CORRECTION

A story in the City & State section Thursday incorrectly said new standards for administering medication in adult-care homes were contained in a bill that set up a star-rating system for the homes. Instead, the standards were included in the law that the star-rating bill amended.

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Mistakes in prescribing, ordering and dispensing medicine top the list of complaints to state adult care homes.

Residents take as many as 10 medicines a day, and medication aides in adult-care homes across North Carolina must make sure the correct dose of medicine gets to the the right person at the right time. Since 2001, the state has documented the deaths of six residents in cases involving medication errors.

Roughly a third of state penalties -- the most serious are types A and B -- against adult-care homes have involved medication mismanagement during the past year and a half, since the state established a public database of sanctions.

Dealing with the number and consequences of medication errors will require more education for front-line employees and better means of analyzing how errors are made, experts on aging say.

"Good training for both the people who administer the drugs and people who monitor drugs is really imperative," said Thomas Konrad, a senior researcher at the UNC-Chapel Hill Institute on Aging. "These places that are getting type B or type A penalties, it's generally a serious error."

The state will have to set up minimum standards for administering medications in adult care following the General Assembly's passage of a bill that establishes a a star-rating system for adult care homes. Those standards will cover:

* Training for aides, including periodic refresher training.

* Standards for complicated medication regimes.

* Oversight by licensed professionals.

* Ways to make sure that drugs are stored properly.

Durham Ridge, a Durham assisted-living center, registered a 53 percent medication error rate at a state inspection in September. Reports show that Durham Ridge has since lowered its medication error rate to 10 percent, but that is still twice the federally recommended rate.

"It was true, that's what they reported," Tom Husvar, one of the center's owners, said Monday.

He said part of the problem stemmed from medications being given outside the required time span on the resident's prescription. With many medications, that time span isn't critical, but exact timing can be crucial with some drugs treating diabetes, cardiac arrhythmia and Parkinson's disease, said Phillip Sloane, a professor at UNC-Chapel Hill who is jointly certified in family medicine and geriatric medicine.

"There's no question that medications are a huge issue in older populations in general, but we have yet to home in on what the most salient issues are," Sloane said. "One of the biggest deals is that the number of medications is going up. It's gone up by about two medications per patient in the last 10 years, which is a lot."

Surveys of medication errors sometimes fail to track certain kinds of incidents, such as cases in which needed medicines aren't prescribed. A 2004 study in which Sloane was a principal found that underprescribing indicated drugs -- even for heart and stroke patients -- appeared to be common in residential and adult-care centers.

"One reason for that could be that there's a legitimate side effect to the drug," Sloane said. "Another could be that the person has so many problems that it doesn't cross the doctor's radar screen to add one medicine. Another issue sometimes is cost; some of these medicines that are particularly good are new and costly."

A statewide study in Alaska that led to reduced medication errors found that looking at the causes of mistakes produced the most useful information, a summary of the effort said.