Article Updated: April 4, 2022
Medication Errors in Long Term Care
As you’ll discover below, not surprisingly, nursing home residents take lots of medications. Increased amounts of medication means increased risk of errors and harm.
For that reason, when the risk of harm increases, so too must the level of safety measures that protect those who are in harms way.
Nursing homes fail to grasp this basic concept, but I do my part to hold them accountable for that carelessness.
After reviewing my research and article below, if you need more help, I invite you to call me for a free consultation.
Clickable Table of Contents
Medication Errors in Long Term Care
7 – About the Author
Medication Errors In Long-term Care : The Culprits
Every year hundreds of thousands of medication mistakes are made by a number of people who are responsible for safely dispensing drugs to patients.
From the moment a medication is prescribed to you, to the moment you take your medication, there are a number of people who can potentially make mistakes in your drug doses.
This long chain of people means that there are many opportunities to make mistakes, and each one can happen because of carelessness, negligence, incompetence or lack of experience.
Wrong Rx Given By Physician, Physician Assistant or NP
One potential way that medication errors in long term care occur is when the wrong Rx is written from the start by the person responsible for treating your illness.
Generally, a doctor, a PA or a nurse will be responsible for writing a prescription for medication that you need to take.
This is a problem that can cause significant harm and happens more than many would think it does, but also frequently goes undetected.
Why do so many nurses and doctors prescribe the wrong medication to their patients?
One reason that has been identified is that physicians are tired, overworked and are suffering from fatigue and burnout.
A survey of nearly 7000 physicians found that shocking realities in the physical, emotional and mental well-being of physicians who are responsible for writing prescriptions:
◊ 54.3% reported burnout
◊ 33% reported fatigue
◊ 10.5% reported making a major medical error in the last 3 months alone
◊ 6.5% reported Suicidal thoughts
◊ 4% reported poor or failing patient safety grade in their primary work area
What these numbers mean is that medication errors are far more common than many know about starting right with the physicians making mistakes.
This is even more prevalent when a patient has many medications that they must take on a daily basis, as frequently is the case in elderly patients in nursing homes.
Pharmacist Incorrectly Dispenses Medication
Pharmacists that work with patients who have a long list of medications can also make mistakes in dispensing medications.
A pharmacist can make mistakes like putting the wrong medication into the wrong container, attaching the wrong directions sticker onto the wrong medication bottle, or failing to catch a mistake where two or more medications can actually cause a patient harm if used at the same time.
Pharmacists can even make mistakes like putting too many pills into a container, failing to inform a patient of allergy information or giving the wrong strength of a medication to a patient.
The average patient cannot look at a pill or liquid or patch and know that it is the wrong dose, or medication overall.
These patients will implicitly trust the work of the pharmacist, and if the pharmacist made a mistake, it can cause serious injury or death to the patient.
Commonality of Medication Errors In Long Term Care?
You would believe that there are many safeguards that should mitigate errors in medication, but in reality, hundreds of thousands of people are subjected to medication errors in health facilities every single year.
In fact, there is a substantial body of medical evidence that shows that medications prescription methods used in care home residents is suboptimal and requires improvement.
The problems seen in medication errors in nursing homes are worse than most other medical facilities because of the large number of medications that residents are all taking and how many people are taking them in the long-term care homes.
Some of the reasons that so many mistakes happen in care homes are:
◊ There is not enough documentation that medications are being given correctly
◊ Residents are not adequately monitored after they take medication
◊ Expiration dates on medications are not checked, which leads to problems
◊ Because the facilities are often busy and understaffed, doses of medications are either missed or too little is given
◊ In other cases, carelessness leads to too much medication being given.
These mistakes are often serious and a large number of people die in the US every year because of medical errors were preventable and medication mistakes are high on that list.
Patient Is Given Wrong Dose of Medicine
With nursing home patients there are many people involved in their care and well-being which can create a problem with communication between all of these stakeholders.
This itself leads to a large number of errors in dosage with 36% experiencing order errors and another 85% of patients seeing errors that originate in their extensive medication histories.
However, to this day there is a serious problem with dosages either too high or too low being given to residents of nursing homes because they have such extensive medication needs, and are in hectic environments without enough staff.
Nursing Homes Don’t Follow the Rules
Even medication rules for common nursing home drugs are not followed in many cases.
Medications do not only need to follow dosage rules, but also specific rules on how they are taken, when they are taken and under what conditions they are taken.
Many medications for example need to be taken with food and other medications need to be taken only during the morning hours while others need to be taken before sleep.
When the stringent rules for medications are not followed, like a medication being taken only in conjunction with another medication, there can be serious adverse reactions that can lead to hospitalization or death.
Common Nursing Home Drugs Involved In Mistakes
Some drugs are very common amongst residents of a nursing home but despite this, even these
common nursing home drugs are often prescribed or dispensed incorrectly.
The medications most commonly involved in an error were found to be drugs like lorazepam, warfarin, hydrocodone, and fentanyl patch.
These medications were frequently found to be given incorrectly, in the wrong dose, or at the wrong times.
Nursing homes have also reported high rates of potentially inappropriate drugs being given to their residents as a serious problem that they face in medication errors.
One of the most common nursing home drugs to be given to patients are analgesics, and in a study of nearly 400 nursing homes nationwide close to 5oo errors were found with this medication alone.
These mistakes accounted for 11% of all medication errors in nursing homes.
Central Nervous System Agents
Central nervous related medications came in even higher in this study and were found to be misused at a rate of over 16% in nursing home patients.
Insulin mistakes accounted for about 6% of medication mistakes and well over 300 instances of insulin mistakes were found in just one study of nursing home patients. This is a serious issue of concern as insulin is highly relied on in nursing homes, and mistakes with insulin can easily lead to death.
Lorazepam & Alprazolam
A high percentage (10%) of medication mistakes found were innaporirate medications being given to the elderly.
The medication most reported in these errors were associated with lorazepam (nearly 500 instances or 8% of medication mistakes) and alprazolam (130instances, or 2% of mistakes).
Warfarin is another highly used and relied on medication in older patients, and needs to be used with extreme care as misuse can lead to problems with bleeding that can become life threatening very fast.
It is therefore highly concerning that close to 400 mistakes (6% of medication mistakes) are found to be related to taking warfarin.
Medication Errors Are Made In Nursing Homes
There are many medication errors that can be made while dispensing and administering medications to nursing home patients.
In some cases, nurses are not even sure why the medication is being given in the first place and a majority of patients in nursing homes had at least one drug prescribed for which the indication was unknown in their files.
Common ways that medication errors occur are:
◊ Medication is given at the wrong time of day
◊ Wrong dose of medication is given
◊ The wrong patient is given the wrong medicine
◊ A needed dose of medicine is missed overall
Some of these mistakes are made more frequently than others. For example, medications being given at the wrong time of day are far more frequent than an unauthorized medication being given to a patient.
The wrong dose being given and medications being missed are other frequent mistakes that are commonly made in nursing homes.
In an observation of nearly 5000 nursing homes, medications being given at the wrong time occurred nearly 71% of the time, while 12.9% of the time the wrong dose was given, while in 11.1% of cases there was an omitted dose, and in 3.5% of cases there was an extra dose given.
Only in 1.5% of cases was there an unauthorized drug given to a patient. And even rarer was the wrong drug being given which came in at under 1% of the mistakes in medications being given to patients in nursing homes.
Medication Errors Are A Breach Of Standards of Care
Medication errors nursing homes show a clear breach in standards of care. These errors in medication can harm patients in serious ways.
Patients are supposed to be afforded a standard 5 rights with regards to their medications. These five rights are:
◊ Right patient is given the medication
◊ Right drug is given
◊ Right dose is given
◊ Right time is followed for the medication
◊ Right route is adhered to in the medication being administered
Despite these rules being clear, a high number of medications are administered with some form of error in nursing homes.
Q&A On Medication Errors in Nursing Homes
Which common nursing home drugs are frequently mis-administered?
The most commonly involves medications in errors in nursing homes are central nervous related medications, analgesics and medications like Lorazepam.
How frequently do medication errors occur in long term care homes?
Medication errors in nursing homes are very high and have been found to occur in rates as high as 85% in some cases. These errors are frequently committed by everyone from the pharmacist to the physicians and nurses responsible for drug being dispensed.
Why are nursing home residents more prone to medication errors?
Nursing home residents are at a higher risk of medication errors because this is a population that frequently has a much higher medication list to take which can cause confusion.
What is the most frequent mistake made in medications in nursing homes?
The most frequent mistakes made in medications in nursing homes are being given medications at the wrong time of day, followed by being given the wrong dose of medication and a dose of medicine being missed overall.
Who is involved in incorrect medications being given to a resident?
There are many people who are involved in medication being given incorrectly to a patient and each of them can cause damage to the patients well-being. This includes the doctors who prescribe the medication, the pharmacists who dispense the medication and the nurses who administer the medications.
Need Help With Medication Errors in Nursing Homes?
A mistake in your medication can mean serious injury, the need for hospitalization and, in extreme cases, even long-term damage to your health or even death.
If medication errors in a nursing home have caused you or your loved one any suffering, you will need help and someone to talk to about your options.
I am here to listen and offer my advice any time day or night with a free consultation.
Reza Davani, Esq.
State Bar No.: 1212110211
Federal Bar No.: 30168
Supporting Literature, Citations & Resources:
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Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. Bmj, 353.
Gleason, K. M., McDaniel, M. R., Feinglass, J., Baker, D. W., Lindquist, L., Liss, D., & Noskin, G. A. (2010). Results of the Medications at Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. Journal of general internal medicine, 25(5), 441-447.
Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal medicine, 170(8), 683-690.
Westbrook, J. I., Li, L., Lehnbom, E. C., Baysari, M. T., Braithwaite, J., Burke, R., … & Day, R. O. (2015). What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 27(1), 1-9.
Alldred, D. P., Kennedy, M. C., Hughes, C., Chen, T. F., & Miller, P. (2016). Interventions to optimise prescribing for older people in care homes. Cochrane Database of Systematic Reviews, (2).
Di Muzio, M., Dionisi, S., Di Simone, E., Cianfrocca, C., Di Muzio, F., Fabbian, F., … & Giannetta, N. (2019). Can nurses’ shift work jeopardize the patient safety? A systematic review. Eur Rev Med Pharmacol Sci, 23(10), 4507-19.
Tawfik, D. S., Profit, J., Morgenthaler, T. I., Satele, D. V., Sinsky, C. A., Dyrbye, L. N., … & Shanafelt, T. D. (2018, November). Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. In Mayo Clinic Proceedings (Vol. 93, No. 11, pp. 1571-1580). Elsevier.
Young, H. M., Gray, S. L., McCormick, W. C., Sikma, S. K., Reinhard, S., Johnson Trippett, L., … & Allen, T. (2008). Types, prevalence, and potential clinical significance of medication administration errors in assisted living. Journal of the American Geriatrics Society, 56(7), 1199-1205.
Finkers, F., Maring, J. G., Boersma, F., & Taxis, K. (2007). A study of medication reviews to identify drug‐related problems of polypharmacy patients in the Dutch nursing home setting. Journal of clinical pharmacy and therapeutics, 32(5), 469-476.
About the Author
This nursing home and medical malpractice article was written by Baltimore, Maryland nursing home attorney Reza Davani, Esquire. Mr. Davani received his Juris Doctor degree from a Tier 1 law school, the University of Maryland Francs King Carey School of Law. He received his first license to practice law from the State of Maryland’s Court of Appeals (MD State License No. 1212110211), and just four months later received a federal law license from the United States District Court for the District of Maryland (Federal License No. 30168).
Mr. Davani has been practicing law for over 10 years. He began practicing law by helping clients as a sanctioned student lawyer before receiving his law license, and second chaired his first jury trial in federal court before even graduating law school. He is a registered member of the Maryland Association for Justice (MAJ), the American Bar Association (ABA), the American Association for Justice (AAJ), and was formerly on the MAJ’s Legislative Leader’s Circle.
Mr. Davani has taken over 20 cases to trial in state and federal court, and favorably settled well over 100 cases for injured victims. He has personally helped his clients recover over $15,000,000 in personal injury, medical malpractice, and nursing home abuse settlements and verdicts in Maryland and other states. He is dedicated to fighting for justice, and welcomes the opportunity to help you.
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