7 ways patients can help reduce medication errors

7 ways patients can help reduce medication errors

I just got off the phone with a very upset patient who had just discovered that her pharmacy had been giving her the wrong medication for the past 5 months, substituting a similarly spelled antibiotic for her rheumatoid arthritis med. She was tipped off when she realized how bad she had been feeling of late and decided to check the expiration date of her med, only to find it was the wrong drug. I won’t get into the unethical behavior of the pharmacist when she pointed out the error, something I’ll be reporting on her behalf to both the head of the pharmacy chain and the state pharmacy board.

But that’s not the point of this post. The point is that, despite all our fancy technology and advances in health care, medication errors can and will occur.

So what can you do, as a patient, to be sure that your prescriptions are correct?

1. Keep a list of your current meds with you at all times. Include brand or generic name, dose and frequency. Paper, online, or on your phone — wherever its easiest and most accessible. But a paper list in your wallet will cover you in emergencies, so consider that even if you use your phone routinely.

2. Cross check and update your med list with your provider at every visit. In quality parlance we call it medication reconciliation, and it’s one of the most important things we docs do at a patient visit.  You’d be shocked how many patient come to a visit without knowing the names of the drugs they are taking. Now, if I go to prescribe a new medication, how can I be sure it doesn’t interact badly with something you are already taking? Or even if you may already be taking the very med I am prescribing? If I’m lucky, your pharmacist will pick it up, but only if you’ve filled a prescription in his system before. Don’t leave it to chance. Take charge.

3. Ask for an updated list of your medications and prescriptions before leaving your doctor’s office. Most EMRs can create a current med list, so ask your doc or his/her staff for a copy. If you use it as your med list to carry with you, we’ll all be on the same page.  Alternatively, if your practice gives out an after visit summary (AVS) at check out, that usually will have your med list on it.

4. If you’re tech savvy, use the practice portal. Your providers practice portal has a med list. Take it upon yourself to check the portal between visits to be sure your med list is up to date and correct. You can usually print your med list yourself from the patient portal.

5. Cross check every med after you pick it up against the prescription your provider wrote. This includes refills. Use your printed med list, the portal or your AVS to check what your provider wants you to be taking. If you don’t have that, you can ask the pharmacist for a copy of your prescription. Don’t wait till side effects occur, as my patient did, to double check. Your health is too important for that.

6. Don’t hesitate to speak up if you think a prescription is wrong. You take it once a week, and now it says twice a week? Say something. And it’s not just the pharmacist who can make a mistake. Your doc isn’t perfect either. In fact, we’re less perfect in some ways since we started using the EMR to write prescriptions. More than once, I’ve caught myself typing in a prescription in the wrong patient’s chart — with up to 4 charts open on the computer screen at a time, it happens, trust me. Recently, my EMR made every part of a prescription a discrete field or check off box from a drop down, so that writing a single prescription is more like completing an online tax return than ordering a med. I hate it. It used to be so much faster (and safer) for me to just write or type out the frequency and dose. So please, stop me if you think I got it wrong.

7. Finally, don’t forget that so called “natural” supplements are meds too. Don’t  get me started on the over use of these unregulated products. (And yes, overuse of prescription drugs as well, but at least we know whose making them and what’s in them.) But do know that many, many interactions can occur between so called “natural” products and prescription meds. So if you’re taking any kind of supplement, vitamin, herb or natural product, be sure to add it to your med list.

Margaret Polaneczky is an obstetrician-gynecologist who blogs at The Blog That Ate Manhattan.

Image credit: Shutterstock.com

Comments are moderated before they are published. Please read the comment policy.

  • Kristy Sokoloski

    I have seen mistakes a couple times with my own medications. So I make sure to let my doctor know. I even had to let the MA know when I was there last week that one of my regular medicines got taken out of the system when it should have still been there. Also, when I went in for my physical exam the week before and I wrote out things I also put down all the other OTC items that I use on a regular basis when I need them.

    • Margaret Polaneczky, MD

      OTC meds are so important, esp as they can interfere with prescription meds. Some OTC meds are actually drugs (like progesterone) or act like drugs (like red yeast rice or St Johns Wort).

      Thanks for your comment

      Peggy

  • LeoHolmMD

    I’ve got a few more for you:
    1. Ditch the whole Brand and Generic game. I can’t think of anything more belligerently confusing than giving a medication two names. We need to stop protecting corporate branding interests and call one drug, one name.
    2. Stop insurance companies from switching formularies every few months for short term financial gain. This is dangerous. Churning a patient through numerous similar but not equal drugs is reckless. Medications are not skittles. Worse yet, patients are financially intimidated to change to “preferred agents” that are not even remotely similar to what was prescribed. On the other end, physicians are administratively intimidated with pointless precertification forms.
    3. Do not use mail order pharmacies. Use your local pharmacy where there is a human who knows you, and you can trust. The robots are not looking out for you. Pharmacists are invaluable allies in your care. Do not outsource these people.

    • Kristy Sokoloski

      When I use my mail order pharmacy I actually talk to a person. Do I like to use my mail order pharmacy? No, but unfortunately I have to for some of my medications because it’s cheaper for me to get them through the mail order pharmacy. One of my medications if I do it through retail pharmacy for a 30 day supply is $89 and for $9 less it was easier for me to get it through my mail order. Another one of my meds for a 30 day supply would have been $66 and yes, that was for the generic. So, it was easier for me to go through my mail order to pay for the generic it’s $15.

    • DeceasedMD

      Well put. It is amazing to me how mail order pharmacies can mail stimulants or benzodiazepines through the mail. And how it is legal for pharmacies to keep sending autorefill requests on all meds started as if they will continue indefinitely…

    • Margaret Polaneczky, MD

      I agree wholeheartedly that the local pharmacist can be a lifesaver. But it’s no panacea – I’ve seen some terrible mistakes made by poorly trained pharmacists in the rapidly sprouting chain drug stores in manhattan – seems like there are now two on a corner! A typical one is substituting the oral contraceptive estrogen ring for the vaginal dryness estrogen ring – an enormous increase in dosing.

      Part of the problem there is online software that thinks every drug that has estrogen in it can be a substitute for another, and actually prompts the prescriber to substitute one for another. If you don;t know your drugs, its an easy mistake from a system that’s supposed to be saving us from errors.

      I use a local mom and pop place that has been in business for decades. (and delivers!) But for many folks, the costs of staying local are just too high.

      Thanks for your thoughtful comment.

      Peggy

      • Spring Texan

        WOW! Substituting the oral contraceptive estrogen ring for the other. Just WOW.

    • Margaret Fleming

      “Stop insurance companies from switching formularies” is not something the patient can do!
      At least I have to give my Rx insurance co credit for being suspicious of a med I did not agree with doctor on.

  • Lisa

    The first thing I do when I get a new script is read the label. Is it what I expect? Then I check to see if the pills match the desciption (usually on the label) of what they are supposed to look like. Then I count the pills. The most common error (still relatively uncommon) I have found involves the number of pills.

    • Margaret Polaneczky, MD

      The same name mistake is one the EMR should catch – if it knows if I’ve seen someone else who has that same name, it should prompt me each time to confirm the DOB. EPIC are you listening?…

      Thanks for your comment. .

  • southerndoc1

    Why was an Ob/Gyn involved in the prescribing of RA drugs?

    • Margaret Polaneczky, MD

      I was not the prescriber. She called me because I had prescribed an antibiotic for her UTI and she thought she was already taking the same med for her RA.

      • southerndoc1

        Thanks for the clarification. What a mess.

  • HJ

    When confronted with a new prescription, I google the name on the bottle to make sure it does what it supposed to do. I then look at images of the medication and make sure the pill matches the picture. I also make sure the codes on the pills are correct. This takes care of an inappropriate prescription, an illegible prescription and a wrongly filled prescription in about 2 minutes…

    • Margaret Polaneczky, MD

      NJ –
      Great strategy.
      Thanks for your comment.

      Peggy

    • Lisa

      I find it helpful to read about a drugs side effects. My doctors have a habit of only mentioning the usual side effects and glossing over the unusual ones. Of course, I am the one who gets the unusual side effects. I just love it when someone looks at me and says “that isn’t listed as a side effect of x.” It helps if I know it is.

      • Spring Texan

        Yes, my sister was told that tendon pain was not a side effect of a fluoroquinolone by her OB/GYN. It definitely helps if you know that it is.

        Some doctors are sharp as tacks and others — dull and overconfident and way too quick to tell patients they are not suffering a side effect.

        • Lisa

          I developed cataracts within a month of starting arimidex. I didn’t have them before, per my OD, who saw me about a month before I started takikng arimidex. My OD and my pcp agreed that cataracts are a rare side effect. My oncologist, to her credit, told me she had never seen anyone develop cataracts as a result of taking arimidex. She didn’t tell me it wasn’t a listed side effect. My prior oncologist was the one who discounted side effects, which was a great source of frustration to me. He probably would have told me I was imagining the cataracts or that I would have developed them whether or not I was taking the drug.

  • medicontheedge

    Actively involved patients. What a concept.

    • Peggy Zuckerman

      Getting patients/permitting patients to be actively involved with their own care involves some basic education, preceded by the doctor’s expressed willingness to do so, and to be questioned by the patient. That sets a tone by which the patient will question the pharmacist, double check the meds and OTCs against what patient and physician discuss, and monitor and report side effects.
      Not every patient will take advantage of that approach, but all will benefit in the long run.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Hello Dr. Polaneczky: Thank you for writing an outstanding article. You offer excellent tips. Meds are one of my “hot button” issues — I could talk about meds for weeks! I think all patients need a mini course, Meds 101. Most patients I’ve talked to really don’t under generic vs. brand. I had one patient who told me that generic meds were “meds on sale.” Also, patients are often confused that generic meds of one drug look differently — I have to do that explanation many times. I have also worked with many patients who describe their meds by color (e.g., “I take the white pill twice a day and the orange pill at bedtime …). A lot of work needs to be done and your article is an excellent first step.

  • Spring Texan

    You don’t mention the most obvious way to check, look up your drug on the internet, and as HJ and Lisa have already noted, this is probably the quickest, most effective strategy. If the patient had tried to read up on the prescription she was given, she’d have detected the error much sooner.

    I think your bring all the lists and keep checking with your doctor is kind of unrealistic and would take up more time than i want to spend with a doctor or crowd out other concerns. But yes, one should not just trustingly take whatever the pharmacist hands them without checking the label and what the drug is. But yes not all patients are the sort who will or can check for themselves, so multiple strategies can be appropriate.

    • Spring Texan

      I am not saying that of course you don’t need to be able to give your doctor an accurate list of your current medications and it may have sounded like that . . . of course you do and I didn’t mean otherwise.