Articles Posted in COVID-19

Medication errors occur all too frequently in the United States. They account for thousands of deaths each year throughout the country. They may be the result of negligent acts, such as failing to follow proper procedures, failing to communicate necessary information, and failing to verify the patient’s information, including any allergies. In a Maryland medication error case alleging negligence, a medication error victim must prove that the defendant owed the victim a duty by exercising a certain degree of care toward the victim, the defendant failed to meet the requisite standard of care, the victim suffered injuries, and the defendant’s conduct caused the victim’s injuries.

Medication errors can involve the improper administration of a vaccine. According to an analysis conducted by the Institute for Safe Medication Practices of reported vaccine errors in 2017, the majority of errors involved administration of the wrong vaccine. Other errors included expired vaccines, the wrong dose, the wrong age, the wrong timing, the wrong patient, the wrong route, and a component/vaccine omission. In some cases, a vaccine error may simply negate the effect of the vaccine, but other errors may cause injury and even death.

While Maryland patients often trust their pharmacies to give them the correct prescription medication and dosage, pharmacy errors, unfortunately, do occur consistently throughout the state. These errors can take various forms—such as incorrect dosage or incorrect medication—can be harmless or cause severe injuries and illness. Currently, there are three known pharmacy errors repeatedly happening across the country, reported by the Pharmacy Times. Maryland patients should be on alert for these errors that may affect themselves or their family members.

The first is an error occurring with rapid-acting insulins. According to the Pharmacy Times, errors have been reported due to searching for rapid-acting insulins by generic name, which has caused mix-ups between two insulins that pharmacists may think are the same but are not. The authorized generic version of a new type of insulin has a different onset of action after the injection, and some different ingredients. It cannot be used as an exact substitution for the brand name, although some are prescribing it that way, which may cause issues as patients use it.

The second error is a dispensing error in fentanyl. Transdermal fentanyl patches are placed on the skin. Sometimes, when writing the prescription, there can be multiple confusing numbers that lead to mix-ups. For example, one prescription read “fentanyl patch 72-hour 50 mcg/hour,” with mcg/hour being the dosage or strength of the patch. But the pharmacy employee who entered this prescription into the computer read “fentanyl patch 72,” which led him to mistakenly select a 75 mcg per hour patch instead of 50. This dispensing error can lead to stronger dosages of fentanyl being given to patients.

The COVID-19 pandemic has put added pressure and stress and healthcare professionals, especially as some hospitals have seen an influx of hospitalizations due to COVID-19, including the increased risk for medication errors for Maryland patients. A recent report from the Institute for Safe Medication Practices highlights the issue of medication errors related to the pandemic. There has been at least one lethal drug error in a hospital that struggled to cope with a surge in coronavirus cases. According to the report, a nurse who worked at the hospital where the death occurred worked in a busy intensive care unit that was treating about 20 COVID-19 patients each day. The nurse reported that they were overwhelmed with patients and under-resourced, and had stashes of medication left in patients’ closets and drawers. One researcher said a “rushed and hectic environment” can lead to a relaxation of safety measures and double-checks to avoid errors.

The report highlighted the University of Maryland Medical Center in Baltimore, which established a process to review workflow changes and patient safety events at the beginning of the pandemic in order to minimize potential medication errors. The Center made it standard practice to use a single concentration for high-alert medication whenever it was possible. On the other hand, the University of Maryland decided to eliminate a previous requirement that two nurses had to sign off on the administration of all medications. It now allows nurses to administer non-high alert medication without having witnesses present. The Institute provided several suggestions for avoiding prescription errors during the COVID-19 pandemic, including establishing a process for carrying out independent double checks before certain critical infusions are administered and affixing bold auxiliary labels to critical care infusions when dispensing a nonstandard concentration or a neuromuscular blocking agent.

Maryland pharmacy errors can take many forms—an incorrect dosage, for example, or even the incorrect medicine. Perhaps the pharmacist accidentally prints instructions telling the patient to take the medicine twice a day instead of twice a week, or misreads a doctor’s written prescription. Whatever the error, pharmacy errors have one important thing in common: they are more likely to happen when pharmacists are stressed, overworked, and distracted—three things they have been known to be since the beginning of the COVID-19 pandemic.

With pharmacists and pharmacy technicians overworked and operating in stressful and hectic work environments, it may come as a surprise to many that there has been a significant decrease in the number of pharmacy errors and patient safety incidents being reported since March. According to a Pharmacy Business article, there was a 44.5% decrease in the number of incidents reported during the second quarter of 2020, compared to the first. Additionally, there was a 40.6% decrease in the number of incidents reported compared to the same quarter in 2019. While this may seem like good news, experts say it’s not. In fact, the National Pharmacy Association (NPA) has asked community pharmacies to report all safety incidents—believing that they are currently not doing so. In a recent update, NPA said that the significant reduction in the number of incidents being reported “may be due to the increased workload and pressure on pharmacy teams due to the COVID-19 pandemic, whereby pharmacy teams may not be prioritizing reporting of patient safety incidents.”

It is thus important that Maryland residents understand that a decrease in reported errors probably does not mean an actual decrease in errors—if anything, pharmacy errors are expected to be increasing during this stressful time. Pharmacists are working frantically to fill prescriptions, maintain a safe and clean working environment, and respond to patient requests, with the stress of COVID-19 constantly looming. As such, they are likely to be distracted and hurried, perhaps missing pharmacy errors that could cause significant harm to patients.