Medication Errors in Children

Medication mistakes are caused by human error and are largely preventable. They can occur at any stage of the medication process, from selection and ordering of drugs, to transcribing the order, to formulating the drug and dispensing it, to its administration and monitoring. Though not always fatal or even injurious, medication errors kill as many as 98,000 hospitalized patients per year. When the victims are children, the fact that their deaths could have been prevented becomes even more heartbreaking.

Most pediatric drug errors result from incorrect dosing. At one Seattle children’s hospital, for example, overdosing caused the deaths of three children over a period of just a few years: a 12 year-old from a fatal dose of the painkiller Fentanyl, another 12 year-old from an overdose of codeine, and an 8 month-old from a fatal dose of calcium chloride.

Why Are Children More at Risk?

Adverse drug events (ADE’s), those medication errors which cause harm, occur 3 times more often in children than in adults. Children and adolescents are at greater risk of injury from medication mistakes because their organ systems are immature and vary in their ability to process drugs and excrete them. The kidneys, livers and immune systems of children and teenagers are still developing, so even the smallest increase in drug dosage can have serious consequences.

Medication error risks are often highest for those least able to overcome them: premature infants. Furthermore, because children are less able to communicate their feelings, it is sometimes difficult to diagnose their problems or to know when a symptom or complication due to a drug error has developed. In a recent study of 12 children’s hospitals across the United States, medication errors were detected in 11.1% of patients. Many of these mistakes were determined to be preventable.

Calculating the Right Dosage

Adult medications come in standardized prepackaged doses. Calculating the right dosage for a child involves mathematical skill and can be quite challenging. In the past, pediatricians calculated children’s dosages by determining a fraction of the adult dose. A more refined calculation method is based on the child’s weight or body surface area (height and weight).

Errors in computing percentages, fractions, ratios and decimals are distressingly common. Plus, children’s medications come in different formulations, such as drops, liquids and chewables, which increases the chance for dosing errors. Mistakes in pediatric dosage calculation could be reduced if medications were manufactured specifically for children, with standardized dosing instructions and clear labeling and packaging.

Further Prevention Strategies

Some medications, notably opioid painkillers, antibiotics and antifungals, seem to be more frequently associated with pediatric adverse drug events. A more effective system of monitoring children’s medication would focus on specific drugs, events and procedures that potentially trigger harm.

Experts also recommend the use of computerized physician order entry (CPOE) to avoid mistakes caused by illegible handwriting and misplaced decimal points. Currently, only about 10 percent of hospitals make use of computerized prescribing. The Journal of the American Medical Association (JAMA) reports that 94 percent of children’s medication errors could be prevented by staffing pediatric wards with clinical pharmacists. These professionals have the expertise to review medication orders for appropriateness and safety as well as incorrect doses. In addition, since nurses play the most significant role in administering medications, clinical pharmacists could assist them in calculating the correct dosages.

As the smallest and youngest victims of medication error, children are in need of the best protection we can offer. If your child has been injured due to medication error, the attorneys at the Orlow firm are available to provide knowledgeable and compassionate assistance.

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Pharmacy Negligence: Nursing Homes

Nursing home residents often have multiple health problems that require several types of medication. While this is to be expected, some of the drugs routinely given to nursing home patients do not seem reasonable at all. Among the institutionalized elderly, the rate of prescribed sedatives , anti-depressants and anti-psychotics is shockingly high and of grave concern.

In too many instances, overworked staff find it easier to drug a patient with behavior problems than to deal with the effects. It is not unusual for a nursing home resident with dementia who refuses to be showered, dressed or groomed, to be dosed with strong anti-psychotic medications. In nursing homes nationwide, at least 40% of claims submitted for anti-psychotic drugs are inappropriate or unnecessary, or given in excessive doses for too long a time without adequate monitoring.

Risks of Excessive and Improper Medication

Elderly people who take anti-psychotic drugs increase their chances of experiencing a seizure. Those who already have a medical history of seizures may be severely injured by anti-psychotic drugs which can cause further seizures as well as irregular heartbeat. In nursing homes, medications prescribed for the wrong reasons, in questionable dosages and in unsafe combinations can create adverse drug reactions, accidents and death.

Incidences of Prescription Error

Nursing home pharmacists are responsible for reviewing patient medications and preventing potentially lethal medication mistakes. A recent study of California nursing homes found that more than half the pharmacists investigated had approved or overlooked inappropriate prescriptions for anti-psychotic drugs and ignored dangerous irregularities in drug dosages and combinations. Under California law, consulting pharmacists who work for nursing homes are required to conduct monthly reviews of patient medication charts. In 90 percent of cases, pharmacists failed to identify misuse of anti-psychotic drugs.

A Cause of the Problem

California investigators discovered a possible link between inadequate patient medication review and nursing home failure to pay a fair market rate for pharmacist services. In a majority of facilities where patients received anti-psychotic medications, pharmacists were paid below-average fees for their services. Although the average pay rate for California pharmacists is $56.29 per hour, some nursing homes billed as little as $11 an hour for their services. Investigators suspect that some pharmacists, in clear violation of the state’s anti-kickback law, were recouping their financial losses by endorsing and extending prescriptions for expensive and potentially harmful drugs.

Nursing home resident advocates argue that pharmacists who compromise their integrity and independence cannot adequately perform their protective function in regard to patient prescription care. They also call for limiting and regulating use of anti-psychotic drugs in California’s nursing homes.

If you believe your loved one has been improperly medicated in a nursing home or otherwise harmed by pharmacy negligence, contact the Orlow firm for a professional, compassionate consultation.

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Pharmacy Negligence: An Overview

We place a level of trust in pharmacists that we rarely show to other health care providers. It is not uncommon for patients to question their doctors’ diagnoses and medical advice or to seek two or more opinions from other physicians and hospitals. Yet, when we walk into a pharmacy, present our prescriptions and obtain our medications we hardly ever give the process a second thought.

Nevertheless, thousands of medication errors are committed by pharmacists each year, some with disastrous consequences. The rate of mistakes made in filling prescriptions may be as high as 10%. In our nation’s hospitals, more than 2.2 million patients suffer adverse drug reactions annually, resulting in 106,000 deaths. Experts estimate that two-thirds of the injuries and fatalities caused by medication errors could have been prevented.

The Role of the Pharmacist

A pharmacist is a health care professional who compounds and dispenses medications and who advises and instructs people as to the proper use of those medications. The days of the pharmacist as chemist, mixing his potions and powders, are nearly past. Today, much of the work of compounding medications is done by drug manufacturers or compounding pharmacies. Pharmacists do reconstitute medications, such as by adding syrup to antibiotics to make the medicine more easily ingested by children. Occasionally, mistakes occur because the pharmacist has contaminated the medication or used the wrong solution to reconstitute it. In general, however, the most common medication errors caused by pharmacists are:

  • Wrong Medication
  • Wrong Dosage
  • Mislabeling of Medication
  • Improper Warnings or Instructions for Use
  • Wrong Combination of Drugs
  • Nonbodily Injury, such as Breach of Confidentiality.

Room for Error

With a staggering 12 million chemical substances now available to pharmaceutical companies, the drug industry is booming, But as the volume of drug manufacturing increases, so does the potential for danger. Pharmacists are under a great deal of pressure to fill prescriptions quickly while keeping abreast of new and complex product information. Under these conditions, mistakes that should have been preventable become inevitable. Not surprisingly, pharmacists are increasingly being targeted for negligence lawsuits.

Over the next few months, the Orlow firm will post a series of articles on pharmacy negligence. We strongly believe in keeping our clients informed and aware of legal issues that may affect their daily lives. Please check our website for further articles and don’t hesitate to contact us with any questions or concerns you might have about medication errors.

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Long-Term Health Care Falls Short

The belief that health workers and care facilities provide patients quality care, observation and respect eases the worry that comes with placing a loved one in a health care facility.

For the most part, medical professionals live up to or exceed these expectations. But, unfortunately, some facilities are not run with the quality service and care people would want for either themselves or for their friends and family. Nursing home neglect and abuse can result.

What are Long-Term Health Care Facilities?

Long-term care hospitals are health care facilities that keep patients longer than regular or specialized hospitals. Patients in these sorts of facilities are often seriously ill and require constant care. Traditional hospitals do not have the beds or the money to keep such patients in their facilities, and nursing homes are not equipped to handle the severity of the patients’ conditions.

Long-term hospitals, therefore, are an important addition to the healthcare field. Medicare funds allow them to treat patients needing chronic care, and beds remain open in traditional hospitals and nursing homes for patients needing them.

Shortcomings

According to a recent study, these long-term care facilities face serious problems:

  • Of the 400 facilities in the U.S., very few have doctors on staff
  • Limited regulation and inspection
  • A focus on profit means “monitored staffing,” lowered “supply costs” and unethical discharge of patients

The recent, highly overdue investigation into the hospitals – the facilities of Select Medical Corporation in particular – reveals an alarming number of preventable injuries and deaths occurring in long-term care facilities, likely due to the above factors.

Devastating Effects

Long-term care hospitals violate Medicare rules at an average rate 4 times higher than the average rate of traditional hospitals. One recent study found that instances of bed sores – a preventable skin condition often caused by negligent care – were also significantly high in long-term facilities.

Further allegations of negligence include multiple cases where the preventable death of long-term care patients occurred:

  • In 2004, a Kansas patient died when a nurse failed to respond to his heart monitor reading.
  • In 2007, an Oklahoma patient died after her long-term caregiver injected her with 10 times the amount of insulin she should have received. Not only did the medication send her into a coma, but the workers in the long-term facility did not notify a doctor until at least 90 minutes after the incident.

Protect Lives and the Integrity of Healthcare

The Senate Finance Committee recently opened an investigation of the hospitals’ practices. Because the committee oversees Medicare, the future funding of the hospitals depends on this important investigation’s findings.

If you or a loved one has been mistreated or a victim of negligence in a health care facility, it is crucial that you contact a personal injury attorney in your area. Reliability and dignified treatment in our hospitals is important, and an experienced attorney can not only help you get the damages you deserve, but also serve to change health care practices for the better.

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