How Doctors Administer Medication (and Why It Matters)
Drugs serve many roles in a healthcare setting. They can be used to treat a disease, ease suffering, supply a missing substance, encourage a bodily reaction, or induce unconsciousness. But in the United States, delivering the right drugs to the right patients is a process beset with medication errors.
As noted by the Agency for Healthcare Research and Quality, drug-related reactions and injuries account for nearly 700,000 emergency room visits and 100,000 hospitalizations each year, and these numbers are likely underreported. Meanwhile, at least 5% of hospitalized patients will suffer harm through an adverse drug event. And an estimated 50% of these ADEs are preventable.
Medication errors can take place at any stage between the doctor prescribing a medication to the nurse administering the medication to a patient. There are five “rights” of medication safety every healthcare provider should know: right medication, right dosage, right time, right patient, and right route. Some lists also include the right reason and the right documentation.
Today, we’ll be discussing a failure to use the “right route” to deliver medication, also called erroneous route of administration, wrong-route error, and medical device misconnection. These failures are mostly committed by nurses, who tend to be the ones to administer drugs in an inpatient setting. Though children under 5 and elderly adults are at higher risk for most medication errors, administration errors are equal-opportunity: for example, no one can survive their oxygen tubing being connected to an IV line. The embolism will kill within seconds.
That is why we cannot afford to overlook an incorrect administration. Ever. Here’s what our law firm thinks you should know.
How Doctors Prescribe Medications
Besides relying on the drug manufacturer’s indications and the U.S. Food & Drug Administration’s approval for use, doctors must consider the type of drug, the part of the body that needs treatment, how the drug will interact with all the patient’s systems, and that particular patient’s age, weight, and health. Does he have liver trouble? Does she have a condition that makes her more vulnerable to certain side effects? In addition, the prescribing physician must take into account medications that the patient is already taking as well as allergies. The potential benefits of the medication must be weighed against any potential harm caused by known side effects or drug interactions.
Doctors may not get it right the first time, which is why blood tests are often run to determine if a prescribed amount of medication is working or not. For some high-risk drugs, patients should be kept in hospital care so staff can observe how the drug is affecting them. Would medical professionals do any less for their own family members? We don’t think so.
Deciding how a medication should be administered largely depends on standard practice, clinical research, and the effectiveness vs. the danger of a particular application. For example, some drugs are destroyed by gastric juices and therefore shouldn’t be delivered via the stomach. But serious harm is a bigger consideration. One of our clients was given an epidural steroid injection for pain control prior to her son’s wedding. The problem? This particular drug, Kenalog, had an explicit warning that it was not to be given as an epidural injection. The drug caused a stroke; minutes later, our client was permanently paralyzed from the waist down. This once-active woman is now confined to a wheelchair and couldn’t even attend her son’s wedding. The family was devastated; we recovered $14.9 million for them in a jury trial.
How Medications Can Be Administered
There is some overlap in these definitions, but we want to be thorough. For example, a medication may be an intravenous infusion. A medication delivered enterally may also be delivered rectally with no ill effects. Here is a list detailing possible administration methods, though it is not all-inclusive:
- Buccal: Placed inside the cheek, absorbed through the mouth’s tissues and delivered to the bloodstream.
- Enteral: Delivered directly to the gastrointestinal tract (usually, into the stomach or intestine through a J-tube), but can also be delivered through the rectum. There are two main methods: mixing the substance with food or water, or using a G-tube passed through the nose or mouth into the stomach.
- Epidural: Injected into the epidural space around the spinal cord.
- Inhalable: Breathed into the lungs through a tube or mask. Anesthesia is sometimes delivered this way.
- Infused: Injected into a vein with an intravenous line and slowly dripped in over time.
- Intracerebroventricular or intraventricular: Injected into the cerebral ventricles (sections in the brain where cerebrospinal fluid is produced) to bypass the blood-brain barrier. It is used in the treatment of certain cancers.
- Intramuscular: Injected into muscle with a syringe. Which muscle, and how deep the syringe goes, may differ depending on the drug and the condition it is meant to treat.
- Intraperitoneal: Injected into the perineal cavity, which is a fluid lining in the abdomen.
- Intrathecal: Injected into the spine.
- Intravenous: Injected into a vein or IV line.
- Nasal or intranasal: Delivered into the nostrils as a mist or droplets, by spray or pump. Most intranasal delivery is not FDA approved.
- Ophthalmic: Delivered into the eye by drops, gel, or ointment.
- Oral: Delivered by mouth via swallowing. Usually in the form of pills, tablets, capsules, lozenges, or liquids.
- Otic: Delivered via drops in the ear.
- Rectal: Delivered via inserting into the rectum.
- Subcutaneous: Injected just under the top layers of skin.
- Sublingal: Held under the tongue, where it dissolves into the blood-rich tissues.
- Topical: Held against or rubbed on the skin
- Transdermal: Absorbed through a patch placed against the skin.
Some of these delivery methods are used mainly in animal studies (like intraperitoneal, intraventricular, and intranasal), but are rarely used on humans. A route may be classified based on where the medication is applied, or where it is intended to take action. Different medications require different administration to be effective – obviously, eye drops are of little use outside the eye. And the wrong medication delivered the wrong way, as we’ve seen, can be life-changing or fatal.
What Allows Administration Errors to Happen?
Let’s use an example. Tranexamic acid is given to patients to stop bleeding by preventing the breakdown of fibrin, a protein that helps to clot blood. But recently, this medication has been confused with a common anesthesia and inserted into patients’ spines. This turns it into a “potent neurotoxin with a mortality rate of about 50%…Survivors of intraspinal tranexamic acid often experience seizures, permanent neurological injury, and paraplegia.” Since several errors were reported secretly to the Institute for Safe Medication Practices, we do not know if these patients lived or died. The “reason” for the administration failure? Both tranexamic acid and the anesthetic came in bottles with blue caps, though they are different sizes and have different labels. Doctors failed to re-check the labels before administering the deadly dose.
Mistakes like this simply cannot be made, and show the larger issue at stake in American healthcare. Our law firm has experience with various wrong-route situations, such as:
- Enteral formulas given any other way than through the digestive tract. For example, delivering a formula meant for a feeding tube to an IV line. These cases are usually fatal.
- Oral medication given intravenously. This is a surprisingly common error that comes about when nurses use IV syringes to measure out an oral solution dose, and are interrupted or pass the syringe to someone else who then inserts it intravenously. These cases are also usually fatal.
- Intravenous medication given through the spine. See the tranexamic acid example above. IV and epidural lines may also be mixed up, and this can prove deadly, especially to a mother in childbirth.
- Intravenous medication given orally. IV solutions are given in this manner specifically to control the dosage and duration of the drug administration. If a patient ingests IV drugs, it will almost always be harmful and may lead to an overdose.
- Intramuscular preparations given intravenously. Intramuscular solutions are to be injected as far as possible from major blood vessels and nerves to avoid nerve damage AND intravenous absorption, generally because they are supposed to be absorbed more slowly into the body. Overdose is a danger here as well.
How do these injuries and deaths happen? Failures to communicate are believed to cause up to 85% of hospital‐related never events and are strongly associated with medication errors – and it’s easy to see why. Unclear labeling, vague instructions from doctor to nurse, similar-looking containers that aren’t kept separate, and “one size fits all” tubing or line connectors all play a part in harming thousands of people every day. When patients are seriously injured by professional failures, we believe medical professionals need to be held responsible, both at an individual level and for their hospital-wide policies and procedures. And we can do this through a medical malpractice lawsuit.
Talk to a Nationally Acclaimed Law Firm About Your Situation
If you desire more information, or you suspect incorrect drug administration was the cause of a loved one’s injury or death, please contact Leventhal & Puga, P.C., at (877) 433-3906 to set up a no-cost initial consultation. Our Denver medical malpractice attorneys have deep experience in these cases and handle claims across the United States. In addition, we take no upfront fees for our services and only get paid after we have won or settled your claim. Do not hesitate to reach out for help after a medical provider has caused you harm through their negligence.