Nearly half the people in the United States take at least one prescription medication on a regular basis, and one in six people take three or more medications, according to statistics released by the U.S. Department of Health and Human Services. Between 1998 and 2005, the frequency of adverse drug reactions, including serious injury and death, more than doubled, according to an article published in the Archives of Internal Medicine on September 10, 2007.
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The Joint Commission on Accreditation of Health Care Organizations is a non-profit organization responsible for evaluating and accrediting medical institutions, including hospitals, nursing homes, independent or freestanding laboratories and rehabilitation centers across the United States. The JCAHCO adopts and implements standards that govern practices and procedures to be followed at the institutions that it accredits. Violations of these standards may be powerful evidence of medical malpractice.
It is widely recognized that medication errors account for well over a million deaths or serious illnesses in this country every year. The medication errors may be attributable to physician error prescribing the medication, pharmacy error either transcribing or compounding the medication, or point of care, or bedside error (nurse, physician assistant) administering the medication. Some problems are the result of medications sounding alike, poor penmanship on the part of the prescriber, and improper dosing of the medication. Medication errors can occur in hospitals, clinics, out-patient facilities, stand alone surgical centers and nursing homes. All of these events may give rise to a medical malpractice claim.
On January 25, 2006, the JCAHCO issued a special reminder known as a Sentinel Event Alert, which dealt with the use of “medication reconciliation” to help prevent medication errors. The alert recognized that particular risks to patients are raised during transition points of medical care, notably when a patient is admitted to, transferred within, and discharged from an institution. The standard that the JCAHCO has established for dealing with medication reconciliation is designed to prevent omissions, medication duplication, dosing error, and harmful interaction of medications. This is done by closely comparing the patient’s current medications to the medications prescribed within the institution, to special medications related to procedures, to pre- and post- operative medications, and to medications prescribed upon discharge. There is also a concern expressed by the JCAHCO with the use of blanket orders, such as “resume all pre-surgery medication,” as such an order is particularly susceptible to error and thus is prohibited under the Commission’s standards. Death or serious injury resulting from the use of a blanket order would likely create a solid foundation for a successful medical malpractice case.
In the September 2007 issue of Joint Commission Journal on Quality and Healthcare Safety, Frank Federico, RPh from the Institute of Health Care Improvement in Cambridge, Massachusetts, notes in an article that the administration of medication is perhaps the most common form of health care intervention in the United States, and is also the most common intervention associated with adverse events for hospitalized patients. He writes that there are over 400,000 adverse medication events each year in this country. The most frequent types of medication errors involve the use of anticoagulants (Warafin and Heparin), sedatives, narcotics and insulin. The report summarizes specific recommendations for improving safety for patients. The recommendations are largely common sense practices that should be implemented. These are not new ideas, but rather an effective collection and articulation of practice standards that can no longer be avoided by hospitals seeking to avoid accountability for grave injuries inflicted as a result of preventable medication errors.
On September 24, 2008, the Joint Commission issued another Sentinel Event Alert relating strictly to the use of anticoagulants. The Joint Commission noted that patients under consideration for use of anticoagulants must be carefully screened for contraindications and drug interactions, and they must be carefully monitored to ensure effectiveness and for side effects and overdosing, the latter of which can cause dangerous if not fatal hemorrhage.
There are a number of other medications that require close monitoring by health care provider,s and the failure to adhere to the applicable standards of care may constitute actionable medical malpractice. For example, a diabetic patient prescribed insulin to regulate blood sugar must be adequately monitored. Failure to properly monitor insulin has been cited as one of the top reasons for drugs causing serious injury as a result of an adverse event. The mismanagement of a patient taking insulin can result in low blood sugar that can lead to problems with balance, and possibly affect levels of consciousness that can result in an accident. Balance problems can lead to falls that can cause fractures and traumatic brain injury.
Other serious medical problems can result from administration of the wrong medication or medication to which a patient is allergic. These mistakes can result in anaphylaxis (shock), respiratory distress, or serious skin reactions such as Toxic Epidermal Necrolysis (TENS) or Stevens Johnson Syndrome (SJS.) Other significant problems are caused by prescribing or administering an incorrect dose of medication and ignoring dangerous drug interactions.
Withholding medication can also cause serious illness or death. The December 11, 2007 edition of Neurology, the Journal of the American Academy of Neurology, reports that sudden interruption of oral statin medication (cholesterol lowering drugs such as Lipitor™, Zocor™, Vytorin™, etc.) in patients suffering from an acute stroke can enhance the risk of death or dependency four fold (Neurology 2007 Aug 28; 69:904.).
If you or a loved one has been injured as a result of an adverse drug reaction or the improper withholding of medication, it is important to consider whether the injury was caused by the failure of a health care provider to adequately monitor the use of the medication or was caused by the commission of malpractice in the administration of the medication. If our Connecticut medical malpractice lawyers can be of assistance, please do not hesitate to contact us.