Medical malpractice or negligence happens when a doctor, nurse, tech, or hospital makes a mistake that’s beneath the standard of care.
There are some health care mistakes that should never be made, though. They’re called sentinel events, or never events. Any time they occur, the standard of care requires a root cause analysis. A root cause analysis allows hospital leaders to figure out what went wrong and identify the root cause so the sentinel event won’t be repeated in the future.
The fourth most common root cause of medical malpractice claims is medication errors.
According to a study of medical malpractice closed claims, there are four areas where medication errors occur: ordering, dispensing, administering, and monitoring and management.
Errors in ordering medications
The riskiest step for potential medication errors is the process of ordering them, accounting for 35% of medication-related malpractice claims.
In our experience, there are several ways that doctors, nurse practitioners, and physician’s assistants can make mistakes when ordering medications:
• Ordering a drug that’s inappropriate for the patient’s age.
Many medications, for example, are only approved and recommended for patients 12 years old and up.
• Ordering the correct medication, but with an incorrect dosage.
Some medications are dosed based on the patient’s weight. Others are based on the patient’s lean body mass. Still others are dosed without relation to the patient’s weight. Then, once the provider orders the correct dosage, there still an opportunity for error by giving bad instructions for the patient to take the drug too frequently or not frequently enough.
• Getting in a hurry and not obtaining a complete patient history.
In the patient history, a physician or mid-level provider asks the patient or family about past and present medical conditions, allergies, and the current drugs that the patient is taking. Of course, it’s important to avoid prescribing a drug that could trigger an allergic or anaphylactic reaction. It’s also critical to be aware of the patient’s other medications to avoid a drug-drug interaction.
Pharmacy dispensing errors
This used to be a larger problem, but now only accounts for 3% of medical malpractice claims related to medication errors. Most experts believe that the improvement has come because of sophisticated software systems of pharmacies that should prevent most errors when used properly by pharmacy staff.
Drug administration errors
Around 31% of medical malpractice claims involving medications have a root cause in administration.
In our experience, these mistakes often come about because nurses and doctors are rushed and not paying attention. Here are the common areas of concern:
• Verifying that the correct medication is going to the correct patient.
We recently had a case where a parent saw a nurse inject medication into his child’s intravenous (IV) line at a hospital. The child immediately started having severe seizure activity. Later, a physician told the parent that a nurse had mistakenly injected fentanyl that was intended for another patient.
• Mistakes in preparing or measuring the correct dose of a drug.
Risks associated with monitoring and managing medications
The final category of common medication errors, accounting for 31% of medication-related claims, is monitoring and managing a patient’s medications.
It’s not enough to administer a medication and move on. Under Texas Board of Nursing rules and regulations, for example, nurses are required to understand the rationale and effects of medications they administer. Under the standard of care, they are required to follow physician orders when giving a medication, assess the patient before giving medication, and then reassess the patient around an hour later to determine the effect of the drug.
Another important area of medication monitoring is on long-term medications, including opioid painkillers and anticoagulation drugs. Narcotic opioids are closely regulated because of their addiction-forming properties that prescribers must keep in mind. Anticoagulation drugs, on the other hand, are blood centers that are currently used by over 6 million people in the United States each year. Anticoagulants work well so long as they are closely regulated within narrow therapeutic windows. When things get out of line even a bit, it can lead to dangerous or deadly complications.
On the management end of this responsibility, both doctors and nurses are required to participate in an important patient safety process called medication reconciliation. This involves obtaining and documenting in the patient’s medical record a complete list of the patient’s current and recent medications.
The idea behind medication reconciliation is that a patient could be taking other prescriptions or over-the-counter medications or supplements that could interfere with new medication orders that may be part of the treatment plan. This is an important conversation that can’t be rushed. Nurses and doctors must explain to patients that just because a medication had been recently discontinued, it could still be in the patient’s system. Therefore, the comprehensiveness of the medication list is crucial.
What you can do
Be aware of the risks of medication errors and the impact they can have on your healthcare.
We recommend maintaining a list of medications by name, dose, instructions, and provider. Bring it with you for reference any time a doctor or nurse asks for your medication history. Be comprehensive and thorough in these conversations.
When a doctor, nurse practitioner, or physician’s assistant prescribes a new medication, ask for an explanation of the purpose of the new drug. Inquire about whether it would interfere with any of your existing medications or if there any side effects that you should know about. The same questions are appropriate when picking up a medication at the pharmacy—always ask for the free consultation with the pharmacist.
If you’ve been seriously injured because of a medication error, then contact a top-rated skilled Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
