To Protect Against Drug Errors, Ask Questions
Jane E. Brody
January 2, 2007
New York Times - The elderly aunt of a colleague was sharp as a
tack, living on her own and busy doing everything a healthy woman in
her 80s might want to do. That is, until she went to the pharmacy to
pick up a refill of methazolamide, the pills she took to control her
glaucoma, and instead was given methotrexate, a potent chemotherapy
drug that suppresses immunity. The woman noticed that the color of the
new pills was different from her previous pills and questioned the
pharmacist, who told her they were fine. She even counted them, noting
that she was short six pills. But on the pharmacist's reassurance, she
took them for a month, by which time the drug had seriously suppressed
her body's immune system.
The woman developed a painful attack of shingles
that she couldn't shake off. She lapsed into a coma, and when she
finally emerged, she was no longer able to care for herself.
A similar error befell my father at a leading New
York hospital. After weeks of intensive care following a massive heart
attack, he was sent home with medication from the hospital pharmacy to
prevent his body from rejecting his damaged heart. He was about to take
the first pill when my mother noticed that the name on the vial was
Mrs. Rosenberg, not Sidney Brody, and that it contained estrogen, not
the prednisone my father needed.
Medication errors are among the most common medical
mistakes, injuring or killing at least 1.5 million people a year and
incurring at least $3.5 billion a year in extra hospital costs alone,
according to a report issued in July by the Institute of Medicine of
the National Academy of Sciences. This was the institute's second
report on the subject, and the committee that compiled it stated that
insufficient progress had been made since its first report, "To Err Is
Human," was issued in 1999.
"We need a comprehensive approach to reducing these
errors that involves not just health care organizations and federal
agencies, but the industry and consumers as well," said Linda R.
Cronenwett, dean of the School of Nursing at the University of North
Carolina in Chapel Hill and co-chairwoman of the institute committee.
While consumers can do little to improve
drug-prescribing procedures in organizations, they can do a lot more to
protect themselves.
Know What You Are Taking
Preventing medication mishaps starts with knowing
what medications you are taking -- or supposed to be taking -- and how
they might interact with other drugs, supplements or herbal remedies
you take and even the foods you eat.
Far too many patients leave the doctor's office or
medical clinic with a prescription that borders on the illegible. They
may have been told the category of the drug -- antibiotic, for example,
or painkiller -- but not its name. And they may have at best a vague
memory of how to take it -- how much, when and with what. Rarely are
they warned of possible adverse effects and what to do if they notice
no improvement or a downturn in their health.
You can help protect yourself by maintaining a list
of all the drugs you take -- prescription and nonprescription,
vitamin-mineral supplements and herbal remedies, including the dosing
schedule and amount. Bring this list with you whenever you visit the
doctor and make sure it is reviewed by the health care provider.
If you have ever experienced an allergic reaction to
a medication, or have a food allergy, be sure to tell your health care
provider before any medication is prescribed.
When you are given a prescription, ask the name of
the drug, what it is supposed to do for your condition, how much to
take and how often it should be taken, whether it should be taken with
food or on an empty stomach, what side effects are possible and what
effects warrant a prompt call to the doctor. Also ask how the
medication might interact with other remedies you take or foods you
eat. And, of course, write down the answers while you are still in the
doctor's office.
When picking up the prescription, check the name and
dosing schedule against what the doctor told you. If the labels are too
small to read, bring a magnifying glass or ask the pharmacist or
someone with better vision to read it to you.
If you have any questions, ask. It is the
pharmacist's responsibility to explain how to take the drug properly,
its side effects and what to do if you experience them. The pharmacist
can also provide written information about the drug.
Many consumers sign a book when they pick up a
prescription, not realizing that their signature means they have
received needed information about the drug or that they are waiving
their right to such information.
When patients are too ill to obtain adequate
information about their medications, a surrogate -- family member,
friend, or, in a hospital, a nurse, social worker or patient advocate
-- should obtain it for them.
The Institute of Medicine committee noted that
hospitalized patients have a right to have a surrogate with them
whenever they receive medication and are unable to monitor the process
themselves. Many mistakes are made when hospital personnel administer
the wrong drug or the wrong dose, give the drug by the wrong means
(intravenously instead of intramuscularly, for instance) or to the
wrong patient.
The administering nurse should always check the
patient's hospital bracelet against the name on the medication before
giving it and should tell the patient the purpose for a drug each time
it is administered.
If you are scheduled for surgery or an invasive exam
like a colonoscopy, make sure you ask what drugs you can or should take
preoperatively and which you should stop taking. Aspirin and its
over-the-counter relatives, as well as prescribed blood thinners, can
result in uncontrolled bleeding during such procedures.
Before leaving the hospital, ask for a list of the
medications you should be taking at home. Have the provider go over the
list with you and be sure you understand how much of each to take and
how to take it. Again, write it down or have your surrogate write it
for you.
Follow Directions
Failure to take medications according to the
prescribed directions is one of the most common reasons for bad
outcomes. Sometimes this results from a misunderstanding of dosage
schedules. The label may say "Take one capsule every six hours" but the
patient assumes, incorrectly, that this does not include the hours
during sleep. Or the patient, whose native language is Spanish, may
read "once" as 11 o'clock, as it could be interpreted in Spanish,
instead of as one time.
It is vitally important to follow warnings about
possible drug or food interactions or hazards operating motorized
equipment, including cars, while taking the medication.
Most pharmacies now routinely place yellow warning
stickers on medicine vials, and many include patient information
leaflets with the drugs they dispense. It is the consumer's job to read
these and follow directions like "take with food" or "do not drink
alcohol while on this drug."
Many consumers now check out prescription and
alternative remedies on the Internet. This can be risky because most of
this information is posted by lay or commercial sources, not medical
experts. If you use the Web, make sure the information is provided by
an official government source, such as the National Library of
Medicine's MedlinePlus program (www.medlineplus.gov), which provides
easy-to-read drug information and interactive tutorials.
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