Medication error was a ‘catalyst’ in John’s death
71-year-old was given own drugs & another patient’s at care home
A CORONER delivered a verdict of medical misadventure in the death of a man given an accidental overdose of meds at a care home.
Limerick Coroner John Mcnamara said the “medication error” by a nurse on duty at the Cahercalla Nursing Home, Ennis, Co Clare, was a “catalyst” in the events that led to John Mee’s death on June 30, 2021.
It was accepted by all parties Mr Mee, 71, from Miltown Malbay, Co Clare, was given another resident’s meds, including a high dose of anti-psychotic drugs, in addition to Mr Mee’s own meds he was receiving for a number of co-morbidity issues. The erroneous overdose of prescribed drugs occurred at around 9pm on June 24, 2021, however Mr Mee was not taken to hospital for 18 hours, despite being visibly drowsy.
Cahercalla NH staff nurse Collette Mannion, told the inquest, held at
Kilmallock Courthouse, that she mistakingly gave Mr Mee some of his own meds together with high doses of drugs that were prescribed to another resident.
She said it was “unusually busy” at the nursing home on the night and she and one healthcare assistant were looking after 23 residents on St Joseph’s ward. Caoimhe Daly, barrister representing Cahercally nursing home said Ms Mannion had “candidly accepted she had made an error”.
Dr Gabor Laskai who conducted a postmortem on Mr Mee’s remains, said cause of death was due to hemorrhage following extreme pancreatitis, pneumonia, and gastric stress erosions.
The Coroner said: “I want to stress I am not ascribing blame to anybody, I am not allowed do so.”
He recommended Cahercally “adopt best practices” in respect of the administration of medicines for residents, which he was told it has done.