Pharmacy Error Injury Lawyer Blog

Hospital Uses New Computer System to Reduce Pharmacy Errors

February 5, 2009 | Lebowitz & Mzhen

In earlier posts, the Maryland pharmacy error attorneys at Lebowitz & Mzhen Personal Injury Lawyers have discussed how computerized prescription entry programs decrease the risk of patient injury due to pharmacy errors. A study at the Norwalk Hospital in Norwalk, Connecticut is another example of how these systems work.

Recently, I spoke on the phone with a friend who lives in Norwalk and who is currently expecting her first child. As we talked about her child’s upcoming birth and the plans of her and her husband, she mentioned that the hospital where she is likely going to deliver her baby was in a local paper for being one of the safest in the nation. A recent newspaper article highlights how Norwalk Hospital in Norwalk, Connecticut employs a computerized prescription program that has, in part, helped earn nationwide recognition for patient safety. The computer system allows physicians at the hospital to electronically submit prescriptions with dosage instructions to the pharmacy, bypassing the necessity for doctors to write a hardcopy of the prescription. This procedures largely eliminates the possibility that the doctors’ handwriting will be misread.

Dr. Stephen O’Mahony, the associate chairman of medicine and a medical quality officer at Norwalk Hospital commented that, “With the old way we were doing things there was the chance of there being transcription errors, meaning a patient could get the wrong medication, but now there is no chance of [hospital pharmacists] reading it wrong.”

During the three years since the hospital introduced the computerized system, medication errors have decreased from an average of 13 errors per 1,000 patients to 2 errors per 1,000 patients. Additionally, the hospital has noticed a decrease in the length of hospital stays for Medicare recipients from an average of 7 days down to 5.7 days.

The electronic system not only prevents medication errors, it also uses a “best practices” approach to suggest the appropriate drug therapy for particular patients. For example, if a patient comes to the hospital suffering from a heart attack, the computer system will remind the doctor to prescribe aspirin. Also, when a doctor treats a person suffering from pneumonia, the system will prevent the doctor from discharging the patient until the patient has received a flu shot. With features such as these, the hospital’s computerized prescription program helps reduce the time patients suffer from their current aliments, and it also helps reduce the risk of further health problems.

External Links

Newspaper Article

New York Pharmacies to Provide Foreign Language Prescription Instructions

January 30, 2009 | Lebowitz & Mzhen

Maryland pharmacy error attorneys serve a number of clients who do not speak English as their first language. Some of these clients have raised the issue of not being able to receive prescriptions or dosage instructions written or spoken in their native languages from big box pharmacies. The attorneys at Lebowitz & Mzhen Personal Injury Lawyers believe that this shortcoming places a large number of citizens in danger of harmful pharmacy errors. According to the 2000 US Census, 667,357 Marylanders speak a language other than English in their homes.

As we discussed in an earlier post, Maryland pharmacists must provide medication counseling to patients when requested, and must provide written dosage instructions with prescriptions. Counseling and written instructions in English are useless to a pharmacy patient that has difficulty understanding the language.

Pharmacy Today reports that following an undercover investigation by New York Attorney General, Andrew Cuomo, Rite Aide and CVS have agreed to provide medication instructions in languages other than English at their New York locations. The investigation began after reports that pharmacies failed to provide side effect information and drug interaction warnings in patients’ native language. New York Rite Aid and CVS locations will now provide dosage and side effect information to patients in Russian, Spanish, Chinese, Italian, French and Polish. The companies also agreed to provide assistance using an over the phone translation service.

Our attorneys believe that Maryland pharmacies should follow suit and help ensure that all patients fully understand their medication dosage instructions and other relevant information.

Medication Errors in Maryland Pharmacies May be Reduced with Periodic Brown Bag Check Ups

January 28, 2009 | Lebowitz & Mzhen

In many of our earlier posts, we have discussed the threats posed by medication errors in Maryland pharmacies. The Maryland pharmacy error attorneys at Lebowitz & Mzhen, LLC suggest that our clients take an active role in their health care in order to prevent prescription errors. Consumers should get as much information about their medications as possible, direct questions about their medications to their doctors, nurses, and pharmacists, and persist until these questions are answered clearly and understandably.

Individuals with chronic medical conditions are at increased risk for prescription errors. These patients often receive a number of prescriptions bearing various dosage instructions from different physicians. Maryland medication error attorneys suggest that their clients, especially those with chronic conditions, schedule a “brown-bag check up” with their pharmacist and primary care doctor. During a brown bag check up a patient gathers all of their prescription and over the counter medications and has them reviewed by health care professionals for dangerous interactions. Additionally, the pharmacist or doctor ensures that the medications are labeled and filled correctly, double checks the prescribed dosage strengths, and screens the drugs for serious side effects.

Maryland medication error attorneys believe that pharmacy patients should take advantage of prescription counseling provided by pharmacists to help reduce their risk of injuries caused by pharmacy misfills. A brown bag check up may help prevent injuries caused by jumbled medication dosage instructions. Under complex medication regimes, it is easy for confusion to cause a potentially harmful medication error.

Pharmacy Malpractice Insurance Companies Advice to Pharmacists Facing A Claim: Admit Nothing

January 21, 2009 | Lebowitz & Mzhen

There are many reasons why I believe that someone injured due to a Maryland pharmacy error should hire an attorney. One of the reasons is that pharmacists are instructed by their malpractice insurance companies to avoid admitting that they have done anything wrong, even when the pharmacist knows that he or she was sloppy, careless, wrong or negligent, and that injury and harms resulted to the patient.

The instruction to pharmacists to be silent in the face of causing injury to a pharmacy customer was re-emphasized in a letter sent within the last two weeks to pharmacists by a very large pharmacists’ malpractice insurance carrier. The letter contained a plastic card which the pharmacist was told to “KEEP THIS CARD IN A SAFE PLACE.” The full instructions to the pharmacist, as contained on the card, stated:

WHAT TO DO IF YOU’RE SUED:

1. Contact. . . [insurance company] as soon as you are aware of a potential claim.
2. Do not discuss claim with anyone – including the patient.
3. Do not sign/accept any document without approval from your. . . [insurance company] Claims Consultant.
4. Do not admit liability or agree to any settlement proposal.
5. Report any communication you receive immediately to your. . . [insurance company] Claims Consultant.”

So, while your local pharmacist may be pleasant, nice, and generally helpful, if that same pharmacist has been negligent, do not expect the pharmacist to be open and forthright with you. By following the common instructions given by his or her malpractice insurance company, the pharmacist will act as if everything is fine, without acknowledging errors or injury.

Maryland Passes Law to Regulate Pharmacy Technicians

January 19, 2009 | Lebowitz & Mzhen

In the past, when you filled a prescription at a Maryland pharmacy, you may have wondered about the training received by the technicians behind the counter. In some cases, technicians have attended nationally accredited pharmacy technician training programs. Other time, however, the pharmacy technician training is limited to training received on the job.

Under a new state law, all Maryland pharmacy technicians must attend and successfully complete training approved by the Maryland Board of Pharmacy.

By February 28, 2009, any person working in a pharmacy, except for clerical workers, must receive certification from the Board of Pharmacy. In order to receive the certification, the applicant must already be a registered pharmacy technician or be enrolled in an accredited training program approved by the Maryland Board of Pharmacy. After an applicant completes a Board approved training class, the technician must then pass an examination within six months to continue working at the Maryland pharmacy.

Maryland Pharmacists Must Offer to Educate Patients on Medication Errors

January 15, 2009 | Lebowitz & Mzhen

We recently posted that pharmacists owe a duty of care to patients filling their prescriptions in Maryland pharmacies. Pharmacists owe a duty to accurately fill these prescriptions. Maryland law, however, increases the duty of care owed to Medicare pharmacy patients in the state by requiring pharmacists to offer to discuss issues pertaining to the prescription being filled. A Maryland pharmacist may be responsible for injuries that occur as a result of a failure to comply with this expanded duty of care.

In 1990, Congress passed legislation that increased the responsibilities of pharmacists with regard to Medicare recipients. The Omnibus Budget Reconciliation Act of 1990 (the “OBRA”) required pharmacists to offer to educate individuals receiving Medicare on the medications that they are taking. Under federal law, a pharmacist’s patient counseling must address a number of topics designed to reduce the chance of prescription errors. In the OBRA, Congress also suggested that individual states develop their own laws that require pharmacists to educate consumers about the risks of medication errors pose.

Maryland’s legislature passed laws that increase a pharmacist’s duty of care in the state that helps protect patients from prescription errors. Under Maryland law, a pharmacist must offer to discuss information pertaining to a Medicare recipient’s prescription. A Maryland pharmacist must offer this consultation through face to face communication, or by way of pamphlets included within the prescription’s packaging, signs posted throughout the pharmacy, or communication by telephone. The topics addressed during the consultation may include the following:
1. the name and description of the medication;
2. how to take the medication;
3. any special directions and precautions for preparation, administration and use by the patient;
4. common severe side effects or drug interactions;
5. techniques for the patient to monitor the drug’s effectiveness;
6. proper drug storage;
7. prescription refill information; and

8. actions to be taken in the event of a missed dose.

However, the law does not make these consultations mandatory, and a patient may waive his or her right to talk with their pharmacist. The medication error attorneys at Lebowitz & Mzhen Personal Injury Lawyers suggest that our readers take full advantage of the protections provided by Maryland law and consult with their pharmacists when receiving their prescriptions.

Related external source

Article discussing how the OBRA 1990 has affected pharmacists’ duty of care

Maryland law requiring pharmacists to educate patients

Maryland and D.C. Pharmacies Among Those Requesting Federal Aid

January 12, 2009 | Vadim A. Mzhen

In the past year Americans have watched the federal government bail out failing banks, and the lagging automobile industry. As the economic downturn progresses, the flow of government funds into the flagging commercial sector is likely to continue. The pharmacists’ lobby has added its name to a growing list of corporations seeking federal stimulus dollars. Recently, representatives from the American Pharmacists Association and similar organizations wrote a letter on behalf of America’s pharmacists to Congress. The letter sought federal stimulus money to help employ cutting edge health information technology (“Health IT”) in more pharmacies.

According to the U.S. Department of Health and Human Services, Health IT can help reduce medical errors, improve health care quality, and reduce health care costs. In an earlier post, we noted how the use of technology reduced the number of medication errors in cancer outpatient clinics. The attorneys at Lebowitz & Mzhen Personal Injury Lawyers recognize the important role technology will play in reducing the threat caused by prescription errors.

However, medication error attorneys believe that increased technology alone is not the solution to the widespread problem of prescription misfills. Lebowitz & Mzhen Personal Injury Lawyers urges Congress to, for example, require pharmacies to implement better training of their technicians, and to increase the number of pharmacists who staff busy pharmacies in order to reduce the number of prescriptions filled per pharmacist, per day. Additionally, Congress should better monitor and enforce the requirement that pharmacists review all prescriptions before they are dispensed.

Pharmacy Errors Harm Children More Than Adults, So Says the Joint Commission

January 9, 2009 | Jack D. Lebowitz

In preparing a recent case for an 8 year child and her parents, I came across an interesting report from The Joint Commission. (The Joint Commission is a private organization that works closely with the Federal Government to evaluate the quality of care being provided by hospitals.) The report indicated that experts within the medical community agree that children are at a higher risk of harm from prescription errors than adults.

The Joint Commission reported that pediatric medication errors occurred more often due to weight-based dosage calculations that are required when prescribing and administering medication to children, and the more frequent use of decimal points in prescriptions for children. The report went on to indicate that medication errors injure children more severely than if the same errors were made to an adult patient.

The Joint Commission gave four reasons why children are more prone to medication errors that result in serious injury:
1. Medications used for children are primarily designed and packaged for adults. Before medications are administered to children, the concentrations must be appropriately diluted according to the child’s weight. These solutions require a number of complicated calculations that significantly increase the possibility of error;
2. Many health care facilities are primarily designed to care for adults and lack personnel adequately trained in pediatric care. The study found that emergency rooms are particularly high-risk environments for children;
3. Young children are unable to physically tolerate medication errors due to under developed immune systems; and

4. Young children cannot communicate the side effects they suffer due to medication errors.

Medication Errors Common in Hospital Outpatient Cancer Clinics

January 7, 2009 | Vadim A. Mzhen

Recently, University of Massachusetts Medical School researchers concluded that medication errors are increasingly common at outpatient cancer clinics across the country. The report reviewed nearly 11,000 prescriptions dispensed at adult and pediatric oncology clinics nationwide. The research published in the Journal of Oncology, found medication errors in 18% of pediatric visits and 7% of adult visits.

The researchers also found that patients made dosage mistakes at home due to poor communication between doctors, pharmacists and the patients. The authors concluded that better communication between oncology clinics and pharmacists would prevent many prescription errors. One of the clinics reviewed in the study utilized an electronic record keeping system. Not surprisingly, the computerized system reduced the frequency of medication errors.

The medication error attorneys at Lebowitz & Mzhen Personal Injury Lawyers suggest that our readers always check with their nurses and physicians prior to receiving any intravenous medication to make sure that the correct drug and dosage are being supplied.

The Maryland Board of Pharmacy Accepts Complaint Forms When Pharmacy Errors Occur

January 2, 2009 | Jack D. Lebowitz

Maryland law does not require pharmacies to report medication errors. The Maryland Board of Pharmacy, the body that licenses pharmacists in the state, relies upon inspections and consumer complaints to assist in keeping drug stores and pharmacies operating safely.

The Maryland Board of Pharmacy provides a pharmacy error complaint form on its website. Once the Board receives a consumer complaint, a Disciplinary Committee initiates an investigation. If the Maryland Board of Pharmacy concludes that a pharmacy error has occurred, it may take several types of actions, including:

1. Letter of Education (informal, non-public discipline): This is a letter aimed at improving the pharmacist’s adherence to safety procedures in the pharmacy.
2. Letter of Admonishment (informal, non-public discipline): This letter is normally issued following the Board’s determination that a minor violation has occurred.

3. Formal Disciplinary Action: Formal discipline can result in fines, or more severe discipline, including suspension or revocation of a pharmacist’s license.

If you are the victim of a pharmacy misfill, or any other type of pharmacy error, please consider filing a complaint. Your involvement will assist in the process of making Maryland pharmacies safer.