Nursing homes and their caregivers face numerous challenges as they deliver compassionate care to facility residents. As America’s elderly population ages, more and more are turning to nursing homes for long-term care. In these facilities, elderly residents are often saddled with complex health conditions that may require stringent medication administration. As a result, medication missteps are becoming more common. In addition to the protections afforded by nursing home insurance, facility managers must adopt risk management practices that focus on medication administration. By doing so, they can help avoid the injuries or deaths associated with medication errors.
Medication Administration Errors: Common Errors and their Causes
Complex health conditions of elderly nursing home residents are only one aspect of the risk exposures facilities face when administering medications. Many nursing homes are experiencing staffing shortages, with qualified caregivers leaving facilities to seek higher wages and lighter workloads. When a facility is understaffed, the likelihood of a medication error grows. Common medication administration errors include:
Providing patients with the wrong medications – medication packages and labels may look similar, leading to mistakes. Similar names of prescription medications may also lead to errors in delivery.
Poor understanding of patient histories – a nursing home resident’s medical history is an integral part of the care delivery model. Unfortunately, caregivers may not have complete access to detailed medical histories and may be unaware of allergies or undesired reactions to certain medications.
Prescribing incorrect dosages of medications – caregivers may give residents too much or not enough of medications, leading to severe or potentially fatal complications.
Improperly administering medications – certain medications must be taken at regular intervals, with food, or on an empty stomach. Failure to address these parameters may result in complications.
Improper preparation of medications – some drugs may require careful mixing or preparation. Pharmacists and caregivers can make errors in preparation and can cause adverse reactions as a result.
Providing patients with medications that must not be taken together – certain medications, when combined with other medicines, may cause injury, health declines, or deaths. Thorough knowledge of medications and their contraindications is necessary to avoid reactions.
Skipping/missing or failure to provide medication – overworked staff members may forget to administer medications, or may skip individual doses. In other cases, negligence or neglect stemming from nursing home abuse can result in residents having their medication withheld.
Any of these common medication administration errors could open the door to severe risk exposures, including insurance and legal claims against facility managers, owners, and staff members. These errors can also result in tragedy for the residents who received the incorrect medications for their health conditions.
How Serious is the Nursing Home Medication Error Problem?
Several studies have been conducted to determine the prevalence and severity of medication administration errors in nursing homes. In an article published in the American Journal of Managed Care, Australian researchers reviewed 11 similar studies involving medication errors between 2000 and 2015. Another study exploring the impact and prevalence of medication errors was published in the Journal of the American Geriatrics Society. In both studies, between 16 and 27 percent of all nursing home residents were the victims of a medication error; in other words, an average of nearly one in every four nursing home residents has experienced a medication administration error.
Thankfully, the impact of these errors was surprisingly low. In the Australian study, only about 1% of medication errors were reported to authorities, and deaths from the mistakes were rare. The authors of the study point out that reporting mechanisms may be insufficient to capture the true nature of medication errors, and that health professionals do not connect errors with severe injuries or deaths of residents.
Risk Management: Reducing Medication Administration Errors
Nursing home insurance is only one part of a more comprehensive risk management strategy for long-term care facilities. To reduce the impacts associated with medication administration errors, facility owners and managers must adopt robust care practices.
First, staff members must receive regular and ongoing medication administration training, including the preparation of medications, delivery of medications, and adverse reactions to be aware of when combining medications. Training is a crucial component of initiative to reduce medication errors.
Training must also include education on cognitive declines like depression and dementia/Alzheimer’s disease. These conditions may aggravate medication reactions, or may mask adverse reactions being experienced by residents. Specialized training in dementia care is a valuable addition to the staff educational roster, even when medication errors are rare.
Reviewing patient histories with previous caregivers and physicians, especially when receiving new patient transfers to a care facility, can help pinpoint any possible problems with medication administration. As many patients are allergic to certain medications, knowing their histories can help to prevent a serious or fatal error.
Finally, implementing a robust medication review and error reporting process can help to reduce the impacts felt by medication errors. Residents’ medicines should be reviewed regularly with caregivers and pharmacy professionals. Irregularities with preparing, dispensing, or prescribing of medications should be flagged and reported for follow-up. Resources for minimizing the likelihood of medication errors are available from numerous organizations, including the American Geriatrics Society and the Centers for Medicare and Medicaid Services (CMS).
About Caitlin Morgan
Caitlin Morgan specializes in insuring assisted living facilities and nursing homes and can assist you in providing insurance and risk management services for this niche market. Give us a call to learn more about our programs at 877.226.1027.