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Are Nursing Homes Dispensing “High-Alert” Medications Safely?
Federal law does not mess around when it comes to ensuring the safe distribution of medications to nursing home residents. In order to keep the community safe, nursing homes must follow two critical rules when dispensing medications:
- 42 C.F.R. 483.25(m)(2). The [nursing home] facility must ensure that residents are free of any significant medication errors.
- 42 C.F.R. 483.60(a). A [nursing home] facility must provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals) to meet the needs of each resident.
What are High-Alert Medications?
High-Alert medications are drugs that can cause harm even when used as intended. High Alert Medications are well known for their potential to cause adverse effects, making it even more important that those involved in dispensing medications to nursing home residents pay attention to the medication and the process for giving the mediation. Legislation even requires High Alert Medications to come in standardized labeling to reduce medication errors.
There are several High which are categorized as anticoagulants, opiates, insulin, and sedatives – drugs that are wide prescribed and dispensed to elderly patients in long-term care facilities. Anticoagulants thin the blood and prevent clotting; opiates manage pain symptoms; insulin regulates blood sugar levels; and sedatives calm and relax patients before or after medical procedures. Mistakes in prescribing or administering anticoagulants may lead to internal bleeding in patients. Misuse of opiates and sedatives can cause addiction, overdose, cardiac or respiratory arrest, and death. Errors in insulin use can cause extremely high or low blood sugar which can lead to strokes or sugar coma.
The Institute for Safe Medication Practices has published a list of High-Alert Medications often in use at nursing home facilities. Some of the specific medications identified by the ISMP are epinephrine, magnesium sulfate, methotrexate, nitroprusside sodium, opium tincture, and oxytocin. The complete list can be found here:
How Should High-Alert Medications be Administered in a Nursing Home?
Modern society is increasingly reliant on drug therapies as first-line interventions when treating disease. This is certainly true in a nursing home setting. Drugs affect the structure or function of the body when used for diagnosing, curing, mitigating, treating, and preventing disease. Receiving medication exposes patients and nursing home residents to potential benefits of drugs but they also expose patients to potential harm resulting from medication errors.
In a nursing home setting, the order and dispensing of High-Alert Medications should have multiple safeguards to ensure that errors do not happen. Physicians orders should be verified with the physician before being sent to the pharmacy. Pharmacies that work with nursing homes should themselves have a series of levels to prevent the dispensing of an improper order or an order that would be dangerous to the nursing home resident. Finally, before the medication is administered to the resident, the nursing home and its staff members should have a means of checking the medication to ensure it is safe.
Risk of Medication Errors
As we have seen, administering medication in a long-term care setting is a complex process that involves doctors or advanced practice nurses that prescribe drugs and the manner that they are administered, pharmacists that fill the prescriptions, and nurses that dispense them to patients. At any step of this process mistakes and errors can occur.
A medication error is any act of commission or omission in the process of using drugs. A medication error is a mistake in ordering, labeling, packaging, distributing, dispensing, or administering that may cause inappropriate use and thus, patient harm. Medication errors are clearly preventable when proper precautions are used.
Thankfully, most medication errors do not result in serious injuries or death. However, when High-Alert Medications are involved, any error places the resident at significantly higher risk of serious injury or death just by the nature of the drug itself.
Studies estimate that around 800,000 preventable medication-related injuries happen every single year in nursing homes. In a long line of studies, 16 to 27 residents out of one hundred nursing home residents have experienced some type of medication error.
Recommended Safeguards and Strategies in Handling High-Alert Medications
Because of the potential danger posed by High-Alert Medications especially to the elderly, the Institute for Safe Medication Practices has recommended that these drugs be manufactured with black-box labels to alert patients and professionals to the potential dangers they pose. For safe handling High-Alert Medications should be packaged, stored, prescribed, and administered differently from other drugs.
High-Alert Medications must be stored and labeled accordingly. They must be stored in individual containers with only one type of medication per storage container. The labels must contain the recommended route of administration such as: topical use only or epidural use only. The labels must also contain warnings of the risk or danger posed by the drug such as: “paralyzing agent causes respiratory arrest”.
There should also be automated dispensing cabinets to minimize risks of double dosing. Access to areas where High-Alert Medications in nursing homes are stored must be restricted only to authorized personnel. And when High-Alert Medications are administered to residents, there must be automated alerts to enable independent double-check mechanisms. A double-check is usually a series of questionnaires or checklists used to verify another healthcare provider’s completed tasks.
All medical personnel are required to undergo medication training or medication information training. Most importantly, the necessity of prescribing and dispensing High-Alert Medications must be explained to the patients or the patients’ relatives. They must be notified that High-Alert Medications will be administered to the patients.
High-Alert Medications are a class of powerful drugs that even when used as intended can still cause harm to patients. Any error in the use or administration of High-Alert Medications can lead to devastating adverse effects on nursing home residents. Because of the clearly higher risk of medication errors involving High-Alert Medications in nursing homes, extra care should be taken when administering them to elderly adults.
St. Louis Lawyers Leading the Fight Against Medication Errors in Missouri and Illinois Nursing Homes
At the Terry Law Firm, we have the experience needed to investigate medication errors and other claims of abuse or neglect in Missouri and Illinois nursing homes. We handle nursing home neglect cases and stand up nursing home owners who choose personal gain over protecting vulnerable residents from harm. If you are considering legal action against an Illinois or Missouri nursing home, contact us and tell us your story.
All calls and discussions with our nursing home negligence attorney David Terry are confidential. You can reach us directly by phone as well at (314) 878-9797.
ISMP Medications List
ISMP List of High-Alert Medications in Acute Care Settings