IDPH has cited and fined Landmark of Des Plaines nursing home after the staff got an antifungal medication into a resident’s eyes, causing chemical conjunctivitis.
The resident at issue was suffering from a brain injury following a gunshot wound and was in need of significant ongoing care. One of the problems which developed after his admission to the nursing home is that he developed a facial fungal infection and was also suffering from redness of the eyes. The nurse practitioner tried treating the redness of the eyes with eye medications but the redness of the eyes persisted, so she ordered an antiufungal medication. The theory was that by clearing the fungal infection on the face, the redness in the eyes would diminish.
The way that the order was written was to apply the antifungal cream to the bilateral eyes twice per day in addition to an anitbiotic ointment. The problem with writing the order in this manner is that manufacturer instructions for the medication is that it is not indicated for opthalmic use and should not be put into the eye. The pharmacy dispensed the medication and the staff applied the antifungal medication to the resident’s eyelids which led to the medication getting into the resident’s eyes.
Once the antifungal medication got into the resident’s eyes, he began to experience pain in the eyes, heavy redness, and yellowish discharge. He was sent to the hospital, where an opthalmologist had the eyes irrigated to wash as much of the medication out as possible, ordered the antifungal medication discontinued, and ordered the resident begin receiving lacrilube and artificial tears. Essentially, these are intended to treat drying of the eyes.
There are a number of issues associated with this nursing home medication error. To begin with, the order that the nurse practitioner wrote was unclear at best as to the instructions that the nursing staff was to be following in giving this medication. The goal of the therapy was to reduce the fungal infection on the resident’s face with the hope that this would also serve to reduce the redness in his eyes. However, the way that the order was written, the medication was to be applied to the eye. The pharmacy dispensed the medication with the order written in that manner without bringing to the attention of either the nursing staff or the nurse practitioner that the way that the order was written was contrary to manufacturer instructions. Finally, the staff followed the order as written without consulting the warnings and labels on the packaging that this was not intended to be put into the eye itself. As a result, this resident suffered chemcial conjuctivitis of the eyes – an utterly predictable and preventable outcome.
This is a situation where there is some degree of fault which rests on people other than the nursing staff. Nurse practitioners are generally considered independent contractors meaning that they are not direct employees of the nursing home. The same would hold true of the pharmacist. Anyone considering pursuing a case against persons who are independent contractors working inside a nursing home (and the other major category in this would include people working in the various therapy departments – physical therapy, occupational therapy, and speech therapy) would do well to get quality legal help well in advance of the statute of limitations date because there are additional issues which need to be investigated in order to make sure that all of the proper parties are added to the lawsuit before the expiration of the statute of limitations.
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