In this episode, attorney Calder Mellino of the Mellino Law Firm joins John Maher to discuss medication errors during surgery. Mellino explains common mistakes such as administering the wrong drug, incorrect dosages, or giving medications that conflict with patient allergies. He emphasizes the crucial roles of pharmacists, nurses, and procedural safeguards—like barcode scanning and color coding—in preventing these errors. The conversation explores how breakdowns in communication and failure to follow safety protocols can lead to “never events,” and outlines the types of evidence necessary to prove negligence in a medical malpractice case. Mellino also discusses the wide-ranging consequences of medication errors, from prolonged recovery to permanent injury or death.
John Maher: Hi, I’m John Maher and I’m here today with Calder Mellino, a partner with the Mellino Law Firm, a personal injury law firm in Cleveland, Ohio with a focus on medical malpractice. Today we’re talking about medication errors during surgery. Welcome, Calder.
Calder Mellino: Hi, thanks for having me.
Common Types of Medication Errors During Surgery
Maher: Sure. Calder, what are some of the most common types of medication errors that occur in surgical settings and what factors contribute to those errors?
Mellino: Sure. Unfortunately, there’s a lot that can go wrong with medications if medical professionals are not being careful. They, first and foremost provide the wrong medication, and even if it’s the correct medication, it could be the wrong dosage or administered at the wrong route, administered incorrectly.
Whether it’s the wrong medication or not, it could be a medication that the patient’s allergic to. Certainly if it’s the wrong one, they could be allergic. Or even if they intended to give that medication, they could have overlooked or misunderstood a note in the patient’s chart that they were allergic to that medication.
And the way these things happen are not being careful with commonly named drugs. It’s about not communicating effectively between the team as to which medication we’re administering, how much and where. That can happen by rushing, by sloppiness, by fatigue, by being overworked, or it could just happen by either not having the proper policies and procedures in place, or simply not following them or skipping steps.
Pharmacists & Nurses During Surgery
Maher: Beyond just the physician or the doctor maybe doing a surgery, what role do pharmacists and nurses, and other members of the surgical team play in preventing those types of medication errors during surgery?
Mellino: Yeah. Each member of the surgical team has its own role and responsibility, and overall what they do is they serve as a checks and balances on each other, that not only are the surgeons and the anesthesiologists ordering for certain medications, the pharmacists are checking those and making sure they’re not contraindicated or that the patient’s not allergic to them or that you can’t give these two medications together and that the dose is correct.
The nurse is making sure that the right amount of medicine goes into the vial or into the bag to make sure that the patient’s getting it and make sure they’re getting it in the correct way. And by working together and communicating effectively, they ensure that even if there was a misunderstanding or a slip-up along the way that it’s caught. And when they’re not communicating effectively and not checking each other’s work, that’s where these errors happen.
How Procedures Protect Patients
Maher: What are some of the ways, procedures, that are in place at hospitals that are intended to prevent medication errors in the operating room? And how can those failures in those systems lead to what’s called a never event, something that should never be allowed to happen?
Mellino: Yeah, so like I said, when these checks and balances are not working against each other, when the team’s not cooperating or communicating effectively, that’s why this should never happen. Because there’s so many policies and checkpoints and checklists in place that this should never occur and it should also never occur because the effects can be so dangerous and long-lasting and catastrophic. And they break down when someone’s not doing their job, someone’s not being careful or the team is not communicating effectively and following the policies and procedures that are in place for a reason.
How To Prevent Medication Mix-ups During Surgery
Maher: You mentioned before that medications can have similar sounding names. There’s so many medications out there. They can be similar sounding. There’s also the brand name of a medication versus a generic name for that same medication. So, there could be mix-ups there. Do the medications have barcodes on them and do they have to scan those barcodes and then match them with something that’s on the patient’s record or anything like that?
Mellino: Yes, they absolutely have that. There’s also color coding for certain categories or types of drugs. And then there’s also just the medical professional reading it on top of all of these safeguards that compound upon one another. And what you have is people just blowing through those or ignoring those, ignoring the alert that pops up on the computer when they scan the barcode and let it in or the pharmacist not checking what’s being written even though it’s coming across their desk.
What Evidence Is There For Medical Neglect With Medication Mix-Ups?
Maher: In a case that’s involving a medication error during surgery, what types of evidence are most crucial for establishing negligence and determining liability?
Mellino: Yeah. The most important thing is first going to be the patient’s medical record and not just what’s written on the medical record today, but the metadata of when that was added or changed to see if anything was changed after the fact or not added until we know what happened to see if people are writing a different narrative to cover themselves.
What we also look at are the separate from the patient’s medical record is the record of when that medication was ordered and when it was sent to the pharmacy and that the pharmacy reviewed it and then that it was sent up and then that the nurse pulled it out of the, it’s called the Pyxis, is basically a medicine cabinet which is locked, that they pulled it out and what they pulled out and how much they pulled out is all a separate record separate from the patient’s medical record that you’ll obtain in these type of cases.
And you also look at things to figure out what was going on, how did this happen, such as all of the medical provider’s schedules. How long had they been there? Was it the end of a long shift had they just walked in the door and been handed this patient? And again, also their personnel file. Is this repeated problem with them that the administration didn’t address or didn’t sit down and talk to them about? All these different piece of information or puzzle pieces to piece together what happened here and why it happened.
Consequences of Medication Errors
Maher: And then what are the potential consequences of medication errors during surgery ranging all the way from just minor reactions to a medication to potentially life-threatening complications? How are those addressed in a medical malpractice claim?
Mellino: Yeah, I mean, first and foremost, the wrong medication can kill you if you’re allergic to it or if it’s contraindicated mixed with another medication, that result can be fatal. And even if it’s not fatal, it can cause long-term catastrophic harm such as brain injury. And even less catastrophic impact can cause you to take longer to recover, keep you in the hospital longer, even down to just causing discomfort, whether that be short-term or long-term from having the wrong chemicals in your body that shouldn’t be there.
Maher: All right, well that’s really great information, Calder. Thanks again for speaking with me today.
Mellino: Absolutely. Thank you for having me.
Maher: And for more information, you can visit the Mellino Law Firm website at mellinolaw.com or call 440-333-3800.