Mix-ups on medication happen when events occur that cause inappropriate ingestion or use of medications. It may be as simple as taking an over-the-counter pain reliever like Tylenol while already taking a prescribed medication that also has acetaminophen. The added dosage could damage the liver. Or it could be as serious as the pharmacist giving the wrong medication or the wrong dosage. All of these dangerous scenarios are referred to as adverse drug events.
There are 1.3 million people injured annually by medication mistakes. The National Coordinating Council for Medication Error Reporting and Prevention defines a medical error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer.”
The United States Food and Drug Administration reviews medication error reports via MedWatch, a safety and information reporting program that will take anonymous tips from patients. The agency also gets reports from drug manufacturers and from the Institute for Safe Medication Practices and the U.S. Pharmacopeia.
Most medication errors can be prevented, but it takes a pro-active approach by the patient and some careful attention to what is being taken and how it should be scheduled. It is wise to always ask questions of the doctor, pharmacist, nurse and any other attendants, and always keep everyone in the loop on any others medications being consumed.
HOW DO ADVERSE EVENTS HAPPEN?
Any place medication is dispensed, an adverse event can happen. That includes the home, a hospital, pharmacy, doctor’s office or other dispensary. Like an error, these occurrences can be the result of inattention, omission, confusion or miscommunication between all parties. Since many medications have similar sounding names and prescriptions are still handwritten, human error is still a possibility.
As with anything done by people, mistakes can and will be made, even by the most seasoned medical professional. That problem with medication mistakes is that there are serious, sometimes fatal, consequences to such errors.
When in doubt, ask questions. Doctors are often busy, and hospitals can be even busier. Thus, it is incumbent to ensure the patient has received written instructions when available and thoroughly understand the schedule for taking medications.
Some important questions:
1) What is the medication supposed to do? This seems like a basic question, but it certainly pinpoints what the effects will be and how long until results.
2) What is the duration of the prescription? The answer can be days or until the last bit of medication is taken. Also ask the optimal time of day to take the medication.
3) What activities or foods should be avoided? Things like acidic juices and certain foods may have to be avoided while taking certain medications in order to avoid counteracting the benefits.
4) Are there any side effects? If you have a reaction, you need to know whether it’s normal or an indication of something more serious.
5) What happens if I miss a dose? This is particularly key if there is a schedule to your dosage. Don’t assume doubling up on the next round is the answer. The same with taking too much – is there a concern if you forget and take the pill twice?
6) How will the medication interact with other medications you’re taking? Make sure you don’t overdose or counteract the benefits of the prescribed medication.
MEDICATION RECONCILIATION
Medication reconciliation is a process whereby you compare the current medication orders to the other medications you may already be taking. This avoids duplications, omissions, drug interactions and dosing errors. The process should be performed whenever you transition to a new doctor, or when new medications are ordered or existing ones rewritten. Transition can include changes in service, doctors, level of care or change of residence, i.e., transferring to an assisted living facility from your home.
When transitioning, it’s important to have the name of all medications being taken. That includes prescribed medications, over-the-counter medications, herbs, vitamins, nutritional supplements, vaccines and any feeding tube supplements, blood products or intravenous medications. It can also include radioactive medications and anything one is allergic to or have had a reaction to in the past. It is also important to mention if pregnant, trying to become pregnant, or any chronic health problems one is currently experiencing or have had problems with in the past.
REAL LIFE MISTAKES
Some of the most common errors actually seem like the most innocuous. Yet they happen on a regular basis.
These monumental mistakes include:
1) Chewing non-chewable tablets – Chewing a pill is not necessarily the same as swallowing it. There are medications that may not be properly absorbed by the body if they are cut, crushed or chewed.
2) Cutting pills – Splitting pills may not be safe, as many pills are coated. The coatings are designed to help long-acting medicines and/or protect the stomach lining.
3) Eye drops/Eardrops – If the label says “otic,” it is medication for the ears. If it says “opthamalic,” it is eye medicine. Needless to say, the wrong medication in the wrong spot will not help you heal.
4) Using the wrong spoon – Use an oral syringe or a dosage cup when taking specific amounts of medication. Don’t rely on your eyes or measuring spoons in your kitchen drawers.
ORGANIZATION IS KEY
A medication list is a good thing to have around the house, particularly in cases where the patient may be elderly and forgetful. This helps caregivers make sure the medications stay on dosage. It is also a good idea to keep medications in their original containers and to organize them in a pillbox or automatic pill dispenser. This takes the human element out of taking medications and helps keep track of when and what you are taking.
It is a good idea to maintain a regular relationship with the same pharmacy. That way, the trained eye of the professional behind the counter can advise you and keep track of things that seem out of the ordinary. Before leaving the pharmacy, always make sure the bottle indicates it’s the right medication.