Medication Error Law Firm

The Hamilton Drug Error Attorneys

The lawyers and Hamilton & Associates regularly handle catastrophic injury and death cases resulting from medication mistakes. We have a large population of drug experts to draw support and have developed specialized knowledge and experience with drug malpractice cases. We present this page to assist drug error victims and their families with research into their own experiences. We also encourage you to visit the pages of this website dedicated to particular errors. Last, please look to the videos we present as they are a valuable asset to your learning.

How Common are Drug Errors?

Prescription drug use has increased exponentially in the United States of America. About 29% of adults are on five or more medications and 82% on at least one medication.[1] Due to this high volume of drug dispensing, drug safety is of great importance.

The amount of prescriptions dispensed every day continues to climb. In 2009, over three billion medications were dispensed, with approximately four errors every day per 250 prescriptions filled.9 Therefore, more than 51 million dispensing errors occur every year. [2] Dispensing errors can result from the miscalculation of the correct dose, failure to identify drug interactions, warnings or contraindications. In addition, human error is also a common component. A lack of judgment or attention may result in the dispensing of the incorrect medication, dosage or dosage form.

Safety issues related to medications are known as adverse drug events (ADEs). An ADE is described as an unsafe or undesirable event following exposure to medication. One type of ADE, a medication error, is an adverse event that involves preventable incidents in the prescribing, dispensing or consumption of medication while in the hands of a patient, caregiver or health care professional.[3] An ADE or medication error can occur in any heath setting whether in the hospital, pharmacy, out-patient clinic or at home. Technology has revolutionized medications and established new indications for older medications, producing many new health benefits. Innovation has helped prevent many medication errors but it also brings new complexity that may increase the risk of error.[4]

Medication errors each year cause 500,000 emergency room (ER visits) and 100,000 hospitalizations.[5] It is projected by the Institute of Medicine that about 50% of out-patient ADE costs could be preventable.[6] Misdiagnosis, a very simple mistake, is an under-recognized medical error. Research from both the British Medical Journal (BMJ) of Quality and Safety and Harvard find it to be one of the most common errors with the most potential of causing harm or death. [7],[8] According to BMJ, the frequency of misdiagnosis errors is higher in the out-patient setting, but more likely to result in death if in-patient.[6]

Prescription Errors

Prescribing errors are a common medication error. The error may be due to physician negligence or merely stem from the prescriber’s illegible handwriting. A prescription error can stem from the wrong drug, administration, dose, dose frequency or length of treament.[8]

Most prescription errors are a result of either human error or an unsafe work environment.8 Electronic prescribing and order entry as well as medication reconciliation have helped deter these avoidable sources of error. The electronic systems alert healthcare providers to potential drug allergies, drug interactions, duplicate medications as well as maximum and/or minimum drug doses. [9]

High risk medications are medications that can cause detrimental or fatal issues if administered in error.[2] The American Geriatrics Society and Institute for Safe Medication Practices both distribute lists of high-risk medications, the latter being specific to the senior citizen population.[10],[11]

Heparin Drug Errors

A high-risk medication prone to medication errors, is the administration of the intravenous (IV) version of the anticoagulant, heparin. The safe administration of heparin requires vigilance, weight based dosing and the monitoring of the patient’s blood to assess whether the patient’s current dose is too high or too low.[2]

Stevens-Johnson Syndrome

The prescribing of unnecessary or inappropriate medication due to negligence or malpractice may result in debilitating side effects such as Steven’s Johnson Syndrome (SJS). Steven Johnson’s syndrome typically occurs due to a medication or infection. It affects the skin and any mucous membrane. Steven Johnson’s Syndrome initially presents with flu like symptoms. In addition, the following symptoms will continue to spread over the hours following initial onset: swelling of the face and tongue, a blistering rash of the mucous membrane of the mouth, eyes, nose and genitals as well as an extensive rash and peeling of the top layer of skin.[26] If the rash takes over 30% of the patient’s skin, it is classified as Toxic Epidermal Necrolysis (TEN’s).[26] Recovery from SJS or TEN’s is a long process that requires hospitalization; severe cases or complications from the disease such as sepsis could also result in death. Surviving patients may experience lifelong scarring of the skin and/or mucous membranes, vision problems, light ant temperature sensitivity. Medications that are known to potentially cause SJS or TEN’s are:

  • Antibiotics: specifically pencillins and sulfa drugs such as sulfamethoxazole / trimethoprim (Bactrim).
  • Anticonvulsant drugs: phenobarbital (Luminal), phenytoin (Dilantin), lamotrigine (Lamictal), carbamazepine (Tegretol), and valproic acid (Depakene).
  • Pain medications: nonsteroidal anti-inflammatory medication (NSAID)s such as piroxicam (Feldene).
  • Anti-gout medication: allopurinol (Aloprim, Zyloprim). 

Drug Interaction Errors and Serotonin Syndrome

Medication errors not only cause disorders but may also lead to a catastrophic drug interaction. A well-known and potentially fatal example is Serotonin Syndrome. Serotonin Syndrome is caused by a chemical imbalance in the body. Serotonin is one of many chemicals that our body uses to function. It significantly affects the nervous system, brain function, behavior and digestion. Many medications, particularly those focused on behavior, target a patient’s serotonin levels. When there are multiple medications, both targeting serotonin levels, problems occur. Serotonin Syndrome is becoming more common with increased usage of anti-depressants and mood stabilizer medications. Symptoms present themselves after dose modification of current therapy or the addition of new medication. Patient’s present with a rapid heartbeat and high blood pressure, involuntary muscle spasms or stiffness, restless behavior, headache, brain fog, and extreme temperature sensitivity. Severe cases typically present with seizures, fever and unconsciousness. This reaction is frequently seen with the following drugs and drug classes:

  • Mood stabilizers and anti-depressant drug class, Selective Serotonin Reuptake Inhibitors (SSRIs): citalopram (Celexa), escitalopram (Lexapro, Cipralex), paroxetine (Paxil, Seroxat), fluoxetine (Prozac), fluvoxamine (Luvox), sertraline (Zoloft, Lustral).
  • Mood stabilizers and anti-depressant drug class, Serotonin and norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta) and venlafaxine (Effexor), trazodone.
  • Anti-depressant, smoking cessation medications: Bupropion (Wellbutrin, Zyban)
  • Other anti-depressants or mood stabilizers: amitriptyline, nortriptyline (Pamelor), socarboxazid (Marplan) and phenelzine (Nardil), and lithium (Lithobid).
  • Anti-migraine medications: sumatriptans (Axert, Amerge, Imitrex), carbamazepine (Tegretol) and valproic acid (Depakene).
  • Muscle relaxers: cyclobenzaprine (Amrix, Flexeril and Fexmid).
  • Pain medication: fentanyl (Duragesic), meperidine (Demerol) and tramadol (Ultram).
  • Antibiotics or antivirals: Linezolid (Zyvox), Ritonavir (Norvir).
  • Anti-nausea medications: granisetron (Kytril), metoclopramide (Reglan), droperidol (Inapsine) and ondansetron (Zofran).
  • Over the counter medication or supplements: dextromethorphan (Delsym, Mucinex DM, etc.), St. John’s wort, ginseng and nutmeg.

Chronic Kidney Disease

Patients with Chronic Kidney Disease (CKD) or End Stage Renal Disease (ESRD) are particularly sensitive to medications. CKD is the loss of kidney function over a period of time. It typically presents with a slow onset or no symptoms at all and is diagnosed with a blood test.

Many patients with impaired kidney function are senior citizens and/or have diabetes, heart disease or dehydration. Left untreated, it can cause a build-up of waste in the body and complete kidney failure. CKD progresses to ESRD where kidneys are no longer able to function normally.

To survive, patients require dialysis or a kidney transplant. Without proper kidney function, medications that require the kidney to work are not broken down correctly. Stress and kidney injury can occur following inappropriate medication usage. If healthcare providers are negligent of their patient’s CKD status and improperly prescribe medications or care, their patient’s disease could progress more rapidly and potentially cause or prolong hospitalization. Drugs that may be toxic to the kidney or need their dose adjusted are:

  • Pain medication: acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve) and aspirin
  • Cholesterol medications: all “statins” may need their dose adjusted
  • Anti-fungal, anti-viral and antibiotic medications: these medications are broken down by the kidneys, including penicillins, ciprofloxacin (Cipro) and acyclovir (Zovirax).
  • Stomach upset medications: Protein-pump inhibitors, which include esomeprazole (Nexium), dexlansoprazole (Dexilant), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex).
  • Dyes: Ethiodol, the contrast dye used in magnetic resonance imaging (MRI) testing

IV Drug Errors

The fastest acting medications are those that are delivered directly to the blood stream. Intravenous (IV) medications may have the benefit of quick access to the bloodstream, but they are also the most likely to be the source of fatal medication errors. IV medications are complex and have specific preparation instructions for storage, administration and monitoring. An error can occur at any stage of preparation. In a United Kingdom and Germany study examining the incidence of IV errors, 88 (26%) preparation errors of 337 cases were found. In addition, 93 (34%) administration errors of 278 cases were observed.[12] The Institute of Safe Medication Practices (ISMP) frequently releases safety alerts related to frequently reported errors with IV medications. An example of such an error is the administration of IV medications via the wrong route. Morphine and vincristine (a chemotherapy agent) have both had reports of being administered around the spinal cord (epidural) or into the spinal canal (intrathecal), leading to fatal consequences.[13][14],[15] The numbing IV medication, bupivacaine, has also had numerous reports of erroneous epidural administration leading to fatal or near fatal results. [13],[16],[17], [18]

Extravasation

A common IV error is extravasation, the leakage of the IV medication into the surrounding tissues of the injection site due to inadequate set-up of the infusion device.[19] Extravasation can cause merely inflammation and irritation, but some drugs can cause the tissues affected to die. Chemotherapy drugs are particularly toxic. One example is doxorubicin (Doxil, Adriamycin). Doxorubicin can remain in the tissues for an extensive period of time, side effects may not present immediately.[20],[21] Severe skin ulcers are a common side effect of these agents, which require skin grafts and plastic surgery.[22] Chemotherapy agents, broken down by potential severity, are listed below 20:

  • May cause irritation and tissue breakdown: melphalan (Alkeran), 5-Fluorouracil (Adrucil), docetaxel (Taxotere), paclitaxel (Taxol, Abraxane), bleomycin (Blenoxane) and etoposide (VePesid, Toposar).
  • May cause tissue breakdown: dacarbazine (DTIC), daunorubicin (Cerubidine, DaunoXome), doxorubicin (Doxil, Adriamycin), idarubicin (Idamycin), cisplatin (Platinol), vinblastine (Velban), vincristine (Oncovin, Vincasar), vinorelbine (Navelbine), dactinomycin (Cosmegen) and mitomycin (Mutamycin).
  • May cause skin irritation: cyclophosphamide (Cytoxan), ifosfamide (Ifex), gemcitabine (Gemzar), carboplatin (Paraplatin), irinotecan (Camptosar) and topotecan (Hycamtin).

Drug Allergy Errors

An easily avoidable medication error is the prescribing of medications related to a pre-existing allergy. Drug allergies can occur due to a reaction to the drug itself, an ingredient or how it was prepared. In addition, a drug product can also cause a more severe react to a mild environmental or food allergy; this type of reaction is commonly seen in patients on a blood pressure drug, such as lisinopril.[23]

Another rare and often overlooked allergic reaction is to the material used in medical tests, particularly iodinated contrast medium (ICM). In one study of 6000 patients receiving ICM, 2.5% experienced mild allergic reactions, 1.2% medium reactions and 0.4% experienced severe reactions.[24] Allergic reactions can vary from mild to medium discomfort such as sneezing or itching to something more life-threatening like anaphylaxis.

Anaphylaxis may include shortness of breath, low blood pressure and facial swelling. If not treated rapidly, it can result in death. One of the most common prescription and over the counter (OTC) drug classes, nonsteroidal anti-inflammatory drugs (NSAIDS) which includes ibuprofen (Advil) and aspirin, is commonly associated with anaphylaxis reactions. In one study of 117 patients experiencing anaphylaxis, NSAIDS accounted for 50% of the reactions.[25] Prevention of such events relies on the healthcare provider paying adequate attention to the patient’s medical records and constant communication during the prescribing, dispensing and administration of any medication, medium or medical procedure. With the advent of many combination drug products, healthcare providers must remain vigilant in order to avoid a negligent mistake. Additional medications that are commonly associated with anaphylactic reactions are:

  • Antibiotics: Penicillins (amoxicillin, ampicillin) and penicillin containing antibiotics (Augmentin), Cephalosporins (cephalexin, cefixime, cefotaxime), Macrolides (erythromycin, azithromycin, clarithromycin).
  • Blood pressure medications: ACE inhibitors such as benazepril (Lotensin), enalapril (Vasotec) and lisinopril (Prinivil).
  • Pain medications: Naproxen (Aleve), Diclofenac (Voltaren).

Whom Should I call?

Especially for death cases, or when the medical bills exceed $250,000.00, you will want to contact the law offices of Hamilton and Associates for an evaluation of the merits of your claim. Death and high bill cases are difficult; you will want a lawyer experienced in your specific type of case to evaluate your case so that your decision can be accurate. Call our office today at 816-540-4040.

CROSS REFERENCES:

[1] Slone Epidemiology Center at Boston University. Patterns of medication use in the United States, 2006.

[2] Flynn EA, Barker KN, Carnahan BJ. National observational study of prescription dispensing accuracy and safety in 50 pharmacies. J Am Pharm Assoc (Wash). 2003;43(2):191-200.

[3] Food and Drug Administration (FDA). Medication Errors Related to Drugs. http://www.fda.gov/drugs/drugsafety/medicationerrors. Accessed September 9, 2016.

[4] Agency for Healthcare Research and Quality (AHRQ). Medication Errors. Patient Safety Primer. https://psnet.ahrq.gov/primers/primer/23/medication-errors. Accessed September 9, 2016

[5] Budnitz DS, Pollock DA, Weidenbach KN, Mendelsohn AB, Schroeder TJ, Annest JL. National surveillance of emergency department visits for outpatient adverse drug events .External Web Site Icon JAMA 2006;296:1858-66.

[6] Institute of Medicine. Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors, Washington, DC: The National Academies Press 2006.

[7]Saber Tehrani AS, Lee H, Mathews SC, et al. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf. 2013;22(8):672-80.

[8] Brennan TA ; Newhouse JP; et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991; 324: 377-384

[9] Charles D, Gabriel M, Furukawa MF. “Adoption of Electronic Health Record Systems among U.S. Non-federal Acute Care Hospitals: 2008-2013,” ONC Data Brief, no. 16. Washington, DC: Office of the National Coordinator for Health Information Technology. May 2014.

[10] American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults . JAGS 2015; 1-20.

[11] Institute for Safe Medication Practices (ISMP). ISMP High-Alert Medications. https://www.ismp.org/tools/highalertmedicationLists.asp. Accessed September 9, 2016.

[12] Wirtz V, Taxis K, Barber ND. 2003. An observational study of intravenous medication errors in the United Kingdom and in Germany. Pharmacy World & Science 25(3):104–111.

[13] Institute for Safe Medication Practices (ISMP). Epidural-IV route mix-ups: Reducing the risk of deadly errors. ISMP Safety Alert! http://www.ismp.org/newsletters/acutecare/articles/20080703.asp. Accessed September 9, 2016.

[14]Institute for Safe Medication Practices (ISMP). IV potassium given epidurally: getting to the route of the problem. ISMP Medication Safety Alert! April 6, 2006:1-2.

[15] Institute for Safe Medication Practices (ISMP). Fatal administration of IV vincristine. ISMP Medication Safety Alert! December 5, 2005:1-2.

[16] Institute for Safe Medication Practices (ISMP). IV potassium given epidurally: getting to the route of the problem. ISMP Medication Safety Alert! April 6, 2006

[17] National Patient Safety Agency (NPSA). Safer practice with epidural injections and infusions. Patient Safety Alert. March 28, 2007:1-8. http://www.npsa.nhs.uk/patientsafety/alerts-and-directives/alerts/epidural-injections-and-infusions/. Accessed September 9, 2016.

[18] Hill M. Epidural drug drip ‘killed’ new mother. BBC News. February 5, 2008. http://news.bbc.co.uk/2/hi/uk_news/england/wiltshire/7219434.stm. Accessed September 9, 2016.

[19] Fischer D, Knobf M, Durivage H. The Cancer Chemotherapy Handbook, Mosby, 1997. p.514.

[20] Garnick M, Israel M, Khetarpal V, Luce J. Persistence of anthracycline levels following dermal and subcutaneous adriamycin extravasation. Proceedings of the American Association for Cancer Research. 1981;22:p. 685.

[21] Al-Benna S, O’Boyle C, Holley J. Extravasation injuries in adults. ISRN Dermatol. 2013;2013:856541.

[22] Alberts DS, Dorr RT. Case report: topical DMSO for mitomycin-C-induced skin ulceration. Oncology Nursing Forum. 1991;18(4):693–695.

[23] American College of Allergy, Asthma and Immunology (ACAAI). Oral Allergy Syndrome And High Blood Pressure Medications Can Create Lethal Cocktail. ACAAI News. http://acaai.org/news/oral-allergy-syndrome-and-high-blood-pressure-medications-can-create-lethal-cocktail. Accessed September 12, 2016.

[24] Siddiqi N et al. Contrast Media Reactions: Incidence of Adverse reactions to ICM. Medscape. http://emedicine.medscape.com/article/422855-overview#a4. Accessed September 12, 2016.

[25] Aun MV et al. Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis. J Allergy Clin Immunol Pract 2014 Jul/Aug; 2:414.

[26] Foster S et al. Stevens-Johnson Syndrome : Practice Essentials, Background, Pathophysiology. Medscape. http://emedicine.medscape.com/article/1197450-overview. Accessed September 12, 2016.