Medication Errors

Medication Errors in the Nursing Home

elder abuseA common problem in hospitals and nursing homes is errors related to medication administration. When these errors are investigated in nursing homes, the state inspectors are required to identify the medication error rate of each facility.

The frequency of medication errors must remain below an acceptable percentage of errors. If the error rate is above that standard, the nursing home must create and partake in a plan to correct those errors.

Medication Standards for Elders

The nursing home medication error rate must remain below five percent. While it is inevitable to have minor errors, all nursing facility residents must be free of significant medication errors.

The definition of a medication error includes mistakes that are made while making or administering the residents’ medications.

A medication error is made when it is different from the doctor’s order or the manufacturer’s instructions, or when it falls below accepted professional standards for the medication.

The Administration of Medication in the Nursing Home

In most nursing facilities, the medication is given when the nursing staff member completes what is known as a “med pass”. This is the term used when describing the process of dispensing medication to nursing facility residents according to order. The nurse usually uses a cart when doing a med pass, giving out medication from resident to resident according to the doctors’ orders.

Med passes are carried out by licensed nurses. Some states, on the other hand, will allow unlicensed staff members to provide medication as long as a nurse is supervising. Med passes usually take 4-5 hours to complete. In addition to giving the medication, it can take several more hours to organize the medications and document the administration of the medications.

Examples of Medication Errors

These are various types of medication errors that can happen in a nursing home, including:

  • Slicing or cutting a pill that shouldn’t be split. This can include tablets or capsules that carry the instructions not to crush.
  • Providing inadequate liquids with medications. Many medications have instructions as to how much liquid should be given with the medication. If the resident does not drink this amount of liquid, they will not be adequately hydrated and the medication may cause harm to the resident.
  • Providing inadequate antacids or food with the medication. Some medications require that the resident takes the medication with or without food. Some require antacids to be given prior to ingesting the medication. It is up to the nursing staff to give the medication in the right way.
  • Failing to mix, shake or roll the medication. Some medications require special shaking or mixing before being ingested. If the medication is not properly mixed, there is a risk of giving the resident too much or too little of the medication. This is true of insulin suspensions and other types of suspensions.
  • Giving medications with enteral nutritional formulas. Some residents are taking enteral nutrition.  There is a list of practices and guidelines that must be followed in order to give medications to these patients. If the proper protocol isn’t followed, there may be a medication error that harms the patient.
  • Improperly giving eye drops. Some medications for the eye must be given directly into the eye. The nursing home staff member must make sure that the eye drop connects with the eye for a reasonable amount of time (about 3-5 minutes) to allow for absorption of the medication. If this is not done, it constitutes a medication error.
  • Having the resident swallow medications designed to be sublingual. Some patients are very resistant to taking sublingual tablets. If the resident repeatedly swallows the sublingual tablet, the medication needs to be changed.

Negligent Medication Errors

Because many nursing homes are understaffed with remaining staff members that are overworked and tired, medication errors can happen. The staff member may be distracted during the med pass and may make a mistake. The staff member doing the med pass should not feel as though they are being rushed, as this can lead to medication errors.

According to a study by the Medication Error Quality Initiative, the most common medication errors include the following:

  • Giving expired medications
  • Giving too much medication
  • Giving too little or skipping a dose of medication
  • Using an incorrect med administration technique
  • Giving the medication at the wrong time or at the wrong rate
  • Giving the wrong form of the medication, the wrong strength or the wrong medication altogether
  • Documenting the giving of the medication incorrectly
  • Failing to monitor the resident after giving the medication
  • Having a lab error
  • Following the wrong med pass routine

Medication Malpractice

There are various malpractice concerns that may be experienced by nursing facility residents that are grounds for a lawsuit on the basis of a medication error. These include:

  • Ignoring an order. Some employees will ignore the administration instructions and change the order, add medications that are not ordered, or discontinue a medication.
  • Poor medication management. This happens when the nursing facility fails to have the right medication on hand so that the nursing home resident will not have the medication available.
  • Medication borrowing. When the staff is busy during the med pass, there may be medications missing. Instead of getting the right medication, the person doing the med pass may borrow a medication from one resident to another. If this is not documented, mistakes can be made.
  • Diversions of medication. When the staff member diverts a medication, it is usually a matter of stealing the medication for their own personal use. The medication may also be taken to sell to other people.
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Dr. Christine Traxler

Christine Traxler, MD is a retired family practice physician, graduate of the University of Minnesota School of Medicine in 1986, and freelance writer, having worked with patients in rural Minnesota for two decades. She has written several books on medical topics and currently resides in Minneapolis, MN, where she works as a freelance writer on medical topics.

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