Nursing home residents typically enter a facility having been prescribed many different medications from various physicians for multiple medical issues. Federal and state laws require detailed record keeping regarding the on-time distribution of medication to patients at the correct intervals and in the correct dosage. CFR §483.25(m) Medication errors. Failure to do this is breaking the law. Elderly individuals depend on the accurate and timely administration of medications. A late dosage could cause serious and even fatal results. In the very least, nursing homes should be meeting their residents' most basic needs - which includes the proper administration of medicine.
With the daily number of doses to cart, administer and document, medication errors are one of the most common malpractice errors that occur in nursing homes and assisted living facilities. Most medications are administered to resident in what is called the “med pass”. This process of dispensing medications as ordered is usually done from a cart going from resident to resident following a clearly defined schedule. The med pass is most often done by a nurse but may be conducted by an unlicensed person under the general supervision of a licensed nurse. The procedures for the administration of medications must be clearly defined by the nursing home in written procedures. The med pass can take 4 to 5 hours just to dispense the medication plus the necessary time to manage the acquisition of drugs, organize storage, and complete the documentation related to dispensing, controlling and storing of medications. The nurse assigned these tasks will spend a significant amount of time on medication related matters that will take them away from direct care tasks with residents. The med pass offers the most opportunities for medications errors. It is important for the facility to ensure proper handling and administration of medications in the med pass to limit errors.
Some examples of medication errors are:
- Wrong Medication - The nurse should be sure the medication to be administered is that ordered by the physician and appropriate to the resident’s medical condition.
- Wrong Dosage - The nurse should ensure the dosage ordered is appropriate to the resident and their physical and medical condition.
- Wrong Patient - New patients, those with similar names, and new employees can lead to the wrong person getting the medications of others so photo, armband, and self identification by the resident are necessary each time medication is dispensed.
- Wrong Manner and Route - Crushing pills to be hidden in food should not be done with delayed absorption medication and someone vomiting may need oral medication administered in another approved form and/or route.
- Right Time - Keeping a medication at the same level in the body may require adhering to a tight schedule of dispensation.
- Failure to “Shake Well”: The failure to shake a drug product that is labeled “shake well.” This may lead to an underdose or overdose depending on the drug product and the elapsed time since the last “shake.” With some drugs, for example Dilantin, it is more critical to achieve correct dosage delivery than with others.
- Insulin Suspensions: Also included under this category is the failure to “mix” the suspension without creating air bubbles. Some individuals “roll” the insulin suspension to mix it without creating air bubbles. Any motion used is acceptable so long as the suspension is mixed and does not have air bubbles in it prior to the administration.
- Crushing Medications that should not be crushed: Crushing tablets or capsules that the manufacturer states “do not crush.”
- Adequate Fluids with Medications: The administration of medications without adequate fluid when the manufacturer specifies that adequate fluids be taken with the medication is an error.
- Medications that must be taken with Food or Antacids: The administration of medications without food or antacids when the manufacturer specifies that food or antacids be taken with or before the medication is considered a medication error.
- Allowing Resident to Swallow Sublingual Tablets: If the resident persists in swallowing a sublingual tablet, such as nitroglycerin, despite efforts to train otherwise, the facility should endeavor to seek an alternative dosage form for this drug.
- Borrowing medications - With defective medications management and the rush to complete the med pass, a nurse may have a missing drug due to poor organization, the failure to resupply the medication, or because the needed dose has been borrowed for another resident. Faced with the pressure to complete the dispensing process, this nurse may resort to borrowing the medication from yet another resident. The effect of borrowing, poor record keeping, and unordered stock destroys organization in the medications supply process, leads to missing doses for some residents, and can hide the diversion of drugs by an employee.
- Ignoring medication orders - An employee who purposefully ignores the details of the nursing home’s dispensing procedures or guidelines is committing malpractice. There are instances of nursing staff choosing to change the dose, discontinue medication, add an unordered medication, or make other medication changes on their own. The result can be the resident not getting the full benefit of the drug therapy ordered or being exposed to potentially harmful conditions.
- Diverting medications - Diverting is another way of saying stealing medications. Sooner or later all nursing homes must deal with an employee diverting residents’ drugs for their own use. As within any career field, nursing will have persons who become addicted and support that addiction any way they can. The large supply of drugs in nursing homes can be a tempting opportunity.
- Poor medications management - The failure to renew or maintain a supply of the ordered medications will leave the resident without the required doses. The poor organization and disorderly maintenance of the medications cart and storage room discourages accounting for and the immediate availability of medications that may be in stock but not where staff can find them.
Our medication error lawyers are experienced in analyzing, reviewing and assessing potential medication errors in nursing homes and assisted living facilities, and are prepared to try your case to verdict. If a loved one in a nursing home has been injured through a medication error, you need to take steps to ensure that he or she is receiving the care that is deserved. Our experienced medication error attorneys can help you uncover the truth and hold the proper parties responsible for any substandard care your loved one may have received. Turn to the experienced Ohio nursing home attorneys of The O’Keefe Firm. To schedule a free initial consultation, call 937-643-0600 or simply contact us online.