Nursing Home Medication Errors — When Wrong Drugs or Doses Injure Residents

## Medication Errors in Nursing Homes — A Preventable Cause of Serious Harm

Nursing home residents take an average of 7–8 medications daily — a regimen that creates substantial risk for medication errors including wrong drug administration, incorrect dosage, missed doses, harmful drug interactions, and administration to the wrong resident. Medication management is a core nursing function, and failures in this process constitute clinical negligence that can cause serious injury, accelerated cognitive decline, hospitalizations, and death.

A study published in JAMA found that adverse drug events occur in approximately 40% of nursing home residents annually, with approximately 20% of those events considered preventable through proper medication management — representing a massive ongoing harm that the nursing home industry has been slow to address.

Types of Medication Errors in Nursing Homes

• **Wrong medication:** Administering a drug not ordered for this specific resident — including dangerous mix-ups between residents with similar names
• **Wrong dosage:** Over or under-dosing compared to the physician's order — particularly dangerous with anticoagulants, antidiabetics, and cardiac medications
• **Wrong time:** Administering medications outside the ordered schedule, disrupting therapeutic levels of time-sensitive drugs
• **Missed doses:** Failure to administer medications as ordered, potentially causing withdrawal, therapeutic failure, or dangerous condition relapse
• **Drug interactions:** Failure to identify and prevent harmful interactions between co-administered medications — a particular risk in elderly patients on multiple medications
• **Inappropriate chemical restraint:** Administering sedating medications ("chemical restraints") to control resident behavior rather than for therapeutic purposes — a federal regulatory violation

Evidence in Medication Error Nursing Home Cases

• Medication Administration Records (MARs): the primary documentary evidence showing what was administered, when, and by whom
• Physician orders: what the doctor actually ordered versus what was administered
• Pharmacy dispensing records: what medications the pharmacy dispensed to the facility
• Nursing notes: documentation of the resident's condition around the time of the error
• Incident reports: required internal documentation of medication error events
• Hospital records: if the resident was hospitalized for the medication error, those records document the harm

A pharmacist expert or clinical nursing expert can review the MARs and orders to identify the specific medication error and testify about how it departed from the nursing standard of care.