Inaccurate records can cause emergency room medication errors.
Medication errors at emergency departments lead to hundreds of thousands of injuries annually, says Rita Shane, chief pharmacy officer and professor of medicine at Cedars-Sinai Medical Center in Los Angeles. Emergency rooms at U.S. hospitals handle more than 141 million visits annually, treating heart attacks, fractures and other ailments, according to the Centers for Disease Control and Prevention, and medication errors can happen when hospital staff rely on incomplete or outdated prescription records or when patients transition from one setting to another and current medication information isn’t passed along.
Relying on pharmacy professionals greatly reduces errors.
Mistakes in drug orders can be reduced by more than 80 percent when pharmacy professionals — in collaboration with doctors and nurses — take the medical histories of high-risk patients admitted through the emergency department, according to a recent Cedars-Sinai study. Investigators focused on 306 patients who took at least 10 medications or had a history of heart failure or other serious medical issues. In response to the findings, Cedars-Sinai now assigns pharmacy staff members to record medication histories for high-risk patients admitted to the hospital through the emergency room. You, the patient, can also take steps to prevent medication errors. Here are nine strategies to guard against emergency room-related medication errors:
Compile and carry a current drug inventory.
Carry a list of your prescription medications and dosages in your purse or wallet at all times, and update it when you add or stop taking a medicine, says Dr. Joshua Pevnick, associate director of the division of informatics at Cedars-Sinai. Note any drug allergies. If you arrive in the emergency room unconscious or with compromised ability to communicate, this list can be vital. “Obtaining accurate medication histories is a huge challenge, particularly in emergency situations,” Pevnick says.
Include over-the-counter medications on your list.
If you’re taking herbal remedies, laxatives, over-the-counter pain relievers, cough or cold medications or vitamins, include them on your drug list. Some of these products may interact with drugs that you’re prescribed at the hospital, or they could have harmful side effects, Shane says. For instance, some herbal medications may interact with blood thinners, increasing the risk of bleeding. Don’t forget to note your caffeine intake through coffee, soft drinks or other beverages. “Caffeine can ‘boost’ the effect of certain asthma medications, for instance, causing symptoms such as a racing heartbeat,” Shane says.
Carry your physician and pharmacy contacts.
Your doctor can provide background on why you’re taking certain drugs, so carry his or her contact information, including phone number, email and fax number. If you have multiple physicians who prescribe you medication, carry their contact information, as well. These doctors can provide your prescription drug history and discuss the reasons you’ve been prescribed the medication, which is valuable information for hospital pharmacists and physicians. Also carry contact information for your pharmacy.
Be sure the hospital staff verifies your identification.
Before any hospital staff member administers a drug, be sure he or she checks your patient identification bracelet to confirm it matches the name on your medication record. This record shows the medications prescribed for you during your hospital admission. Many hospitals scan the identification bracelet and review prescription drugs before they’re administered to ensure the drugs are correct. But later, confusion over patient IDs can can cause a drug to be administered to the wrong person, in the wrong dose or at the wrong time.
Consider bringing a patient advocate to the hospital
Going to the emergency room is an extremely stressful experience, notes Teri Dreher, a registered nurse and owner of NShore Patient Advocates in Chicago. Patients under that kind of stress sometimes forget parts of their medical history, including the prescription and over-the-counter medications they take, allergies and past adverse reactions to drugs. A patient advocate can be a trusted family member, a close friend or a hired private patient advocate, Dreher says. If you become incapacitated, your advocate can relay wishes about your treatment — including medication choices — to doctors. You can arrange for your advocate to speak for the rest of your family, according to the National Patient Safety Foundation.
Don’t hesitate to ask questions.
When you receive a drug for the first time, ask a hospital staff member to explain the medication’s purpose, its benefits, its risks, whether it interacts with other medications and its possible side effects. Be sure to ask whether taking the medication requires monitoring; some drugs, for example, can affect kidney function and require you to undergo specific blood tests. If you’re worried about a particular medication’s risks or side effects, ask about possible alternatives. If you don’t feel fully informed by the staff member’s answers, ask for the doctor or pharmacist on duty.
Review your medication regimen.
As you’re being discharged from the hospital, review with the hospital pharmacist the full list of drugs you’ll be taking, along with doses and instructions. Verify which of the drugs you were taking before you entered the hospital should be continued, and whether any new drugs you received during your stay should be discontinued. Ask about the purpose of each medication, and write everything down. Call your pharmacy to find out how much any new medications will cost you after insurance contributions. If the prices seem prohibitive, talk to your pharmacist and your physician about potential strategies to reduce your costs.
Be sure your caregiver understands your new drug regimen.
Everyone who helps you take medications — whether it’s a professional caregiver, spouse or partner or a close family member — should be brought into the loop on your post-discharge drug regimen, Shane says. Bring your caregiver or close family member or partner to your post-discharge drug consultation to provide a second set of eyes and ears. In particular, older adults or those with disabilities should make sure to update any family members or caregivers who may help them by buying medications, picking up refills, arranging medications in a pillbox and confirming that medications have been taken as prescribed.
Update your home pharmacy.
After confirming your new drug regimen with your primary care physician and any relevant specialists, contact your pharmacy and ask them to remove your prescriptions for discontinued medications from their records. “When patients go back to their pharmacy after being discharged, the staff there sometimes inadvertently provides refills of medications that were discontinued during the hospitalization,” Pevnick says. “For instance, a patient may be hospitalized for a bleeding problem, and so the previously prescribed anticoagulant is discontinued. Then the home pharmacy gives the patient a refill from the old anticoagulant prescription when they visit the pharmacy to get their post-discharge medications.”
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9 Strategies for Reducing Emergency Room Medication Errors originally appeared on usnews.com
