Why Medication Mismanagement is Common in Facilities

Medication mismanagement is unfortunately common in assisted living and long-term care facilities. In fact, medication administration is a complex process that presents many risks to individuals dependent on staff for accurate administration. There are many types of medication errors and multiple factors that lead to medication administration mistakes, ranging from human error to failures of facility systems and processes that should ensure accuracy. Patients and facility residents can suffer serious harm when their medications are not managed accurately.

Many Types of Medication Errors

A wide variety of medication errors can occur in facilities due to process mismanagement. A medication error is considered a preventable event that may harm the individual. Some of the preventable events include the following.

• Wrong medication amount
• Wrong medication
• Drug was not diluted as required
• Required medication was never administered
• Medication given was harmful to the person
• Medication was administered incorrectly, i.e., via the muscle versus intravenously
• Expired medication
• Repeat medication dose schedule was not followed
• Medication requiring a prescription was not physician-authorized
• Drugs are mislabeled

A facility resident may experience a drug reaction, worsened medical condition and treatment failure. An experienced nursing home abuse lawyer has handled many medication mismanagement cases in which medication errors caused disability or death.

Unfortunately, medication errors are common. Various pharmacy organizations and research projects have found that up to 27% of facility residents have experienced a medication error. The Institute of Medicine (IOM) Committee on Quality of Health Care defines a negligent adverse event as the failure of a qualified healthcare worker to meet a reasonable standard of healthcare, or substandard medical care that meets the legal criteria for negligence and causes harm. Ultimately, medication mismanagement stems from the negligent behavior of healthcare workers and from poorly designed facility systems and processes.

Why Do Medication Errors Occur?

The risk of medication mismanagement is high in facilities for several reasons. One is that many assisted living and long-term care facilities are understaffed. In fact, the American Health Care Association and National /Center for Assisted Living survey found that 94% of the 14,000 nursing homes and long-term care facilities it represents are understaffed.

Understaffing leads to worker burnout and reduced attention to critical details in patient care. It also makes it more challenging to ensure that newly hired staff get adequate training. They must learn how to utilize the in-house electronic charting system, medication protocols and general operating procedures. It is also important for facility staff to stay up-to-date on residents’ specific needs, which can change. This training is in addition to the need to stay current on medications and their risks. Understaffing and training are interrelated in terms of increasing the risk of medication mismanagement. High staff turnover, coupled with understaffing, results in facility workers not receiving proper training.

Many people are involved in medication management: physicians, nurses, pharmacists, nursing aides and more. Communication between departments, healthcare professionals and shifts must be highly accurate to prevent medication errors. Some of the miscommunications that occur include outdated medication orders, incorrect transcription of medication orders, failure to discontinue old prescriptions, and missing patient information, such as allergies. A high-risk point in care is when an individual is transferred from one medical facility, such as a hospital, to a long-term care facility.

Polypharmacy is a situation in which facility residents are taking multiple medications, often prescribed by different doctors, such as general practitioners and specialists. They include drugs to treat heart conditions, diabetes, sleep disorders and blood pressure. The multi-medication schedule creates opportunities for medication mismanagement. They include overmedication, dangerous drug interactions and missed medications.

Also contributing to medication mismanagement is a poor medication management system that is not audited regularly. Lack of quality control increases the likelihood that medication errors go undetected. Periodic auditing can identify repeated missed doses, overuse of sedatives, inaccurate records and various poor medication practices, such as the presence and use of expired medications.

Poor patient documentation systems are yet another source of medication mismanagement. Poorly designed systems or poorly maintained systems will lead to medication errors. For example, incorrect data or delayed dose entry poses a risk of harm to patients. Duplicate patient profiles and failure to reconcile medications can also lead to medication mismanagement.

Holding Facilities Accountable

When family members move a relative into a facility, it is because the resident needs more assistance than at-home care can provide. It is with the belief that a loved one will receive good medical care and be safe. Medication errors can lead to severe consequences.

A resident experiencing an adverse reaction because of medication errors may develop new medical issues or even die. Facility residents may have an increased risk of falling, and many suffer physically and mentally. A facility resident is likely to experience anxiety when the quality of life is reduced.

It can be overwhelming and frustrating to address medication mismanagement. The assisted living and long-term care facility is unlikely to admit to making errors willingly. Given the complexity of the medication system in general, how does a family prove their loved one is a victim of one or more medication errors? They must gain access to all the medical records, overcome privacy laws and have expertise in evaluating events. Adding to the barriers to holding facilities accountable for medication mismanagement is the lack of an established methodology for reporting errors.

A nursing home abuse lawyer specializes in assisting families and residents of nursing homes in several ways. The lawyer gains legal access to facility records, including medication administration logs and staff training logs. Working with a network of pharmacists and physicians, accepted standards of care are identified, and the facility’s failures to adhere to them are identified. The abuse lawyer communicates directly with the assisted living or long-term care facility and insurance companies to ensure the family recovers damages for medical expenses and other costs of care.

Though these are complex cases, the outcomes benefit more than the person experiencing the medication error or other risk factors for nursing home abuse. Bringing the issues into the light forces the facility to make critical changes in its systems and procedures, improving safety for all vulnerable residents.