In the complex and challenging landscape of the American healthcare system, medication errors stand as a pervasive issue that, unfortunately, casts a shadow on patient well-being, safety, and satisfaction.
There are close to 7,000 prescription medications and over-the-counter drugs available to consumers in the United States. The public also regularly uses thousands of health supplements, homeopathic herbs, and topical ointments to treat their medical problems. Each year, over 8,000 Americans die because of medication errors. Thousands more experience side effects or adverse reactions and do not report their complications. Medication errors are estimated to cost the healthcare system over $40 billion annually. Patients who develop complications, physical pain, or suffering associated with medication errors often develop a distrust for the healthcare system and overall reduced patient satisfaction.
Medication errors can also occur at any step of the patient care process, including:
Over 50% of medication errors occur in the ordering and prescribing process. This is where the practitioner orders or prescribes the wrong route, dose, or frequency. The remaining 50% of errors occur in the administration and monitoring process. Nurses play a pivotal role in performing or catching medication errors due to their direct involvement in administering and monitoring medications and their proximity to patients.
A medical malpractice attorney assessing a case involving a medication error must examine and understand the multifaceted nature of medication administration in any setting to build a strong case for their client. A legal nurse consultant is uniquely positioned to collaborate with an attorney and help them understand the medical records by:
1. Reviewing the medical records: This includes prescriptions, medication administration records, vital signs, and any communication between all healthcare professionals regarding the medication in question.
2. Establishing negligence: Investigate whether the medication error occurred due to a prescribing mistake, incorrect dosage, administration error, or monitoring issue.
3. Determining damages: This involves examining additional treatments, any long-term health implications, or pain and suffering due to the error.
4. Review regulatory compliance or standard protocols regarding the medication in question. This includes reviewing and providing documentation regarding established protocols, standards of care, guidelines, and regulations about medication administration. Any deviation from these standards could strengthen the case.
A 45-year-old man was admitted to the intensive care unit (ICU) to manage a life-threatening cardiac arrhythmia of atrial fibrillation with a rapid ventricular rhythm (Afib with RVR) and a heart rate sustaining in the 150-160 range. The physician ordered a 150 mg loading dose of amiodarone intravenously, followed by a maintenance infusion of 1mg/min for 6 hours, followed by a reduction maintenance infusion to 0.5 mg/min for the following 18 hours.
The nurse misread the medication administration instructions and administered the entire 150 mg loading dose as a rapid IV push instead of a slower infusion over one hour as intended.
The patient was under continuous cardiac monitoring, and upon administration, initially, the nurse noted that the patient’s blood pressure to be 110/68 with a mean arterial pressure (MAP) of 82. 30 minutes later, the blood pressure was 88/52 and a MAP of 64. The patient’s heart rate was still in the 130s so the nurse continued the infusion without notifying the physician. The nurse was busy with her other patient and when she checked on them an hour later the blood pressure was 66/30.
The patient subsequently went into cardiac arrest and was unable to be resuscitated.
Our experienced nurses at Bridge Point Legal Nurse Consulting provided crucial insight into the deviations within the standard of care for administering amiodarone. Including:
Failure to follow the physician/pharmacy instructions for amiodarone: Amiodarone is a medication that can cause or worsen low blood pressure. Unless otherwise instructed by the physician, this medication must be paused or stopped if the systolic blood pressure (top number of blood pressure reading) falls below 90. The physician should have been notified at the first indication that the blood pressure was dropping 30 minutes after the initiation of the infusion.
Failure to follow the ICU standard of care for low blood pressure (hypotension) management: When the blood pressure dropped and the MAP fell below 65, it is that standard of care to notify the physician of this change. Typically, instructions will be given to mitigate this. In this case, the physician likely would have added a vasopressor medication or given an IV fluid bolus to support the blood pressure, and/or pause the amio until the blood pressure was back to a normal range.
Failure to follow one of the 6 rights of medication administration: right time/rate: Continuous IV infusions vary greatly from an IV push, and certain medications can have catastrophic outcomes if given incorrectly. By giving this medication much faster than ordered, the patient suffered complications that could have been avoided.
Our experienced registered nurses can help medical malpractice attorneys better understand the complexities of medication administration errors, especially in critical care areas where details matter. This is vital to building a compelling argument to demonstrate the healthcare provider’s liability and patient damages.
Tariq RA, Vashisht R, Sinha A, et al. Medication Dispensing Errors and Prevention. [Updated 2023 May 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/
Florek JB, Lucas A, Girzadas D. Amiodarone. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482154/