Common Errors

The Problem of Prescription Language Translations in Pharmacies

May 17, 2010 | Lebowitz & Mzhen

Our Pharmacy Misfill Attorneys in Baltimore, Maryland recently posted a blog that discussed the epidemic of prescription error stemming from poor language translations in pharmacies across the country—causing pharmacy misfill and medication errors that could lead to patient injury.

In a study that our attorneys discussed, published in the May issue of Pediatrics, researchers found that pharmacies using labels that have been translated into Spanish with a computer program often provide inaccurate or confusing drug instructions filled with medication errors—often delivered in a mix of English and Spanish or “Spanglish.” The study looked at 76 labels for prescriptions generated by 13 different pharmacy translation computer programs, and there was a reported error rate of 50 percent.

Dr. Alejandro Clavier, a doctor in Chicago told the Chicago Tribune that he experiences translation issues with his patients in his practice every day. In one example, a patient who suffers from anemia was not improving after taking the iron supplements that Clavier prescribed. Clavier found that the patient had only been taking one drop of the iron supplement—not the stronger dosage Clavier prescribed. The patient had reportedly received instructions from the pharmacy that were confusing and hard to understand.

According to a study performed by Northwestern University’s Feinberg School of Medicine, many pharmacies in four states with a large and growing Latino population are unable to even provide translations for prescriptions. The 2009 study found that nearly 35 percent of the pharmacies surveyed did not even offer translations services, and 22 percent offered pharmacy translations that were limited.

Electronic Prescriptions and the Path to Preventing Medication Errors

April 30, 2010 | Lebowitz & Mzhen

In yesterday’s blog, our pharmacy error attorneys in Baltimore, Maryland, discussed the rapidly growing numbers of doctors switching from hand-written prescriptions to electronic prescriptions—to create a more efficient system that helps to prevent medication errors in every step of the prescribing and pharmacy process.

The Wall Street Journal documented an example of possible prescription error with 59-year old Debbie Kenny, who was prescribed a new hypertension medication by her doctor that had just become available at the end of last year. Unknown to both Kenny and her doctor, the medication had the potential to interfere with her asthma—a dangerous side effect. Kenny consequently had trouble breathing after coming down with a cold, still not understanding the side effects of the medication.

After Kinney’s doctor started to e-prescribe the following month, the new electronic system indicated very clearly that Kinney should not be taking that particular hypertension drug, because of her asthma, and the drug’s side effects. She was promptly switched to another medication for hypertension that was compatible with her asthma. Kinney said that she feels more comfortable now with the new electronic system. If her doctor prescribes a new drug, she can ask for a clear computerized diagram of the side effects or the drug interactions before taking the medication—to avoid any personal injury.

As of last year, the Center for Medicare and Medicaid Services (CMS) was helping to promote the switch to electronic prescribing by enticing doctors and paying them a bonus for e-prescribing. As of the beginning of 2012, a stronger encouragement will appear, as CMS will begin penalizing doctors who haven’t embraced the electronic system to issue patient’s prescriptions.

Study Shows E-Prescribing Significantly Reduces Prescription Errors

April 29, 2010 | Lebowitz & Mzhen

In a recent news that our Baltimore, Maryland Attorneys have been following, doctors are reportedly increasingly leaving behind paper when prescribing medications, and depending more and more on electronic prescriptions, or “e-prescriptions”—in an effort to avoid pharmacy misfills and medication errors, along with hard-to-read doctor handwriting, or even prescription fraud, as our attorneys reported on in our last blog.

E-prescribing immediately sends the prescriptions to the pharmacy in a digital format through a secured Internet network, from a handheld device or from their computers. The doctor simply selects the drug from a computerized list, with other symbols indicating the best drug option, different dosages, and either generic or name-brand medicine, instead of hand-writing the prescription, which can lead to medication error. Some e-prescribing programs give symbols in the form of colored or smiling faces, delineating between cheapest, preferred, or less desirable drug options.

According to the Wall Street Journal, the number of e-prescriptions almost tripled last year, from 68 million in the previous year, to 191 million in 2009. Surescripts, LLC, the company that handles the majority of the electronic communications in e-prescribing, reports that this represents 12% of the 1.63 billion original prescriptions, which excludes refills. The first three months of this year showed that one out of every five prescriptions is being filed electronically—a number that is rapidly growing, as nearly 25% of doctors based in offices already have the technology to e-prescribe.

In a study published in the Journal of General Internal Medicine in February of this year, e-prescribing was found to reduce common hand-written prescriptions errors significantly, including pharmacy misfills containing the wrong dosage, or incorrect usage instructions that could lead to patient injury or even wrongful death.

AHRQ Tips for Preventing Medical Mistakes with Children

March 30, 2010 | Lebowitz & Mzhen

In yesterday’s blog, our Baltimore, Maryland Medical Mistake Attorneys discussed leading causes of medical mistakes with children in this country, and important ways to prevent medical errors from happening.

According to the Massachusetts College of Pharmacy and Allied Health Sciences, 88% of medication errors involve the wrong dosage or incorrect drug. The Agency for Healthcare Research and Quality (AHRQ), the lead Federal agency that supports research to improve the quality of healthcare, addresses the importance of patient safety and the cause of many medical errors in a recently published press release.

In the press release, the AHRQ addresses the large problem of medical mistakes with children in this country, and gives parents and guardians tips on how to prevent these medical errors from happening with children, to avoid personal injury.

According to the AHRQ:

• Being involved in your child’s healthcare is the most important way to prevent medical errors or pharmacy misfills. The AHRQ stresses that it is extremely important for parents or guardians to take part in every decision that is made regarding the healthcare for a child.

• Make sure that your child’s doctors know every detail regarding the history and statistics (height and weight) of your child, every prescription, all over the counter medications, and any vitamins or dietary or herbal supplements, as well as any known allergies to any medication.

• At least once a year, bring a bag of everything your child is taking and go through each one with the doctor to ensure that there is no problem or conflict with any medication.

• Make sure you can read every prescription that the doctor writes. Double check the name and dosage, or if there is any question, have the doctor re-write the prescription in capital letters, printing the name of the drug and the dosage. If you can’t read the doctor’s handwriting, chances are the pharmacist will not be able to either.

ISMP Reports of New Medication Errors Leading to Drug Omissions

March 1, 2010 | Lebowitz & Mzhen

A recent article from the Institute for Safe Medication Practices (ISMP) that our Maryland-based medication error attorneys have been reading reported that the order management scanning system (OMSS) technology that was created to improve the efficiency and safety of the drug ordering process for doctors and pharmacies, is now experiencing error-prone problems that are leading to medication errors, drug omissions and missed drug therapy in patients.

OMSS is a technology that was created to capture a digital image of a handwritten or printed prescription order and send it to the pharmacy—eliminating faxing, the use of a courier, or the use of pneumatic tubes to transport the information to the pharmacist. The idea behind OMSS was to accelerate the time the prescription hit the pharmacy, speed up the prescription filling process, with electronic filling, easy retrieval of scanned orders, and reduce the risk of transcription errors because the order can be magnified. Unfortunately, according to the article, these OMSS benefits are null and void if the pharmacy never receives the prescription orders.

The problem that is reportedly occurring is that multiple pages of orders are being pulled through the scanner at the same time, and the scanner is only reading a single page at a time—a problem that has also plagued pharmacies with faxing or copying orders in the past. When this problem occurs, staff may not be aware that only one page was scanned, and the pharmacist may not be aware that they should have received multiple pages of orders. As a result, drug omissions can take place, leading to medication mistakes or missed drug therapy.

In one documented case, a physician wrote three pages of admission orders for a patient suffering from lung cancer, as well as difficile colitis and fever. When the orders were scanned with OMSS, the pharmacy only received two pages of the orders, because one page was not pulled through. Neither the nurse who administered the medication the physician, nor the pharmacist noticed the prescription error and omission. The drugs prescribed on the missing page were seizure medications. By the forth day of receiving only a fraction of the medication, the patient was exhibiting behavior that lead the emergency response team to determine that the patient was having a seizure. The patient was transferred to critical care unit, where the doctor figured out the pharmacy mistake, and although the patient required intubation, he ultimately experienced a full recovery.

Dangerous Error-Prone Prescription Abbreviations

January 20, 2010 | Lebowitz & Mzhen

As Maryland Pharmacy Error Attorneys, we have been following a recent report by The Institute for Safe Medication Practices (ISMP) about the danger of error-prone abbreviations and when it comes to writing a prescription—the fact that some shortcuts don’t save time, and can result in pharmacy error or injury.

According to the ISMP Error Alert article, nearly everyone in the healthcare industry uses shortcuts, like abbreviations and symbols, in an effort to save time when handwriting specifics for the prescription—including phrases, units of measure and words. Some shortcuts can in the end can be very time consuming, as they need to be checked and verified for accuracy on the receiving end. These verifications could also reportedly cause a greater chance for medication error than if the prescription was written out without abbreviations or symbols. The article claims that it is important to prevent future misunderstandings now, instead of waiting until medical abbreviations, dose designations or symbols lead to a patient injury.

The article lists a few common error-prone abbreviations, symbols and dosage misunderstandings that take more time for the pharmacist to check, and could cause medication mistakes:

• Some abbreviations that indicate the frequency of when to take the drug, can be difficult to understand, and can lead to error. In one prescription for “Penicillin VK 500 mg Q1D X 7D,” the physician accidentally typed “Q1D” (once a day) instead of “QID” (four times a day). The pharmacist realized the mistake, and that the patient was supposed to be taking the penicillin four times a day for seven days (7D). Another example of frequent error comes in the abbreviation for “D” (days), where it can also be mistaken for “doses.”

Understanding the Prescription Drug’s Path through a Pharmacy can Reduce Error

December 28, 2009 | Lebowitz & Mzhen

In a recent study that our Maryland Pharmacy Error Attorneys have been following, USA Today investigated every step of a prescription’s path in a pharmacy—to uncover the potential for medication mistakes with each step of the filling process, that can lead to patient injury or wrongful death.

In the research, USA Today interviewed pharmacy experts and toured two pharmacies, a CVS and Walgreens, to study the six steps of the prescription filling process, and the potential errors that can happen along the way, as well as real cases that have caused actual injuries or death.

Step 1: Prescription received

When the customer drops off the prescription to the technician, or the doctor’s office calls in the prescription, errors can occur if a technician misunderstands a doctor’s handwriting, prescription codes and abbreviations or misunderstands the oral instructions over the phone. In one case, a doctor’s prescription for methadone read “sig 4 tablet BID for chronic pain,” which means “Please label (sig) this drug to say: take 4 tablets twice per day (BID) for chronic pain. The technician typed, “Take 4 tables by mouth as needed for chronic pain.” The patient allegedly died of an overdose of methadone.

Step 2: Prescription entry
A technician then scans the original prescription into the computer and manually enters the patient’s personal data, like name, address, date of birth and phone number, as well as drug information, strength, dosage instructions and quantity. If a technician incorrectly types the prescribed drug dosage, formulation or the patient’s medical condition, history or allergies into the computer, then serious errors can occur, including personal injury. Also if the wrong drug code is chosen in the computer system, it can be mistaken for a similarly named drug. In one instance, a pharmacy was asked to fill a prescription for compazine, an anti-nausea drug, (COM) and accidentally gave the patient a generic substitute for coumadin, a blood thinner (COU).

Pharmacy Mistake Leads to Wrongful Death—Rite Aid Faces Lawsuit

December 22, 2009 | Lebowitz & Mzhen

Our Maryland Pharmacy Error Injury Lawyers have been following the recent case filed last week on behalf of John Sheridan, a man who died after being prescribed the wrong dosage of a cancer medication.

According to the suit, Sheridan was prescribed Temodar, a powerful drug for brain tumors that was part of his treatment of cancer in September 2007. The prescription was allegedly written incorrectly, and Sheridan was wrongly prescribed 10 times the correct dosage—he reportedly took the medicine daily when it was only to be used every other week. Rite Aid Pharmacy allegedly dispensed the drug to Sheridan, without checking with Sheridan’s oncologist for a second opinion to clarify the prescription mistake.

The lawsuit accuses a Rite Aid pharmacy for contributing in the wrongful death of Sheridan, who reportedly had consumed toxic doses of the cancer medication. According to the Associated Press, the doctor who wrote the incorrect prescription has settled with Sheridan’s estate.

According to a 2006 report from the Institute of Medicine, at least 1.5 million Americans are injured by medication mistakes every year, and nearly 7,000 people die every year from medication errors annually.

QJM: How to Prevent Medication Errors and Injury with Balanced Prescribing

November 30, 2009 | Lebowitz & Mzhen

As Maryland Medication Mistake Attorneys we have recently read an article published in the QJM, the long-established leading general medical journal, on the topic of medication errors—giving an overview of what medication mistakes are, how they happen, and how to prevent them from happening in the future.

According to the article, published in August 2009, a medication error is a failure in the process of treatment that can lead to the harming or personal injury of a patient. Medication errors can often occur in:

• Prescribing faults: ineffective prescribing, irrational or inappropriate prescribing, under-prescribing and over-prescribing when deciding which treatment and dosage plan to take.

• Prescription writing: illegibility
• Formulation manufacturing: incorrect strength, misleading packaging
• Drug formulation dispensing: incorrect drug, formulation and label
• Administering the medicine: incorrect dosage, wrong directions for frequency, invalid duration of treatment
• Monitoring drug therapy treatment and drug treatment alteration when required

Medication errors can be classified, according to the article, by the use of psychological error classifications—knowledge-errors, rule-errors, action-errors, and memory-based errors. It is important to detect the medication mistakes, that can range from trivial to serious, and to create a working environment that is free of blame, and encourages the reporting of errors.

The article also recommends, “balanced prescribing” to avoid medication errors. In balanced prescribing, the mechanism of action of the drug should complement the pathophysiology of the disease—optimizing the balance of benefit to harm.

Alert for Public Safety—FDA Reports Medication Error with Tamiflu

November 18, 2009 | Lebowitz & Mzhen

The FDA has recently published a patient safety alert, reporting medication dosage errors associated with Tamiflu, (for oral suspension), the top doctor prescribed anti-viral flu medication, administered to both adults and children. Our Maryland Pharmacy Misfill Injury Attorneys have been following this prescriber and pharmacy alert report, and how it could effect patient safety in this current H1N1 influenza pandemic.

According to the agency alert, the FDA has received reports that the Tamiflu (oral suspension) dosing instructions for the patient do not match the dosing dispenser. U.S. health providers often write liquid medicine prescriptions in teaspoons or milliliters (mL), while the dosage of Tamiflu is in milligrams (mg). Prescribers and pharmacists have been warned that Tamiflu’s dosing dispenser included in the package has markings only in mg—30, 45, and 60.

The alert recommends that: