Pharmacy Error Injury Lawyer Blog

Consumer Reports Health Investigation Finds Drug Label Warning Inconsistency

July 18, 2011 | Lebowitz & Mzhen

A recent investigation that our Hartford County pharmacy error injury attorneys have been following found evidence that drug labels are often missing the important safety warnings necessary to prevent medication error and that many pharmacies neglect to include the proper medication guides that are required by the U.S. Food and Drug Administration (FDA).

The investigation was performed by Consumer Reports Heath, by filling warfarin prescriptions at five different New York drugstores. Warfarin is a blood thinner used for stroke prevention that is one of the most frequently prescribed drugs in the country.

The results found that four out of the five pharmacies neglected to provide the FDA-approved medication instructions that are required for specific drugs, warfarin included. Although the pharmacies reportedly provided their own medication materials, they were different from the warfarin drug information approved by the FDA, in that the warnings about the usage of alcohol were different. Warfarin can reportedly cause life-threatening internal bleeding if used incorrectly, and is the second in line for drugs that cause emergency room visits in hospitals across the country, due to medication error.

Another goal in the investigation was to see how certain drug labels, consumer drug information sheets, and medication warning stickers differed in each pharmacy. Although a certain degree of variation was expected, as various drugstore chains use different software to print labels and drug instructions, the findings raised significant concern.

Medication Errors Linked to Death of Patient in Nursing Home

July 8, 2011 | Lebowitz & Mzhen

In a recent Baltimore pharmacy error injury blog, our attorneys discussed a pharmacy misfill and medication error that lead to a 94-year-old nursing home resident’s wrongful death in New York, after she received the incorrect medication for nearly twenty days as a result of a pharmacy misfill.

In a related news report, a patient in a nursing home, also in the State of New York, has recently died, after medication errors allegedly led to her wrongful death.

The patient reportedly entered the Lake Ridge Care Center on the 10th of January in 2010, due to congestive heart failure and low potassium. Her doctor reportedly ordered that the she receive three doses (two-tablets) of potassium every day. According to the New York State investigation, the staff of the home failed to properly administer twenty-six of the medication doses to the patient over a period of eight days.

On January 23, 2011, the patient was reportedly sent to the hospital emergency room, where she suffered a severely abnormal heart rhythm and died the same day, from cardiac arrest. Her potassium levels were found to be extremely low, due to medication errors that led her to miss her prescribed potassium doses to help blood pump through the heart.

New Study Finds Electronic Medication Error Rates Consistent with Handwritten Prescriptions

July 1, 2011 | Lebowitz & Mzhen

In recent news that our Pharmacy error injury attorneys have been following, a new study from the Journal of the American Medical Informatics Association found that prescriptions sent electronically to pharmacies by doctors are almost as likely to have errors as the prescription medication orders handwritten by doctors.

The study examined 3,850 electronic prescriptions that a commercial pharmacy retain chain received over a period of four weeks in 2008. Out of the 3,850 e-prescriptions studied, researches found that 12%, almost 500, contained a total of 466 prescribing errors.

The researchers noted that their findings on e-prescribing error rates are consistent with their earlier study and research for error rates on handwritten prescriptions. Out of the 466 electronic prescribing errors discovered, only one-third of them could have caused patient harm or personal injury.

According to Bloomberg, the results undermine the safety benefits expected from e-prescribing, especially as the federal government paid over $158.3 million to doctors and hospitals in the beginning of 2011 to encourage doctors to switch over to electronic health records, as a way to reduce healthcare costs and eliminate medical and medication errors. The report found that although many providers are rapidly adopting electronic health records and e-prescribing, many of the expected benefits of the electronic computerized prescribing will not take effect if the electronic prescribing applications are not able to catch medication errors, or in fact cause medication errors.

FDA Warns of Confusion between Risperdal and Requip, Leading to Medication Error

June 27, 2011 | Lebowitz & Mzhen

The Food and Drug Administration recently issued a warning about the potentially dangerous medication errors occurring with the drugs Risperdal (risperidone) and Requip (ropinrole)—with 226 reports of patients accidentally receiving the wrong drug, causing sickness and at least one death.

Risperdal (risperidone) is an antipsychotic used for the treatment of schizophrenia, autism side effects and bipolar disorder, and is reportedly being confused with Requip (ropinirole), a drug used for the treatment of Parkinson’s disease and Restless Legs Syndrome, that acts in place of dopamine.

According to the Food and Drug Administration report, the medication errors are happening as a result of the drug name similarity as well as the similarity in generic drug labels and packaging, with overlapping drug characteristics such as the drug strengths, and dosing intervals. Other errors have reportedly stemmed from illegible handwriting on prescriptions.

Patients who were victims of the medication errors have reportedly experienced confusion, tiredness, hallucinations, and an altered or changed mental status, among others health problems.

The FDA warns patients who are taking the generic versions of Requip or Risperdal to notice the name and appearance of their medication, to know exactly why they are taking the drug, and to ask any questions and to report any difference in medication appearance to their pharmacists—to avoid pharmacy misfills or medication errors.

Walgreens Pharmacy Misfill Causes Dosing Error

June 21, 2011 | Lebowitz & Mzhen

In a recent pharmacy misfill news story that our Maryland pharmacy error injury lawyers have been following, a pharmacy customer has received an apology from a local Walgreens pharmacy, after receiving refills of a medication that contained a dosage that was ten times stronger than what the doctor had prescribed.

The pharmacy misfill reportedly took place repeatedly for around a year, where Larina Helsom took a 50mcg tablet twice a day instead of a 5mcg dose. The medication reportedly caused the Helsom to suffer from chest and esophageal spasms that were so painful she couldn’t talk or breathe. When they first started happening, Helsom thought that she was dying.

After months of taking the prescription misfill, Helsom reportedly went through several hospitalizations for the spasms, along with other prescribed medications to control the symptoms. Once the drug misfill was discovered, her doctor advised that Helsom stop taking the drug immediately.

The Arizona State Pharmacy Board is reportedly now investigating Walgreen’s pharmacy misfill, to decide whether negligence was a factor in the mistake. Last year, the pharmacy board reportedly received 131 complaints about pharmacies statewide. Walgreens claims that the prescription dose at issue was within the normal range of dosing for this drug.

Study Shows Transition to Electronic Medical Record Systems May Cause Potential Errors

June 15, 2011 | Lebowitz & Mzhen

According to a recent study published in the Journal of General Internal Medicine, although doctors and hospitals are in a mad dash to update to new electronic medical record systems (EMR)–after last year’s stimulus package promised a $27 million pay out to providers that meet the new EMR use–that transition can be risky and lead to an increase in certain types of medication errors in the months after the switch.

In the study, that our Hartford County, Maryland pharmacy error attorneys have been following, researchers found that although the change to a more streamlined system for entering prescription drug orders led to a general decrease in prescribing errors, other types of errors surfaced in the first few months after the changes were made.

Researchers reportedly followed 17 doctors who switched to new EMR systems, and found that improvements were immediately found in prescribing errors, where abbreviations that have a high potential to cause patient injury or harm dropped significantly. But rates of other prescription errors, such as medication direction mistakes were higher three months after the EMR switch over, and some rates of errors were even higher after an entire year using the system.

Rainu Kaushal, the chief of the division of quality and medical informatics at New York-Presbyterian Hospital/Weill Cornell Medical College, and the author of the study, claims that although the overall drop in prescribing errors is good, the results of the study show that there is a need for constant reassessments of the new systems—especially to prevent prescribing and medication errors in the future.

FDA Tips for Administering OTC Medication to Children—to Reduce Medication Error Injury

June 6, 2011 | Lebowitz & Mzhen

In a previous Washington D.C. medication error injury lawyer blog, we covered the recent guidelines announced by the U.S. Food and Drug Administration (FDA) aimed to prevent medication errors and overdoses with children’s over-the-counter (OTC) medications.

According to the FDA, accidental medication errors and overdoses in young children are a common health problem, but a problem that is entirely preventable. The new guidelines are aimed to reduce frequent medication administration errors that happen as a result of confusing label instructions, inconsistency with the drug measuring devices, and confusion over the exact units of medication measurement—to prevent harm or injury.

Along with the new medication error prevention guidelines, the FDA also outlined tips for parents and caregivers, to reduce administration error when giving medicine to a child or infant.

According to the FDA, always:

• Know the active ingredients in the medicine that you are giving to your child.
• Read and follow the drug facts label on all medicines that are OTC.
• Use the tools for dosage administration that come with the medicine. Never use tools from other medication.
• Be aware of the difference between a teaspoon and a tablespoon.
• Know your child’s weight exactly.
• Check the medicine three times.
• Make sure to give the right medicine in the exact amount that is directed.
• Ask your doctor, nurse or pharmacist to make sure which medicines can be used at the same time.
• Store your medicines in a safe place that is out of reach for children.
• Make sure to use caps on all medicines that are child-resistant.

Hospital Fined $50K in Medication Mistake

June 3, 2011 | Lebowitz & Mzhen

In recent news that our Rockville, Maryland medication error injury attorneys have been following, twelve Los Angeles-area hospitals were hit with administrative penalties this week by the California Department of Public Health, ranging from $25,000 up to $75,000, after the facilities were found to be non-compliant with requirements that were likely to cause serious injury or death to patients.

One medical center, Promises Hospital, was reportedly fined $50,000 for a medication mix-up that caused a patient with a heart condition to require emergency response.

According to the Los Angeles Times, a medication error was reported in 2010 that led to the inspection of Promises Hospital. The inspectors reportedly found that a patient was given a dose of Cardizem, the drug used to treat irregular heart rhythms, that was 10 times the ordered dose—causing the patient’s heart rate to drop so quickly that the nurse was unable to get a blood reading for almost 10 minutes.

According to the department, when problems are found in facilities, hospitals must take corrective actions to prevent any similar medication errors or other problems from happening in the future, and causing injury or death to patients.

Promises Hospital reportedly claimed that it has initiated an investigation into the drug error, and has taken the necessary steps to prevent this medication mix-up for happening again in the future.

New FDA Guidelines to Prevent Children’s OTC Medication Errors

June 1, 2011 | Lebowitz & Mzhen

In a recent Baltimore, Maryland pharmacy error injury lawyer blog, our attorneys discussed an FDA panel’s recent recommendation that dosing instructions be based primarily on children’s weight, and not age—as studies found that many parents administer the wrong drug dosage to their children because of confusing medication label instructions.

The FDA has recently released new guidelines that are expected to reduce the prevalence of medication error and overdoses with Children’s liquid over-the-counter (OTC) medication, which is administered and dispensed with cups, spoons and droppers.

The guidance was reportedly developed after past reports of medication errors revealed that labels often cause confusion with administration, the measuring devices provided in drug packages are often inconsistent with the labels, and parents often used devices from other drug products to dispense the medication that do not match the label instructions—leading to medication error.

According to the FDA recommendations:

• Dosage dispensing devices (cups, spoons, droppers) should be included with all OTC medications that are liquid and taken orally.
• Over-the-counter (OTC) drugs will reportedly now come with dispensing devices that are calibrated to match the exact units of measurement specified on the drug label—to avoid drug error or injury.
• Companies should make sure that the liquid dispensing devices are used only to measure the intended drug products.

• The markings on the dispensing devices should be visible when the liquid medication is added for measurement.

And as our Maryland medication mistake attorneys discussed previously, the FDA is also advising that liquid acetaminophen products will be changed to one concentration only, with age-appropriate dosages, to reduce medication dosing errors.

FDA Panel Looks to Prevent Drug Error by Changing Children’s Acetaminophen Product Labels

May 27, 2011 | Lebowitz & Mzhen

In recent pharmacy error injury news that our Hartford County, Maryland attorneys have been following, a panel advising the U.S. Food and Drug Administration (FDA) has recommended that dosing instructions for children’s acetaminophen be based primarily on a child’s weight and not age, and be changed to include children under two years—to reduce the risk of medication error.

According to the Wall Street Journal (WSJ), a majority of dosing information for over-the-counter (OTC) children’s medicine containing acetaminophen have instructions based on age, with only some information on dosing by weight, causing confusion in dosing that could lead to error or injury. Acetaminophen is the most commonly used OTC medication to lower fevers in children and relieve pain, with the best-known brand being Children’s Tylenol.

The federal advisory panel has recently recommended that all acetaminophen products should contain a standard label with updated weight tables to reflect average weight increase among children over the past 20 years.

According to the FDA reports from 2000 to 2010, there were 14 fatalities and 74 non-fatal adverse events that were related to acetaminophen drug errors in infants and children from the age of 13 and younger. Some of the medication error fatalities were due to incorrect usage of the more-concentrated infant drops that were meant for older children, but used on infants.

The FDA panel reportedly recommended a single infant and children’s medication formula in 2009 that is slated for release this summer. The panel also recommends that the FDA should consider a single concentration of acetaminophen in solid forms, to avoid possible drug errors or overdoses with children.. The panel also voted to add dosage instructions for children from six months to two years onto liquid products. Currently on acetaminophen formulations for children, the dosing information is for children from 2-12 years old, with instructions to contact your doctor for children under 2 years.