Medication Errors in Med-Surg Units: A Guide for Attorneys.

Medication errors are among the most common and preventable causes of patient harm in hospitals, and medical-surgical (med-surg) units present a particularly high-risk environment. These errors can lead to adverse drug reactions, prolonged hospital stays, permanent disability, and even death. While attorneys handling medical malpractice, wrongful death, and personal injury cases are familiar with general negligence principles, the medical complexity of these cases can present unique challenges.

This guide provides an in-depth look at medication errors, focusing on technical medical aspects attorneys may not be familiar with, including:

• The medication administration process and critical failure points
• The role of nurses, pharmacists, and physicians in medication safety
• Systemic issues contributing to medication errors
• The legal implications of errors at different stages of medication administration
• Key investigative strategies to build strong malpractice cases
• Case studies demonstrating real-world legal outcomes

Understanding these complexities will allow attorneys to effectively litigate medication error cases, identify deviations from the standard of care, and secure compensation for clients.

Understanding the Medication Administration Process: A Breakdown for Attorneys

Many attorneys may not fully understand how medication is prescribed, dispensed, and administered in a hospital setting. This process involves multiple healthcare providers and several checkpoints designed to prevent errors. However, system failures can occur at any stage, leading to preventable harm.

1. Medication Ordering (Prescribing) – The Physician’s Role

The process begins when a physician, nurse practitioner, or physician assistant prescribes a medication based on the patient’s condition.

?? What Attorneys Should Look For:

• Inappropriate drug selection (e.g., prescribing a nephrotoxic drug to a patient with kidney failure)
• Wrong dosage calculation (especially for pediatric or geriatric patients)
• Failure to check allergies or drug interactions
• Use of dangerous abbreviations (e.g., “U” for units, which can be mistaken for a zero, leading to a 10x overdose)

Example: A physician prescribes Methotrexate daily instead of weekly for rheumatoid arthritis, leading to fatal toxicity.

2. Medication Dispensing – The Pharmacist’s Role

Once the medication order reaches the pharmacy, the pharmacist is responsible for verifying, preparing, and dispensing the correct medication.

?? What Attorneys Should Look For:

• Look-Alike/Sound-Alike (LASA) drug mix-ups (e.g., hydralazine vs. hydroxyzine)
• Failure to detect a physician’s prescribing error
• Mislabeled or poorly packaged medications
• Automated dispensing machine errors (e.g., the wrong medication being loaded into the Pyxis system)

Example: A patient in diabetic ketoacidosis (DKA) receives long-acting insulin instead of fast-acting insulin, delaying treatment and leading to brain damage.

3. Medication Administration – The Nurse’s Role

Nurses are the final safeguard in the medication process. They are responsible for ensuring that the right drug, right dose, right patient, right route, and right time are followed (the “5 Rights” of medication administration).

?? What Attorneys Should Look For:

• Failure to verify patient identity (leading to wrong patient errors)
• Administering medication via the wrong route (e.g., IV potassium chloride given as a rapid IV push instead of diluted in an IV bag, causing cardiac arrest)
• Missed or delayed doses (especially for antibiotics, anticoagulants, and pain medications)
• Failure to monitor for adverse drug reactions

Example: A postoperative patient on patient-controlled analgesia (PCA) morphine is not monitored for respiratory depression, leading to death.

Systemic Issues That Contribute to Medication Errors

Medication errors are not always due to individual negligence—many result from systemic failures within the hospital environment. Attorneys handling these cases should consider hospital liability and corporate negligencewhen investigating claims.

1. Understaffing and Nurse Fatigue

Hospitals often assign more patients than nurses can safely manage, leading to increased errors due to fatigue, stress, and multitasking.

?? Key Facts for Attorneys:

• Research shows that each additional patient assigned to a nurse increases the likelihood of medication errors.
• Nurses working 12+ hour shifts are significantly more likely to make errors.
• Hospitals can be held liable for failing to provide adequate staffing levels.

Example: A nurse working back-to-back 12-hour shifts mistakenly administers 10 times the intended dose of insulin, causing hypoglycemia and coma.

2. Electronic Health Record (EHR) and Automated Dispensing Errors

While electronic health records (EHRs) and automated dispensing cabinets (ADCs) like Pyxis and Omnicell are designed to reduce errors, they can also create new risks.

?? Key Facts for Attorneys:

• EHR “drop-down” selection errors can result in the wrong drug being ordered.
• Alert fatigue causes providers to ignore crucial medication warnings.
• Overridden safeguards in automated dispensing systems can lead to incorrect medication selection.

Example: A nurse overrides barcode scanning in the Pyxis system, administering neuromuscular blockers instead of an anti-nausea drug, leading to respiratory arrest.

3. Failure to Follow Double-Check Protocols for High-Risk Medications

Certain medications (insulin, chemotherapy, heparin, opioids) require a second nurse to verify the dose before administration.

?? Key Facts for Attorneys:

• Hospitals are responsible for enforcing double-check protocols.
• Failure to follow these safeguards can constitute negligence.

Example: A new nurse administers a fatal dose of heparin without a second nurse verification, causing internal bleeding and death.

Key Evidence for Attorneys Investigating Medication Errors

Attorneys should obtain the following documents to establish negligence:

?? Medication Administration Records (MARs) – Shows what was given, by whom, and when.

?? Pharmacy Dispensing Logs – Verifies whether the correct medication was dispensed.

?? Hospital Policies on Medication Safety – Identifies deviations from protocol.

?? Electronic Health Records (EHR) – Reveals prescribing errors and overrides.

?? Nurse Staffing Schedules – Determines if understaffing contributed to errors.

?? Surveillance Footage (if available) – Captures real-time medication administration errors.

Conclusion: How Attorneys Can Strengthen Their Cases

Medication errors in med-surg units are complex and multi-faceted, requiring attorneys to go beyond basic malpractice principles and understand the intricate systems that contribute to errors. By:

? Investigating hospital-wide failures (e.g., staffing, training, EHR issues).

? Working with Legal Nurse Consultants (LNCs) to identify deviations from standard care.

? Leveraging hospital policies, pharmacy records, and surveillance footage.

Attorneys can strengthen their cases, prove negligence, and secure justice for injured patients.