A Nashville hospital is publicly acknowledging medication errors that critically impacted four patients, and announcing internal changes.
Ascension Saint Thomas Hospital Midtown released a statement late Friday apologizing for the harm. “Our hearts remain entirely with the four patients and families impacted … we extend our deepest apologies for the harm caused,” it reads in part.
The hospital says the wrong medicine was given to four joint replacement patients on Aug. 14. Instead of the anesthetic medication mepivacaine they received potassium phosphate, causing serious reactions. News Channel 5 has reported that patients went into heart failure, and that at least two were paralyzed.
Saint Thomas says it is adding safeguards for storage, adding an extra review for spinal medications, and will be requiring a second pharmacist to double check such medicines. Here’s how the hospital detailed the changes:
Isolated Medication Storage: High-alert medications, including mepivacaine, are stored in separate, distinctly marked locations to eliminate selection errors.
Mandatory Hard-Stop & Escalation: Implement process to stop and resolve, through independent verification, for any spinal medication scan alert.
Independent Dual Verification: Spinal medicine workflows now require a second trained pharmacist to perform final visual and physical checks.
The hospital also says an independent expert will review its work and that it is cooperating with state and federal officials.
— Tony Gonzalez
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