Medication errors in nursing homes and other inpatient medical facilities are recognized as a common problem in the medical field. When investigating medication errors within nursing facilities, state inspectors must identify each facility’s medication error rate. The nursing facility’s frequency of medication errors must be kept below a standard or acceptable percentage of medication errors. If the medication error rate rises above that standard, the nursing facility will be required to create and enact a plan for correction. What causes nursing home medication errors?
Elder Medication Standards
All facilities must maintain a nursing home medication error rate below 5 percent. While minor medicine errors are inevitable, nursing home residents must remain free of any severe medication errors. By definition, medication errors are mistakes that occur while preparing or administering medicine. The medication error occurs in a manner that contradicts the doctor’s orders, the manufacturer’s instructions, or the accepted professional standards regarding that medicine.
Administering Medication in Nursing Home
In most nursing homes, medication is administered when a nurse or nursing staff member completes a “med pass.” A “med pass” is the common term used to describe the process of dispensing medicine to nursing home patients as ordered. During a med pass, the nurse typically uses a cart while transitioning from resident to resident on a clearly-defined schedule.
In most cases, a licensed nurse conducts the med pass. However, some states allow for an unlicensed nursing staff member to administer the medication under the general supervision of a nurse. The med pass typically requires 4 to 5 hours of the nurse’s time during medication administration. In addition, it can take several more hours to organize the medications and complete any necessary documentation.
Examples of Medication Errors – Undermedication in Nursing Homes
The following is a list of examples regarding how nursing home medication errors may occur:
– Crushing or slicing medications that should not be split. These include capsules, tablets, or other medications that include “do not crush” instructions.
– Inadequate fluids with medications. Many medications come with instructions for the elder patient to drink a certain amount of fluid when the medicine is administered. If the elder does not drink the proper amount of fluids or is not properly hydrated at the time of taking the medication, the medicine may harm the patient.
– Inadequate food or antacids with medications. Some prescription medications require that the elder patient takes the medicine with or without food. Furthermore, some medications require elderly patients to take an antacid prior to taking the medicine. Nursing home staff should ensure patients are following proper medication instructions regarding food, fluids, and antacids.
– Failure to properly shake, mix, or “roll” the medication. Certain nursing home medications require mixing or shaking prior to being used by the patient. Without properly mixing or shaking the medication, the nursing home staff places the elderly patient at risk of receiving too little or too much of the medicine. Specifically, insulin suspensions must be mixed without air bubbles prior to administration. As a result, many members of the medical field “roll” the elder insulin medication to safely mix it.
– Improper administration of medication to be used with enteral nutritional formulas (ENFs). Many elderly patients require the use of enteral nutritional formulas at some point during their stay at a nursing facility. There are a specific list of guidelines and standard practices that the nursing home staff must follow to properly administer medication for these elder patients. If the standard medical protocol is not followed while administering medication with ENFs, a medication error will occur and may harm the patient.
– Improper administration of eye drops. Some medications must be administered directly to the elder patient’s eye. The nursing staff member administering this type of medication must ensure that the eye drops make eye contact for a sufficient amount of time, which is typically 3 to 5 minutes. This ensures that the eye drop is adequately absorbed before the next eye drop is instilled. If this procedure is not followed correctly, a medication error will occur.
– Improper use of metered dose inhalers (MDIs). Nursing home staff must properly shake and position metered dose inhalers for elder patients. If more than one puff is necessary for the elder patient, the nursing staff member must wait roughly one minute in between puffs to avoid a medication error.
– Allowing elder patient to swallow sublingual tablets. Some elderly patients are highly resistant to using sublingual tablets, despite training efforts by the nursing home staff. If the patient repeatedly misuses a sublingual tablet, the nurse or doctor should identify this as a reoccurring issue and the elder’s medication should be changed accordingly.
Negligent Medication Errors
Many nursing facilities are understaffed. This causes nursing staff members to feel tired and overworked. At times, unexpected events, other nursing home residents, or other nursing staff members may distract the personnel during the med pass. The person conducting the med pass may also feel rushed. All of these factors may lead to an elder medication error, causing harm to the nursing home resident.
According to a study conducted by the Medication Error Quality Initiative in North Carolina, repeated elder medication errors occur 37.3-percent of the time and may cause the most harm to the patient. If the licensed nurse is easily distracted by other patients while the unlicensed staff member administers medicine, a severe medication error may occur due to the nurse’s negligence. Variables that affect the severity of the medication error include medicine type, medical condition of the patient, and frequency of the elder medication error.
Based on the study conducted by the Medication Error Quality Initiative, the most common negligent medication errors include:
– Medication dose omission or under dose
– Medication overdose or multiple doses
– Expired elder medication
– Incorrect medical product, strength of product, or form of product
– Incorrect time, duration, or rate of elder medication administration
– Incorrect elder medication administration technique
– Incorrect elder patient or documentation
– Elder patient monitoring error following medication administration
– Error with lab work
– Outdated, or expired, elder medication order
– Nurse or staff member follows the wrong med pass route
Medication Malpractice by Nursing Staff
The following is a list of medical malpractice concerns that nursing home residents may experience, and they are grounds for a nursing home lawsuit regarding elder medication error:
– Ignoring medication orders. Some nursing home employees may ignore medication administration instructions on purpose. Examples include discontinuing elder medication, adding unordered medication, or changing the elder medication dosage.
– Poor elder medication management. This occurs when the nursing home fails to renew or maintain the specified medications, leaving the nursing home resident without the proper elder medication dose. This medication malpractice may occur through poor organization, inadequate documentation, or defiant nursing staff actions.
– Medication borrowing. When the nursing home staff is busy during the med pass, they may be missing the proper elder medication due to poor organization. As a result, the person conducting the med pass may “borrow” a medication from one patient to give to another. This often occurs in conjunction with a failure to note or account for the borrowed medication, leading to more negligent medication errors and nursing home malpractice. Medication borrowing can also mask the diversion of medications by causing confusion.
– Diversion of elder medications. When a nursing home staff member diverts medications, the staff member is stealing the medication for personal use. The nursing staff member may steal or divert a medication for actual use, or the nursing staff member may attempt to sell the stolen elder medications.
Crespin, D., A. Modi, D. Wei, C. Williams, S. Greene, S. Pierson, and R. Hansen. United States. National Library of Medicine. Repeat medication errors in nursing homes: Contributing factors and their association with patient harm. Bethesda: PubMed Health, 2010. Print. http://www.ncbi.nlm.nih.gov/pubmed/20624615
Hamilton, Thomas. United States. Department of Health and Human Services. Nursing Homes – Clarification of Guidance related to Medication Errors and Pharmacy Services. Centers for Medicare & Medicaid Services, 2012. Print. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-13-02.pdf
Hansen, R., P. Cornell, P. Ryan, C. Williams, S. Pierson, and S. Greene. United States. National Library of Medicine. Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunities. Bethesda: PubMed Health, 2010. Print. http://www.ncbi.nlm.nih.gov/pubmed/20684035
“Medication Errors in the Nursing Home.” Nursing Home Families. N.p., n.d. Web. 20 May 2013. http://www.nursinghomefamilies.com/NH_web/Medication_Errors.html