How Do Families Uncover Hidden Medication Errors in Nursing Homes?

Nursing homes rarely announce or admit their own mistakes, so families uncover medication errors in nursing homes by watching their loved one and reading the chart. Nearly every resident takes prescribed medication, often several drugs on strict schedules, and handing that job to the facility is one of the main reasons families choose long-term care.

Before the move, you may have called every morning to ask whether Mom took her pills.

Now you’re trusting the staff to get every dose right. When they don’t, the result can be a fall, a hospital stay, or a slow decline that nobody connects to a missed or wrong dose.

Here’s how to recognize the warning signs, which records to review, and what to do when you suspect a mistake.

Recognizing the Warning Signs of a Medication Error

Every visit is a chance to see how your loved one is really doing and to ask the staff for their read. If your loved one takes prescription medications, watch for these warning signs, especially after a new prescription, a dose change or a refill:

• Sudden confusion or drowsiness. Trouble staying awake during your visit, slurred speech, dizziness or a sharp change in behavior.
• Balance and mobility problems. New unsteadiness, poor coordination or an unexplained fall. Ask staff whether a fall was documented.
• Allergic reactions. Wheezing, trouble breathing, swelling of the face or lips, or hives that spread quickly. A reaction to a new drug can mean an allergy on the chart was missed.
• A condition that comes back. Medications are supposed to control things like pain, blood pressure and blood sugar. When those problems return or worsen despite treatment, a skipped dose is one explanation to rule out.
• New symptoms that don’t fit. Physical changes that don’t match your loved one’s known conditions or the drug’s usual side effects.

Trouble breathing, facial swelling or unresponsiveness is an emergency. Alert staff and call 911. For anything less urgent, tell the charge nurse what you saw and ask that the attending physician be contacted.

Federal rules require the nursing home to consult the physician and notify the resident’s representative immediately when a resident’s condition changes significantly.

Reviewing Daily Administration Records and Medical Logs

Polypharmacy is prevalent in many nursing homes. According to Quality Insights, some studies find that 60-90% of nursing home residents take five or more medications daily.

The more medications a resident takes, the more chances there are for a mistake. Many nursing home residents take five or more drugs a day, and researchers who watched staff give medications in hospitals and long-term care facilities found median error rates of 8 to 25 percent. The most common errors outside hospitals are wrong doses, missed doses and the wrong medication. The records below are where those show up.

Medication Administration Records (MARs)

MARs let you confirm that every drug name, dosage, route (oral, injection), date, and time match the physician’s orders. You should also look for staff initials or signatures for each dose given.

PRN (As-Needed) Logs

PRN refers to the Latin phrase “pro re nata” or “as needed.” These logs can confirm that staff documented the specific reason that a PRN medication was given. It should also have a follow-up note on how your loved one responded.

Daily Care Flowsheets

Daily care flowsheets should include notations for vital signs, skin integrity/wounds, turning and repositioning, food and fluid intake, and bowel and bladder output. Look for consistency across these records.

Progress Notes and Incident Reports

Cross-reference nurse notes and incident logs with the daily logs to identify falls or sudden health changes. Reporting and follow-up care should be timely.

Watch for blank spaces, unsigned shifts, and missing dates. Watch just as closely for entries that are identical day after day, because a chart that never changes may not reflect a resident whose condition did.

Under federal law, a nursing home must let a resident inspect their records within 24 hours of an oral or written request, not counting weekends and holidays, and provide copies within two working days. Family members generally exercise that right as the resident’s legal representative or with the resident’s permission. A licensed pharmacist must also review each resident’s drug regimen at least once a month, so ask to see what the most recent review found.

Steps to Take When You Suspect a Medication Error

Once your loved one is safe and stable, put your concern in writing to the director of nursing and ask for the records above. Federal rules require nursing homes to keep their medication error rates under 5 percent and to keep residents free of any significant medication error, so a documented mistake is the facility’s problem to answer for.

Write down what you saw, when you saw it and who you spoke with. Keep copies of everything the facility gives you. If the answers don’t add up, you can take a complaint outside the building. Every state runs a long-term care ombudsman program to help residents and families resolve problems with their care, and every state has an agency that inspects nursing homes and investigates complaints.

My Nursing Home Abuse Guide Can Help You Find the Answers

A medication error probably won’t be obvious at first. It shows up as a loved one who is suddenly drowsy, unsteady, or sick again, and it hides in a chart that most families never think to request. My Nursing Home Abuse Guide has resources to help you recognize neglect, understand your loved one’s rights, and report what you find.

If you believe a medication error harmed your loved one, speak with a nursing home abuse attorney in your state about your options.