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Friday, May 19, 2017
Long-Term Care Facilities and the Prevalence of Prescription Medication Errors
Posted by Andera Colon of
Taking the wrong prescription can cause illness, nausea and inflammation, or an allergic reaction.  For senior citizens, medication errors in nursing homes can be fatal. With all the technology, and the adoption of electronic health information exchange (HIE) records, serious injuries from inaccurate dispensing of medications in long-term care facilities still happen. In fact, one report from a Medication Error Quality Initiative in North Carolina found that “repeated elder medication errors occur 37.3% of the time”.

Under what circumstances can prescription drugs be administered incorrectly, in a way that threatens the wellness of a seniors in nursing homes? How do medication errors occur in hospitals and nursing homes, where multiple prescriptions may be administered to the elderly? While the errors can be difficult to fathom for in professional healthcare, they do happen with surprising frequency, causing secondary health risks, and morbidity and wrongful death for seniors.

Medication Borrowing

Like any healthcare setting, medications are sustained in a controlled inventory environment. However, human error or the expiration of medications can lead to a brief shortage of prescriptions inside the nursing home dispensary, which can result in medication borrowing.

The scenario involves one patient requiring a medication, and a shortage of the prescription drug on hand. A nurse or pharmacy technician may temporarily "borrow" a quantity from another patient’s inventory. If a failure to note the type of medication or quantity used by another patient happens, the medication can be erroneously replaced by another type of drug. The confusion can cause a medication switch, if nurses do not consult with a pharmacist, or if they are not able to accurately identify the drug they are replacing.

Ignoring Medication Orders

While this should never happen in professional healthcare, some nurses have been charged and become civilly liable for negligence, after altering the medication orders of a trained physician. If a certain drug is causing stomach upset, allergic reactions or excessive drowsiness or irritability, the nurse may choose to alleviate the patient reactions by reducing the dose, omitting a drug, or replacing it with another type of medication. Without consulting with a doctor, these types of changes can result in an overdose or unexpected contraindication (negative reaction) between other medications that the patient is taking.

Diversion of Prescription Medications

One of the most serious, dangerous and liable acts that a nurse can engage in, is the diversion of prescription medications in patient care. Many drugs that are used for pain and inflammation have a substantial black market value, and unscrupulous healthcare providers may ‘steal’ medications rather than providing the patient with their normal dosage. Stolen medications are then sold, or in some cases used by Nurses or practitioners who have a drug dependency.

Incorrect Administration of Medications

Some medications must be dissolved, or given with liquids, while others lose their efficacy if they are split (dividing tablets or capsules). The time of day and the condition of the patient is important when accurately dispensing medications in a nursing home environment, as some prescriptions require an ‘empty stomach’ or need to be taken with a small meal or snack, to be absorbed correctly. Failure to comply with the administration directions for a drug can result in injury or death for seniors.

Error in Lab Work and Diagnostics

Clerical errors occur every day, but when they happen in healthcare settings, lives are impacted. Regular testing is conducting on nursing home residents to monitor changes in health status, and to adjust or add medications are required, in treatment. However, an error in the diagnostic reporting from blood results, to radiological (x-ray) testing can misdiagnose a senior, or mandate an increase in medication that can be deadly, for many who are diagnosed with a chronic or life threatening condition.  

The American Controlled Substance Act (CSA) requires that only an authorized DEA registered prescriber can write or sign prescriptions for controlled substances, like pain medications and narcotics. The Nursing Home Reform Law has required that a licensed physician be accessible and available to support patient care and nursing staff, in the event of an emergency, but in the absence of a physician on staff, are care coordinators making the wrong decisions when it comes to pharmaceutical dispensing?

Family members who suspect a health decline or development of new and unexplained medical conditions for their loved one, should consult with a lawyer to regarding care orders, and investigation in the facility and similar cases of neglect or negligence. Given the shortage of nursing home facilities and waiting lists in many communities, moving a family member immediately out of care may not always be possible, but legal action can require a review of care, current prescription medications (and method of dispensing to the patient) to intervene in suspect cases.

It is natural to trust members of the medical community, who are trained healthcare experts, but the significant risk posed by medication errors requires an immediate response, if tampering, or other types of negligent care may be exacerbating chronic conditions, and overall wellness. Take action and advocate for your family member, regardless of the circumstance, to ensure accurate and professional health care.Click Here for Provider's Detail Page
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