Recently in Medication Errors Category

Every year, many nursing home patients are hospitalized due to adverse drug reactions. The multiple medications that are often prescribed to these elderly patients increase their risk for this type of complication. Adverse drug reactions are commonly seen with anticholinergic drugs, sedative-hypnotic drugs, and neuroleptic drugs, especially when prescribed concurrently.

Careful monitoring of the patient's condition and review of their medical history is necessary to avoid an adverse drug reaction. Problems may occur when a patient's medication regimen is altered without careful review of current medications, or perhaps an older medication is continued when it is no longer needed. Sometimes old prescriptions are re-prescribed without being evaluated. It is also important that PRN ("as needed") orders are written with full instructions and that those instructions are followed.

When prescribing medication, the patient's age, weight, and gender should be considered. Older adults generally weigh less and have an increased sensitivity to drugs due to decreased liver and kidney function. Dosage should be altered accordingly.

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of an adverse drug reaction, medication error or prescription mistake.

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A recent Clinical Research Study entitled "The Safety of Warfarin Therapy in the Nursing Home Setting" published in the American Journal of Medicine, Volume 120, No. 6 (June 2007) examined the preventability of adverse warfarin (also known as Coumadin) events in the nursing home setting.  This study concluded that the use of warfarin (Coumadin) "in the nursing home setting presents substantial safety concerns for patients.  Adverse events associated with warfarin therapy are common and often preventable in the nursing home setting.  Prevention strategies should target the prescribing and monitoring stages of warfarin management."   

Coumadin (generic name: warfarin) is an anticoagulant, or blood thinning medication, that is prescribed to many nursing home patients who are at risk for developing blood clots that could result in heart attacks or strokes.  It is a very powerful drug that is also still used as rat poison and requires careful monitoring in humans.  In our practice, we have seen the devastating results when nursing homes fail to take the proper steps to ensure that their residents receive proper administration and/or monitoring of their Coumadin therapy. 

Patients taking Coumadin require periodic blood samples to measure their clotting time, or INR (International Normalized Ratio), and may require periodic adjustments of their daily dosage of Coumadin in order to ensure that their blood remains within their predetermined therapeutic range.  The physician overseeing a patient's Coumadin therapy will set a target INR range usually between 2.0 to 3.0.  Patient's with mechanical heart valves may require target INR in the range of 2.5 to 3.5.    

If a patient takes too much Coumadin, they can suffer life-threatening complications due to excessive bleeding.  If a patient takes too little, their blood will clot and they can suffer a heart attack or stroke. 

The nursing home staff must ensure that the resident takes the appropriate dosage and receives regular INR testing.  The nursing home staff must also ensure that the doctor overseeing the care timely receives the testing results, and is immediately made aware of all significant changes in the patient's condition.  In the event that the physician cannot be reached, residents experiencing significant changes in condition should be transported to a hospital immediately.

The nursing home staff must also ensure that patients taking Coumadin are provided with the appropriate diet because some foods interact with the drug.  Many commonly used medications such as antibiotics also interact with Coumadin.  Additionally, the nursing home staff must institute and implement fall precautions because residents taking Coumadin may have increased bleeding risk.

Ultimately, Coumadin administration and/or monitoring errors may be avoidable so long as nursing homes develop and implement policies and protocols aimed at: (1) ensuring that the resident receives proper INR testing, and that the results are timely analyzed and acted upon; and (2) ensuring there is a clear flow of information provided to all health care providers (especially the prescribing doctor) who interact with the resident.

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of Coumadin administration and/or monitoring errors, bed sores (also known as pressure sores or decubitus ulcers), dehydration/malnutrition, nursing home falls, elder abuse or elder neglect.

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As a result of their cognitive and physical disabilities, nursing home patients are often totally dependant upon the nursing home staff to provide assistance with all activities of daily living, including medication administration. 

Medication errors can result in serious medical complications and ultimately result in death.  According to the Institute of Medicine's 2000 report entitled "To Err is Human - Building a Safer Health System," medication errors result in approximately 7,000 deaths of Americans annually.  These medication errors are often preventable and result from common medication administration and prescribing errors including: administering the wrong dosage; using the wrong drug; failing to monitor and document the patient's response; and failing to follow doctor's orders.

Under Maryland law, when a nursing home resident dies as a result of nursing home negligence, two causes of action arise: (1) a wrongful death claim; and (2) a survivorship claim.

A sample redacted Maryland Circuit Court Wrongful Death/Survivorship Complaint involving claims of nursing home negligence relating to medication errors involving the drug Coumadin follows:

COMPLAINT

Plaintiffs, [insert name], individually and as personal representative of the Estate of [insert name], [insert wrongful death beneficiaries], by their attorneys, David L. Feldstein and Dever & Feldstein, LLC, hereby file this Complaint against Defendants, [insert names], and in support thereof, state as follows:

PARTIES AND JURISDICTION

 1.   At all times material to this case, Plaintiffs have been citizens and residents of the State of Maryland.  Plaintiffs [inset names] are the surviving children of the decedent, [insert name], and are wrongful death beneficiaries in this action pursuant to Section 3-904(a) of the Courts and Judicial Proceedings Article of the Maryland Annotated Code.
 2. [Insert name] is the duly appointed Personal Representative of the Estate of [insert name].  The Register of Wills for [insert County], Maryland issued Letters of Administration to [insert name] on [insert date].  The Estate of [insert name] is bringing this survival action pursuant to Section 7-401(x) of the Estates and Trusts Article of the Maryland Annotated Code.
 3. At all times material to this case, [insert Defendants] have been corporations engaging in the practice of medicine and nursing home services in Baltimore City, Maryland, and acting through actual and/or apparent agents, servants and/or employees.
 4. The venue for this claim is proper in Baltimore City, Maryland.  The amount in controversy exceeds Thirty Thousand Dollars ($30,000.00).

FACTS COMMON TO ALL COUNTS

 5. At all times mentioned and relevant herein, [insert Defendants] have owned and operated the nursing home facility known as [insert name of nursing home] located at [insert address], and have held themselves and their agents, servants and employees out to the general public as experienced, competent and capable providers of medical and nursing home services, and in such capacity owed a duty to [insert name] and the Plaintiffs to render that degree of medical care and skill which is ordinarily rendered by those who devote special study and attention to the practice of medicine and nursing home services.
 6.  At all times mentioned and relevant herein, all of the individuals at [insert name of nursing home] who participated in the care provided to [insert name] were acting on behalf of and within the scope of their employment with [insert names of Defendants]. 
 7. On or about [insert date], [insert name] suffered a fall at home and was taken to [insert name of hospital] for evaluation and treatment.  [Insert name] was diagnosed with a small pulmonary embolism and was started on Coumadin therapy for anticoagulation.
 8. On [insert date], [insert name] was transferred to the [insert name of nursing home] for continuing rehabilitation.  [Insert name] attending physician noted on the transfer summary that [insert name] could be continued on Coumadin therapy at the nursing home provided his anticoagulation would be closely monitored and as long as someone is watching him and he is not at risk for fall.
 9.  At the time of her admission to the [insert name of nursing home], [insert name] was assessed to be at high risk for falls due to his history. Despite this assessment, the staff at the [insert name of nursing home] failed to initiate proper fall precautions for [insert name], and as a result, he suffered serious falls at [insert name of nursing home] on three separate occasions.  Following his third fall, [insert name] was taken to emergency department of [insert name of hospital] where he was diagnosed with head trauma and fractures of his right hip and right femur.  Emergency room physicians examined [insert name] and found three Fentanyl patches on his body.  Fentanyl is a powerful narcotic with a potency many times that of morphine.  A single Fentanyl patch may be applied every three days after removing the old patch.  The emergency room doctors quickly determined that [insert name] had been given excessive amounts of Fentanyl at [insert name of nursing home] and ordered that [insert name] be given Narcan, a drug used to reverse the effects of narcotic intoxication.       
 10. Emergency room physicians also quickly determined that [insert name] had been given excessive amounts of Coumadin at [insert name of nursing home].  Laboratory tests showed that that [insert name]'s anticoagulation, as measured by his INR, or international normalized ratio, was 50, or approximately 20 times higher than his target range of 2.5.  This excessive anticoagulation, along with the trauma from the fall, caused [insert name] to suffer severe internal hemorrhaging. [Insert name] was promptly evaluated by a cardiologist who noted the following in his chart: "the reason for blood loss is likely the very high INR and I would recommend correcting the coagulopathy with fresh frozen plasma and transfusing to control the hematocrit.  Nevertheless, given his present condition, the chances of meaningful survival are poor, and I have communicated this to the family, who understand."
 11. Doctors at [insert name of hospital] attempted to reverse [insert name] anticoagulation by urgently transfusing multiple units of plasma and blood products, but [insert name] was simply too unstable, and he quickly deteriorated to hemorrhagic shock, kidney failure, and respiratory failure.  [Insert name] was ultimately pronounced dead at 8:29 p.m. with members of his family at his bedside.  

COUNT I  (Professional Negligence)

 12. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 13. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, owed Plaintiff a duty to exercise reasonable care in their treatment of him.
 14. Defendants, individually and through their actual and/or apparent agents, servants and/or employees, breached the above-described duty of care to Plaintiff, thereby deviating from the applicable standards of care, and were otherwise negligent, careless and reckless in that they, among other things:
(a) failed to adequately and timely diagnose and treat [insert name] medical conditions;
(b) failed to properly manage [insert name]'s pain medications; 
(c) failed to properly manage [insert name]'s anticoagulation therapy;
(d) failed to respond in a timely and appropriate manner to the results of [insert name] coagulation studies; and
(e) were otherwise negligent and violated the applicable standards of care.
15. As a direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, Plaintiff was caused to sustain serious, painful and permanent injuries to his body, including great physical and mental pain and suffering, and, ultimately, death.
16. As a further direct and proximate result of the above-described deviations from the applicable standards of care and breaches of duty by Defendants, Plaintiff, among other things, was forced to undergo medical treatment, and, as a result, was obliged to expend sums of money for medical, hospital and other care and treatment and was precluded from engaging in his normal and usual pursuits and activities, among other injuries and damages.
17. Had Defendants followed the appropriate and applicable standards of care, Plaintiff would not have suffered the above-identified injuries, damages and death.
18. The injuries and damages herein complained of were directly and proximately caused by the negligence and want of care of Defendants, with no negligence on the part of Plaintiff contributing thereto.

WHEREFORE, Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

COUNT II  (Wrongful Death)

 18. The Plaintiffs incorporate all of the allegations contained in the above paragraphs as if those allegations are set forth in this Count.
 19. As a direct and proximate result of the Defendants' above-described negligence in causing the death of [insert name], [insert wrongful death beneficiaries] have sustained, among other things, pecuniary loss, mental anguish, emotional pain and suffering, loss of society, loss of companionship, loss of comfort, loss of protection, loss of parental care, loss of filial care, loss of attention, loss of advice, loss of counsel, loss of guidance and loss of education. 

 WHEREFORE, the Plaintiffs request that a judgment be entered against the Defendants for compensatory damages in excess of Thirty Thousand Dollars ($30,000.00) and any other relief to which this Court finds them entitled.

*  *  *

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of medication administration error/prescription mistake, bed sores (also known as pressure sores or decubitus ulcers), dehydration/malnutrition, nursing home falls, elder abuse or elder neglect.

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The United States Centers for Disease Control and Prevention ("CDC") has recognized that as the American population grows older, more and more individuals become vulnerable and dependent upon others to meet their most basis needs.  According to the CDC, a 1996 study found that more than 500,000 people age 60 or older were victims of neglect or abuse during a one-year period.  

Sadly, nursing home residents are all too often killed as a result of nursing home neglect or abuse.  For instance, nursing home residents may develop infected stage 3 or infected stage 4 bedsores (also known as pressure sores or decubitus ulcers), experience falls, dehydration, malnutrition, or medication errors/prescription mistakes resulting in painful and life-threatening injuries. 

Under Maryland law, when a nursing home resident experiences death secondary to nursing home negligence, two causes of action arise: (1) a wrongful death claim; and (2) a survivorship claim.

First, the wrongful death claim is a statutory cause of action governed by Sections 3-901 et seq. of the Maryland Courts and Judicial Proceeding Article of the Maryland Annotated Code.  The Maryland Wrongful Death Statute makes clear that there can only be "one action . . . in respect to the death of a person."  See Section 3-904(f).  Section 3-904 sets forth the categories of individuals who are wrongful death beneficiaries.  Generally, the decedent's surviving parents, spouse and surviving biological or legally adopted children are wrongful death beneficiaries who must be included in a claim for wrongful death.  Because there can only be one cause of action for wrongful death, it is required that all wrongful death beneficiaries be joined as plaintiffs and named in the lawsuit.

The wrongful death claim seeks to collect damages suffered by the wrongful death beneficiaries in their own right as a result of losing their loved one.  Wrongful death beneficiaries are generally entitled to seek monetary recovery for their emotional pain and suffering experienced secondary to the loss of their family member.  These damages are subject to Maryland's Noneconomic Damages Cap.

The second cause of action arising following the death of a nursing home resident is the survivorship claim.  This claim is brought on behalf of the decedent's estate by the personal representative of the estate.  In situations where the decedent had a will, the personal representative is named in the will.  In the event the nursing home resident dies without a will (also known as dying intestate), it may be necessary to file a Petition for a Small Estate for litigation purposes in the Orphan's Court of the Maryland County where the decedent resided at the time of his or her death in order to have a personal representative appointed.

The survivorship claim seeks to recover for certain categories of the decedent's individual damages that could have been recovered if he or she had survived, including their conscious pain and suffering resulting from the nursing home neglect (subject to Maryland's Noneconomic Damages Cap), medical bills resulting from the negligence, and funeral bills.  In essence, the personal representative of the estate steps into the shoes of the decedent in order to assert his or her claims of injury and damages.

Importantly, the personal representative does not personally recover for these claims of survivorship damages.  Rather, any monies recovered pursuant to the survivorship action must be deposited into the bank account of the decedent's Estate and distributed in accordance with his or her will (or, if there is no will, distribution is made in accordance with Maryland's laws of intestacy contained in Title 3 of the Trusts and Estates Article of the Maryland Annotated Code). 

Nursing home abuse and negligence lawsuits are vigorously defended by the nursing home and their insurance company and attorneys.  Ultimately, successful recovery in these cases require that the surviving family members and wrongful death beneficiaries unite and work together in cooperation as a team in the pursuit of the case so that the underlying circumstances can be investigated promptly, and then litigated aggressively by the lawyers representing the family.    

Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bedsores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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Your Name: Email Address: Phone Number:
According to the American Diabetes Association, 8% of the United States population (or 23.6 million Americans) have been diagnosed with diabetes.  The prevalence of the diagnosis of diabetes has increased 13.5% from 2005 through 2007.  This disease often affects elderly nursing home residents and requires careful monitoring of blood sugar and careful administration of insulin or other medications in order to prevent serious complications of the disease including kidney failure, hypoglycemia (also known as insulin shock), amputations of legs or feet, heart attacks, blindness and even death.

Diabetes is a chronic, life long disease involving abnormalities in the body's ability to use sugar and is characterized high levels of sugar in the blood.

Type 1 diabetes (insulin-dependent diabetes) often affects children and others whose bodies do not produce enough insulin.  Insulin is a hormone that is generated by the pancreas and controls blood sugar.  These individuals require daily insulin injections to lower their blood sugar.  There are several different types of insulin that differ based on various factors including onset, peak and duration.

Type 2 diabetes (adult onset diabetes) is a more common, rapidly increasing condition in this County under which the body does not properly respond to insulin.  This form of the disease can result from lifestyle issues including obesity/weight issues, diet, lack of exercise and high blood pressure.  Some people with type 2 diabetes may not even know it because the condition may not produce any symptoms.  Certain types of food that are high in sugar (cake, chocolate, candy) can trigger and compound the problems of type 2 diabetes.  The treatment used for type 2 diabetes depends upon the physiological defects experienced by the individual and may include pill(s) instead of or along with insulin injections.  There are many different types of medications that may be used in combination, requiring careful monitoring and oversight.

The good news is that with proper treatment and medical oversight, blood sugar can be kept at the proper levels to prevent or significantly delay the harsh, potentially life-threatening complications of this treatable disease.  Nursing home patients, however, are often totally dependent upon the nursing home staff to perform this care and treatment as a result of cognitive and physical disabilities.     

Sadly, we have seen too many situations where preventable, serious injury and death has resulted from a nursing home's failure to follow diabetes medication protocols in residents with type 2 diabetes.

One scenario that can be especially dangerous involves patients who require nursing home care following cardiac surgery.  These patients may require insulin therapy and medications such as Glyburide (a drug that lowers blood sugar) in order to tightly control blood sugar in the post-operative period.  The nursing home may be responsible for weaning the patient off insulin therapy as they simultaneously increase the dose of Glyburide to effective levels.  The failure of the nursing home staff to perform these functions properly can prove fatal.  For instance, the nursing home staff's failure to reduce the insulin therapy may result in drug-induced hypoglycemia (low blood sugar).  Unless timely recognized and treated, severe hypoglycemia can lead to generalized convulsions followed by amnesia, unconsciousness and, ultimately, death.  Such complications are entirely avoidable so long as the nursing home staff follows the physician orders and carefully monitors the patient's condition and blood sugar levels.

Please feel free to contact the attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury as a result of a nursing home medication error, bedsores (also known as pressure sores or decubitus ulcers), dehydration, falls or elderly abuse or neglect.  
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About this Archive

This page is an archive of recent entries in the Medication Errors category.

Legionnaires' Disease is the previous category.

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