Medication Errors

Posted: February 4, 2017 | Last Updated: February 12, 2017

Approximately 1.3 million people are injured annually in the United States by medication errors.  The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.”

Medication errors can be fatal.  The most common fatal medication error is the administration of an improper dose of medication, accounting for 41 percent of all fatal medication errors.

Many factors can lead to medication errors. The Institute for Safe Medication Practices has identified 10 key elements with the greatest influence on medication use, noting that weaknesses in any of these can lead to medication errors.

  • Patient information
  • Drug information
  • Adequate communication
  • Drug packaging, labeling, and nomenclature
  • Medication storage, stock, standardization, and distribution
  • Drug device acquisition, use, and monitoring
  • Environmental factors
  • Staff education and competency
  • Patient education
  • Quality processes and risk management.

Polypharmacy

The use of prescription drugs is very common and the number of people taking multiple prescription drugs is staggering. Doctors and pharmacists have a great responsibility to their patients to ensure an error does not happen.

Medical professionals must understand the chemical effects of each drug they prescribe as well as the possible side effects when taken with other prescribed and over-the-counter drugs.

More and more, patients are being treated with multiple medications for one or more conditions.  Polypharmacy refers to patients taking more than four medications simultaneously to treat one or more conditions.  Polypharmacy is highly prevalent in patients who see multiple specialists for different medical conditions.

Potentially deadly drug interactions can occur if no single healthcare provider knows the patient’s complete medication picture.  Specific populations significantly at risk for polypharmacy complications include the elderly, psychiatric patients, patients recently admitted or released from the hospital, chronic pain patients, and drug addicted patients.  Drug interactions can be deadly and sudden.

Opioid Overdose

The United States is facing the worst opioid abuse epidemic in the history of modern medicine.  According to the U.S. Centers for Disease Control and Prevention (CDC), around 16,000 Americans die each year from an overdose of opioid painkillers, such as oxycodone, methadone, or fentanyl, accounting for well over half of all prescription related drug deaths in the United States each year.

Those numbers have quadrupled over the last decade and a half.  Each day, 44 people die from prescription painkillers in the United States.  More people die from prescription opioid overdose than heroin, cocaine, and all other drugs combined.

Among people 25 to 64 years old, drug overdose causes more deaths than motor vehicle traffic crashes.  This is such an alarming trend that in November 2011, the CDC declared that deaths due to overdose by prescription medications is the “worst drug overdose epidemic in history.”  Yet, in 2012, health care providers wrote 259 million prescriptions for opioid painkillers, enough for every American adult to have a bottle of pills.

Numerous professional organizations, including the American Pain Society, have created specific guidelines for opioid prescribing.  Utah and Washington States and New York City have also created guidelines for physicians on the prescribing of opioids for pain treatment.  Treatment guidelines are supported by education and training at various levels throughout the system. Prescribers can easily access guidelines and other information via online searches.

The CDC National Center for Injury Prevention and Control, along with the National Institute on Drug Abuse (NIDA), the Substance Abuse Mental Health Services Administration (SAMHSA), and the Office of the National Coordinator for Health Information Technology (ONC) undertook to examine these and other guidelines to identify common elements in prescribing opioids for chronic pain.  Common recommendation elements found in all guidelines include the following:

  • Conducting a physical exam, pain history, past medical history, and family/social history;
  • Conducting urine drug testing, when appropriate;
  • Considering all treatment options, weighing benefits and risks of opioid therapy, and using opioids only when alternative treatments are ineffective;
  • Starting patients on the lowest effective dose;
  • Implementing pain treatment agreements;
  • Monitoring pain and treatment progress with documentation; using greater vigilance at higher doses;
  • Using safe and effective methods for discontinuing opioids (e.g., tapering, making appropriate referrals to medication assisted treatment, substance use specialists, or other services); and
  • Using data from Prescription Drug Monitoring Programs (PDMPs) to identify past and present opioid prescriptions at initial assessment and during the monitoring phase.

Methadone Overdose

Methadone has been used successfully as a treatment for heroin addiction for over 40 years. In the last decade, however, Methadone has become increasingly prescribed for chronic problems like back pain even though it might not help those problems and may actually make the pain worse. Methadone is an especially dangerous drug, even when compared to other opioids.

In 2009, Methadone contributed to more than 30 percent of prescription painkiller deaths, according to the CDC, even though only 2 percent of painkiller prescriptions are for methadone. The number of deaths attributable to methadone overdose is twice that of cocaine and heroin combined.  In 2009, six times as many people died of methadone overdoses than a decade before. The increase in deaths is the direct result of the increased use of Methadone for pain.

For a host of reasons, methadone has special risks as a painkiller. An adverse effect of Methadone is respiratory depression.  Methadone begins to take effect in about 30 minutes. The drug, however, has a long and sometimes difficult to predict half-life that can lead to toxic levels of the drug building up in a patient’s system leading to respiratory depression and death.   The half-life of methadone (the time for blood levels to drop to 50 per cent of the peak concentration) is about 12 to 18 hours for the first dose and about 13 to 47 hours for the second and third days’ doses. The effects of methadone last about 24 to 36 hours.  Accordingly, methadone can build up in a person’s system causing severe respiratory depression and death.

Further contributing to methadone’s risk of respiratory depression is that, unlike other opioids, it does not have an immediate pain relieving or euphoric effect, leading to the user ingesting more medication over a short period of time in an effort to reach a desired effect.  The result is commonly an accidental overdose before the desired effect is ever reached.

Methadone can also seriously disrupt the heart’s rhythm resulting in a prolonging of the QTc interval causing a fatal arrhythmia.  For this reason, numerous medical guidelines call for an EKG before prescribing Methadone to avoid prescribing it to patients who are susceptible to an arrhythmia.  Methadone can be particularly risky when used in combination with certain muscle relaxers, sedative-hypnotics, benzodiazepines, or opioids, which can combine to prolong and magnify the effects of Methadone resulting in death due to an arrhythmia or respiratory depression.

In addition to those recommendations for the prescribing of other opioid medications, guidelines for the prescribing of methadone typically include the following additional recommendations:

  • Clinicians should inform patients of the risk of arrhythmia and respiratory depression when they prescribe methadone;
  • Clinicians should ask patients of any history of structural heart disease, arrhythmia, and syncope;
  • Obtain a pretreatment electrocardiogram for all patients to measure the QTc interval and a follow-up cardiogram within 30 days and annually;
  • Limit the amount or discontinue methadone based on the QTc interval;
  • Clinicians should be aware of interactions between methadone and other drugs that possess QT interval-prolonging properties or slow the elimination of methadone;
  • Clinicians should start at low doses of methadone based on prior opioid exposure, titrate doses slowly, and monitor patients for sedation;
  • Clinicians must use methadone with care in patients who are using concomitant medications with potentially additive side effects. These include medications that (a) alter methadone absorption, metabolism, and / or excretion, (b) have additive or synergistic sedative or respiratory suppressant effects; and / or (3) prolong QTc intervals.

The CDC has concluded that Methadone remains a drug that contributes disproportionately to the excessive number of opioid pain reliever overdoses and associated medical and societal costs.  Health-care providers who choose to prescribe methadone should have substantial experience with its use and follow consensus guidelines for appropriate opioid prescribing.

Providers should use methadone as a pain reliever only where benefit outweighs risk to patients and society. Methadone and other extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis.

How do I Hire You to be my Ohio Medication Errors Lawyer?

The first thing to do is complete the contact form at the bottom of this page. That way, you can put in details that we can review before we schedule a phone call.

You can also call us at 216-777-8856 if you prefer.

You will likely not speak to us immediately, but will schedule a phone or in-person meeting. Why? Because we’re busy working on the important cases other families have entrusted to us. Just like we would not constantly take phone calls when we’re entrusted to work on your case.

You should also gather all the records and papers you have from the medical providers, go back and look for dates, names, and events that happened, and otherwise prepare to discuss the case. We’ll have a meeting and, if it seems like a case we’d be a good fit for, we’ll move into an investigation phase.

Once we’ve investigated, we’ll candidly tell you what we think about what happened, whether the medical provider is to blame, and what we think about the strength of the case.

Fair warning: we only take on clients whose cases we believe have very strong merits. We’re not lazy—the cases are still very complex, difficult, and expensive—but the risk to your family of being drawn into a difficult process with little chance of a positive outcome is not something we do.

Which means when we do take on a case, our reputation tells the other side this is a serious case we believe in.

If for whatever reason we do not take on the case, and we think there is some merit to the case, we’ll try and help you find a lawyer who might take it on.

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