Physician Focus: August 2011
By Mary Anna Sullivan, M.D.
Both in the hospital and at home, medication errors are among
the highest number of errors we experience in medicine. The Centers
for Disease Control estimates that adverse drug events cause more
than 700,000 emergency room visits and 120,000 hospitalizations
each year. Such errors are costly and too common; some end in
tragedy. Many, however, are preventable.
The reasons why medication errors happen are many and
varied.
Patients are taking more medications than ever. Current
estimates are that 82 percent of Americans take a least one
prescription medication, and 29 percent take five or more. That's
likely to continue: the nation's population is aging, chronic
diseases such as diabetes and arthritis are rising, new medicines
are constantly being developed, and huge amounts of advertising -
for both prescription and over-the-counter drugs - reach consumers
directly, creating interest and demand for a wide variety of
remedies.
Other factors contributing to errors include patient confusion
or misunderstanding in taking medicines; drugs with similar
sounding names; and drug interactions with other medicines,
alcohol, or certain foods.
The amount of drugs, medicines, and supplements available to
patients today is enormous. Pharmacies are filled with scores of
over-the-counter medicines, in different dosages and formulations.
The number of commonly prescribed prescription medicines is vast
(more than 1,100 according to Physicians' Desk Reference, a
commercially published volume of information on drugs); and herbal
medicines and vitamins - many touted as alternative or preventive
remedies - are readily accessible.
Technological advances such as electronic prescribing help to
reduce errors, but e-prescribing is not yet universally used, and
it doesn't capture products we buy over-the-counter, many of which
can be quite potent.
The important thing to remember - one that bears repeating - is
that many medication errors are preventable. Here are
steps to take for the safe use of medications.
Ask questions. When prescribed a medicine, ask
lots of questions. Why is this being prescribed? How long
must I take it? Are there side effects? Will it interfere with
other medications I'm taking? Do I really need this or would
another treatment work?
Read the information. Each prescription comes
with information, containing a description of the medicine,
including how and when (e.g., with or without food; how many times
a day) to take it, cautionary advice, and possible side effects.
Read it carefully. Do the same for over-the-counter medicines.
Keep a list. Record each medicine you take
regularly, including frequency, amounts, and why you're taking it.
Keep this "med list" up to date and with you at all times. It's a
tool that could prevent harm and save your life.
List them all. Include over-the-counter
medicines, herbals or vitamins, on your med list and in discussions
with your physicians and pharmacist. Some of these can interact
with prescription medications or certain foods.
Share information. Bring your list to every
doctor's visit. All your physicians (and pharmacist) should know
everything you're taking. This will help to avoid adverse
interactions if you're prescribed a new medication.
Befriend a pharmacist. Pharmacists are a
critical part of medication safety and an important source of
information about prescriptions and over-the-counter
medicines.
Supervise young and old. Be extra attentive
with children and the elderly. Adults 65 and older are twice as
likely to visit an emergency department for an adverse drug event,
and some 53,000 children under 5 wind up in the ER due to
unsupervised ingestions of medicines.
Check the bag. Whenever you get a prescription
filled, check before you leave the pharmacy to make sure it's what
the physician prescribed.
Follow instructions. If you don't take the
medicine when and how you should, not only could problems occur,
but you also won't get the full benefits from it.
Medication safety is a team sport, with the physician,
pharmacist, and patient all playing key roles. The patient,
however, as the last link in the chain and the ultimate consumer,
must be extra vigilant.
For more information, visit www.ConsumerMedSafety.org.
For free copies of a consumer guide to safe medication use and a
pocket-size patient med list, visit the Massachusetts Coalition for
the Prevention of Medical Errors at www.macoalition.org. And for
a video discussion on the topic, visit www.physicianfocus.org.
Mary Anna Sullivan, M.D. is president of the Massachusetts
Coalition for the Prevention of Medical Errors and Chair of the
Department of Psychiatry and Chief Quality and Safety Officer at
Lahey Clinic in Burlington, Mass. Physician Focus is a public
service of the Massachusetts Medical Society. Readers should use
their own judgment when seeking medical care and consult with their
physician for treatment. Send comments to PhysicianFocus@mms.org
