June 18th, 2011 by Jessie Gruman, Ph.D. in Health Policy, Opinion
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I sat in a dingy pharmacy near the Seattle airport over the holidays, waiting for an emergency prescription. For over two hours I watched a slow-moving line of people sign a book, pay and receive their prescription(s). The cashier told each customer picking up more than one prescription or a child’s prescription to wait on the side. In minutes, the harried white-haired pharmacist came over to ask the person if they were familiar with these medications, described how to take them, identified the side effects to look out for and demonstrated the size of a teaspoon for pediatric medications. Then he asked the person to repeat back – often in broken, heavily accented English – what he or she had heard and patiently went over the parts they didn’t understand.
I was impressed. This is what every pharmacy should be like – except, of course, for the dinginess, the creeping line and the fact that it was so crowded I could overhear these conversations. Maybe if we got federal legislation enacted requiring pharmacists to offer counseling with each prescription filled, this kind of attention would be the norm, adherence to medication regimens would improve and drug-related injuries would be reduced.
Wait a minute. Someone already had that good idea. It was Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
April 20th, 2011 by Mary Lynn McPherson, Pharm.D. in Health Tips
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Imagine your mother telling you she’s starting a new pain medicine, only to learn that she ended her life three days later due to a medication error. That’s exactly what happened to Linda Sanders, a 62 year old woman who thought she was getting the pain reliever Lyrica, but she accidently got Lamictal, an antiseizure medication. The mistake was probably caused by the similarity in the two medications names. Unfortunately, suicide is a known risk associated with Lamictal therapy.
Medication mistakes involving pain-relievers have consequences that range from inconvenient to potentially deadly. Why are errors fairly common and potentially serious with this group of medications? There are an estimated 75 million Americans who suffer with chronic pain, which results in a lot of prescriptions being written and filled for pain relievers. Also, people can react differently to specific pain medications. In fact, taking the wrong medication can make an unrelated medical condition worse, or even be fatal!
A large new research study recently analyzed over 2,000 prescribingerrors involving pain medicationsthat were caught before being given to patients that occurred at a teaching hospital. The errors ranged from doctors ordering the wrong dose of the medication or giving incorrect directions to the patients, to prescribing a medication inappropriate for a patient (patient allergic to medication). Most troubling was the fact that pain medicines with names that “look alike” or “sound alike”were also a cause of prescribing errors.
Medications whose names look similarwhen written or sound like other medication names have long been identified as a source of medication errors. The Institute for Safe Medication Practices (ISMP) even publishes a list of “Confused Drug Names.” Doctors aren’t the only ones who make medication errors because of confusing drug names. Pharmacists can accidently dispense the wrong medication, nurses can administer a drug with a similar sounding- or looking-name and patients frequently take wrong medications due to this confusion!
Looking at the list of confused drug names provided by ISMP, we see several pain medications on the list. Here’s a partial listing:
• CeleBREX (a nonsteroidal anti-inflammatory pain medication),CeleXA (an antidepressant) and Cerebyx (an antiseizure medication)
• Codeine (an opioid) and Lodine (a nonsteroidal anti-inflammatory pain medication)
• Hydromorphone (an opioid) and morphine (a different opioid)
• Lyrica (a medication for nerve-damage pain) and Lopressor (a blood pressure medication)
• Methadone (an opioid) and methylphenidate (a stimulant medication)
• Tramadol (an opioid) and trazodone (an antidepressant medication)
What can you do to minimize your risk of a medication misadventure caused by medications whose names look or sound like other medications? Here are some tips that may help:
• Ask questions. Doctors, pharmacists and nurses can make mistakes and you shouldn’t be afraid to question them.It’s your health.
• Use your health care team! Make sure your doctor and pharmacist provide important information about ALL of your medications before you leave the office or pharmacy.
• The National Council on Patient Information and Education (NCPIE) has a terrific handout of “Helpful Steps to Avoid Medication Errors” that you can print out and take with you when you visit your doctor or pharmacist.
• Make sure your doctor and/or pharmacist cover all the following points for each of your medications (and take notes for later):
o What is the name of the medicine and what is it for? Is this the brand or generic name?
o How and when do I take it – and for how long?
o What side effects should I expect, and what should I do about them?
o Should I take this medicine on an empty stomach? With food? Is it safe to drink alcohol with this medicine?
o If it’s a once-a-day dose, is it best to take it in the morning or evening?
o What foods, drinks or activities should I avoid while taking this medicine?
o Will this medicine work safely with any other medicines I am taking?
o When should I expect the medicine to begin to work, and how will I know if it is working?
o Are there any tests required with this medicine (for example, to check liver or kidney function)?
o How should I store this medicine?
o Is there any written information available about the medicine? Is it available in large print or a language other than English?
To quote the National Council on Patient Information and Education – “Educate Before you Medicate!” And if you have ANY lingering questions about your medications, call your pharmacist. It’s part of a pharmacist’sjob to answer patient questions, and it’s your health on the line!
October 22nd, 2009 by Happy Hospitalist in Better Health Network, True Stories
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I was at the pharmacy today picking up some goods. We indicated to the pharmacy tech our cash paying status. The nice lady behind the counter explained that the drug company had a discount plan for cash paying customers that do not submit a claim to their insurance company. We had to promise not to submit the claim and not to sell the medication on the internet for which we obliged. Then we had a seat and waited.
In the next 30 minutes I had the opportunity to listen to several customers blow up in a fit of rage about why their insurance company wasn’t covering this or that. Read more »
*This blog post was originally published at A Happy Hospitalist*
October 19th, 2009 by Dr. Val Jones in True Stories
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I’m working with a small team of primary care physicians in Vienna, Virginia. Part of their strategic business plan is to offer flu shots to local residents via office visits and house calls. Just last week I accompanied Dr. Alan Dappen on a series of flu shot house calls to the frail elderly. They were too weak to come to the office, but wanted to be protected from life-threatening flu. I was really proud to be able to care for them in their own homes and wondered how many emergency room visits we would avert this season with our strategy.
The answer may be “fewer than I thought” – but not for the reason I expected. As it turns out, a local pharmacy conglomerate has bought up most of the flu vaccine supply, so that our practice can’t get any more. Although we have hundreds of patients requesting flu shots, we just don’t have the goods. And I can tell you that the frail elderly (who would have benefited from our house calls) won’t go to the pharmacy to get them. They’ll be at risk for the flu, and will have to wait until we can get more vaccine – whenever that happens. Read more »
November 4th, 2008 by Dr. Val Jones in Opinion, True Stories
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Election anxiety has America on the edge of its seat. I anticipated long lines and a lot of drama, so I voted early to avoid the rush. That left me with nothing election-related to do today, so I decided to head over to my local pharmacy and get a flu shot instead.
Last year the flu vaccine was only 50% effective because experts did not correctly predict which viral strains would victimize Americans. This year I have my fingers crossed that the Brisbane and Florida strains included in the vaccine will do the trick. After all, Influenza is the single leading cause of vaccine-preventable disease in the U.S., with estimates between 15 million and 60 million cases in the US a year among all age groups. Influenza leads to 200,000 hospitalizations and about 36,000 deaths a year in the U.S., mostly in infants and the elderly. I’ll never forget the touching story of how one family lost their three and-a-half year-old daughter to the flu.
So I arrived at the pharmacy only to find a disorderly group of flu-shot seekers, pacing near the entrance to the retail clinic. About 20 minutes later a young woman with a clipboard and sign up sheets came out and started asking people what kind of insurance they had. When my turn came she informed me that my insurance plan was not participating, and suggested that I leave. I asked if I could pay out-of-pocket for the shot and she said that I could and gave me a consent form. More people arrived without any movement in the line, and I overheard one person commenting that the nearby polling booth wasn’t moving as slowly. Another customer decided to leave to go vote and then come back later for the shot.
Forty minutes later my name was called and I entered a small room littered with papers and syringe caps. I rolled up my right sleeve and asked the technician about his injection technique. I watched him carefully draw up half a cc of vaccine from a multiple-use bottle.
He then asked me how I was going to pay. I presented my credit card and he said that he only accepted cash or check. I said that I had no idea that credit cards weren’t accepted and he seemed surprised that I wasn’t aware of the retail clinic policy. A large envelope was leaning against his chair leg, full of $30 cash deposits for the shot. Read more »
