Think Before You Take That Pill

Acc

ording to a recent survey in the Archives of Internal Medicine, an average of 40 drug errors occurred each day of 1999 in a typical, 300-bed hospital or nursing home. That translates to about two errors per patient each day, most of which involved giving patients medications at the wrong time or not giving the dose at all. And while only seven percent of those errors are considered potentially dangerous, the numbers are still enough to leave patients — and families of patients — wondering how to protect themselves.

Hospitals are taking their own steps. "These numbers, while they sound dramatic, have been reported before," says Duane Kirking, professor and chair of the Department of Social and Administrative Sciences at the University of Michigan College of Pharmacy. "Hospitals do know that errors are happening." Remedies range from introducing new computers to monitor and control prescription medication output to adding better-qualified pharmacy staff. The computers will help cut back on mistakes considerably, Kirking says, but the hospitals are still tied to imperfect technology — and human error — so existing problems can't be solved overnight. Additional staff will help ward off the fatigue-related errors sometimes found in hospitals with overworked and understaffed nursing departments — nurses, after all, are often the ones stuck processing prescriptions.

Pharmacists and drug companies are also trying to ward off dangerous mistakes, says Jesse Vivian, a pharmacist and a professor of pharmacy practice at Wayne State University in Detroit. "A lot of pharmacies are now using barcode technology to make sure the medications match the drug that's prescribed," he says.

Ultimately, though, your health is in your own hands. What can you and your family do to reduce prescription error?

Be an active patient: The most common drug error, according to the new study, is accidentally skipping a dose. The second most common mistake is taking the medication at the wrong time. Both of these errors could be diminished considerably if patients and patients' families pay careful attention to the dosage and distribution of what can often be a dizzying array of medications. This is especially true if you're keeping an eye on prescriptions for a young child, an elderly person or someone with compromised immunity, populations that can suffer much more dangerous responses to drug errors than someone whose immune system is up to speed.

Ask questions: "Know what medications you?re taking," advises Kirking, "or have a family member keep a list of the prescriptions. Don't be afraid to ask questions: ask what medications a patient will be on, find out what they do, when they should be taken, how many a day, et cetera." Often, the patient is the best line of defense against mistakes. "You should know what your medication looks like," says Vivian. "If the appearance, color or smell is different, ask your pharmacist to double-check the prescription."

Check on the people writing the prescriptions: Though people in many hospitals, nursing homes and community pharmacies are overworked, try to find the best staffing situation you can. Look especially for a place where patients and their families can come in and talk to pharmacists. "In hospitals and nursing homes," says Vivian, "be sure to check on staffing levels after midnight — a time when many drugs are administered, and often when the least experienced staff are on duty."

Stay on top of the situation: This can be daunting; it's often difficult to find out exactly what's happening with a family members' prescriptions because things change so quickly and so many different doctors can be involved with the case. It's critical, says Kirking, to ask if the facility has a pharmacy consultant who can sit down with you and your family to discuss various prescriptions, drug interactions and side effects. Some nursing home facilities make this relatively easy, providing weekly "consultations" for family members.

Don't forget to check outpatient prescriptions, too: If you visit a hospital and are given a prescription to fill, try to take it to a pharmacist you know and trust. "It's important to develop a good rapport with one or two pharmacists who know you and your family members," says Vivian. "Don't assume every pharmacist will know every drug you're taking."