As a Houston, Texas medical malpractice attorney, I have represented many clients who were seriously injured from a medication error.
An actual case that settled provides a good illustration of this danger to patient safety. A teenaged autistic boy, who is typically uncooperative as a result of his condition, was admitted to a children’s hospital for several dental procedures. An oral surgeon attending physician and a resident physician, still in training, perform the procedures under general anesthesia.
The doctors planned to prescribe acetaminophen with codeine upon discharge, to control pain, but the patient’s mother told them that their plan would not work because her son refused to take oral medication. The resident physician decided to prescribe a fentanyl patch and then used the electronic medical record system to select the dosage of 100 mcg/hour from a drop-down menu.
Once the mom got home with her son, she placed the fentanyl patch on his upper back. He was found dead the next morning. The autopsy showed that his fentanyl level was 19.1 ng/mL, which is 6-20 times the correct therapeutic level.
In this case, the plaintiff alleged that the resident physician prescribed a fentanyl patch without first determining the appropriate strength for the patient’s age and size. The plaintiff also pointed out that the drug had a “black box warning” for prescribers, but that the resident physician ignored most of them, instead just relying on the click-down box on the electronic medical record system.
By the way, the case settled for an undisclosed amount.
What also caught my attention about this case is that there was no safety net in place for the resident physician’s order. Think about all of the healthcare providers that did nothing, even though they had an opportunity to do so: the attending physician supervising the resident physician, the registered nurse handling the patient discharge, and the pharmacist who filled the prescription.
What doctors should do when writing prescriptions
Both Texas Medical Board rules and the standard of care require physicians writing medication prescriptions to exercise competence that can be summed up in Five R’s: (1) the right patient; (2) the right drug; (3) the right dose; (4) the right route; and (5) the right time.
Experts recommend that prescribing physicians check the 5 R’s each and every time they write a prescription. This means that doctors should independently check drugs and dosages each time.
Unfortunately, inmy practice, I have seen time after time when physicians and other healthcare providers rely on computerized medical record systems when it comes to selecting and dosing medications, rather than doing their own research. Certainly, when a prudent doctor uses a medication recommendation from the electronic medical record system, he or she should independently verify the appropriateness of the medication, as well as dosage and routing.
I have also handled a number of cases where inappropriate prescriptions were written that pharmacies should not have filled or dispensed. The standard of care requires pharmacies to have a warning system in place that is automatically triggered under certain circumstances. The warning system should be triggered when there is a drug-drug interaction or contraindication, meaning that the two drugs should not be taken in an overlapping time frame. Similarly, a pharmacy warning system should also be triggered if the dosage falls outside the recommended range for patient’s age.
What you can do
When your doctor, physician’s assistant, or nurse practitioner gives you a prescription, I recommend engaging in a discussion about the medication, signs and symptoms you should look out for, and whether there is any concern about using it with other medications that you are taking. It is important, of course, for the prescribing healthcare provider to be aware of those medications, as well.
Once you go to the pharmacy to pick up your prescription, be sure to take advantage of the opportunity to receive counseling from the pharmacist. This is the perfect time to ask about the dosage and route of administration, and to mention your age and weight. In addition, ask about side effects and other issues that you may need to be aware of.
In my personal experience, pharmacy staff members do not go out of their way to offer pharmacist counseling, but do typically mention it as being available. In some cases that I have handled, pharmacies have kept a record of whether patients accept pharmacist counseling and, if they did not, use that as a means of blaming the patient for any medication error.
We are here to help
If you or someone you care for has been seriously injured as a result of a prescription or medication error, call the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, for a free consultation about your potential case. Our phone number is 281-580-8800.
__________
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC, in Houston, Texas. He represents patients and their families in medical negligence and wrongful death cases, suing doctors, surgeons, anesthesiologists, hospitals, and pharmacies, like CVS and Walgreens.
