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Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

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Medication Errors

Medication Errors

Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

By Kosieradzki Smith Law Firm

July 1, 2013

Transitions between caregivers, changes in condition, and complex medication regimes increase the risk of harm to a nursing home resident. If residents are to be afforded the quality of care that federal nursing home regulations mandate—and more important, the dignity all residents deserve—nursing homes must diligently assess and manage all of these factors.

This means the nursing home must maintain effective clinical oversight, competent nursing, efficient pharmacy resources, quality laboratory services, and a standard level of attention given to all its residents.

For the other parts in this series, click on the following:

Mismanaged Medications in Nursing Homes: An Overview (Part 1 of 6)

Mismanaged Medications in Nursing Homes: Proper Medication Management (Part 2 of 6)

Mismanaged Medications in Nursing Homes: A Resident’s Medical Records and Medication History (Part 3 of 6)

Mismanaged Medications in Nursing Homes: Maintaining Adequate Staffing and Staffing Procedures (Part 4 of 6)

Mismanaged Medications in Nursing Homes: A Nursing Home and Its Pharmaceutical and Laboratory Services (Part 5 of 6)

For the experienced personal injury lawyer representing a neglected nursing home resident, a thorough understanding of a nursing home’s medication policies and procedures—and a meticulous level of inquiry to determine whether they were followed—is the resident and his or her family’s best tools in evaluating and proving medication mismanagement.

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe you or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

TOPICS:   Medication Errors

Mismanaged Medications in Nursing Homes: A Nursing Home and Its Pharmaceutical and Laboratory Services (Part 5 of 6)

By Kosieradzki Smith Law Firm

June 28, 2013

Nursing homes are required to provide and coordinate pharmaceutical services to meet each resident’s needs, and this includes a duty to provide accurate information to the pharmacy furnishing pharmaceutical services.

When transmitting orders to the pharmacy, nursing homes have a dual responsibility to review the medications, as well as to communicate accurate information. If there are any administrative or clerical errors on either end of the facility’s responsibility, then there is a significant chance of mismanaged medication administration.

An experienced lawyer will compare the medications supplied by the pharmacy against the prescribing doctor’s orders.

For any medication order that must be administered promptly, such as an insulin prescription for a diabetic, the facility must administer the medication at the prescribed time. This means at night, on weekends, or on holidays. If the facility’s chosen pharmacy has already made its daily delivery, the nursing home must still find a way to administer the medication at the prescribed time.

To ensure that residents receive their medications safely and in accordance with a physician’s orders, professional standards of care require a licensed pharmacist to review each resident’s drug regimen regularly. This review must occur at least monthly, and any irregularities need to be reported to the physician and the facility’s director of nursing—they have a duty to act on any such reports.

It is important to note that because the pharmacist must use his or her expert understanding of medications and medication interactions, this responsibility cannot be offloaded to subordinate staff members.

The drug regimen review process includes reviewing the nursing home resident’s record for emerging or existing adverse medication consequences, and the potential for adverse drug reactions and medication errors.

Additionally, nursing homes must provide laboratory services to meet their resident’s needs. Lab studies ordered by the physician or pharmacist are essential to evaluating the patient’s response to the medication. The nursing home is responsible for the quality and timeliness of such services, even if the facility does not provide laboratory services on-site.

An experienced lawyer should obtain the contract between the nursing home and the laboratory, as well as the facility’s policies and procedures on laboratory services. Any communications between the facility and the laboratory should be examined as well.

For the other parts in this series, click on the following:

Mismanaged Medications in Nursing Homes: An Overview (Part 1 of 6)

Mismanaged Medications in Nursing Homes: Proper Medication Management (Part 2 of 6)

Mismanaged Medications in Nursing Homes: A Resident’s Medical Records and Medication History (Part 3 of 6)

Mismanaged Medications in Nursing Homes: Maintaining Adequate Staffing and Staffing Procedures (Part 4 of 6)

Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe you or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

Mismanaged Medications in Nursing Homes: Maintaining Adequate Staffing and Staffing Procedures (Part 4 of 6)

By Kosieradzki Smith Law Firm

June 27, 2013

In implementing its policies and procedures, a nursing home facility must hire, retain, and supervise its employees in a manner that minimizes the risk of maltreatment to residents, including having qualified staff administer any medication.

For medications administered on an “as needed basis,” such as anti-anxiety medications like alprazolam (brand name Xanax), diazepam (Valium), or clonazepam (Klonipin), the decision to give the drug must be based on a nurse’s assessment of the resident’s condition and an assessment of whether previously administered doses of the medication or effective. The nurse must document the basis for each instance of medicine administered on an as-needed basis.

The nursing home staff must document all medication orders. This means documenting medication administration on both the physician’s “order sheet” and the resident’s medication administration record. The nursing home must transcribe physician orders accurately, frequently, with start and stop dates, as well as clarify any unclear orders with the physician.

It is the job of a skilled personal injury layer to accurately evaluate whether the nursing home’s practice complied with the expectations set forth in the facility’s policies, procedures, and training records.

To give an example, let’s say that a nursing home’s policies and procedures require two nurses to complete the transcription process—one to transcribe the orders into a resident’s medication administration record, a second to check that the transcript is accurate.  If the facility is following federal regulations, two signatures should indicate a thorough review and transcription of a resident’s medicine records; there should be no discrepancies. However, two signatures on a form that has evident discrepancies means that, in practice, the facility is failing to ensure responsible medication management. This carelessness can have disastrous results.

Mismanaged Medications in Nursing Homes: An Overview (Part 1 of 6)

Mismanaged Medications in Nursing Homes: Proper Medication Management (Part 2 of 6)

Mismanaged Medications in Nursing Homes: A Resident’s Medical Records and Medication History (Part 3 of 6)

Mismanaged Medications in Nursing Homes: A Nursing Home and Its Pharmaceutical and Laboratory Services (Part 5 of 6)

Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe you or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

Details about the Community Memorial Nursing Home in Osakis, Minnesota

By Kosieradzki Smith Law Firm

June 26, 2013

This 52-bed nursing home was cited with 5 health deficiencies, according to Medicare’s 2012 annual report. These include the Community Memorial Home’s:

  • Failure to provide care by qualified persons according to each resident’s written plan of care;
  • Failure to allow residents the right to participate in the planning or revision of care and treatment;
  • Failure to ensure that residents are fully informed and understand their health status, care and treatments; and
  • Failure to ensure that the nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.

Medicare has also identified 2 complaints and facility-reported incidents associated with Community Memorial Hospital.

In addition, the Minnesota Department of Health has substantiated one report of a significant medication error resulting in medication administration not in line with the facility’s resident’s care plan.  During the course of the investigation, it was determined that six residents were involved in medication errors due to the medications arriving from the pharmacy to the facility with the wrong administration directions. The facility did not have a policy or procedure to check medications against the original physician’s order when it was delivered to the facility. The facility did not identify this system failure at the time of MDH’s visit. [Report no. H5045008]

When your loved one has suffered neglect or abuse by those entrusted to care for them because the nursing home or other care facility failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

Mismanaged Medications in Nursing Homes: A Resident’s Medical Records and Medication History (Part 3 of 6)

By Kosieradzki Smith Law Firm

June 26, 2013

Reviewing a resident’s medical records should be the first thing any plaintiff lawyer investigates.  Medical records should include, among other things, documentation of all communications with the attending physician’s chart to assess his or her evaluation of the resident’s condition in relation to the prescribed medications. An experienced plaintiff lawyer should pay particularly close attention to the attending physician’s chart to assess his or her evaluation of the resident’s condition in relation to the prescribed medications. Additionally, billing records can be checked against any pharmacy records for discrepancies.

It is important to evaluate whether the prescribed medications were necessary. A resident’s medication regime should promote the highest practicable health, and should include only medications that are clinically indicated to treat a resident’s assessed conditions.

Federal nursing home regulations define unnecessary drugs as any medication used in excessive doses, for an excessive duration, without adequate monitoring, without adequate indications for use, or in the presence of adverse consequences indicating the dose should be lowered or stopped altogether.

Federal nursing home regulations also mandate that residents who have not used anti-psychotic drugs should not be given these drugs unless anti-psychotic drug therapy is necessary to treat a specific condition, as diagnosed and documented in the resident’s clinical record. For residents who do require anti-psychotic drugs, the facility must ensure that the resident receives gradual dose reductions and behavioral interventions in an effort to discontinue such drugs, unless to do so would decrease the standard of care for a resident.

On May 30, 2012, the Centers for Medicare and Medicaid Services (CMS) announced an initiative to reduce the use of anti-psychotic drug administration in nursing homes. A 2010 report by CMS indicated that more than 17 percent of nursing home patients had daily doses of anti-psychotic medications exceeding recommended levels. Further, CMS found that almost 40 percent of patients with dementia were receiving anti-psychotic drugs at some point in 2010, even though there was no diagnosis of psychosis.

By obtaining and reviewing all records and documents related to a resident’s care plan, a personal injury lawyer will be able to identify the resident’s needs, and how the facility met those needs.  These records include the resident’s pre-admission assessment, the discharge and transfer records from the hospital, physician orders for medications and laboratory procedures, and any communications between the nursing home staff and the physician that verifies or clarifies the medication orders.

For the other parts in this series, click on the following:

Mismanaged Medications in Nursing Homes: An Overview (Part 1 of 6)

Mismanaged Medications in Nursing Homes: Proper Medication Management (Part 2 of 6)

Mismanaged Medications in Nursing Homes: Maintaing Adequate Staffing and Staffing Procedures (Part 4 of 6)

Mismanaged Medications in Nursing Homes: A Nursing Home and Its Pharmaceutical and Laboratory Services (Part 5 of 6)

Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe you or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

Mismanaged Medications in Nursing Homes: Proper Medication Management (Part 2 of 6)

By Kosieradzki Smith Law Firm

June 5, 2013

Proper management of nursing residents’ medication needs and safety does not happen on its own.  It requires a commitment to safety and diligence by the nursing home’s administration and nursing staff.  To ensure that a nursing home accurately manage the complexities and challenges of its residents medications:

  • The nursing home administration must ensure that each resident’s medication is managed and reviewed by a physician, and that each resident has access to his or her own personal physician;
  • The physician is responsible for providing and reviewing the medication orders and the total program of care at the time of a resident’s admission and at each subsequent examination of the resident;
  • The nursing home administration must ensure that the physician approves the resident’s admission, reviews the resident’s care plan (especially medical services and medication management), participates in the resident’s assessment and care planning, monitors changes in the resident’s medical status, and is available to consult or treat when called upon by the facility; and
  • If a physician is unavailable or does not respond to any call for service, the nursing home must have another physician available to supervise the patient’s medical care.

Whether the particular nursing home has a proper system place is a critical issue when a resident has been harmed as a result of a nursing home’s failure to provide the right medication, in the right amount, at the right time.  The following blogs in this series will outline how we investigate cases of mismanaged medication.

For the other parts in this series, click on the following:

Mismanaged Medications in Nursing Homes: An Overview (Part 1 of 6)

Mismanaged Medications in Nursing Homes: A Resident’s Medical Records and Medication History (Part 3 of 6)

Mismanaged Medications in Nursing Homes: Maintaing Adequate Staffing and Staffing Procedures (Part 4 of 6)

Mismanaged Medications in Nursing Homes: A Nursing Home and Its Pharmaceutical and Laboratory Services (Part 5 of 6)

Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe you or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

TOPICS:   Medication Errors

North Ridge Care Center Employee Stole Narcotic Medication from Nursing Home Residents

By Kosieradzki Smith Law Firm

June 4, 2013

A Minnesota Department of Health investigation has found that an employee of the North Ridge Care Center was stealing a resident’s prescription painkillers. The employee was also found to have been stealing prescription medication from at least 12 other residents of the New Hope, Minnesota nursing home, although the number of residents impacted may have been as high as 24, according to the MDH report.  [Report no. H5183093]

According to the MDH report:

  • After the suspected employee left the facility, another nurse spotted a discrepancy in the medication charting for one of the residents;
  • When confronted by administrative staff, the suspected employee admitted to taking  prescription Oxycodone tablets from the resident for the employee’s own personal use;
  • The employee also admitted to taking narcotic medication from several other residents over a four-month period;
  • The suspected employee was terminated from employment at the facility; and
  • The case was forwarded to the county attorney’s office for possible prosecution.

Click here for more details about the North Ridge Care Center.

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe your or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

Mismanaged Medications in Nursing Homes: An Overview (Part 1 of 6)

By Kosieradzki Smith Law Firm

June 4, 2013

Nursing home residents’ safety requires that the facility staff maintain diligent oversight of its resident’s medication regime. The average resident’s medication regime includes seven to eight different medications administered monthly. Federal regulations mandate that nursing home facilities “must ensure that residents are free from any significant medication errors.”

Unfortunately, medication errors are all too common among nursing home facilities. However, the good news is that experienced plaintiff lawyers know the rules that govern medication safety.

This blog will explain the tools and skills used by skilled lawyers to determine if and when mismanaged medication resulted in a violation of a resident’s standard of care. Nursing home residents have rights, and any violation of such rights deserves a diligent and committed investigation to remedy any instance of nursing home malpractice.

Nursing homes are required by federal laws to have in place a system that is free from significant medication errors. Any inquiry into a potential case of mismanaged medication should focus on the facility’s policies, procedures, and training in several areas:

  • a resident’s clinical records
  • the facility’s procedures for acquiring, receiving, and dispensing medications
  • a resident’s physician’s orders regarding medications
  • medication care planning
  • the administration of medications
  • the facility’s assessment and monitoring of a resident’s drug regimen
  • how a facility reports medication irregularities to the attending physician
  • any medication errors
  • pharmacy services
  • laboratory services

These specific methods of inquiry will be explained in detail in the following reports of this blog series.

For the other parts in this series, click on the following:

Mismanaged Medications in Nursing Homes: Proper Medication Management (Part 2 of 6)

Mismanaged Medications in Nursing Homes: A Resident’s Medical Records and Medication History (Part 3 of 6)

Mismanaged Medications in Nursing Homes: Maintaing Adequate Staffing and Staffing Procedures (Part 4 of 6)

Mismanaged Medications in Nursing Homes: A Nursing Home and Its Pharmaceutical and Laboratory Services (Part 5 of 6)

Mismanaged Medications in Nursing Homes: Conclusion (Part 6 of 6)

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe you or your loved one has suffered medication errors because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

 

TOPICS:   Medication Errors

Details About the North Ridge Care Center Nursing Home in Minnesota

By Kosieradzki Smith Law Firm

May 31, 2013

This 397-bed nursing home received a “below average” for its Overall rating, according to Medicare’s 2012 annual report. Additionally, the facility received a “much below average” for its Health Inspection rating. North Ridge Care Center was cited with 7 health deficiencies. These include the facility’s:

  • Failure to hire only people with no legal history of abusing, neglecting, or mistreating residents, or report and investigate any acts or reports of abuse, neglect, or mistreatment of residents;
  • Failure to develop and implement policies for screening and training employees, and the prevention, identification, investigation, and reporting of any abuse, neglect, mistreatment and misappropriation of property;
  • Failure to provide care by qualified persons according to each resident’s written plan of care;
  • Failure to give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores;
  • Failure to provide care for residents in a way that maintains or improves their dignity and respect in full recognition of their individuality; and
  • Failure to maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.

Additionally, Medicare has identified 5 complaints and facility reported incidents, including the facility’s failure to ensure that the nursing home area is free from accident hazards and provide adequate supervision to prevent avoidable accidents.

Finally, the Minnesota Department of Health has substantiated two reports of nursing home malpractice.

  • In October of 2011, MDH substantiated a report of neglect wherein the facility failed to adequately supervise a resident with a history of physical and verbal aggression. As a result, the resident wandered into the room of another resident and proceeded to physically beat her. The victimized resident sustained numerous bruises and abrasions. [Report no. H5183084]
  • In April of 2013, MDH substantiated a report of financial exploitation wherein an employee admitted to stealing prescribed narcotics from two residents. [Report no. H5183093]

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe your loved one has been harmed due to a nursing home’s failures, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.

Details about the Bryn Mawr Health Care Center Nursing Home in Minnesota

By Kosieradzki Smith Law Firm

May 17, 2013

This 112-bed nursing home received a “below average” for both its Overall and Health Inspections ratings,according to Medicare’s 2012 annual report on nursing homes.Bryn Mawr Health Care Center was cited with 7 health deficiencies, including the facility’s:

  • Failure to develop a complete care plan that meets all the resident’s needs, with timetables and actions that can be measured;
  • Failure to ensure that each resident’s entire drug/medication regimen is free from unnecessary drugs, and is managed and monitored to achieve highest level of well-being;
  • Failure to at least once a month, have a licensed pharmacist review each resident’s medications and report any irregularities to the attending doctor; and
  • Failure to have a program that investigates, controls and keeps infection from spreading.

The Kosieradzki • Smith Law Firm represents clients in cases involving catastrophic injury caused by nursing homes and other care facilities that fail to provide proper care. If you believe your loved one has been harmed due to a nursing home’s failures, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a no-cost, no-obligation consultation.