Preventing Medication Errors in Nursing Homes
Medication errors in nursing homes can lead to devastating consequences, including hospitalization or death. In this week’s episode, nursing home abuse lawyer Rob Schenk is joined by guest Angela Gaines to uncover the most common medication mistakes, how they happen, and what can be done to prevent them.
Gaines:
I would say number one is proper training. Empowering the staff to report errors, but just making the staff feel like it’s okay to report errors. I would say even getting a pharmacist involved in the training so that staff can hear from higher level people. So when I think when the staff can hear from pharmacists or physician on the effects of medication errors and what happens, it may make the nurses more aware, more conscious.
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse Podcast. My name is Rob. I will be your host for this episode. Today we’re talking about medication errors in nursing homes, what a medication error is, how they happen, how we can prevent them. We’re not doing that alone. We have the fantastic Angela Gaines on to walk us through that process.
Now it’s time for the meat and potatoes of the episode. Again, talking about medication errors. Not doing that alone. We had the fantastic Angela Gaines.
On the program, Angela Gaines is a registered nurse, legal nurse, consultant, and certified coding specialist with over 22 years of experience in various nursing settings, including skilled nursing. Chart auditing and clinical and coding validation. She started her company ALG Nurse Consulting LLC in 2023 and specializes in medical record reviews and legal and clinical nurse consulting services, and we’re so happy to have her on today.
Angela, welcome to the show.
Gaines:
Hi, Rob. Thank you for having me. I’m glad to be here.
How common are medication errors in nursing homes?
Schenk:
Great. So everybody gets a, like a softball question at the beginning. So my softball question is to, is basically what is a medication error in a nursing home? What, when we say medication error, what are we talking about?
Gaines:
We are talking about wrong medications. Wrong route, wrong dose even given something or blood pressure. Supposed to be high, but they didn’t check it and they gave it for low blood pressure. So it could be route medication. Wrong person.
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Schenk:
When you say route, when you say route, what does that mean?
Gaines:
Route means the way that the medication is given or the, so by mouth under the skin subcutaneously. Intravenous rectal, nasal eyes, ears, that type of thing.
Schenk:
In your experience, how common are medication errors? Are we, is this something happening like multiple times a shift, like once a year?
Gaines:
No, it is very common. Honestly, it probably happens every day. The statistics say about up to 20 something percent of residents experience a medication error in the nursing home.
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Schenk:
My goodness
Gaines:
It’s very prevalent, very high.
What are the main causes of medication errors in elderly care?
Schenk:
We’ve talked about, the different ways that you can mess up the administration of medication, but I guess the question would be like, what are some of the causes that are behind why they’re getting messed up?
Gaines:
I would say the number one cause would be under staffing nurses having a lot of patients or residents with limited time to get the medications administered so they may rush. Don’t take the time to read the order correctly, read the medication label correctly, not enough time to take vital signs properly.
But I would say understaffing nurse to patient ratio, lack of training, lack of care.
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How do medication errors lead to hospitalization or death?
Schenk:
So tell me that’s an interesting point. So tell me then, on a typical shift, or at least what it’s supposed to be or what it, what, what best practice might be. Is it an individual nurse whose sole responsibility it is to wheel a card around and give out medications?
Or is it kinda like you’re assigned a certain amount of residents and somebody else, another a residence and so there’s more than one person giving out medications? Walk us through that process.
Gaines:
No, not usually. So in a nursing home, you’re probably gonna have what they call units or wings. So you’ll have.
One nurse is assigned to sometimes up to 30 patients. And then it depends on if they’re on the long-term care unit, like the resident lives there, like at their home, or if they are on the skilled nursing or rehab unit. So sometimes those ratios, it depends. The nurses on the long-term care units tend to have more patients then on the subacute quote unquote rehab units, because some of those residents are getting. IVs and injections and things like that. So it’s basically up to sometimes 30, 35 patients.
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Schenk:
So in my mind, a as you’ve described then, when you’re saying that understaffing is a root cause for a lot of medication errors, it’s because the one individual nurse has got her cart and it’s going as fast as she possibly can because she’s got way too many people
Gaines:
Correct.
And dealing with anything else that happens during the Med Pass as what they call med pass times. Normally there’s a window an hour before, an hour after. So two hours to give out medications to up to 30 residents to deal with any falls, acute issues that may come up, staffing issues with CNAs meal time, all of that going on at once. So sometimes it’s almost impossible, honestly, to get those medications administered within a two hour window. What then they rush?
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Are there specific medications that pose a higher risk?
Schenk:
That makes sense. I can’t even imagine like you, and again, like depending, you gotta take vitals and all that kind of stuff and it’s, I’m sure it’s a, it can be pretty hairy.
So in your experience, are there any medications that are a little bit, that pose a higher risk for medication error there? There’s maybe certain medications that are more prone for people to mess up,
Gaines:
Anticoagulants, like blood thinners. Some of those require labs, monitoring like Coumadin or Warfarin, you should know what the levels are.
Sometimes nurses, they dunno the levels, the level could be too high or too low and they’ll give the Coumadin so that increases the risk of bleeding or clots. Diabetic medications like. Because you have to draw those up in the syringe if you’re not familiar or you can’t see the lines on the syringe or you’re rushing or choosing the wrong insulin is a big one.
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Antibiotics. Not giving the medication and the amount of time that it was supposed to be given. So that puts residents at higher risk for sepsis and other infections.
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Schenk:
Oh, I see. So not to cut you off. So I see. So like it’s a risk, like where if it’s supposed to be, let’s say once every six hours or once every eight hours, and because of how behind you are, maybe you’re only giving it once every nine or 10 hours, that exposes that resident to a higher risk of X, Y, Z.
Gaines:
And there are some antibodies that require drug levels too. Which the labs needed to be drawn before you give the antibiotic. So they may give the antibiotic without the drug being drawn. Then you have opiates, pain, medications, high risk overdose, things like that.
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Schenk:
You mentioned with Coumadin or blood thinners, there is a level that needs to be known before you give it. What I might’ve missed, you might’ve said it, but what is the level that you’re looking at?
Gaines:
Oh, yeah. Usually it’s the INR level. It’s called an INR level, and it depends on why the patient is taking a resin. It’s taking the Coumadin, so there’s a range. Sometimes it’s from two to three. It just depends on what the reason is that they’re taking.
Coumadin, but those levels are typically done every week. So if you give Coumadin without knowing the level, you’re really putting the resident at really high risk of other complications so that when they give that one a lot in nursing facilities.
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What role do nursing home staff play in preventing errors?
Schenk:
And who is like typically, who is the individual that’s responsible for the administration of medication? Are we talking about CNAs, RNs is the DON.
Gaines:
Usually LPN usually. So an RN would probably be like the manager of the unit or the wing. Typically, you’ll find LPNs that are the nurses that give medications. CNAs are not allowed to give medications. They can check certain vitals, which again, if the CNA does not take the vital sounds correctly, and the nurse uses that vital. Another possibility for a medication error.
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What policies can help reduce medication errors in facilities?
Schenk:
So there are a lot of things that can go wrong with the administration of medication, but let’s back up and look at a higher level, what are some of the policies that a nursing home might be able to put into place that would reduce the likelihood of a medication error?
Gaines:
I would say number one is training, proper training. Empowering the staff to report errors. To prevent further errors. I think a lot of staff, they do not report. I can only imagine how many errors go unreported, but just making the staff feel like it’s okay to report errors, I would say even getting a pharmacist involved in the training, the medical director, so that the staff can hear from higher level people.
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When you’re only hearing from the DON, it becomes okay. We can’t have medication errors. That’s not really that effective. So when I think when the staff can hear from like a pharmacist or a physician on the effects of medication errors and what happens, to the residents, the injuries, the desk, things like that, and to add to the pharmacist’s role, they can do frequent medication reviews.
That could be a policy that could be implemented. And also the use of technology EMRs. Automated medication dispensing systems, things like that.
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How can families ensure their loved ones receive the right medications?
Schenk:
So what about I guess it makes sense. It’s the idea that you have to have somebody that it’s not enough that you’re climbing a ladder.
You gotta make sure the ladder’s on the right wall. Otherwise you’ve climbed the ladder on the wrong wall. So like I get that. So that’s the pharmacist, the attending physician, the medical director, all being involved in the in-service process to hone in on where they’re having problems, I guess might be the best concept.
Okay. So pretend that you’ve got a family that has a loved one in a nursing home, and they have the litany of medications. What’s some of the advice that you would give them? To help reduce the likelihood that their loved one is going to get the wrong medication, wrong route, et cetera.
Gaines:
The number one thing I would say is to attend those care plan meetings.
Sometimes families do not attend those meetings. They can be rapid, they have so many to get done so that the medication list can go, can be skipped or review quickly. If you have a family member present that say, Hey, I would like to go over these medications. I want more information about it.
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What are the side effects? How are they supposed to be taking it? How often? That would be the number one thing that I would say that families should do. Also communicating with the nurses. If you’re there visiting, you’re at the bedside and they’re coming in with something, ask questions. Hey, what is that for?
Okay, can I see it? How long have they been taking that? Those types of things, and that would make the staff more aware, so I feel that families should ask questions, come to the care plan meetings, meet with the pharmacist if possible, because they can’t request that, what they call a medication reconciliation, things like that.
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Schenk:
I think that it’s super important, and we’ve talked about this many times in this podcast about being part, taking part in the care plan meetings, but also second to that is understanding what your loved one’s baseline is. If they’re normally cognitively impaired, understand that versus do they have disturbances when the sun goes down?
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Things like that. I understand the baseline. You mentioned as part of your advice, what are the side effects of the medication? So it’s important to understand that along with the baseline, how does the medication affect your loved one? From a day-to-day basis or a week to week basis. I think it’s super important because then, if something’s outta whack.
Angela, we really very much appreciate you coming on the show and sharing your knowledge with us.
Gaines:
Thank you for having me, Ron. Have a great day.
Schenk:
Folks, I hope that you found this episode educational. If you have an idea for a topic that you would like for me to discuss, please let me know that.
If you have an idea for a guest that you would like for me to talk to, please let me know that as well. New episodes of the Nursing Home Abuse Podcast come out every single Monday. And remember, please make sure that you enter your for your chance to win the Nursing Home Abuse podcast mug. By inputting your answer to the nursing home abuse question regulation, nursing home regulation question of the week, along with your favorite legal movie.
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