How Medication Errors Occur in Nursing Homes

When you entrust the care of a loved one to a nursing home or long-term care facility, you expect a proper standard of care. When that trust is broken in the form of elder abuse—which occurs when a resident suffers harm or neglect—it can lead to serious illness, severe injury, psychological damage, and even death. One of the most common forms of elder abuse is medication errors, which include any mistake in the prescribing, dispensing, or administering of a drug. Medication errors are part of a broader problem –– medical errors, which is now the third-leading cause of death in the United States, having surpassed Alzheimer’s and diabetes.

Medication errors are often the result of ineffective prescribing, sloppy handwriting, misleading packaging, incorrect dispensing, and issues with manufacturing. Though these kinds of mistakes can happen in any healthcare setting, they’re especially prevalent in nursing homes. In fact, a study published in the Journal of the American Geriatrics Society stated that 16 to 27 percent of all nursing home residents are victims of medication errors. These types of mistakes can have severe to fatal consequences, especially for elderly and more vulnerable residents.

What Are Medication Errors in Nursing Homes?

Elderly individuals often require several prescription medications such as blood thinners, anti-psychotics, chemotherapy drugs, laxatives, heart medication, and blood pressure medication to manage their long-term health issues. While exact numbers are difficult to estimate, data suggests that the average senior fills between nine and eleven prescriptions a year, and about 36 percent of older patients take five or more prescription medications daily. Many of these medications require precise preparation and administration to work effectively.

Medications in nursing homes are generally administered during a “med pass,” which can take anywhere from three to eight hours. During a med pass, a nursing home worker will make rounds to every patient who needs medication while pushing a cart that carries the prepared drugs. A registered nurse (RN) or physician must prepare and administer all medications, though sometimes other individuals are permitted to distribute medication under the supervision of a nurse. Each nursing home is required to have clearly defined, written procedures.

When a nursing home is managing the care and medication of dozens of residents, particularly if the nursing home is short-staffed, medication errors can occur. This type of miscalculation often occurs when a drug is prepared in the wrong fashion, administered incorrectly, or managed differently than instructed by a physician or pharmacist.

Common Medication Errors

If your loved one is living in a nursing home, it’s important to understand the prevalence of medication errors in these facilities and to take action steps should they be needed. Medication errors are more common than most people realize and identifying why they happen can help prevent future mistakes. Here are the common types of medication errors:

Knowledge-Based Errors

If a staff member doesn’t have enough information about the medication they’re administering—perhaps because they’re unaware of a patient’s medical history, allergies, diet, or other prescriptions—knowledge-based errors can be made. Communication problems with senior residents are fairly common.

Rule-Based Errors

These types of mistakes occur when an employee is improperly trained, fails to follow protocol, is fatigued, or is unclear of the prescription instructions. Rule-based errors can stem from a nursing home with low-caliber care staff and improper facility management. Mistakes often occur if there are staffing shortages, underpaid staff workers, a lack of experience among caregivers, and poor supervision and accountability.

Action-Based Errors

Medication mistakes can still occur even when employees have the correct information and intentions. Action-based errors are the most common type of medication mistake and stem from a member of the staff performing an action that wasn’t intended, such as a slip of the pen when prescribing. Another example is putting the incorrect pills in the bottle.

Memory-Based Errors

If a nurse administers a medication twice without realizing it, serious consequences could ensue for the patients. Because nursing home caregivers are often overworked and fatigued, memory-based errors are fairly common. Another example of this type of error occurs when a nurse provides a specific medication knowing the patient to be allergic but forgetting.

Other medication errors include slicing or cutting a pill that shouldn’t be split, providing inadequate liquids with medications, giving expired medication, using an incorrect med-administration technique, skipping a dose of medication, and giving medication at the wrong time.

Medication Malpractice

Although most medication errors occur as a result of mistakes, confusion, or carelessness, malpractice can also occur when nursing home facilities or individual workers intentionally disobey a doctor’s instructions for medication distribution and instead decide to improvise treatment or abuse the system for their own gain. Intentional medication errors can be grounds for a lawsuit. These types of deliberate errors can include:

Ignoring an Order

Errors of this nature occur when a nursing home employee knowingly chooses to ignore a doctor’s orders, disregards a prescription’s packaging instructions, or discontinues medication without documenting the change or receiving approval from an RN or physician. This may be done to decrease the labor required for medication distribution and increase the speed of med passes.

Medication Mismanagement

This term applies to nursing home facilities that fail to stock or order a specific known prescription for the residents in their care, which then means the medication isn’t available to the patients who need it.

Medication Borrowing

As the term suggests, medication borrowing refers to the practice of borrowing a pill from one patient to give to another. Nursing home staff might do this if one person runs out of medication or the medication is missing during a med pass and they don’t wish to go and retrieve the correct medication.

Stealing Medication

As prescription drug addiction rates rise, diverting medications from nursing homes becomes more and more lucrative. If a member of the nursing home staff is caught taking a patient’s medication for their own personal use or stealing the pills for sale to others, lawsuits can ensue.

Rights and Legal Recourse

All nursing home and long-term care facility residents have the right to be informed about the medications they’re taking and any changes to their prescriptions or state of health. Family members also have this right, though facilities must also follow the Health Insurance Portability and Accountability Act, which limits access to a patient’s medical records. Sometimes, however, facilities will intentionally prevent family members from obtaining medical records in the case of error.

Likewise, patients have the right to refuse treatment and be informed about the risks associated with refusal and alternative courses of treatment.