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Medication Errors during Labor and Delivery at Pennsylvania Healthcare Facilities

Between June 2004 and April 2009, Pennsylvania healthcare facilities submitted 2,611 event reports involving medication errors in labor and delivery units, says a special supplemental issue to the  Pennsylvania Patient Safety Authority's 2009 December Patient Safety Advisory. The Authority hopes gynecologists, obstetricians, midwives and the entire obstetric team will use the data to develop strategies for prevention.

Wrong drug, dosage and drug route errors in labor and delivery units may adversely affect both the mother and fetus. A variety of high-alert medications, such as oxytocin, magnesium hydromorphone, bupivacaine and fentanyl, are common in labor and deliver units. Errors of dosage or administration route with these medications have risks of significant patient injury.

Of the 2,611 event reports involving medication errors in labor and delivery units, the predominant type of event was dose omission errors with 587 events. Of the remaining events, there were 280 wrong drug, 272 medication error-other, 213 wrong time, 177 wrong patient, 166 wrong dose/overdose, 145 prescription/refill delayed, 136 unauthorized drug, 120 extra dose, 103 wrong route, 99 wrong dose/underdosage, 86 monitoring error-documented allergy and 58 wrong rate (intravenous) events.

The Authority outlined several risk reduction strategies to prevent medication errors during labor and delivery.

Facilities are encouraged to establish standardized concentrations, dosing regimens and administration protocols for high-alert medication infusions. They should use commercially available or pharmacy prepared solutions to eliminate the need for nurse preparation at the point of care.

Facilities should use a policy of administering all intravenous medications using an infusion pump, preferably a smart pump with operational dose range alerts. Pumps for epidural infusions should look different and have use yellow-lined tubing without injection ports to differentiate it from standard IV lines.

Infusion bags and syringes of should be clearly and boldly labeled with the name of the drug. Label infusion pumps with the name of the solution being infused as well as the IV tubing near the IV pump. Infusion bags and syringes containing epidural medications and infusion pumps for epidural use should be labeled FOR EPIDURAL USE ONLY.

Do not store high-alert IV drug infusions, epidural infusions and regular fluids together. Organize medications by use during different phases of the labor and birth process and never store medications with look-alike names together or place side by side on anesthesia or epidural carts.

Differentiate medications with look- and sound-alike names through the use of "tall man" lettering, in which uppercase letters are applied to the parts of the names that are different (e.g., EPINEPHrine, ePHEDrine).

Verbal medication orders should be reserved only for emergencies, such as when the prescriber is physically unable to write or electronically transmit orders due to working in a sterile field. The medication order should be repeated back the prescriber and announced the again just before administration.

Require an independent double check of the drug, concentration, infusion rate, pump settings, line attachments and patient before administering high-alert medications. When transferring patients, have the receiving and transferring nurse verify the patient, drug/concentration, line attachment, and pump settings at the bedside against the original order.

Medical personnel should monitor patients' vital signs, oxygen saturation, and level of consciousness, as well as fetal heart tones, maternal uterine activity, and other necessary patient parameters when infusing high-alert medications. If the status of the mother and fetus changes suddenly, check the infusing solution to ensure that it is the one prescribed.

If you or your child suffered injury while in a labor and delivery due to a medication error, you may be entitled to compensation. Some of the most common forms of hospital negligence include wrong-site surgeries, medication errors, surgical errors, development of hospital-acquired infections, improper use of anesthesia, improper treatment of a diagnosed medical condition, failure to monitor or stabilize a patient, or improper use of a medical device. Hospital negligence can result in serious injuries and even deaths. If you have been injured as the result of negligence while you were a patient in a hospital, or if a loved one died due to hospital negligence, you may be able to file a claim and collect compensation for pain and suffering, lost wages, medical expenses and other losses. Call Napoli Bern Ripka, LLP at 888-529-4669 today to discuss your legal options.