How to Prove a Medication Error: Understanding the Medication Administration Record (MAR)

What Is a Medication Administration Record (MAR)?

The Medication Administration Record (MAR) is the primary document used in hospitals and long-term care facilities to record the administration of medications. The MAR documents:

• The medication name: The name of the medication that was ordered and administered.
• The dose: The dose that was ordered and the dose that was actually administered.
• The route: The route of administration (oral, IV, subcutaneous, intramuscular, etc.).
• The time: The time the medication was ordered and the time it was actually administered.
• The administering nurse: The name or initials of the nurse who administered the medication.
• The vital signs and monitoring: Any vital signs or monitoring that were performed before or after the medication was administered (e.g., blood pressure before administering an antihypertensive, blood sugar before administering insulin).
• Documentation of PRN (as-needed) medications: The reason the medication was given and the patient response.
• Documentation of refused or held medications: If a medication was refused by the patient or held by the nurse, the reason should be documented.

The Medication Use Process and Where Errors Occur

The medication use process consists of several stages, and errors can occur at any stage:

• Prescribing: The physician selects the medication, dose, route, and frequency. Errors include wrong medication, wrong dose, wrong route, wrong frequency, and failure to check for allergies or drug interactions. [Link to: /medication-errors/wrong-drug-interaction]
• Transcribing: The physician order is transcribed into the MAR (or entered into the eMAR). Errors include transcription errors, abbreviation errors, and decimal point errors.
• Dispensing: The pharmacy dispenses the medication. Errors include dispensing the wrong medication, wrong dose, or wrong concentration. [Link to: /medication-errors/pharmacy-malpractice]
• Administering: The nurse administers the medication to the patient. Errors include administering the wrong medication, wrong dose, wrong route, or to the wrong patient. [Link to: /medication-errors/hospital-overdose]
• Monitoring: The healthcare team monitors the patient for therapeutic effect and adverse effects. Errors include failure to monitor, failure to recognize adverse effects, and failure to act on abnormal results. [Link to: /medical-malpractice/failure-to-monitor]

Key Evidence in a Medication Error Case

The key evidence in a medication error case includes:

• Physician orders: The original physician orders, which specify the medication, dose, route, and frequency.
• The MAR or eMAR: The Medication Administration Record, which documents what was actually administered. Discrepancies between the physician orders and the MAR can prove the error.
• BCMA logs: Bar Code Medication Administration logs, which record when the nurse scanned the patient wristband and the medication barcode. BCMA logs can confirm or refute whether the right medication was given to the right patient.
• Pharmacy records: Including dispensing records, medication reconciliation records, and pharmacy intervention notes.
• Omnicell/automated dispensing cabinet logs: These logs record when and by whom a medication was removed from the automated dispensing cabinet.
• Nursing notes: The nurse narrative notes, which may describe the patient condition before and after the medication was administered.
• Laboratory results: Including drug levels, blood glucose, aPTT, PT/INR, and other lab values that can show the effect of the medication.
• Vital signs: Including blood pressure, heart rate, respiratory rate, oxygen saturation, and temperature trends.
• Imaging studies: CT scans, MRIs, and other imaging that can show the harm caused by the medication error. [Link to: /radiology-errors/ct-scan-negligence]
• Incident reports: Hospital incident reports, which may document the error (although these are often privileged and difficult to obtain in New York).

Electronic MAR (eMAR) and Bar Code Medication Administration (BCMA)

Most hospitals now use electronic Medication Administration Records (eMAR) integrated with Bar Code Medication Administration (BCMA) systems. These systems are designed to reduce medication errors by:

• Scanning the patient wristband: The nurse scans the patient wristband to confirm the patient identity.
• Scanning the medication barcode: The nurse scans the medication barcode to confirm that the right medication is being given in the right dose, by the right route, at the right time.
• Generating alerts: The system generates alerts for potential errors, such as wrong medication, wrong dose, or drug interactions.
• Documenting automatically: The system automatically documents the medication administration in the eMAR, including the time, the nurse, and the patient vital signs.

When BCMA Systems Fail

While BCMA systems are designed to reduce errors, they are not foolproof. Errors can still occur when:

• The nurse overrides the system: The nurse bypasses the barcode scanning, often due to time pressure or system difficulties.
• The barcode is unreadable: The nurse manually enters the medication, increasing the risk of error.
• The wrong barcode is scanned: The nurse scans the wrong patient wristband or the wrong medication barcode.
• The system generates alert fatigue: The system generates too many alerts, causing the nurse to ignore them.
• The system is down: The eMAR/BCMA system is unavailable, and the nurse reverts to paper documentation, increasing the risk of error.

Pharmacy and Dispensing Records

Pharmacy records are critical evidence in medication error cases. These include:

• Dispensing records: Records of what medication was dispensed, in what dose, and when. [Link to: /medication-errors/pharmacy-malpractice]
• Medication reconciliation records: Records of the process of comparing the patient home medication regimen with the hospital regimen to avoid duplicate dosing or missed doses.
• Pharmacy intervention notes: Notes from the pharmacist about any concerns or interventions related to the medication order.
• Automated dispensing cabinet logs (Omnicell, Pyxis): Logs of when and by whom a medication was removed from the automated dispensing cabinet. These logs can show whether the right medication was removed and whether it was removed by the right person.
• Compounding records: For compounded medications (e.g., IV admixtures, TPN), records of the compounding process.

Laboratory and Monitoring Evidence

Laboratory results and monitoring data can prove the effect of the medication error:

• Drug levels: Blood levels of the medication (e.g., digoxin, phenytoin, vancomycin) can show overdose or underdose.
• Blood glucose: Blood glucose levels can show insulin overdose (hypoglycemia) or underdose (hyperglycemia). [Link to: /medication-errors/insulin-error-lawyer]
• aPTT and PT/INR: Coagulation tests can show anticoagulant overdose (bleeding) or underdose (clotting). [Link to: /medication-errors/heparin-error-lawsuit]
• Electrolytes: Sodium, potassium, magnesium, and calcium levels can show electrolyte disturbances from medication errors.
• Arterial blood gas (ABG): Can show respiratory depression from opioid overdose.
• Imaging studies: CT scans or MRIs can show the harm caused by the medication error (e.g., intracranial hemorrhage from anticoagulant overdose, brain damage from hypoglycemia). [Link to: /radiology-errors/ct-scan-negligence]
• Vital signs trends: Blood pressure, heart rate, respiratory rate, and oxygen saturation trends can show the physiological effect of the medication error.

Building Your Case: The Discovery Process

In a medication error lawsuit, the discovery process is how we obtain the evidence to prove your case. Discovery includes:

• Demand for medical records: We obtain all medical records, including the MAR, eMAR, BCMA logs, pharmacy records, laboratory results, imaging studies, and nursing notes. [Link to: /resources/how-to-get-medical-records-for-a-lawsuit]
• Demand for hospital policies and procedures: We obtain the hospital medication administration policies and procedures to establish the standard of care.
• Interrogatories: Written questions that the hospital and providers must answer under oath.
• Depositions: Sworn testimony from the nurses, pharmacists, and physicians involved in the medication error.
• Expert review: We engage board-certified physicians, pharmacists, and other experts to independently review the records and provide testimony. [Link to: /delayed-diagnosis-lawyer/loss-of-chance]

New York Statute of Limitations

Medication error claims are subject to the 2.5-year statute of limitations for medical malpractice (CPLR 214-a), running from the date of the negligent act.

Key considerations:

• Date of the negligent act: The 2.5-year clock starts on the date of the medication error.
• Continuous treatment doctrine: If you continued to receive treatment from the same provider for the same condition, the statute may be extended.
• Municipal hospitals: If the error occurred at a municipal hospital (NYC Health + Hospitals), a notice of claim must be filed within 90 days. [Link to: /hospital-negligence/suing-nyc-h-h]
• Wrongful death: If the medication error caused death, the wrongful death claim must be filed within 2 years. [Link to: /wrongful-death-lawyer]
• Infancy toll: If the patient was a minor, the statute of limitations is tolled until the child 18th birthday. [Link to: /cerebral-palsy-lawyer/statute-of-limitations]

Common Defense Arguments and How We Counter Them

Defense: The medication was administered as ordered.

Defense attorneys use several arguments in medication error cases:

• Our Counter: We examine the MAR, eMAR, BCMA logs, and pharmacy records to determine whether the medication was administered as ordered. Discrepancies between the physician orders and the MAR can prove the error. We also examine whether the physician order itself was correct -- if the physician ordered the wrong dose, the physician is liable, even if the nurse administered it as ordered.

Defense: The patient had a complex medical condition that caused the harm.

Our Counter: While complex medical conditions can complicate medication management, the standard of care requires providers to follow established protocols for medication administration and monitoring. If the harm was caused by a deviation from the standard of care (e.g., wrong dose, failure to monitor), the provider is liable, regardless of the patient underlying condition. We use expert testimony and laboratory evidence to establish that the harm was caused by the medication error, not the patient underlying condition.

Defense: The patient was non-compliant with their medications or diet.

Our Counter: While patient compliance is important, the provider must still meet the standard of care. We examine the MAR, eMAR, and BCMA logs to determine whether the error was caused by provider negligence, not patient non-compliance.

Defense: The BCMA system was working correctly, so the error could not have occurred.

Our Counter: While BCMA systems are designed to reduce errors, they are not foolproof. We examine the BCMA logs for overrides, manual entries, and system downtime. If the nurse bypassed the system or if the system was not used correctly, the standard of care was breached.

Compensation Available

A successful medication error claim in New York can provide compensation for:

• Medical expenses: Including past and future medical care, surgeries, rehabilitation, and medications
• Lost wages and lost earning capacity: For time missed from work and reduced ability to work
• Pain and suffering: NY has no cap on non-economic damages
• Permanent disability: For brain damage, organ damage, and other permanent conditions
• Future medical care costs: Based on a life care plan, discounted to present value
• Loss of consortium: For the impact on family relationships
• Wrongful death damages: If the medication error caused death [Link to: /wrongful-death-lawyer]

What to Expect Working with MDLaw Firm

When you contact MDLaw Firm about a potential medication error case:

• Free Consultation: We listen to your story and review the basic facts.
• Immediate Deadline Assessment: We evaluate the 2.5-year statute of limitations and any municipal notice of claim deadlines.
• Record Retrieval: We obtain all medical records, including the MAR, eMAR, BCMA logs, pharmacy records, laboratory results, and imaging studies. [Link to: /resources/how-to-get-medical-records-for-a-lawsuit]
• Expert Review: We engage board-certified physicians, pharmacists, and other experts to independently review the records.
• Causation Analysis: We establish that the medication error caused the harm.
• Discovery: We use the discovery process to obtain hospital policies, BCMA logs, Omnicell logs, and deposition testimony.
• Litigation: We file within the statute of limitations and handle all aspects of discovery and trial.
• Resolution: We pursue maximum compensation through settlement or verdict.

Frequently Asked Questions

The value of a medical malpractice case in New York depends on several factors, including the severity of the injury, the strength of liability evidence, and the economic and non-economic damages involved. New York is one of the few states with no caps on medical malpractice damages, meaning there is no artificial limit on what you can recover. Below are typical settlement ranges based on injury severity.