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The novel coronavirus or COVID-19 has drastically impacted life for Maryland residents and businesses. Pharmacies across the state and the nation have been particularly affected. Pharmacies are a vital part of the healthcare system and have needed to remain open during the pandemic. However, if pharmacies are not careful, they may be doing more harm then good, by contributing to the spread of COVID-19 and causing more and more Americans to fall ill.

The Centers for Disease Control and Prevention (CDC) have been regularly updating guidance for pharmacies on their website. The guidance recommends that everyone entering the pharmacy should wear a face mask or covering, regardless of whether or not they have symptoms. This includes both customers and pharmacists. Also, pharmacists are encouraged to limit contact with customers as much as possible, by maintaining a social distance of at least 6 feet, placing the prescription on the counter for them to pick up instead of handing it directly to them, and using hand sanitizer frequently.

Importantly, the guidance also advises pharmacies to ensure that staff who are sick stay home. Pharmacists and other staff members may come to work even when they have a fever or other COVID symptoms, including body aches or a cough. While they may not want to work while sick, their employer may not have an adequate sick leave policy, and employees may fear losing their job if they request time off. Now more than ever, pharmacies need to ensure that they create policies that allow their employees to stay home when sick, and then encourage their employees to take advantage of these policies.

Over the past two months, the COVID-19 pandemic has drastically changed the lives of individuals across the country, including Maryland residents. Experts say that in order to flatten the curve and beat the pandemic, more widespread testing is needed. Since the beginning of this crisis, test kits have been sparse, with many residents unable to get tested even if they feel ill. While there certainly is a need for more test-kits across the country, a recent story out of Washington state highlights that the need may be even greater than previously thought, as distributed test kits are being recalled for possible contamination.

According to a local news report, the Washington State Department of Health distributed 12,000 test kits to local health jurisdictions, tribal nations, and state agency partners across the state. However, the Department is now recalling these kits, after being alerted by the University of Washington Medicine that there may be possible contamination and a quality issue with them. The specific issue affects the viral transport media, which is the fluid that preserves the individual’s specimen as the test is transported. Healthcare workers noticed the issue when seeing that some vials of the transport media were an unusual color. While this issue is not at this time thought to pose a health risk to patients, the tests are still be recalled in an effort to be as safe as possible when dealing with this potentially deadly virus.

Washington state is working to replace the recalled tests as quickly as possible, but the recall comes at a terrible time, as the entire country is in dire need of tests. While it is still unclear how long this pandemic, or the related stay-at-home orders, will last, what is clear is the immense burden placed on health care workers and facilities, who are struggling to keep up with the increasing rates of infection. Unfortunately, this may mean that there is an increased risk of pharmacy errors or medical accidents occurring, which can result in catastrophic effects for Maryland patients.

The COVID-19 pandemic has affected almost all aspects of society for most – if not all – Maryland residents. Since the beginning of the crisis, necessary supplies have been in short supply. Indeed, healthcare workers have been forced to re-use supplies that are designated for a single-use and even rig their own masks because supplies were so low.

Among the newly raised concerns is a potential shortage of drugs that are needed to operate ventilators. Ventilators are machines that help those with COVID-19 breath while they are unable to do so themselves. According to a recent news report, when a patient requires a ventilator, a doctor or nurse must place a tube down the patient’s throat. To do so, medical staff need to give the patient sedative medication, pain killers, and, in some cases, medication to induce temporary paralysis. Evidently, in a letter to Vice President Pence, a spokesperson for the American Society of Health-System Pharmacists explained that ventilators “will be rendered useless without an adequate supply of the medications.”

The concern is that some hospitals are seeing demand for these drugs surge upwards of 600 percent. Part of the problem is that hospitals are attempting to secure a supply of the medication before they actually need it.

Technology is a crucial component of the healthcare industry. Not only do advancements in technology help pave the way for new medications and treatments, but they also lead to the development of new processes that may reduce the risk of a Maryland pharmacy error.

Recently, we wrote about pharmacist burnout being a significant contributor to Maryland pharmacy errors. While pharmacists typically work long hours, that is especially the case with the ongoing COVID-19 crisis. Thus, the issue of pharmacist burnout is a topical one in need of a solution. According to a recent news report, some experts are suggesting that pharmacists use vending machines to reduce the instances of errors.

While some countries have used vending machines for over-the-counter medications, for the most part, the United States has yet to do so. According to a proponent of the idea, vending machines could be stocked with common over-the-counter and prescription medications. The WIFI-enabled machine would have its own address to which physicians could e-prescribe medication. After a physician prescribed a medicine, the patient would go to their local pharmacy, type in their information, and receive the medication. Proponents of the vending machines agree that while some prescription drugs would be included in the machines, controlled substances would only be available through the pharmacist.

Many individuals across Maryland rely on medication to keep them healthy, or even alive. This medication is crucial, and typically must be taken regularly and in the correct dosage or significant health concerns or even death could occur. Unfortunately, for those who rely on others to handle and administer their medication, they may suffer from medication errors unbeknownst to them. This is especially true for elderly patients, who are more likely to require certain drugs to combat health problems and also more likely to have a caretaker administering said medication.

Often, caretakers administering medications to the elderly do a good job and keep the patient healthy, safe, and on schedule. However, like all human processes, there is room for error, and accidents can and do occur. Unfortunately, mistakes in this process can be deadly. For example, an 87-year-old woman relying on caretakers to give her her daily medication, recently died from a gastrointestinal bleed and stroke. According to a report covering the incident, an investigation of the victim’s death found that her caretakers had given her the wrong medication, four times a day, for two and a half days. While the incorrect medication did not cause her stroke and bleeding, the lack of her correct medicine did, and the victim suffered a tragic death as a result of the mistake.

This case highlights the extreme consequences of medication errors, especially when patients are elderly and rely on caretakers to properly administer their medications. In addition to the problems caused by missing the correct medication, patients may also suffer significant side effects, injuries, or even death caused by the incorrect medication. When this occurs, the results are disastrous and potentially deadly, and nothing can undo the damage done by seemingly simple errors.

Prescription errors occur more often than many people would think. And the health professionals more likely to commit prescription errors may be surprising. A lot of attention has been given lately to overworked pharmacists who may be rushing to fill prescriptions. Yet, a new study reported an interesting finding that may have implications for Maryland patients and the Maryland prescription error victims.

According to an analysis in the European Journal of Hospital Pharmacy, the study found that doctors make more errors than pharmacy technicians in transcribing discharge medicines. One source reported that an audit was completed to compare the transcription of discharge medicines. The analysis found that pharmacy technicians had a 3.8 percent error rate, while doctors had an 18.7 percent error rate. The doctors included in the analysis made 127 errors in transcribing 678 items, including 62 errors that were considered “significant,” and one that was considered “serious.” In comparison, pharmacy technicians only made 25 errors in transcribing 654 items, none of which were considered serious, and 16 of which were considered significant.

The pharmacy technicians reportedly received training at the hospital in transcribing medications from paper-based inpatient notes to an electronic discharge system, while the doctors did not receive the same training. Pharmacy technicians were also taught to seek additional clarification of any medical issues. One of the study’s authors speculated that pharmacy technicians were approaching the task with more focus. He also said that pharmacy technicians are generally trained to clarify any issues with the doctor and another pharmacist. However, experts noted that additional research was needed.

Prescription errors made by pharmacies or medical institutions may be grounds for a lawsuit if the patient was injured as a result of the prescription error. A lawsuit may be filed against a pharmacist and the pharmacy for Maryland prescription errors in instances of negligent or willful conduct by the individual or the organization. In a negligence claim, a patient must show that the individual or organization failed to meet the relevant standard of care by giving the patient medication with the incorrect dosage or drug. A plaintiff must demonstrate that it was more probable than not that the pharmacist’s wrongful conduct caused the injury the patient suffered. In some instances, the wrongful conduct may be so serious as to warrant punitive damages against the individual or the organization.

In Maryland, normally, plaintiffs can recover damages for economic damages, such as medical bills, wage loss, and other losses and expenses, as well as non-economic damages, such as pain and suffering. These damages are referred to as compensatory damages, because they are meant to compensate the plaintiff.

In contrast, punitive damages are not concerned with compensating the plaintiff for their losses but rather to punish the defendant for bad conduct and to deter others from engaging in such conduct. Under Maryland law, in order to warrant punitive damages in a case, a plaintiff must show by clear and convincing evidence that the defendant acted with actual malice, or with knowing and deliberate wrongdoing.

Medical errors are estimated to the third leading cause of death in the United States. Even when they are not fatal, these errors often have a profound impact on a patient’s life. While there are many different types of medical mistakes, Maryland pharmacy errors can be among the most devastating, especially for the elderly and young children.

While there is a risk of error any time a pharmacist fills a prescription, certain situations present an increased risk. For example, according to a recent news report, the following are a few of the most common medication errors.

Zinc overdoses: Zinc is a mineral that most people consume every day in their diet. Small doses of zinc are beneficial and may help fight colds. However, it is possible to overdose on zinc. In fact, in 2019, a two-year-old was almost given a fatal dose of zinc that was 1,000 times more potent than necessary when a physician prescribed 700 milligrams instead of 700 micrograms.

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Pharmacists in Maryland and across the nation have an incredibly important job. However, pharmacists are human, and they make mistakes. When they are stressed, tired, distracted, or spread too thin, they may make careless errors while filling prescriptions, or ignore safety procedures in the interest of time or convenience. A recent New York Times article shows that, while some of these errors are self-reported by employees, it turns out that Walgreens—a leading pharmacy used by many Maryland residents—had been covering up these errors and information about them.

According to the New York Times, pharmacy employees told consultants about the errors—how they were tied to stress, and sometimes involved ignoring safety procedures—but the senior leaders at Walgreens told consultants to keep that information out of their presentation. The director of pharmacy and retail operations, for example, had instructed them to delete a bullet point mentioning the issue. Another senior leader removed an entire slide from the presentation, which included various findings, including instances where pill bottles contained more than one medication.

This cover-up harms patients, who are routinely being harmed by pharmacy errors related to understaffed and chaotic workplaces. Pharmacists may very well be doing their best to fill prescriptions, give flu shots, answer the phone, and tend the drive-through during their shifts, but many pharmacies employ too few employees in an attempt to cut costs, meaning that in the hustle and bustle something gets lost. Adding to the problem are the corporate performance metrics pharmacists must try to meet, which incentivize speed over safety.

Although they pose a risk to Maryland residents, most individuals do not know what a compounding pharmacy is. Compounding pharmacies mix, tailor, and create drugs on their own, to meet specific patients’ needs. These drugs may be helpful to individual patients, but often they are not approved by the FDA and, like any drug, can be dangerous to patients and are subject to pharmaceutical error. According to the International Academy of Compounding Pharmacists, there are over 55,000 compounding pharmacies in the U.S., with roughly 27,000 serving local patients and doctors directly.

Recently, a story of a compounding pharmacy error made headlines when it resulted in severe injuries to a healthy 54-year-old man, who ultimately lost his leg due to the error. According to a local news report covering the incident, the patient was regularly active, working out regularly and playing sports. To help his muscles recover from his workouts, he took injections of an amino acid drug from a compounding pharmacy. After ten months of taking the injections with no problem, he woke up one day drenched in sweat, with a raging fever and swollen leg. It turned out that he had mycobacterium abscesses growing in his leg, which is very rare and hard to treat.

The patient had to undergo 23 different surgeries over five months and was put on five different antibiotics, which caused rashes and nausea. He also began to experience a ringing in his ear, and was told by his doctor that he had to choose between saving his leg and saving his hearing, because he needed the antibiotic causing the ringing to save his leg. He decided to save his leg, because he wanted to continue to be active, but now lives with impaired hearing.

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