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Medication is by far the most common method for the treatment of diseases, with between 75% to 80% of physician office and hospital outpatient clinic visits involving medication therapy. Annually, about 275,000 people die each year, and roughly $528 billion in medicine is wasted due to poorly managed medications. Doctors, pharmacists, and other health care professionals have a responsibility to protect patients and ensure that every prescription is safe, effective, and appropriate for each patient. A recent article in the Pharmacy Times, authored by the executive director of The Get the Medications Right Institute, highlights some of the major barriers to appropriate prescriptions. Issues range from a lack of transparency to inadequate commitment to team-based care and benefit plan design integration by care providers. These problems can compound, ultimately resulting in dangerous results for patients.

According to the article, one of the consistent themes when it comes to the failure of medical professionals to optimize medications or prescribe the proper medicine is the current siloed approach to treatment. With different treatment providers unable or unwilling to communicate with each other in the current health care environment, cost-saving and comprehensive care are significantly more difficult to achieve.

What Are Steps to Prevent Improper Prescriptions?

The piece outlines five straightforward questions that health care providers, patients, and pharmacists can utilize to prevent improper prescriptions and optimize the impact of medication when it comes to health care. Briefly stated, the steps are to ensure the correct medication, allow patients to ask questions, ensure the proper dose, provide patients with a timeline for taking the medication and explain how patients will know the medication is working.

As the medical industry progresses and new treatments are developed to address novel health concerns, pharmacists and pharmacy employees have a responsibility to keep up to date on the safe practices for dispensing the medications that have been prescribed. With the advent of new antiviral treatments for Covid-19 infection, pharmacy errors have unfortunately occurred. The Institute for Safe Medication Practices, a professional organization for the pharmaceutical industry, recently released a report on the misadministration of an antiviral cocktail that had been effective at battling Covid-19 infection.

According to the industry journal, the antiviral medication cocktail marketed as Paxlovid has shown promise at treating Covid-19 infection, however dispensing mistakes have been noticed at pharmacies nationwide. The largest single issue with the administration of the drug appears when it is being administered to patients with kidney disease. If a patient exhibited moderate kidney disease and was prescribed the drug, a pharmacist was supposed to remove some of the pills from the blister pack to avoid damaging the patient’s kidneys, however, this was not always done. Patients with severe kidney disease should not have been prescribed the drug at all.

What Are the Common Causes of Prescription Errors?

A mixture of poor package design, unclear instructions, and pharmacist negligence has resulted in patients receiving the wrong dosage of the medication, potentially causing harm. According to the report, some patients received their prescription with the wrong pills removed, while others were prescribed the medication while suffering from advanced kidney disease, putting them at serious risk. Although the article does not mention any serious negative patient outcomes as a result of these errors, mistakes like these can be fatal in some instances. When dispensing a new medication that a patient has not taken before, a pharmacy employee has a responsibility to confirm that the patient understands the correct dosage and method of administration before sending them home with a bottle of pills.

Following the Centers for Disease Control (“CDC”) endorsement of the Advisory Committee on Immunization Practices (“ACIP”) recommendation that children six months through 5 years should receive a COVID-19 vaccine, many people are flocking to their doctors and local pharmacies to obtain the vaccine. However, this news comes amid a significant pharmacy worker shortage. As such, in an attempt to avoid a Maryland pharmacy error lawsuit, many chains are reconsidering whether they will provide COVID-19 vaccinations to children under the age of 5.

For instance, recent news outlets reported that Publix would not offer coronavirus vaccines to children under 5 “at this time.” A spokesperson for the chain grocery and pharmacy store declined to elaborate on their decision; however, the website indicates that the store is continuing to accept appointments for children five and older.

Despite some retailers and pharmacies’ reluctance to vaccinate young children, many pharmacies can do so safely and effectively. However, given the current supply chain issues and worker shortages, pharmacies must take steps to prevent errors. When a pharmacy fails to do so, it may be liable for any ensuing damages or injuries.

Prescription and pharmacy errors can have devastating consequences for patients and can leave the families of loved ones left seeking compensation and punitive measures to ensure that others do not experience similar harms. A recently published news report discusses the decision by a Midwest court to deny an award of punitive damages. This case involved a labeling error and the failure to correct the error by multiple pharmacists, which resulted in the death of a patient.

According to the facts discussed in the recently published news report, a patient’s death resulted in the family suing the pharmacy for both compensatory and punitive damages. A cardiologist issued a prescription of amiodarone for a male patient who suffered from chronic ischemic heart disease and atrial fibrillation. The pharmacist responsible for initially dispensing the medication made an error by failing to completely and accurately record the medication use directions on the container label. The pharmacist’s labeling error led to the patient being instructed to take a higher daily dosage than the cardiologist intended. A second pharmacist and a third pharmacist did not catch the error when the patient returned multiple times for additional supplies of the medication. The patient’s health deteriorated and he eventually passed away.

The family sued, seeking compensatory damages and punitive damages. Compensatory damages seek to compensate a party for their expenses and the loss suffered. A liability insurance policy can cover the amount awarded as compensatory damages. The pharmacy chain in this case had liability insurance. Punitive damages, on the other hand, involve the jury awarding an amount as punishment, and in this case, as punishment specifically for the chain’s pharmacists’ failure to act in a manner that would have prevented death. Punitive damages cannot be covered by the insurance policy.

The nursing community has been on edge awaiting the sentencing of Radonda Vaught, a former Tennessee nurse who was recently convicted of negligent homicide for her role in the death of a patient she was treating at a nursing home. Criminal prosecutions for medication errors are rare, and generally reserved for situations where the conduct of the defendant was grossly negligent, egregious, and preventable. A national news source recently published an article discussing the sentence that the former nurse Ms. Vaught was given, as well as the case as a whole and the effect that Vaught’s prosecution may have on the nursing home industry.

According to the facts discussed in the news report, Ms. Vaught was convicted of negligent homicide in March of 2022 based on the death of a patient she was caring for in 2017 at a nursing home. The jury found beyond a reasonable doubt that Ms. Vaught was criminally negligent when she inadvertently gave her patient a tranquilizer instead of an anti-anxiety medication (the medications had similar sounding names). The dose of the tranquilizer that was given by Ms. Vaught to her patient was unsafe, and ultimately resulted in the patient’s death. The prosecution argued that serious criminal penalties were warranted because several warning signs were ignored, and Ms. Vaught overrode an automated medication dispensing system that would have prevented the mix-up.

After considering arguments from both sides, as well as testimony from the widower and children of the deceased patient, the judge decided to sentence Ms. Vaught to three years of probation in lieu of prison time. Although Ms. Vaught will avoid prison, she has already faced serious consequences for her mistake, as her nursing license was recently revoked based upon the incident. The article noted that the children of the deceased patient testified that their mother was a very forgiving person, and would not want Ms. Vaught to serve prison time for her mistake.

Anyone who takes prescription medication on a regular basis understands the importance of consistency and accuracy. Whether you pick up one or several medications on a regular basis at the pharmacy, every patient deserves to have peace of mind when they receive their prescription. After all, if a medication error were to take place, the consequences could result in injury, or in extreme cases, even death.

Improper dispensing of medications is more common than you may think—in fact, one in five Americans has experienced a medical error while receiving health care. The issue was given even greater attention more than four years ago, when a nurse typed two letters into a hospital’s computerized medication cabinet, selected the wrong drug from the results, and then administered a fatal dose to a patient. Because most hospital systems or pharmacies have computerized medicine cabinets, such technological vulnerability is not uncommon—and Maryland is no exception.

How can medication and pharmacy errors be prevented?

According to a recent news report, pharmaceutical safety experts are recommending a new method for medical practitioners to avoid pharmacy errors. With a new software update that requires drug names to be searched with five letters rather than three, experts are hoping that the fix will rectify issues surrounding withdrawing the incorrect drugs. Currently, most computerized medicine cabinet software programs require practitioners to type only three letters to search up a drug. For example, when a nurse types “M-E-T,” the search results could bring up anything from metronidazole to metformin. One of these drugs is an antibiotic—the other is for diabetes. Administering the wrong drug could yield disastrous results.

A common theme of the last two years has been the burnout suffered by pharmacy employees, and the increase in patient risk that results from the lack of skilled, motivated, and healthy pharmacy staff. Although some symptoms of burnout, such as increased overtime, lack of retention, and mental health issues among employees are easily measurable, the actual number of error claims may not always be. A recently published investigative report demonstrates that a large increase in pharmacy error claims in the last two years has been obscured by lenient reporting requirements that keep such claims out of the public view. The pattern appears to apply nationwide.

According to the investigative report, several public records requests were used to discover that a large increase in pharmacy error claims corresponded with the labor issues related to the pandemic. The correlation serves as further evidence that the pharmacy industry is unable or unwilling to meet the industry standard of care that patients are entitled to and have come to expect. Pharmacies have little incentive to report instances of error when they are not required to, as public dissemination of such information may hurt the pharmacy’s bottom line. A pharmacy is a business after all.

Patients who are victims of pharmacy error and are hurt or killed as a result may have a significant claim for damages against the pharmacy or employees. Pharmacies are accountable for the conduct and mistakes of their employees, and if they are unable to safely staff their businesses, then they should not be operating under dangerous conditions. While the solutions to this problem may vary, the most important matter is that patient health and safety must come first. Maybe pharmacies need to pay more, maybe they need better training, maybe they need more safeguards, or maybe they need to temporarily close until the adequate standards can be met. Regardless of this, patients can expect adequate care and take legal action in the event of an error or mistake.

Economic factors have combined with the Covid-19 pandemic to make employment shortages in Maryland and Virginia a reality in many industries today. The medical industry is likely the most affected industry by these staffing issues, as the pandemic-related risks and responsibilities have made jobs in the medical field less desirable. Pharmacists and other pharmacy employees have been suffering from increased symptoms of burnout, as the stress and responsibility of a job in a pharmacy can be too much to handle in these times.

A recently-published article in a national pharmacy trade journal discusses the effects that staff burnout and understaffing have had on the industry, as well as the risks to patient health that will be assumed if nothing is done to address the shortages soon. According to the article, pharmacies were facing staffing issues even before the pandemic hit, and the effects of the pandemic and the broader economy have exacerbated the problems, with dangerous results. Throughout the Covid-19 pandemic, pharmacies have been a primary site for testing people for the virus. The surge in demand for pharmacists and pharmacy technicians was never quite met, and pharmacists have had a difficult time staffing their locations adequately.

With pharmacies understaffed, and remaining staff facing increased stress, hours, and workload; it is the patients who ultimately suffer. Overworked pharmaceutical assistants and technicians have been unable to spend enough time with the pharmacy customers to address their concerns with medication and screen for possible mistakes. As time moves forward and the staffing shortages continue, it is becoming even more difficult to retain employees, as many are leaving the industry entirely to seek out better opportunities.

Prescription and pharmacy errors are more common than many patients and consumers may think. The vast majority of prescription errors result in little or no consequence, and many mistakes are never even caught as a result of this. In some instances, a prescription error can be catastrophic. A recently published national news report discusses the decision by a Tennessee jury to convict a nurse of negligent homicide after the death of a patient was found to be the result of a medication mix-up that the nurse was responsible for.

According to the facts discussed in the recently published news report, the 37-year-old nurse was arrested and charged with negligent homicide after one of her patients died. The patient at issue was prescribed an anti-anxiety medication called Versed but was given a paralytic agent, vecuronium, instead. At trial, the prosecution argued that the nurse improperly used an automated medication dispensing system at the nursing home, opening up the medicine cabinet manually and taking the wrong drug for her patient.

After administering the incorrect medication to the patient, the nurse did not remain with the patient to notice any harmful interactions with the drug. When a nursing home employee eventually found the patient, she had died. Medical examiners determined that vecuronium intoxication led to the patient’s death. Based on this evidence, the jury decided to convict the nurse of the charges against her. The nurse has yet to be sentenced, but she could face up to 20 years in prison for the charge.

Prescription drug side effects and drug interactions may be minor and unnoticeable, though some drug effects can be severe, and even fatal. Doctors and pharmacists are responsible for the drugs they prescribe and dispense, and harmful side effects and drug interactions should be considered when giving a drug to a certain patient. Because some drugs are more prone to causing serious side effects and harmful interactions, a nonprofit organization known as the Institute for Safe Medical Practices (ISMP) has been compiling a database of the medications that carry an increased risk of resulting in patient harm when they are used or prescribed incorrectly. This database is part of the ISMP’s division known as the National Medication Errors Reporting Program (MERP). An article recently published by a pharmaceutical trade industry journal discusses some recent revisions that have been made to the ISMP database.

According to the recently published article, the medications in the database are not necessarily more likely to cause side effects or drug interactions, but the effects and interactions that do occur with the listed medications are more likely to be serious and result in patient harm. The article notes that the use of the MERP medication database is only a small part of an effective risk reduction strategy that should be employed by pharmacies to protect their patients. Medication errors will probably never be completely eliminated, and because of that, it is especially important for pharmacies and their employees to utilize a multi-faceted approach to preventing and catching medication errors.

What Is the Most Common Cause of Prescription Errors?

Human error is the most common cause of harmful medication mistakes. Because pharmacists and their employees are often overworked and understaffed, it is not prudent to place all of the responsibility for catching an error with a single person. The great advances in machine learning algorithms and automation technology have enabled pharmacies to automatically catch many errors that may have gone unnoticed before. Even with the technological advances, the ISMP recommendations are not always eagerly followed by pharmacies. Corporate greed, cost-cutting measures, and stubborn decision-makers who are resistant to change can all prevent improvements in the industry. When pharmacies refuse to listen to sound advice like that given by the ISMP, patients can be put at risk. Because of this, patients are still in danger of serious harm from medication errors anytime they visit a pharmacy.

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