specific dose or form of a medication based on a patient’s individual needs. This is called a compounded medication.

Compounded medications require that a pharmacist mix together certain ingredients and essentially create the exact dose and form of a medication that is tailored to a patient’s needs. In many cases, compounded medications are required by the elderly or the very young. While compounded pharmaceuticals are necessary for some patients, there is a chance that the pharmacist creating the medication makes an error, resulting in the wrong medication or wrong dose being delivered to the patient.

Eight-Year-Old Boy Dies Due to Error in Compounded Medication

Earlier this year, a young Canadian boy died in his sleep after his mother provided him with a compounded medication created by a local pharmacist. According to a local news source reporting on the tragic error, the young boy suffered from an REM sleep disorder that required he take tryptophan. However, since the boy had difficulty taking the tryptophan pills, his mother had a special liquid medication compounded by the pharmacist. The compounded medication worked fine for 18 months.

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Prescription medications are powerful drugs that can have major adverse effects on everyone, especially children. These medications are available only with a doctor’s recommendation because they may have serious interactions with other medications, may present a high risk of overdose, or may require very specific instructions regarding how to take the medication. In children, even the smallest mistake can result in a serious injury or even death.

While many medication errors involving children take place at home when a parent gives their child medicine, the ultimate responsibility for the error may not lie with the parent. In fact, the way that many children’s medications are dosed makes it very difficult for parents to make the necessary conversions. In a recent report discussing pharmacy errors that affect children, it is noted that most children’s medication has one set of instructions for administration with an oral syringe and another for administration in teaspoons, leaving parents with the job of converting one into the other.

In fact, a recent study involving 2,000 children under eight years old and their caretakers found that 84% of the caretakers made some mistake with the administration of the child’s medicine. Most of these mistakes involved doses calling for measurement by teaspoon or measuring cups. Currently, there is a push by the Food and Drug Administration to standardize all doses in children’s medication, using milliliters. However, until then, it is recommended that extra precautions be taken to ensure that anyone providing liquid medication to a child understand exactly what the intended dose is.

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Recently, a New Zealand boy was admitted to the hospital three times after he was provided a prescription that was 10 times stronger than prescribed by his physician. According to a local news report covering the error and the subsequent investigation, the boy suffers from cerebral palsy and is prescribed Baclofen, a muscle relaxer, to help him control his symptoms.

Evidently, the prescription was phoned in by the boy’s physician and picked up by his mother. She gave him the medication as directed, and as a result she had to take her son to the hospital three times with increased seizures, shortness of breath, and deep breathing. It was not until the third visit to the hospital that it was discovered that the reason for her son’s exacerbated symptoms was the dispensing error.

An investigation was initiated by a government oversight group to find out how this type of error could occur. The investigators discovered that there were two pharmacists on duty that day:  a filling pharmacist and a checking pharmacist. According to the inspector, the performance of both pharmacists fell short of the duty they owed the child. The investigator explained that “maintaining a logical, safe and disciplined dispensing procedure, including assessing the efficacy and safety of medicine, are fundamental aspects of pharmacy practice.”

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As you may recall reading on this blog a few weeks ago, back in early June of this year, an eight-year-old Colorado boy passed away after he was given 1,000 times the correct dose of his medication. The news of this tragic accident shocked the nation, and reporters have been following up on the story to bring a more complete version of what actually happened to light.

According to one local news report that recently provided an update on the tragic accident, the boy had suffered from the symptoms of ADHD for nearly a year before his parents decided that medicating their son was the best option. Aware of the potentially harmful effects of the medication, the boy’s parents were hesitant to provide their son with such a powerful medication. However, his worsening symptoms and inability to deal with them necessitated the medication.

He was originally prescribed Clonidine, which is used to treat both ADHD and high blood pressure, in the form of a pill. Since he was so young, the doctor prescribed him one-quarter of a pill at first. That was then stepped up to a third of a pill. His parents would have to cut the pills into thirds, but this was difficult because the pills would often turn to powder. The boy’s parents found a solution in that they had a specialty pharmacy make a liquid compound so that their son could ingest the proper amount of medication in a less cumbersome, more accurate manner.

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Pharmacy errors are fairly commonplace, but they range in severity and cause. While most serious pharmacy errors are the result of a pharmacist providing a patient with the wrong medication, there are a good number of errors that are the result of a patient receiving the correct medication but the wrong dose. These errors are especially dangerous to children, who are often prescribed minute amounts of a medication due to their small size and low tolerance of serious medications.

Regardless of the reason for an error or the type of error, pharmacists are ultimately responsible for the medications they provide to their patients. While a pharmacist may not be found to be liable if the doctor fills out the wrong prescription, when a pharmacist receives a correct prescription but improperly fills it, liability may arise. This is even the case if the pharmacist was well-intentioned at the time of the mistake.

Recent Pharmacy Error Claims Eight-Year-Old Boy’s Life

Earlier this month in Colorado, a young boy died after ingesting 1,000 times the prescribed dose of his ADHD medication, Clonidine. According to a recent news article reporting on the tragic accident, the young boy was initially given the extreme dose back around Halloween of last year. He was hospitalized for a short time and then released. It seemed as though he was doing fine, but then his condition started to worsen again. He died a short time after he was admitted to the hospital.

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A pharmacist’s mistake in providing the wrong medication to a patient is always a serious concern, but never is it more serious than when the patient is a child. Children are much more susceptible to suffering serious or fatal side effects when given medication that was not prescribed to them. In fact, the manufacturers of many medications specifically state that the drug is not intended for the use of minors. It is therefore extremely important that pharmacists and parents do everything they can to ensure that a child is not given the wrong medication.

However, pharmacists are human, and busy ones at that. They often fill hundreds, if not thousands, of prescriptions each day. This constant flow of work can create an increased chance that something will break down in the system, and a child will be provided the wrong medication. However, the concern is not only that a child will be given the wrong medication altogether. Children are also at risk for serious injury or death if the dose they are provided is not correct.

When a pharmacist does make a mistake, and a child is harmed as a result, that pharmacist and the pharmacy employing him may be held financially liable in a negligence lawsuit. Despite what the media and the pharmacy industry may say, the ultimate burden is not on the parents or those who administer the medication to the child. The burden remains on the pharmacist.

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Late last month on Halloween, a Canadian pharmacy accidentally provided medication used to treat bipolar disorder to young trick-or-treaters who visited the store. According to one local news source that covered the story, seven children are known to have actually taken the medication in place of candy. However, all of the pills were located before they were consumed by the children.

Evidently, the pharmacy had a candy bin out on the pharmacy counter so that young trick-or-treaters could help themselves as their parents conducted their business. However, at some point in the day, a customer who was visiting the pharmacy to fill her 17-year-old son’s prescription for quetiapine and divalproex inadvertently dropped the medication on the floor prior to leaving.

Another customer, thinking she was preventing a potential mix-up, picked up the medication off the floor and put it on the counter, next to the candy bin. Shortly afterward, a pharmacy employee saw the pills sitting next to the bin and then dumped them into the candy bin. Seven of the individually wrapped pills were given out to children over the course of the day before management discovered what had occurred.

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Earlier last month, the major pharmaceutical company GlaxoSmithKline was named as a defendant in a lawsuit brought by the parents of a child who was born with a birth defect after his mother took medication produced by the drug manufacturer during pregnancy. According to one national news source, the drug, called Zofran, was initially approved for treating nausea in cancer patients after they received chemotherapy. However, over the years, the drug started to be prescribed to pregnant women looking to lessen the effects of “morning sickness.”

Evidently, the couple filed suit in federal court in Ohio. They allege that the manufacturer marketed the drug for “off label” use to pregnant women back in the 1990s. Shortly after this time, the company allegedly started to get complaints from mothers who took the drug during pregnancy. They were reporting that their babies were being born with heart defects and kidney malformations. In fact, subsequent research has shown that mothers who take Zofran have twice the chance of giving birth to a child with a severe birth defect.

This lawsuit is not unique. In fact, there have been several dozen similar lawsuits brought by parents of children who have been born with severe birth defects after their mothers took Zofran.

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Earlier this month, a CBS news affiliate published an article discussing pharmacy errors broadly and also focusing in on the fact that Walgreen’s Pharmacy is currently facing several lawsuits based on the alleged negligence of their pharmacists. According to the report, just this year two serious pharmacy errors have occurred at Walgreen’s stores across the country.

The first was a five-year-old boy who was somehow provided with anti-psychotic medication rather than his normal allergy medicine. Not only was the provided medication the wrong one, but the dose was ten times stronger than that which should be used for a child his age and size. The boy took two doses of the unprescribed medicine before his parents noticed the mistake. His parents told reporters that “he couldn’t breathe, he couldn’t talk” after taking the two doses. His parents were later told by doctors that if they had given him one more dose they may have lost their son.

The second situation involved a 15-year-old girl who was allegedly given schizophrenia medication instead of simple antibiotics. After getting home and taking the medication, she experienced blurred vision and a racing heart. The girl’s mother told reporters that, as she stood by her daughter’s side that day, she was afraid she was going to lose her. Thankfully, both patients recovered from the medication errors.

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