Remember last week when I wrote about seven silent medical conditions? Well, it’s about another seven today, only it’s about drugs. I touched on this some time ago, but this time we’re tackling it in a slightly different manner.
At least 1.5 million people in the U.S. are harmed every year by medication errors, according to a July 2006 report from a certain institute. One has to figure that we probably have a similar percentage of people in Dominica suffering the same fate. We’ll see why.
Reducing your risk is often a matter of using common sense and asking your doctor or pharmacist not only the right questions, but questions, period. Here are some common mistakes that lead to medication errors, and some practical suggestions to minimize or eliminate the risks.
1. Mixing Drugs That Interact Adversely
Drugs are basically chemicals. When you mix certain chemicals in the chemistry lab, you may even get explosions. You may not get explosions in your body, but drugs interact with each other in your blood and may produce harmful results. Some of the kinds of problems that you should look out for include:
• Painkillers and supplements – you don’t know what’s in a lot of these supplements because they are not regulated.
• Many antibiotics reduce the effectiveness or oral contraceptives. Use back-up protection if you’re on the pill and need an antibiotic.
• Blood thinners, such as those used for DVT, shouldn’t be mixed with ginseng or aspirin. The risk of internal bleeding increases, or a simple cut on your finger can bleed profusely.
• If you’re on high blood pressure medication, taking over-the-counter nasal decongestants is a no-no without first talking to your doctor or pharmacist. Your blood pressure may go up.
2. Mixing Drugs and Alcohol
Medications for insomnia and anxiety cause drowsiness, the same thing that alcohol does. Taking alcohol with these drugs can be dangerous if you do certain dangerous work or drive. What I’m saying is that the effect of the drugs and alcohol is additive, enhancing the depression, or slow down, of your central nervous system.
Alcohol should also not be mixed with paracetamol. Each can damage your lever. Added together, it can obviously worsen matters.
Alcohol should not be mixed with antihistamines. Both cause sedation. Piriton and Benadryl are in this group.
Metronidazole (Flagyl) and alcohol together can cause nausea, vomiting, flushing, headache, and stomach pain. Also avoid mixing alcohol with sulfa-drugs such as, Septrin.
3. Leaving the Doctor’s Office Without Enough Information
When you leave the office, know the name of your medication and what it is for. Ask about how many times per day you should take it, and possible side effects. If you need it, ask for written instructions, even before you get to the pharmacy.
4. The Wrong Prescription from the Pharmacy
The truth is, a pharmacist may not be able to read the doctor’s handwriting, as hard as this is to believe. To remedy this, ask you doc to write down on the prescription pad what the drug is for. That way, if the medication is one of many with sound-alike, look-alike names, your pharmacist can double-check that he’s giving you the right drug by looking at the drug’s purpose.
Always check your drugs before leaving the Pharmacy to make sure it’s your name that’s on the bottle. Picking up a refill? Open the bottle in front of the Pharmacist and make sure the pills look the same. If they don’t, ask why not. It may just be the same drug but from a different manufacturer.
5. Using Multiple Pharmacies
If you go to multiple pharmacies, they can’t screen for drug interactions because they won’t have a complete list of all the medications you take in their computer, as would occur if you use a single pharmacy.
If you use more than one pharmacy for cost considerations, show them a list of every medicine you take.
6. Not Taking Medications as Directed
Compliance is a major problem, especially in the elderly. It may be cost related or just forgetfulness. Putting your medicines in a place where you will remember, or in a location where they will always be in full view, will help. You can also ask your doctor if it’s possible to decrease the frequency of medication dosing to say, once a day, or using a higher dose. It may mean switching to a drug he may not have originally wanted to prescribe. DISCUSS WITH HIM.
7. Not Asking Enough Questions as a Hospitalized Patient
Many preventable drug-related injuries occur in many hospitals, because patients don’t speak up or ask a family member to do so for them.
When you’re in hospital, ask the nurse what the medicine she brings you is for. Ask what you should expect in terms of responding to the medication.
The nurse should ask your name before giving you medication, just to be sure and safe.
And bring to the hospital all the medications you are on, including the dose of each. If it’s an emergency, have a family member do it.
The important thing is to ask questions, and act as partners with your nurse, pharmacist, and doctor.
See you next week.
When I was pregnant, I would not take some medicine with side effects. I was very worried because I didn’t want my baby to get some bad effects because of meds. The side effects that you get are some of side effects from meds.
I WENT TO THE EMERGENCY AT THE PRINCESS MARGARET HOSPITAL ,DUE TO HIGH TEMPERATURE AND SORE THROAT ,I MET A NURSE AT THE EMERGENCY ,THERE WAS NO DOCTOR .THE NURSE GAVE ME SOME TABLETS FOR A WEEK. AFTER I LEFT WHEN I WAS ALMOST IN FRANCIS LANE WHERE I LIVED I HEARD SOMEONE CALLING ME .WHEN I LOOKED BACK IT WAS THE NURSE WHO GAVE ME THE TABLETS.SHE ASKED ME FOR THE TABLETS AND ASKED TO GO BACK TO THE HOSPITAL WITH HER. THERE WHEN I ARRIVED ,I MET A DOCTOR WHO WAS CALLED DOCTOR SWAMMY . HE GAVE ME ANOTHER TABLET,I THINK THAT THE NURSE GAVE ME WRONG AND DANGEROUS TABLET THAT’S WHY THE DOCTOR SENT HER TO CALL ME BACK…. THAT NURSE WAS DRESSED IN BLUE….SHE WAS A LEARNER WHO RECENTLY BECAUSE A NURSE….
WHY PUT A NURSE WHO IS ON TRAINING TO WELCOME SICK PEOPLE KNOWING THAT THEY DO NOT KNOW HOW TO TREAT A SICK PERSON.WHAT ABOUT IF I HAD TAKEN THE TABLETS WHICH I INTENDED TO DO BECAUSE I DID NOT KNOW THAT SHE WAS JUST A STUDENT.
NOT EVEN IN COUNTRIES THAT ARE MORE IN ADVANCE THAN DOMINICA LIKE EUROPE FOR EXAMPLE NURSES HAVE THE RIGHT TO HAND OUT MEDICINE WITHOUT A DOCTOR’S CONSENT .
Hasn’t anyone noticed that the worst doctors and sometimes nurses in Dominica are assigned , of all places, to the EMERGENCY ROOM?
When I was in charge of the ER, many moons ago, I insisted but not always got, Staff Nurses and the most experienced ones. Trainees have to learn, yes, but under tight, vice-like supervision.Lives ought to mean something to the people to whom they’re entrusted, my God.
And why is it that some nurses/doctors are offended if you question them about your medication and side effects?
This has always been incomprehensible to me. This is when you know that these persons should be in some other occupation; they don’t care about people, they care about money.
As a practising physician, I always encourage questions, as many as a patient has. I give loads of information even before the questions.
See another doctor or nurse who is stingy with the information you have a right to know for your health and your hard-earned money.
I mean…..doctor or nure who ISN’T stingy with the information….
Thank you Sir
Oh Doc. How I love your column, keep them coming, good job,that’s like a breath of fresh air on DNO.
I have been seeing the same family doctor for a number of years. Whenever she writes a new prescription for me, we have a long discussion about it – possible side effects, other options. She has one of those large blue pharmaceutical reference books that she refers to when I ask questions.
My doctor never talks down to me. I am totally involved with my therapy.
I remember asking a doctor about my grandmother’s prognosis while she was warded at PMH and she looked at me as if I had just landed from Mars.
I am so happy that your research has landed you with the correct things to say cause that is so typical with Doctors in Dominica and some of them dont like it when a person poses questions to them. Before I buy a medication I actually go to an online medical site in the UK and cross-check the usefulness of that medication because what I have noticed with the pharmacies here they remove the labels to put their own and also the leaflet which is enclosed in medication boxes are removed. I remember a pharmacist once told me that I don’t need to know that information. Little did he know that I was a nurse trained by the British system that encourages people to read the labels and leaflet before use. And why is it that the Pharmacies here remove from the medication and then sell you some of it. That should be made illegal.
Interesting, you could not be more wrong. I work in the pharmacy business I can tell you we include every leaflet, unless someone is buying less than a month supply. Yes this was the school of thought 30 years ago, but no modern pharmacist would advocate this. Any pharmacist worth their salt should be able to provide you with information when requested, if its not provided in the first place.