What Consumers Can Do to Prevent Medication Errors

Read this article on MSNBC.com.

Sometimes I feel like there's not enough plain talk in medicine. So let's cut to the chase.

If you're conscious and cogent as a patient, you CAN assist your care team in preventing serious medication errors.

Can you prevent every error? Of course not. You don't have the knowledge your docs and nurses do. You do, however, have an opportunity to pay attention.

If you'll be out of it for a bit after a procedure, you can designate a family member/friend to assist.

Of course, you can't always predict when something will go awry (unplanned admission via ER/trauma, post-op fever or other complications, etc).

For this reason before any surgical procedure (or procedure with sedation etc.) I designate an advocate (usually the person who will be in the waiting room and will either stay in the hospital with me or drive me home).

Usually this is my mom, a super-nurse, or my husband, a super guy. My family knows if I'm unexpectedly injured, my husband and mom are designated advocates and decision-makers. They've both read my living will, and are aware of my beliefs regarding life support, resuscitation measures, etc.

If an admission or procedure is planned, however, it's much easier to lay out a process for learning your medication dosage and schedule, and tracking whether or not you're being given the correct meds.

As a patient, here's a system that's worked for me.

1. During rounds, I ask the physician to slowly repeat the names of all meds he/she is prescribing.

I repeat this procedure for each doctor on my care team (you may have different meds prescribed by different doctors).

If necessary, ask them to spell it out for you.

If you've had an adverse reaction to a medication the physician mentions in the past, NOW is the time to bring it up. Again. Even if a sensitivity/allergy is well-documented in your chart/plan of care.

Yes, I realize you may look and feel like a bit of a dolt. Yes, I realize docs have far better things to do with their time than spell out medications for me.

They will have far more time to treat other patients if I help prevent the costly complications of a med error.

2. When a nurse enters the room with meds, I ask him/her to please identify each pill (by name) and the strength/dosage.

If the nurse will not or can not identify a med, I can refuse to take it until she/he can do so. Note: You can always refuse a medication/treatment, even if its AMA - in which case the nurse should educate you about the risks of doing so. It's not a light matter to refuse treatment, so think carefully before doing so.

Only once in 3 inpatient hospital stays has a nurse responded to my medication ID request with anger/frustration, replying "it's your pain pill."

Usually the nurse will be extremely helpful, sometimes even offering further explanation, such as "This is Tylenol Number 3 PO - your doctor WhiteCoat has prescribed it for post-op pain every X hours. If you take it now, it will begin to work its way into your system before the physical terrorist gets here."

3. If you're really anal (or have a relative who's a nurse/doc/NP/really nosy at your bedside) you can write down the meds you're given (name, dosage) and the times they're administered.

This is particularly helpful for stepdown periods or other transitions between meds.

If I begin to develop a reaction to a new med for instance, I can refer caregivers to the list and read that I was given XYZ about 45 mins ago, and I noticed onset of symptoms 10 mins ago.

Likewise if you begin to develop breakthru pain, you can maintain a better timeline of which medications are not working for you.

I used this medication schedule at home after discharge as well.

It was very useful in tracking meds, not missing doses, setting alarms for night doses, etc.

We'd also note my pain level on a scale of 0-10 after each dose.

This helped me to step down off pain meds to good old Ibuprofen 24 hours after a bone graft procedure.

I *knew* I was ready because I had the actual data of decreasing pain right there in front of me. For patients who are hesistant to step down, keeping this schedule with corresponding pain measurements may be extremely helpful.

Again, this system worked for me. I don't believe this will work for everyone. I'm not saying it's universally applicable.

But for those of us interested enough in our own care and willing to work with our nurses and docs, who are working very hard to get us well, this is a rough plan of action you may wish to consider.

If I'm someday admitted to a hospital and I don't have to ask, ever, what medications I'm being given because the nurse enters and announces the dosage straight out (after checking my ID verbally and double-checking via my RFID ID bracelet), I'll know the era of
e-patients, H2.0, and consumer medicine has finally arrived.

No comments: