The Scale of the Problem
Medication errors in nursing homes are far more common than most families realize. Studies have estimated that the average nursing home resident is subject to at least one medication error per month, and that a significant percentage of these errors have the potential to cause serious harm. The types of errors range from administering the wrong medication or the wrong dose to failing to administer prescribed medications at all, giving medications at the wrong time, failing to monitor for adverse effects, and continuing medications that should have been discontinued.
For elderly residents who typically take multiple medications for multiple chronic conditions, the risk of harm from medication errors is compounded. Drug interactions, adverse reactions, and dosing errors can cause falls, confusion, gastrointestinal bleeding, cardiac events, respiratory depression, and death. The tragedy is that most of these errors are preventable with proper systems, staffing, and oversight.
Why Medication Errors Happen in Nursing Homes
The root causes of nursing home medication errors are largely systemic rather than individual. Understaffing is the primary driver. When a single nurse is responsible for administering medications to 30 or more residents during a medication pass, the time pressure is intense. Proper medication administration requires verifying the patient's identity, checking the medication against the physician's order, verifying the dose and route, checking for allergies and interactions, and observing the patient for adverse effects. When a nurse is rushing to complete a medication pass for an unreasonable number of residents, steps are skipped, and errors occur.
Inadequate training contributes to errors, particularly among certified nursing assistants who may be asked to assist with medication administration in some facilities. Poor communication between physicians, pharmacists, and nursing staff leads to errors when medication orders are changed but the changes are not effectively communicated to the staff administering medications. Outdated or poorly organized medication administration records create opportunities for confusion about what has been given and what has not.
The use of PRN medications, those ordered to be given as needed based on the nurse's assessment, presents particular risks. Sedatives, pain medications, and psychotropic medications ordered PRN require clinical judgment about when administration is appropriate. In understaffed facilities, these medications may be administered more liberally than clinically indicated because a sedated resident requires less attention than an agitated one. This practice, sometimes called chemical restraint, is a recognized form of nursing home abuse.
Over-Medication and Chemical Restraint
The inappropriate use of psychotropic medications to sedate nursing home residents is a specific and particularly insidious form of medication error. Antipsychotic medications, in particular, have been widely prescribed to nursing home residents with dementia despite lacking FDA approval for this use and carrying a black box warning about increased mortality risk in elderly patients with dementia. The Centers for Medicare and Medicaid Services has made reducing inappropriate antipsychotic use in nursing homes a national priority, yet the practice persists in many facilities.
Chemical restraint occurs when psychotropic medications are administered not for a legitimate medical indication but for the convenience of the staff, to keep residents quiet and manageable in an understaffed environment. This practice violates federal nursing home regulations, state nursing home residents' rights laws, and the standard of care. Residents who are chemically restrained experience increased fall risk, cognitive decline, social withdrawal, and accelerated physical deterioration.
Identifying Medication Errors
Families should be alert to signs that their loved one may be experiencing medication errors or inappropriate medication use. Unexplained drowsiness, lethargy, or changes in alertness may indicate over-medication or inappropriate sedation. New-onset confusion in a resident who was previously oriented may indicate an adverse drug reaction or interaction. Unexplained falls may be related to medications that cause dizziness, orthostatic hypotension, or impaired balance. Changes in behavior, appetite, or bowel function may reflect medication-related side effects that are not being monitored or addressed.
Families have the right to review their loved one's medication administration records and to ask questions about every medication being administered, including the indication, dose, frequency, and expected side effects. If the answers are unsatisfactory or if the staff seems unable to provide clear information about the resident's medications, that is a warning sign that medication management at the facility may be inadequate.
Legal Remedies
Medication errors that cause harm to nursing home residents are actionable under Florida law. Claims may be pursued as medical malpractice against the prescribing physician or administering nurse, as negligence against the facility for systemic failures in medication management, or as violations of the Florida Nursing Home Residents' Rights Act. In cases involving chemical restraint or willful disregard of medication safety protocols, punitive damages may be available.
Our Tampa nursing home abuse attorneys have experience investigating medication error cases and obtaining the records needed to prove both the error and the systemic failures that allowed it to occur. If you suspect your family member has been harmed by a medication error in a nursing home, contact us for a free case evaluation.
The Role of the Consulting Pharmacist
Federal regulations require nursing homes to employ or contract with a consulting pharmacist who reviews each resident's medication regimen at least monthly. The pharmacist identifies potential drug interactions, inappropriate medications, unnecessary medications, and dosing errors. When the pharmacist flags a concern and the facility ignores it, and a resident is harmed by the issue that was flagged, both the facility and the prescribing physician may share liability. Consulting pharmacist reports are valuable evidence in medication error cases because they document exactly the concerns the facility failed to address. Our attorneys know how to obtain these reports and use them to demonstrate that the facility had specific knowledge of medication management deficiencies and chose not to act.