Article from BMH
for 31 May, 2006
Brattleboro Reformer

What You Can Do to Help Yourself Avoid a Medication Error
by Kenneth Van Cott, R.Ph.

According to the Institute of Medicine Report prescription errors kill up to 7,000 patients per year! This statistic is not as surprising as it seems if we examine a couple of facts. In 1960, there were only 800 drugs available; by 1999, the number had ballooned to 17,000! In 1998, 2.5 billion prescriptions were dispensed; by the year 2005, the number of prescriptions had grown to 4 billion!! With that many prescriptions dispensed annually, it is not surprising that the risk for errors has also increased.

Medication errors often stem from poor communication, misinterpreted handwriting, drug name confusion, lack of knowledge, and lack of understanding by the patient as to how a drug should be taken. Considering these factors, it is important to emphasize that Brattleboro Memorial Hospital has many safeguards in place to assure your excellent care. However, it is also important that you, as the patient, are proactive and educated about your medications and feel empowered to ask questions.

What Patients Can Do
In a case reported to the Institute for Safe Medication Practices (ISMP) – http://www.ismp.org – a doctor called in a prescription for the antibiotic Noroxin (norfloxacin) for a patient with a bladder infection. But the pharmacist thought the order was for Neurontin (gabapentin), a medication used to treat seizures. The good news is that when the patient read the medication leaflet stapled to the bag holding his recently purchased prescription, he noticed the drug he received is used to treat seizures, so he asked the pharmacist about it. ISMP president Michael Cohen, R.Ph., Sc.D., says, "You should expect to count on the health system to keep you safe, but there are also steps you can take to look out for yourself and your family." Here are few of them.

• Find out what drug you're taking and what it's for. Rather than simply letting the doctor write you a prescription and send you on your way, be sure to ask the name of the drug. Cohen says, "I would also ask the doctor to put the purpose of the prescription on the order." This serves as a check in case there is some confusion about the drug name. If you're in the hospital, ask (or have a friend or family member ask) what drugs you are being given and why.
• Find out how to take the drug and make sure you understand the directions. If you are told to take a medicine three times a day, does that mean eight hours apart exactly or at mealtimes? Should the medicine be stored at room temperature or in the refrigerator? Are there any medications, beverages, or foods you should avoid? Also, ask about what medication side effects you might expect and what you should do about them. And read the bottle's label every time you take a drug to avoid mistakes. In the middle of the night, you could mistake eardrops for eye drops, or accidentally give your older child's medication to the baby if you're not careful. Use the measuring device that comes with the medicine, not spoons from the kitchen drawer. If you take multiple medications and have trouble keeping them straight, ask your doctor or pharmacist about compliance aids, such as containers with sections for daily doses. Family members can help by reminding you to take your medicine.
• Keep a list of all medications, including over the counter (OTC) drugs, as well as dietary supplements, medicinal herbs, and other substances you take for health reasons, and report it to your health care providers. Brattleboro Memorial Hospital has a patient medication list on their web site which can be downloaded at: http://www.brattleborohospital.org/patient_info.shtml. The often-forgotten things that you should tell your doctor about include vitamins, laxatives, sleeping aids, and birth control pills. One National Institutes of Health study showed a significant drug interaction between the herbal product St. John's wort and indinavir, a protease inhibitor used to treat HIV infection. Some antibiotics can lower the effectiveness of birth control pills. If you see different doctors, it's important that they all know what you are taking. If possible, get all your prescriptions filled at the same pharmacy so that all of your records are in one place. Also, make sure your doctors and pharmacy know about your medication allergies or other unpleasant drug reactions you may have experienced.
• And finally, if in doubt, ask, ask, ask. Be on the lookout for clues of a problem, such as if your pills look different than normal or if you notice a different drug name or different directions than what you expected. Robert Krawisz of the National Patient Safety Foundation says it's best to be cautious and ask questions if you're unsure about anything. "If you forget, don't hesitate to call your doctor or pharmacist when you get home," he says. "It can't hurt to ask."