Medication Error FAQ


1. What is a medication error?


Medication error is defined as any preventable event that may cause, or has caused patient harm while the medication is in control of a health care professional (e.g., a doctor, nurse or pharmacist), patient or consumer. Such events may be related to professional practice, order communication, product labeling, packaging, compounding, dispensing, distribution, administration, education, and use.


2. What is considered a “medication”?


• Prescription medicines
• Sample medicines
• Over-the-counter medicines
• Radioactive medications
• Vaccines
• Respiratory treatment
• Intravenous solutions
• Diagnostic or contrast agents
• Parenteral nutrition
• Blood derivatives
• Herbal remedies, vitamins, nutraceuticals
• Any other product designated by the FDA as a drug


3. What are the types of medication mistakes?


Medication errors can be broadly classified as prescribing, dispensing or drug administration errors.


Prescribing errors account for somewhere between 20%-60% of all medication errors. These errors are made prescribers, including doctors, physician’s assistants, or nurse practitioners.


The numerous types of prescribing mistakes include:


Failure to alter drug therapy in patients with impaired kidney or liver function. This mistake leads to an excessive dose of the prescribed drug.
• Failure to notice a patient’s history of allergy to the prescribed drug class or missing critical information about a patient’s known drug allergies.
Use of the wrong drug name (e.g., sound-alike or look-alike drug names), wrong dosage form (e.g., intramuscular v. intravenous injection), wrong abbreviation (e.g., “qd” [everyday] instead of “qid” [4 times per day].
Incorrect dosage calculations, including wrongly placed decimal points and wrong rate or frequency of administration.
Failure to prescribe when there is a medical indication or prescribing a drug without an indication (e.g., use of antibiotics to treat a cold).
Incorrect drug selection for a patient.
• Failure to take into account drug-drug or drug-food interactions or duplicative therapies.


Prescribing errors are caused by:


• The doctor’s, physician’s assistant’s, or nurse practitioner’s insufficient knowledge about the medication and its correct use.
• The doctor’s, physician’s assistant’s, or nurse practitioner’s lack of knowledge about the patient (e.g., incomplete medical history).
Miscommunication among doctors, nurses, and pharmacists (e.g., illegible handwriting on written orders/prescriptions, misunderstanding of verbal orders, mistakes using electronic ordering).
• Doctors or other prescribers not following policies and procedures.
Incorrect record-keeping or charting.


Dispensing errors account for 6%-12% of all medication mistakes. These mistakes are made by pharmacists or pharmacy technicians. In a study of 500 pharmacist malpractice claims, over 85% of dispensing errors could have been prevented.


Common dispensing mistakes made by the pharmacy staff include:


Dispensing the wrong drug: This happens when the patient’s doctor prescribed the correct medication, but the prescription was filled by the pharmacist with the wrong medication.
Dispensing a prescription to the wrong patient: Here the prescription is filled correctly, but is given to the wrong patient by the pharmacy staff.
Dispensing the wrong dosage of the prescribed drug: In this case the doctor prescribed the correct dose, but the wrong dose was dispensed.
Confusing drugs that have similar sounding names or look alike: This is a common mistake. Examples of this include Glyburide, Glipizide; Quinine, Quinidine; Serzone, Seroquel; Lamictal (for epilepsy), Lamisil (for nail infections).
Failing to verify a drug name or dosage with the prescribing doctor.
Failing to protect against harmful drug interactions: This occurs when a pharmacist does not check if a patient is currently taking other medications that can affect the efficacy, side effects or action of the prescribed drug. This includes not only interactions between two or more medications, but also the harmful combination of a drug with certain foods or beverages.
Failing to identify patient drug allergies: This occurs when the pharmacist fails to determine whether the patient is allergic to the prescribed medication, its ingredients or any of the substances from which the drug may be made.
Failing to give the correct directions for taking the prescribed medication.
Mislabeling a prescription: This occurs when a label has improper use instructions or inadequate or erroneous warnings.
Failing to provide adequate counseling to the patient.


Common causes of pharmacy error include:


Inadequately trained personnel.
Improper abbreviations used in prescribing.
Inappropriate use of decimals.
• Illegible handwriting: illegible handwriting on prescriptions or orders alone count for 15-25% of all medication errors.
Inaccurate drug history taking.
Labeling errors.
• Insufficient filling time/excessive workload.
Regarding chain drug stores in particular, a 2008 USA Today Investigation found evidence that corporate policies such as allowing or encouraging pharmacists to fill hundreds of prescriptions daily and rewarding fast work-can contribute to serious or fatal pharmacy errors.
• Lapses in individual performance.
Poor oral and written communication between prescriber and pharmacist: one in ten medication errors results from an incorrect name, misinterpretation of dosage, misunderstanding of an abbreviation or misinterpreting the decimal point placement.
Interruptions and distractions are highly correlated with dispensing errors. Almost 26% of pharmacists’ time is spent dealing with interruptions related to third parties and miscellaneous tasks.
• Drug reference files, texts, and/or other database systems may not be current, resulting in errors associated with outdated and incorrect information.


Drug administration errors are made by nursing personnel and occur when one or more of the “five rights” is wrong.


The “five rights” have long been the basis for nurse education concerning drug administration, i.e. giving the right dose of the right drug to the right patient at the right time by the right route.


These errors are made by nursing personnel in acute care hospitals, in long-term facilities, and during home care. In many of these settings, the environment for nurses is demanding, characterized by long hours, staffing shortages, high patient and staff turnover, and constant interruptions. These errors also are made by the patient or patient’s caregiver at home.


4. What law applies to a medication error?


In general, medication errors are a type of medical malpractice. Medical malpractice, also known as medical negligence, is an act or continuing conduct of a health care professional that does not meet the standard of professional competence and results in provable damages to his/her client or patient. Medical malpractice can be asserted against any licensed health care provider, including doctors, nurses, and pharmacists.


5. What should I do if I think a medication mistake has been made?


Immediately, you should contact your physician, pharmacist or nurse (preferably all three) to make them aware of the situation and advise you from a medical standpoint to prevent any harm to you or further harm from occurring.


If you already have been harmed or think you may have been harmed by such a mistake, as soon as possible, you should consult with an attorney who specializes in medication error cases.


6. What is the statute of limitations for a medication error?


A statute of limitations is a law which sets the maximum period of time you can wait before filing a lawsuit. These periods of time vary by state. In California, medical malpractice actions must be commenced one year from the date the plaintiff discovers or reasonably should have discovered the injury or three years from the date of the injury, whichever occurs first. Do not delay in consulting a medication error attorney.


7. What kinds of damages are available in a medication error case?


In general, the types of damages available include:
Non-economic damages include pain, suffering, inconvenience, and other non-economic injury. California imposes a $250,000 limit or “cap” on non-economic damages.


Economic damages include medical costs, loss of earnings, and other provable economic losses. There is no limit or cap on the amount of economic damages.


Under certain circumstances, punitive damages may be available.



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