Medication Errors and Pharmacy Negligence in Delaware

A medication error is unusual among malpractice claims in that the mistake is often plainly visible in the record. The prescription says one thing, the label says another, or the chart shows a drug given to a patient documented as allergic to it.

What is less straightforward is who is responsible, because a single prescription passes through several sets of hands. This article explains how these claims work and where liability can fall. It is one part of a larger topic; for the full picture, see our guide to medical malpractice in Delaware.

What is a medication error?

A medication error is a preventable failure in prescribing, dispensing, or administering a drug that causes harm to a patient. It covers the wrong medication, the wrong dose, the wrong route or timing, a dangerous interaction that should have been caught, and administration to a patient with a documented allergy. An adverse reaction to a correctly chosen and correctly given drug is not an error.

That last sentence matters. Medications carry side effects, and some patients react badly to drugs that were entirely appropriate on the information available. The claim is about a failure in the process, not about the fact of a bad reaction.

Common causes

• Wrong drug. Frequently involving medications with similar names or similar packaging — a recognized hazard that dispensing protocols exist to guard against.
• Wrong dose. Decimal-point errors, confusion between units, or a standard adult dose given to a child or to a patient whose kidney or liver function required adjustment.
• Dangerous interaction not caught. A new prescription that should not be combined with something the patient is already taking. Both prescribers and pharmacists are expected to screen for this.
• Documented allergy overlooked. The allergy is in the chart and the drug is given anyway.
• Administration errors. The right drug given by the wrong route, at the wrong time, at the wrong rate, or to the wrong patient.
• Failure to monitor. Some drugs require monitoring — blood levels, kidney function, clotting times — and harm can follow from the monitoring not being done rather than from the prescription itself.
• Communication failures at transitions of care. Discharge from hospital to home or to a nursing facility is a recognized point of risk, where medication lists are reconciled incorrectly or not at all.

Who can be liable

This is what distinguishes medication cases from most other malpractice claims. Several independent parties may be involved, each with their own duty, and the investigation has to establish where the failure actually occurred.

• The prescribing physician — for selecting an inappropriate drug or dose, failing to check the patient’s medication list or allergies, or failing to arrange required monitoring.
• The nurse or administering clinician — for giving the wrong drug, the wrong dose, or by the wrong route, or for failing to notice a discrepancy between the order and what was dispensed.
• The pharmacist — for dispensing incorrectly, or for failing to catch an interaction or a dose that should have prompted a query to the prescriber. A pharmacist’s duty is independent of the prescriber’s, which is why a prescription error caught nowhere in the chain can implicate more than one party.
• The hospital or facility — both for the conduct of its employees and, separately, for systemic failures: inadequate staffing, absent verification protocols, or known problems with a medication system that were not addressed.
• A nursing home or long-term care facility, where medication administration is routine and residents are often on many drugs at once.

Because the chain has several links, these cases usually begin by obtaining records from every point in it — the prescription itself, the pharmacy record, the medication administration record, and the nursing notes. A claim against one party does not preclude a claim against another, and it is common for the responsible party to be unclear until the full record is assembled.

Establishing liability still requires expert testimony that the conduct departed from the standard of care for that profession, and that the departure caused the harm. Where harm is proven, the categories of recovery are the same as in any malpractice case; see how damages are calculated.

What to do if a medication error happened to you

Keep the medication itself, the container, and the label if you still have them. Photograph them. Request your complete records from every provider involved — including the pharmacy, which is a separate request from the hospital or physician’s office.

Write down what you were told the medication was for, what you were told to expect, and when you noticed something was wrong.

Then act reasonably promptly. Delaware’s filing deadline runs from the date of the injury, and the state requires an affidavit of merit from a qualified medical expert to be filed with the complaint — see Delaware’s statute of limitations and the affidavit of merit.

The full set of practical first steps is in what to do if you suspect medical malpractice. For the wider context, start with our guide to medical malpractice in Delaware.