Pharmacy Error Injury Lawyer Blog

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.

Walgreen’s Pharmacy Misfill—Child Given Heart Medication Instead of H1N1 Antiviral Drug

November 27, 2009 | Lebowitz & Mzhen

Our Pharmacy Misfill Attorneys in Maryland have been following the recent news of a dangerous medication mistake made by a Walgreen’s pharmacy, where a child was given heart medication instead of an antiviral drug to treat the H1N1 flu virus.

When Wilma O’Neill picked up the prescription for her daughter earlier this month, she expected to administer an antiviral medication to help her child’s swine flu symptoms. Over the next 24 hours, O’Neill gave her daughter two doses of the Walgreen’s prescription, and only stopped the medication after the drugstore called, claiming that there had been a pharmacy medication mistake, and someone had received the wrong prescription.

O’Neill brought the prescription back to the pharmacy, where they discovered that her daughter had been given the liquid pediatric medication Amiodarone by mistake—a drug used to treat irregular rapid heartbeats. According to Medline Plus, the U.S. National Library of Medicine on-line service, Amiodarone is used to treat and prevent life-threatening abnormal heart rhythms by relaxing overactive heart muscles, and is used only when other medications are not tolerated. The first few doses should reportedly be administered in a hospital setting, as the medication could cause fatal side effects. The child had been given two times the normal dosage of the actual heart medication, which could have resulted in pharmacy error injury.

O’Neill’s daughter was raced to the emergency room, and monitored carefully. Her EKG was initially normal, and then irregular a day later. O’Neill believes that had the mistake not been realized, the outcome could have been much worse, as her daughter was also very sick with the H1N1 virus.

Walgreen’s acknowledged the mistake and apologized for the error. The company didn’t disclose how the error was discovered, but claimed to have numerous safety checks in place in the drugstore to reduce the possibility of human error. In 2007, Walgreen’s was profiled in a the news program “20/20” for making prescription drug errors, after a child was mistakenly given an adult blood-pressure drug by the pharmacy. The child was rushed to the emergency room after weeks of taking the medicine with delirium symptoms and shaking limbs.

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:

Dangerous Drug Abbreviations that Lead to Medical Injury

November 13, 2009 | Lebowitz & Mzhen

In the ongoing topic of medical error and injuries that our Maryland Medication Mistake Lawyers covered earlier this week in a previous blog, the National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) recommends that in order to help prevent medical error injury and death every year, it is important that the prescribers of medication avoid the use of dangerous abbreviations in prescriptions, including those for drug names and Latin directions for use.

The current NCCMERP list of dangerous abbreviations commonly made by prescibers include:

• Mistaking “µg” for “mg” or milligrams, resulting in an overdose

• “U” is mistaken for zero or a 4, which also results in an overdose. “U” is intended to mean “Units” but with poor handwriting, it can also be mistaken for “cc” or cubic centimeters.

• “Q.D.” means “every day” in Latin. The period after the “Q” is sometimes mistaken for an “I”—and the drug is given “QID” (four times daily), which results in an overdose.

• “T I W” means three times a week. This is often misinterpreted as “three times a day”
• “IU” means International Unit, and is often mistaken for “IV” or intravenous

• “AU, AS, AD” are the Latin abbreviations both ears, left ear and right ear. These are often misinterpreted as the Latin abbreviation “OU” (both eyes), “OS” (left eye), and “OD” (right eye)

The Council also recommends that in order to enhance the accuracy of prescription writing and communications, doctors, nursing and pharmacy staff should:

• Make sure all prescriptions are legible and include notes on medication purpose—like cough, or allergies—maintaining that the proper medication is dispensed.

• All prescription orders should be written in the metric system, except for orders that use standard units like vitamins or insulin. Units should also be written out, rather than abbreviated with “U”

• Medication orders should include the exact drug name, metric weight or concentration, dosage form, with strength and concentration expressed in metric amounts.

• The NCCMERP reports that numerous errors in drug strength and dosage have occurred with the use of decimals—due to the trailing zero (1.0 mg) or the lack of a leading zero (0.1 mg). A leading zero should always be used before a decimal, and trailing zeros should never be used.

Death from Medication Error Leads to Prevention Awareness

November 10, 2009 | Lebowitz & Mzhen

As Maryland Medication Error Injury Attorneys, we have recently read data from the U.S. Food and Drug Administration (FDA) stating that in the United States, 1.3 million people are injured by medication errors every year, with at least one death reported every day.

According to the National Coordinating Council for Medication Error Reporting and Prevention, (NCCMERP), injury from medication error is an urgent, a widespread public problem, that needs to receive far more public attention. The NCCMERP estimates that 98,000 people die annually from medical errors that occur in hospitals—an amount that is greater than deaths from motor vehicle accidents, breast cancer, AIDS, even workplace injuries. Medication error can happen at any point, and result in injury—from communication, distribution, prescribing, dispensing, administering or monitoring.

A medication error is defined by the the NCCMERP as any event that is preventable, and may cause medication misusage or patient harm while the medication is being controlled by the health care professional, consumer or patient. Medication errors can happen in professional practices and during procedures, as well as in the systems of prescribing, ordering, the labeling of a product, packaging, dispensing, education, monitoring, usage, and naming conventions.

The FDA states that common causes of medication error stem from poor communication between doctor, pharmacist, and patient, with unclear product names or suffixes, medical abbreviations or handwriting, poor techniques or procedures, or a lack of understanding of directions for patient usage. Job stress or lack of training or knowledge can also lead or contribute to pharmacy error injury or misfills.

Veterans Hospital Paves the Way for Computerized Records

October 30, 2009 | Lebowitz & Mzhen

In a post from earlier this year, our attorneys at Lebowitz & Mzhen Personal Injury Lawyers discussed how computerized health records would help Maryland pharmacists and doctors to eliminate Maryland medication mistakes.

According to a recent article in the Wall Street Journal, on how to digitize the health-care industry, Veterans hospitals have proven to have paved the way——showing doctors and pharmacists important lessons on how to effectively make the digital transformation.

The U.S. Department of Veterans Affairs digitized their records years ago, with great results. Independent studies show that the VA outperformed the private sector and Medicare on preventative services and chronic care. VA officials have claimed that the digital technology has helped cut down on patient hospitalizations and has helped patients live longer.

The VA’s digital records system has been a blessing to patients, allowing doctors and nurses at more than 1,400 facilities to share the medical history of the patients—avoiding the unnecessary repetition of costly tests. As well as storing patient data, the system gives screening warnings and keeps an eye on patient levels, like blood pressure and weight—all safeguards for improved quality care.

In a digitized record for a 59-year old Maryland patient at the VA medical center, all of his health problems were listed, like diabetes and hypertension, as well as all of his data since he has been a patient at the center. The screen showed a list of all current medications, including insulin, the drug Furosemide for heart failure, and Oxycodone, the pain medication. The patient’s doctor can reorder a drug through the system, sent directly to the pharmacy—eliminating medication mistakes and pharmacy misfills. If the doctor orders a new prescription that conflicts with a drug the patient is already taking, there is a warning in the system.

Medication Error Injury Prevention—Study Recommends Knowing Your Pharmacist

October 26, 2009 | Lebowitz & Mzhen

A recent American Pharmacists Association (APhA) survey, that our Maryland Pharmacy Error Injury Attorneys have been following, revealed that 1.5 million people are injured by medication-related errors every year. The APhA commissioned the consumer survey, led by Harris Interactive, to investigate how consumers interact with their pharmacists, and how building relationships with pharmacists can avoid patient error and reduce medication mistakes and pharmacy misfills.

The APhA always recommends that people carry an updated list of their current prescription medications, over-the-counter (OTC) drugs, herbal supplements and vitamins. The list should include the name of the medications, the dosage, as well as the conditions that the medications treat. Any patient allergies should also be included in the list.

The study reports that while a large percentage of Americans have an up-to-date list of medications, only 28% of consumers actually carry the list with them at all times—an act that could prevent personal injury and medication mistakes, by providing emergency personnel and pharmacists with lifesaving information regarding drug names, proper dosing, allergy information, and drug interactions and side effects.

According to Kristen Binaso, pharmacist and national APhA spokesperson, until electronic medical records are used as the standard in sharing patient information in the health care industry, consumers should protect themselves by keeping a current medication list with them at all times, to show the doctor and pharmacist—to avoid the risk of improper dosing, medication duplication, pharmacy misfill, and harmful drug side effects and interactions. In a recent post, our Maryland Mistake Attorneys further discussed how these electronic health records will help pharmacists and doctors to eliminate medication errors.

Next to doctors, pharmacists are the second most trusted health care providers and trained medication experts, yet the survey found that 77% of consumers do not know their pharmacists names, and only 40% of consumers have asked their pharmacists valuable questions about their medication needs.

Cardiac Medication Dosing Errors Reported Most Commonly With Infants

October 23, 2009 | Lebowitz & Mzhen

As Maryland Medication Mistake Attorneys, we have been following a recent article from Cardiology Today, revealing that cardiac medication mistakes are reported most commonly with infants—in community hospitals, university hospitals, and pharmacies.

The results of a study showed that diuretics and antihypertensive agents are the most commonly reported drugs that are improperly dosed with infants—frequently prescribed by doctors for pediatric patients with heart disease. According to the article, these drugs have the potential for more widespread use because of neonatal care advances, and the increasing incidence of metabolic syndrome and childhood obesity.

Diuretics and antihypertensive agents are considered by many to be safe, because of their frequent use by doctors, but according to the research, it would be much more beneficial for the physicians, clinicians and pharmacists to have accurate information on the assessments of harm rates, and the groups of infant patients who are at particular risk—to prevent serious medical mistake errors and injury with children.

The most harmful error reports came from reported dosing error of the heart condition drugs: nesiritide, calcium channel blockers, milrinone, digozin, and antiarrhythmic agents.

According to the results from voluntary CV medication error reports that were submitted to a medication error database from the years 2003 and 2004, 50% of the total errors reported occurred in children younger than 1 year of age, and 90% of the error reports occurred in infants younger than 6 months of age.

In the 1,424 causes reported, the most frequent causes of medication error or pharmacy misfills were:

• Human error
• Improper dosing
• Missed or double doses
• Misunderstanding of drug orders
• Mathematical errors which include dilutional errors

ISMP Medication Error Cases and Prevention Checklist

October 9, 2009 | Lebowitz & Mzhen

In a prior post from this week concerning pharmacy error injury, our Maryland Medication Error Attorneys at Lebowitz & Mzhen Personal Injury Lawyers discussed a recent study published by the Institute of Medication Practices (ISMP), and the ongoing problem with drug naming standards in extended release medications.

In this study, the ISMP revealed a series of cases reported to the institute, in which drug name suffix medication mistakes have frequently occurred. This study showed specific case examples in order to establish clearer naming conventions in the industry, and improve comprehensive pharmacist and patient awareness—to prevent pharmacy error injury and misfills in the future.

The ISMP study reported these specific medication mistake cases:

• Physicians often prescribe extended release products without the correct suffix, or with a suffix that does not exist for that particular product.

• In an analysis of 402 prescribing errors published by Medscape Pharmacists, the most common type of error in the study (280 cases, 69.7%) was failure to specify the controlled release formulation.

• The ISMP received reports of cases in which pharmacists dispensed Metadate ER instead of Metadate CD—two different extended release forms of methylphenidate-UCB, a stimulant medicine commonly used to treat ADHD. In one case, a prescription for Metadate CD 20 mg was misfiled at a pharmacy, where the staff dispensed Metadate ER 20 mg.

• Some products have multiple suffixes for different formulations of the same drug. Diltiazem products for example (calcium channel blockers) are used to slow the heart rate and normalize the heart rhythm in hypertension and arrhythmia. The many suffixes for Diltiazem include SR, CD, XR, XT, and LA.

• Electronic prescribing can also lead to medication errors on behalf of the prescriber. In one case, a prescriber electronically selected metroprolol tartrate instead of metoprolol succinate because of choosing incorrectly on his PDA.

According to this report, pharmacists, practitioners, and patients should take extra care when reviewing the different formulations and medication names, especially if the medication is available in more than one dosage form.

The ISMP recommends the following medication error prevention checklist:

Patient Safety Alert: ISMP Reports Medication Error with Drug Name Suffixes

October 6, 2009 | Lebowitz & Mzhen

As Maryland Medication Error Attorneys, we have been following a recent study published by the Institute of Safe Medication Practices (ISMP), about the lack of prescription drug naming standards in extended release medications that lead to pharmacy error injury.

According to the study, although extended release drug formulations provide multiple benefits for many patients, the titles used for many medications are often confusing, and can cause patient error when the same drug is presented with several different oral dosage forms in the suffix.

Extended release drug formulations play an important role in maintaining consistent prescription therapies, by preventing the need for patients to remember to repeat dosages—delivering a steady dose of the medication throughout a specific period of time. The difficulty with many of these medications comes in the name. According to the study, drug manufacturers add suffixes or modifiers to already well-known medication names, to keep awareness of the brand, yet differentiate between the immediate-release counterparts. For example: Wellbutrin SR is a sustained release anti-depressant, whereas Wellbutrin XL is the extended-release version. Same name, different release rate.