Nursing Home Medication Errors: Signs to Watch and What to Do Next

Medication in a nursing home should be tracked closely, from the doctor’s order to the moment it is given. So when someone becomes unusually sleepy, suddenly confused, unsteady on their feet, or ends up in the hospital after a medication change, families start wondering what fell through the cracks.

If the facility’s explanation feels vague or keeps changing, it is reasonable to wonder whether a medication mistake played a role. This guide explains what nursing home medication errors can look like and what you can do next.

What Are Nursing Home Medication Errors?

A nursing home medication error is a problem in how a medication is prepared, administered, documented, or monitored, including errors such as giving the wrong medication, the wrong dose, the wrong time, or missing a dose.

In plain terms, it means the medication process did not go the way it should have for that resident. Even small deviations can matter when an older adult is taking multiple medications or has a fragile medical baseline.

Medication error vs. adverse drug event (ADE)

A medication error is a breakdown in the medication process, like giving the wrong drug, the wrong dose, the wrong time, or missing a dose. An adverse drug event (ADE) is the harm that follows a medication, such as a fall after over-sedation, abnormal bleeding after a blood thinner issue, or dangerously low blood sugar after diabetes medication.

Ask to review the prescriber’s orders alongside the medication administration record (MAR) so you can confirm what was ordered and what the facility documented as given. Then, ask the follow-up question: what side effects were they watching for, and what monitoring was actually done?

The Most Common Medication Mistakes in Nursing Homes

Medication problems tend to fall into a few common patterns:

• Wrong medication or wrong resident
• Wrong dose (too much or too little)
• Missed dose or delayed dose
• Duplicate dosing (given twice)
• Wrong time or wrong route (including crushing meds that should not be crushed)
• Dangerous interactions that are not caught
• No monitoring after a change, even when side effects are predictable

Even when a facility has policies on paper, mistakes can still slip through if communication breaks down or staff are stretched thin.

Why Medication Errors Happen in Long-Term Care

Residents may be taking multiple prescriptions at once, doses get adjusted, and new orders come in after a doctor visit or hospital stay. With that much moving around, it doesn’t take much for information to get lost between the order, the MAR, and the med pass.

Common contributors include:

• Many medications taken each day (polypharmacy)
• Hospital discharges and frequent order changes
• Shift changes and handoffs between staff
• Documentation mismatches between orders and the MAR
• Rushed med passes and interruptions

What might be a simple paperwork error for the facility can mean serious consequences for a resident. Some medications are less forgiving than others, which is why extra safeguards and closer monitoring are so important in long-term care.

High-Risk Medications (When Errors Are More Likely to Cause Harm)

Some medications leave little room for mistakes, especially in older adults. A dose that's slightly too high, a missed pill, or an overlooked drug interaction can lead to falls, dangerous drops in blood sugar, internal bleeding, or sudden confusion.

Common high-risk medications in nursing homes include:

• Blood thinners
• Diabetes medications (including insulin)
• Opioid pain medications
• Sedatives or sleep aids
• Heart or blood pressure medications

Staff should check vital signs regularly, monitor for warning signs after dose changes, and order lab work as needed, even when workloads are heavy.

Warning Signs Families Can Spot

Families are often the first to notice the signs of a medication error in a nursing home, especially after a new prescription, a dose change, or a return from the hospital. These red flags do not prove anything on their own, but they are common signals that something in the medication routine may be off.

Possible warning signs include:

• Sudden confusion, agitation, or unusual mood changes
• Excessive sleepiness, grogginess, or “zoned out” behavior (sometimes linked to overmedication)
• New falls, dizziness, or unsteady walking
• Slurred speech or slowed responses
• Breathing changes after pain medication, anxiety medication, or sleep medication
• Shaking, sweating, weakness, or faintness (possible low blood sugar)
• Unexplained bruising or bleeding (a potential concern with blood thinners)
• Rapid decline in health soon after a new medication is started, a dose is increased, or a medication is stopped

If you notice a pattern, document what changed and when you first observed the change. A simple timeline can make conversations with the facility and the medical team a lot clearer.

What to Do If You Suspect a Nursing Home Medication Error

Not every bad outcome is negligence, but nursing homes are responsible for medication safety systems and for responding promptly when a resident shows signs of harm.

1. Ask for the current medication list and what changed recently. Request the full list, including doses and schedules. Ask what changed in the last two to four weeks, or whenever the relevant timeline.
2. Ask to review the MAR and the most recent orders. The medication administration record (MAR) shows what the facility says it administered. Comparing it to current orders can reveal missed doses, delays, or duplication.
3. Ask what monitoring is in place. If a medication was changed, what is the facility watching for, and how often?
4. Request a care plan meeting and take notes. Write down dates, names, and what you were told. If possible, follow up in writing.
5. Get medical evaluation if symptoms are urgent. If your loved one is overly sedated, struggling to breathe, showing stroke symptoms, or otherwise in immediate danger, urgent medical care comes first.
6. If concerns continue, consider reporting and getting legal guidance. Oversight options vary by state. Legal guidance can also help you understand what records matter and whether the pattern suggests preventable failures.

If you believe a nursing home medication error played a role in your loved one’s decline, Morgan & Morgan is here to help you find the truth. Our team can help you review what happened, including the medication orders, administration records, and the timeline of symptoms, so you can understand whether the harm was preventable.

With more than $ftp_global_var:total_funds_recovered_count] billion recovered for clients and 1,000+ attorneys nationwide, we have the resources to take on any organization accused of negligence. Get started today with a free, no-obligation case evaluation, and you pay nothing unless we win.

Frequently Asked Questions

What is a “significant medication error”?

A “significant” medication error is one that puts a resident’s health or safety at risk, or causes meaningful harm. The term is often used for situations that go beyond a minor paperwork issue, such as errors connected to falls, bleeding complications, dangerously low blood sugar, severe sedation, or hospitalization. 

Can I request my loved one’s medication records and MAR?

Yes, in many cases, if you have legal authority to access your loved one’s medical records. You can request the current medication list, recent changes, and the medication administration record (MAR), which shows what the facility documented as given and when. 

If the nursing home says it needs paperwork first, ask what they require, submit the request in writing if possible, and keep a record of dates and who you spoke with.

When should I talk to a nursing home negligence lawyer?

Consider speaking with a lawyer when a suspected medication error led to serious harm, the facility’s explanation does not match the records, or medication issues keep repeating without a clear fix. A conversation can help you understand what documentation matters, what questions to ask, and whether there are options to pursue accountability.