pharmacist and physician errors

Primum non Nocere – Pharmacist and Physician Errors

pharmacist physician errorsWhen you go to visit your doctor, you hope to feel better and be healthier when you leave than before you made the trip. And when you go to the pharmacy to get medicine prescribed by the doctor, you have similar expectations. But that’s not always the case.

The phrase “do no harm” comes from the Latin primum non nocere and is believed to be the basis for a portion of the Hippocratic Oath, which includes a promise made by physicians to “abstain from doing harm.” Non-maleficence, which is derived from the maxim, is one of the principal precepts of bioethics that all healthcare students are taught in school and is a fundamental principle throughout the world. Another way to state it is that, “given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.” It reminds the health care provider that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

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When are Pharmacy Errors Considered Malpractice?

Alexander Pope, an 18th century English poet, said “To err is human; to forgive, divine.” That may be true, but it’s difficult to forgive someone when their error causes serious damage.

pharmacy errorsIn the healthcare industry, human error has become one of the leading causes of death, and people in hospitals now refer to serious mistakes as “nevers” which means they are never supposed to happen. There are lots of checks and balances, and yet people are still harmed and killed by “nevers.”

With prescription medications, these mistakes can happen in the hospital, in your doctor’s office, and in your local pharmacy. When does a “never” mistake become malpractice? Malpractice is defined as improper, illegal, or negligent professional activity or treatment, especially by a medical practitioner, lawyer, or public official. These are people who are held to a higher standard by the legal system due to their level of education, training, and the vital nature of their work. If you order a steak medium-rare but they cook it until it’s black, that’s not malpractice. Just a mistake.

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“Their Anxiety Grew as the Pills Dwindled”

Supply Chain Issues Cause Stress and Jeopardize Patient Health

Pharmacy Supply Chain ErrorsWe have discussed the fact that medical errors are now the 3rd leading cause of death, and that pharmacy errors account for a great number of those deaths. Many mistakes regarding prescription medications occur as a result of human error such as putting the wrong pills in the bottle, mislabeling, or incorrect dosages.

A new article in Forbes – A Prescription Drug Bottleneck Put My Husband’s Life in Danger – addresses a growing number of patients dealing with the “supply-chain” side of getting medicine from the pharmaceutical manufacturers to the patient.

Some companies are trying to by-pass traditional pharmacies and send medication via mail-order in order to save money. This article describes a patient afflicted with Parkinson’s disease and his wife who endured several very stressful episodes when crucial medication was completely unavailable.

Are Prescription Medications Safe?

Another issue related to the pharmaceutical supply chain is the fact that drugs often pass through many hands as they travel from the factory to the consumer.

Wholesalers and secondary wholesalers often distribute medicine to the highest bidder, or ship them out of the country if there is a buyer willing to pay. It is also in these mid-level channels that counterfeit drugs sometimes infiltrate the market from China, Thailand, or Columbia. The more frequently a drug changes hands, the greater the chance that counterfeit or diverted drugs can enter the legitimate supply chain.

Such a porous supply chain poses hazards to patients — thousands of people worldwide die every year from ingesting fake drugs — and it costs the pharmaceutical industry an estimated US$46 billion a year in lost profits. The World Health Organization (WHO) in a recent study said that counterfeit drugs represent more than 10 percent of global sales. In 2004, the FDA reported that the number of its investigations of counterfeit drugs rose by 150 percent from the previous year as a growing number of criminal groups take advantage of high profits and penalties that are less severe than those for selling illegal narcotics such as heroin or cocaine.

The chances of receiving a counterfeit pill from one of the major pharmacy chains in the U.S. are very slim, but it’s not a bad idea to inspect your medications and make sure they look right, that they’re the right color, etc.

If something doesn’t look right with your medication check with your pharmacist, and there are pictures of pills online, look for one published by the manufacturer.

Lazarus and Lazarus has been dealing with pharmacy-error-related injuries for over 20 years. If you believe you have suffered due to a prescription medicine related error or negligence on the part of a pharmacist, pharmacy, or any medical practitioner, we would be happy to sit down with you and listen to your story. We can be reached by calling 954-356-0006

Edited by Telarfa Czanno

Adverse Drug Events Soar as Number of People on Meds Reaches Record Number

Nearly Two-Thirds of American Adults Take 5 or More Medications

As 2013, the U.S. Census Bureau estimates that there are 242,470,820 adults living in the United States, and a new study says that 62% are regularly taking five or more medications. That’s a lot of pills, inhalants, drops, elixirs, ointments, and suppositories.

When someone has a serious reaction, becomes ill, or dies because of a medication it could be an error by the patient, a mistake by the physician, a mix-up by the pharmacist, or a defect in the medication itself. The terminology for these events varies, but the government has decided the general term is Adverse Drug Events, or ADEs.

It’s important that when an ADE occurs, and it’s serious or life threatening, that the cause be determined. Sometimes it is negligence or malpractice on the part of the medical professional involved. These people and, in the case of pharmaceutical companies and pharmacies, companies, need to be held accountable to the victims who suffer as a result of their errors.

ADEs account for nearly 700,000 emergency department visits and 100,000 hospitalizations each year. ADEs affect nearly 5% of hospitalized patients, making them one of the most common types of inpatient errors; ambulatory patients may experience ADEs at even higher rates. Transitions in care are also a well-documented source of preventable harm related to medications.

Another term you may not be aware of is Polypharmacy—taking more medications than clinically indicated. This is likely the strongest risk factor for ADEs. Elderly patients, who take more medications and are more vulnerable to specific medication adverse effects, are particularly vulnerable to ADEs. Pediatric patients are also at elevated risk, particularly when hospitalized, since many medications for children must be dosed according to their weight. Other well-documented patient-specific risk factors include limited health literacy and numeracy (the ability to use arithmetic operations for daily tasks), both of which are independently associated with ADE risk.

This is a table that identifies potential places where ADEs can happen and safety strategies:

Prescribing •Avoid unnecessary medications by adhering to conservative prescribing principles
•Computerized provider order entry, especially when paired with clinical decision support systems
•Medication reconciliation at times of transitions in care
Transcribing •Computerized provider order entry to eliminate handwriting errors
Dispensing •Clinical pharmacists to oversee medication dispensing process
•Use of “tall man” lettering and other strategies to minimize confusion between look-alike, sound-alike medications
Administration •Adherence to the “Five Rights” of medication safety (administering the Right Medication, in the Right Dose, at the Right Time, by the Right Route, to the Right Patient)
•Barcode medication administration to ensure medications are given to the correct patient
•Minimize interruptions to allow nurses to administer medications safely
•Smart infusion pumps for intravenous infusions
•Patient education and revised medication labels to improve patient comprehension of administration instructions

Note that the largest section of the table is “Administration” which is where the patient and his or her caregivers are most-directly involved. This is where the drugs contact the patient.

If a patient is unable to properly count the pills and understand when to take them, then someone must help that person. Almost everyone has been aware of a family member or friend who is in this situation. Please try to help them or find them the help they need.

If a family member, other loved one, or friend is the victim of an ADE, it’s important to contact the right people for help. Medication errors that cause harm is an arena in the legal profession that requires experience and expertise due to the complexity of the pharmaceutical industry and the various medical professions.

The Law Firm of Lazarus and Lazarus has dedicated a substantial portion of their legal practice to pharmacy errors and negligence. Calling 954-356-0006 will put you in touch with a dedicated team of legal professionals who can help.

Florida’s Prescription Drug Monitoring Database Opens to More Online Users

Program is Intended to Reduce Abuse of Controlled Substances

When Florida’s famous “pill mills” were pushing out dangerous medications to patients with addictions, advocates for better medical records pushed for a central database to track prescriptions for controlled substances. The result was the 2009 Prescription Drug Monitoring Program (PDMP) and most health-care professionals believe it has been a success.

Close-up of the Rx prescription symbol on a computer keyboard.

One of the drawbacks of the program has been the restrictions placed on who can actually access the system to input records, and view existing information. These restrictions specified that only physicians, pharmacists, and certain other practitioner s were able to actually access the system, not pharmacy techs or office personnel in doctor’s offices. The limits were put in place for good reason, as confidentiality is crucial to patient rights, but often the doctors and pharmacists are so busy that they lack the time to properly run the system as intended.

Often this blog has covered the high-volume of work placed on pharmacists as a contributing factor in the increasing number of prescription errors, and so this change may turn out to be a good one, time will tell.

Last month, the Florida Legislature passed Senate Bill 964, which changes who may access the database.  Currently only pharmacists and prescribers, such as physicians, dentists, and nurse practitioners, are authorized to access and submit reports to the database. Beginning July 1, 2016 the new law will specifically allow designees working on behalf of pharmacists and prescribers to check the database and submit reports.  This change is intended to improve compliance by making it easier for busy pharmacists and prescribers to delegate reporting activities to their staff.

While the PDMP is a good idea in principal, it applies only to controlled substances such as powerful painkillers and will not prevent patients from having drug interactions with their normal medications. It is very important for all patients to take time to discuss all their medications with their doctors and pharmacists. If you don’t understand something, ask.

The Law Firm of Lazarus and Lazarus has been representing victims of prescription medication errors and negligence for over 20 years. In that time the number of drugs approved by the Food and Drug Administration (FDA) has increased by over 3000, which makes this area of law extremely complex. Gary and Arleen Lazarus remain highly proficient and are eminently qualified to represent victims of prescription errors, and their office is dedicated to protecting the rights of victims. Calling 954-356-0006 will put you in touch with their caring staff.

Online Pharmacies – Are Savings Worth the Risk?

You May Not Have Recourse for Internet-Purchased Pharmacy Errors

Nearly 60% of all Americans are taking prescription drugs, the highest rate ever according to a Washington Post article citing a study by the Journal of the American Medical Association. Not everyone has insurance to cover their drugs, and with the rising prices charged by pharmacies, many look to save money online.

online-rx-_Herby__Herbert__Me_largePharmacies and pharmacists are licensed in each state and are also required to have liability insurance. In Florida you can verify the license of any member of the medical community by visiting this website operated by the Florida Department of Health. While this may provide a certain comfort level for patients, it doesn’t guarantee an error-free experience when you visit Walgreens, CVS, or your local family-owned pharmacy. Mistakes still occur.

Doing business with online pharmacies carries a level of risk above and beyond a normal pharmacy. It is not so easy to verify licenses for pharmacies operating online, because many times you won’t have any idea where they are located, or who they really are. Insurance is also a gray area, they may have it, or they may not.

A lot of red flags should go up when thinking about ordering medicine over the internet: Consider that recent studies show that up to 50% of the medications are fake, and don’t even contain the ingredients they are supposed to deliver to a patient. Food and Drug Administration (FDA), which has found in many instances counterfeit medicine – pills passed off as being from an established pharmaceutical company – don’t even have an active ingredient, or might have ingredients that are dangerous.

Study after study shows that it’s critically important to not only communicate with your physician, but with your pharmacist. Many people in a hurry use the drive-thru to pick up their prescribed medications, but we encourage people to take the time to go inside the building and avail themselves of a short but meaningful discussion with their pharmacist. Ask them to double-check the bottles, the dosages, and ask about any side-effects and interactions with other drugs or foods that you eat.

We also believe that online pharmacy orders are not worth the amount of money you might save, unless the business is thoroughly checked out and you can confirm that they are selling legitimate products.

Understanding the complex issue of prescription errors and pharmacy negligence requires special training and study in some very intricate areas law. Knowledge of the latest, and the older pharmaceuticals is also necessary to advise victims on their rights when it comes to injuries sustained because of prescription mistakes.

The Law Firm of Lazarus and Lazarus has dedicated a major portion of their practice to helping people who are the victims of prescription errors of all types. They have over 20 years of experience advising and defending the rights of victims, and they are always willing to listen to you. Calling 954-356-0006 will connect you with Gary and Arleen Lazarus, south Florida attorneys who truly care about the community and want to help those who have been harmed by others.

“Legal” Overdoses and Injuries from Drug Interactions in Florida

Drug Dealers are not the Only Ones Dispensing Injuries and Death

Almost everyone knows someone who has had an addiction to drugs or alcohol, or both. It is far too common, and despite laws against drunk driving, illegal drugs, and a crackdown on “pill mills” there are still too many overdoses, deaths, and fatal car accidents involving alcohol and drugs.

People always attempt to find a way to get what they want.

Recently in Florida and across the country heroin has risen in popularity, possibly due to the aforementioned closure of the unscrupulous pain medication dispensaries. The drug was detected in 447 fatalities throughout the state in 2014, according to a report released Tuesday by the state’s medical examiners. That’s an all-time high, and more than double the 199 people who had the drug in their bodies when they died in 2013. The deadly surge paralleled that of another drug — fentanyl — which was detected in 538 deaths. That was an 84 percent jump from the 292 fatalities in 2013.

Fortunately Florida just passed and enacted a law to allow the drug naloxone to be sold over-the-counter. Naloxone counters the damage done by opioids like heroin and can save lives.

NOTE TO INSPECTOR:  the commercial and personal identifying info has been reomved on all labels Dozens of prescription medicine bottles in a jumble. This collection of pill bottles is symbolic of the many medications senior adults and chronically ill people take.A tactic used by many drug addicts called “doctor shopping” is where the individual goes from doctor-to-doctor getting multiple prescriptions for their particular pharmaceutical drug of choice. They fill the orders at different pharmacies and thereby skirt the laws intended to prohibit this type of activity. The State of New York just implemented electronic prescribing, which is designed to stop doctor shopping but has both pro and con opinions on whether it will help.

Doctors and pharmacists are committed and bound to follow a standard of care when prescribing or dispensing drugs. For example, if a patient fills a prescription for several hundred strong pain pills, well over the normal dosage, a pharmacy and their employed pharmacists and technicians should be aware there is a problem. Instead, in this day of drive-through pharmacies, the practice goes on and people suffer.

Despite the fact rates of painkiller addiction are lower now than ever, Florida remains the 11th state in terms of the severity of painkiller abuse; moreover, the majority of drug-related deaths that occur in Florida are still caused by benzodiazepines and oxycodone.

We encourage anyone and everyone who is taking prescription medications to do some homework on their own regarding the possible side-effects and interactions with other drugs or food. But that’s not enough. Take the time to speak with every doctor who gives you a prescription. Go inside your pharmacy and speak with the pharmacist. Information and education are the tools to staying well and avoiding drug injuries.

The Law Firm of Lazarus and Lazarus is committed to help people who have suffered due to errors, carelessness, or negligence on the part of physicians or pharmacists who make mistakes related to prescription medications that hurt victims through no fault of their own.

pharmacy errors

The Rate of Prescription Errors is High and Rising

Every job has a potential for making errors. Getting the wrong entrée at a restaurant happens every now and then, and I took home another person’s dry cleaning last month when the clerk handed me the wrong items. Filling prescriptions, one would think, has a very low rate for errors. That’s not entirely accurate.

Most patients who deal with buying prescriptions on a regular basis probably think that with advances in computer technology and the high level of training for pharmacists and pharmacy techs, they don’t even need to check what’s in the little brown bottles. But studies show it’s smart to check, and double-check.

Big Mistakes

One study revealed a dispensing error rate “of more than one in five prescriptions” (Journal of the American Pharmacists Association). Last year, more than 4 billion prescriptions were filled in the U.S. A 20 percent error rate would represent 800 million mistakes. Though most are relatively minor, some have led to disability and even death.

Another study concluded that error rates are actually getting higher, especially in large medical centers and hospitals. Errors included mistakes on labels and duplicate orders, but one of the most common errors was incorrect dosage for warfarin, also known as brand name Coumadin, which is a blood-thinning medication. When warfarin is administered in too-high dosages, very serious internal bleeding may occur.

pharmacy errorsFrom the results the Journal of the American Pharmacists Association study: Of 100 prescriptions dispensed, 22 had one or more deviation from the physician’s written order, for a 22% dispensing error rate. Three of the errors were judged to be potentially harmful when dispensed to a typical patient requiring these therapies. A total of 43 shoppers (43%) received verbal counseling, including 16 cases in which the shopper prompted counseling. All shoppers received written information with their prescription, covering an average of 90% of the required topics.

The results also included this very disturbing conclusion: Some 68% of the warfarin shoppers purchased aspirin without the pharmacist verbally warning about taking the drugs simultaneously. Conclusion: The dispensing error rate of more than one in five prescriptions is similar to the rate found in a similar study conducted 14 years ago, but counseling frequency has decreased significantly during the period.

Drive-Thru Counseling?

Today’s pharmacies have drive-thru windows, which obviously makes counseling with a pharmacist very impractical. Patients should understand that taking just a few minutes to discuss side-effects and interactions may prevent a harmful side-effect from happening. Patients should also carefully examine their prescriptions to make sure they received the right medication and the correct dose.

Seek the Best Help

The Law Office of Lazarus and Lazarus has represented victims of pharmacy errors for over 20 years, and we are eminently qualified to handle any situation related to injuries, sickness, or death related to medication mistakes. A call to 954-356-0006 will put you in touch with Gary and Arleen Lazarus, personal injury attorneys who will carefully listen to your story and then recommend the best course of action for your individual situation.