At least 1,300,000 people in the U.S. are harmed each year because of medication-related errors. - FDA
Had Michelle LaRowe not caught the error on the prescription label in time, her infant daughter would have received nearly triple the dose of the antibiotic the doctor ordered. The May 2009 incident spurred LaRowe to demand that pharmacies educate parents on how to protect their children from dangerous drug errors.
At one time or another, we all handle prescription medicines for ourselves, our children, our older relatives. Here’s what to what to look for - and what to do if you don’t see what you should.
DOCTOR’S OFFICE - FIRST CHECKPOINT
When a clinician writes out a prescription, the office visit should include counseling about the new drug - with the doctor or nurse telling you:
• The name of the drug,
• Its strength,
• How much to take
• And how to take it.
Plus, you should know:
• WHY you’re taking the medicine,
• And not only that, what the drug should do
• And how long it should be before you see results.
If you don’t get this vital information, ask the physician for it.
Whether a prescription is e-mailed, phoned in, or hand-carried, you need written information that you can keep and refer to as needed.
An aware patient is a crucial leg in the system, says John Gadea, director of the Connecticut Department of Drug Control. “You’re part of the checks and balances.”
Michelle LaRowe of Hyannis, Mass., is a savvy patient. Years of experience as a nanny paid off for LaRowe when a local pharmacy dispensed an antibiotic for her 10-month-old daughter. Her husband had picked up the prescription and along with it, was given an oral syringe. But when he repeated the instructions to his wife, red flags flew.
Long story short: “The pharmacy label was incorrect. The pharmacy label said three teaspoons three times a day,” LaRowe recalls. When she backtracked to her pediatrician, she confirmed that the correct dose was three ccs - not teaspoons - three times a day: a much smaller dose.
Ask the doctor or pharmacist to give a dosage that matches the measuring tool you will use to take the medicine.
If the syringe or medicine cup that comes with the bottle is marked in milliliters, or mls, ask them to describe the dose in milliliters, too.
When you get a prescription from the doctor, it’s fine to jot down instructions and it’s also a good idea to repeat them back to the doctor. By all means ask for patient information sheets or pamphlets. Do whatever you need to leave a doctor’s office with a clear understanding of how a new drug should be taken.
AT THE PHARMACY COUNTER - SECOND CHECKPOINT
Pharmacy counseling provides a second chance at understanding. This is also the perfect moment to ask about drug interactions.
Pharmacists can be a goldmine of information, whether your question is about a prescription drug or an over-the-counter drug.
Rebecca Snead is executive vice president of the National Alliance of State Pharmacy Associations. She tells of a person with diabetes “who couldn’t get his blood sugar under control and came to the pharmacy to see why his insulin was not working. They had gotten their insulin through the mail. No one had told him that the particular type of insulin they had given him lost its effectiveness 28 days after opening and should have been discarded.”
If you have questions when you pick up a prescription, say, “I would like to ask the pharmacist some questions in private.” Counseling for new prescription drugs is a legal requirement in many states, but you might have to speak up to get it.
Some pharmacies routinely start off prescription transactions by having customers sign standard forms - on paper or electronically - saying they’ve been offered and declined counseling. So, “no counseling” becomes the default. You’re waiving your right when you sign that paper.
“One reason that counseling isn’t happening is people aren’t demanding it,” Snead says. “If your pharmacy isn’t providing it [when you ask], find another pharmacy.”
Would you walk away from the bank teller’s window without counting your money first? Don’t be any less cautious at the pharmacy counter.
“You should open the bottle there at the pharmacy, but most people don’t,” Gadea says. “A lot of the information is there on the insert” - what the pill looks like, how and when you take it.
Even with refills, you might still have something to learn, he adds: New information might come out, for instance on side effects or safe usage. Ask your pharmacist for updated patient information sheets.
Counseling should be offered in a place that affords privacy, not over the cash register in earshot of the line behind you. And a pharmacist should be doing the counseling, not the cashier or pharmacy assistant.
If you’re one of the millions of Americans who gets their prescription drugs by mail order, “safety precautions are the same as with any pharmacy setting,” Snead says. “Patients should leave the prescriber with something in writing about what they are supposed to be on.”
If you choose to save money by using mail-order drugs from other countries, remember that you are on your own without the benefit of consumer protections.
ENGAGED PATIENT - THIRD CHANCE AT SAFETY
As a nanny, Michelle LaRowe says that “a lot of parents tell me they feel rushed. They don’t take time to read through materials. They leave antibiotics on the counter and they don’t refrigerate them.”
Yet, she says, “You have to be aware of:
• What your children are taking,
• Why they’re taking them,
• And the proper way to take them.”
Most important single fix: “To educate patients and parents,” she says. “Your doctor has to educate – and you have to do your own education. Yes, I read inserts, I read labels.”
Even young children can become part of the safety solution, says Dr. Ramon Resa, a pediatrician in central California. “When I give my patients medication, even if they’re five years old or eight years old, I give them instructions, not just their parents: ‘This is for your ears. You take it once in the morning and once at night.’ Kids will abide better than their parents - they’ll tell their parents it’s time for their medicine.”
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KNOW THE FIVE RIGHTS OF DRUG TAKING
The “five rights” of medication administration are drummed into every student in the health professions. Even as a health care consumer, you can use these to keep yourself and your family safe.
The five rights:
• Right Patient
• Right Route
• Right Dose
• Right Time
• Right Medication.
Source: Center for the Advancement of Health, Washington, DC (http://www.healthfinder.gov/orgs/hr2729.htm) press release Jan 5, 2009