Managing Medications

Mix-ups can cause severe problems

Robert Zinnes, MD, still remembers an elderly man with a bad case of emphysema who came into the hospital where Zinnes worked years ago as a medical resident. The man was struggling to breathe. After speaking with the man’s wife, the medical staff learned that he had recently run out of one of his oral medications, says Zinnes, now a family medicine physician with Foundation Medical Partners. In an effort to help, the man’s wife had given him some of her medicine — Valium, a potent tranquilizer that can suppress breathing ability. The man had to be put on a ventilator.

You might say the moral of this story boils down to “don’t mess with meds.” But many people struggle to accurately track and properly use their medications and seem unaware of the power — and potential danger — of drugs. Additionally, ineffective communication or misunderstandings sometimes leave doctors, patients or pharmacists in the dark regarding a patient’s current medications, a scenario that “can have very serious consequences,” Zinnes says, particularly since medications can adversely interact with each other.

Electronic health records, in use at many hospitals and doctors’ offices today, help to prevent some of the problems related to medications but are limited in what they can do. Records at one hospital are not often accessible at unaffiliated healthcare institutions, for example, and even when an electronic patient record is available, mistakes can occur, such as when a patient fails to understand a doctor’s directions.

Trouble related to medication is a major reason for doctor and ER visits and even hospitalization, says Karen Pellerin, RN, BS, a nurse at Rockingham Visiting Nurse Association & Hospice in Exeter. With the wealth of medications on the market today, better patient access to specialists than ever before and the differing times and rates at which different medicines should be taken, Pellerin says, there is great potential for miscommunication, confusion among patients and harmful drug interactions.

It doesn’t help that people do not always discard expired or unneeded medications. In many instances, when a visiting nurse goes to an individual’s home and asks to see the person’s medications, Pellerin says, “The number of pill bottles that comes out is staggering.” Visiting nurses also often find that patients can’t afford their prescriptions and try to stretch the medicine by fudging on the prescribed dosages. “Instead of taking them every day or twice a day the way they’re supposed to,” Pellerin says, “they might be taking them just once a day or once every other day. It’s a huge, huge problem.”

Doctors see medicine mix-ups and mistakes in a variety of patients, Zinnes says, from young to old. Teenagers and people in their 20s who are not accustomed to taking medication, for example, sometimes misunderstand their doctor’s instructions or, for various reasons, fail to take the medicine that the doctor prescribes. But medication-related trouble is particularly prevalent among the elderly, who are more likely than younger people to take a significant number of medicines and to suffer from hearing, vision or cognition problems that can affect their ability to take medicines as prescribed. With the growing elderly population in the US, the issue is an increasing concern. “Some people in their 70s or 80s might be taking 12 medicines a day,” Zinnes says. “You wonder when you look at the meds that people are [supposed to be] taking, ‘Are they really getting what we are giving them?’”

When possible, it can be helpful (especially for the elderly) to arrange some sort of home care, whether it be a visiting nurse or a family member. Having a loved one present at the time of discharge from a hospital is also a good idea, Pellerin says — ideally someone who is familiar with what medicines the patient already takes. Such an individual can help the patient better understand and remember the discharge instructions, can reconcile the medicines that have been ordered with the bottles that end up in the patient’s home, and might know if a medication presents a financial burden for the patient.

People of all ages can also benefit from the various medicine organizers and reminder systems available today, from simple compartmentalized pill boxes labeled with the days of the week to fancier electronic alarms and tools. Some even come with a built-in alert system, Pellerin says, that notifies a caregiver if the patient fails to take medication.

Regardless of the chosen method of medicine organization, each of us should keep a list of our medications in our wallet, Zinnes says, so that it is on hand at all times. Bring it to every doctor’s appointment, Zinnes says, and keep it up to date. “It’s essential, especially for someone who is older, to have that information,” he says. “Medicines do a lot of good, but everything has a side effect, and so they can do bad.”

If the emphysemic man and his well-meaning wife whom Zinnes met as a resident had checked with a doctor or better understood the purpose and potential risks of their medicines, Zinnes says, the man’s hospitalization likely would have been avoided. The incident serves as a reminder that medical professionals need to educate patients regarding medications, Zinnes says, and that patients should speak up if they have questions regarding the medicine they are being told to take. “It’s really important for patients to understand what they’re taking, the [proper] doses and why they’re taking it,” he says. “That way, they can be their own best advocate.”

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