When you (or a loved one) are being discharged from the hospital, there is a lot to keep track of, including medications, home care needs, follow up appointments, etc.  Unfortunately, there is frequent misunderstanding regarding which medications to take and how to take them.

A recent study led by Dr. Leora Horwitz at Yale-New Haven Hospital reviewed 377 patients (age 64+) who had been admitted with heart failure, acute coronary symptoms or pneumonia, who then were discharged to home.

Findings:

• 81% experienced a medication error due to provider error, or because the patient had no understanding of at least one intended medication change.
• 24% of the medication errors were due to provider error.
• 60% did not understand at least one of their medication changes (a new or altered prescription, or a discontinuation of a medication, based on their recent hospitalization).
• Errors and misunderstandings were more common for medications that were not related to the patient’s primary ailment resulting in the hospitalization.

What can you do?

Roberta Carson, of Zaggo, suggests the following:

• Keep a detailed medication journal with the patient at all times
• Before leaving the hospital, make sure you go over the list of medications with the discharge team, making sure:
  • You write down exactly what new medications are being prescribed, including: spelling of the medication, dosage, instructions on how and when to take it, when to stop, and possible side effects
  • Write down any changes in dosage or instructions for existing medications
  • Go over the list of medications with the discharge team of all medications that were taken previous to this hospitalization, to make sure there are no possible adverse interactions
• Fill and take all medications as prescribed – if the patient has a problem with a specific medication, call the doctor immediately
• Use a medication chart to keep track and ensure that all medications are taken as prescribed (the Zaggo Daily Medication Chart can be downloaded for free and personalized)

Read the December 3, 2012 article by Lisa Chedekel of the New Haven Register.

More and more people are buying their medications online.  It certainly is easier that going to a store. Any sometimes it is significantly cheaper.  But is it safe?  Not always.

The FDA has launched a new website to help consumers understand the risks of buying medications from a fake pharmacy, as well as tips for identifying safe online pharmacies.

What are the risks involved with buying from fake pharmacies?  According to the FDA site,  the risks include:

• You can receive unsafe medications that are either counterfeit or substandard
• There may be slight differences in the medications that can have significant impact
• You could put your personal and financial information at risk

How can you tell if a website pharmacy is fake?  According to the FDA site, beware of pharmacies that:

• Do not require a written prescription from your doctor
• Offer steep discounts that seem too good to be true
• Are located outside of the U.S.
• Send you spam emails offering cheap medications

The site also allows you to look up an online pharmacy through the state board of pharmacy (there is a link on the site for each state).  If your pharmacy isn’t listed, don’t use it.  The FDA also advises that once you have identified a state-licensed online pharmacy, you should still make sure they require a prescription from your doctor, have a U.S. street address and phone, and have a pharmacist on staff to answer questions.

Learn more at the FDA’s BeSafeRx Website.

A study at Kaiser Permanente found that people who have multiple chronic conditions  have difficulty managing their illnesses.  The study followed 29,000 patients (treated in 2 locations) who each had 3 issues: diabetes, hypertension and high cholesterol.

The study, published in American Heart Association, found that only 16% of patients at one location, and 30% at a different location, were able to keep up with their complex healthcare regimens.  This includes issues such as following nutritional guidelines, being compliant with medication regimens, self-monitoring their condition and other health related issues.

Study physician, Dr. Edward Havranek, states: “This study highlights the fact that having several chronic health problems is common.  We can’t treat these conditions in isolation. We need to learn to help patients find ways to manage difficult combinations of conditions through strong relationships with primary care providers, simplified medicine regimens, and training in good diet and exercise.”

What can you do?

If you are managing a complicated illness or injury, there are steps you can take to make it easier to navigate the medical world and be more compliant with medication and other doctor guidelines.  Roberta Carson, of Zaggo, suggests the following:

• Use a notebook (or other system) to keep accurate records of each doctor visit, test results, and for tracking symptoms at home.  Write down everything!
• Ask as many questions as you need to make sure you fully understand what you are being told.  Do not be afraid to ask for further clarification if you do not understand.
• Do not assume all of your doctors is communicating with each other.  Use your notes and test results to keep each doctor informed.
• Be honest with your doctors!  If you are not following advice (e.g. exercise, diet, smoking) be sure to be honest about it.
• Be sure you understand exactly how and when to take each medication.
• Do not assume that each doctor knows what medications other doctors have prescribed – be sure you have a complete, up to date, record of all medications, including over the counter drugs.
• Use a medication chart (such as the free chart available on www.ZaggoCare.org) to make sure you are following medication schedules.
• If your medication regimen seems impossible to follow, or is too overwhelming, speak to your pharmacist, doctor or nurse to see if adjustments can be made (e.g. in timing of specific medications) to make the regimen easier to follow.

Read the July 31, 2012 PR Newswire release of the Kaiser Permanente Study.

It happens to all of us – years pass by as you accumulate partially used bottles of medicine – prescription and over-the-counter (OTC).  How should you dispose of these medicines properly?

Resist the urge to flush these medications down the toilet.  According to Dispose My Meds, over 100 pharmaceuticals have been detected in lakes, rivers and other bodies of water.  These traces of medications can affect our health.

However, throwing them in the trash can be unsafe as well, particularly if the home has  young children and/or pets who could accidentally ingest the medications.  Dispose My Meds reports that each year, over 71,000 children under the age of 18 are admitted to Emergency Departments due to accidental overdoses of medications (prescription and OTC).

What to do?

For non-narcotics, you can wrap the medications in coffee grounds and seal them in childproof containers.  However, this can be risky for narcotics and other potentially dangerous drugs.

Many cities and towns have annual “take-back” days where citizens can drop off all unwanted medications.  Call your city hall to find out if your city participates.

Additionally, some pharmacies will take back medications as well.  Use the pharmacy locator program at Dispose My Meds to help you find a pharmacy in your community.

Be careful with your medications!

Medication errors are on the rise.  The number of people in the U.S. treated in hospitals because of medication errors has increased more than 50% in recent years.

According to a study by the Agency for Healthcare Research and Quality, 1.9 million people became sick, or injured, from medication in 2008.

These incidents were caused by medication side effects, or people taking the wrong type or dose of medication (either because patients were given the wrong medication by the doctor, pharmacist or nurse; or because the patients took the wrong type or dosage at home, or didn’t follow instructions).

What can you do?

Roberta Carson from Zaggo recommends the following steps to reduce your risk of medication errors:

• When being prescribed a new medication, write down the name and dosage of the medication before leaving the doctor’s office.  Ask the doctor to verify the spelling.
• Make sure you understand when and how to take the medication.
• Verify that you are buying the correct medication at the pharmacy, before you pay.
• Use a medication chart to make sure you are taking the right medications at the right time (use the free ZaggoCare daily medication chart found on our home page).
• Set up an electronic alert to remind you when medicaiton is due.  Consider a watch or cell phone with multiple alarms.
• If you are hospitalized, check the names and dosage of all medications before taking them.  (If you are unable to do so, have a trusted family member or friend check for you.)

Read The New York Times April 14, 2011 article on the AHRQ study by Tara Parker-Pope at Drug Errors on the Rise.

Many patients take multiple medications, prescribed by various specialists.  Did you know that adverse drug reactions (ADRs)  can cause serious health issues?

Adverse drug reactions (ADRs) occur for a number of reasons, including patients who take too much of a medication, or when a medication is mixed with something it should not be mixed with, such as an additional medication.  These reactions can lead to serious consequences, including death.

A study by Swedish researchers reviewed the results of 22 studies on adverse drug reactions and found that over 50% of ADR cases dealt with by hospitals or emergency departments were preventable.  For elderly patients, at least 70% were preventable.  For patients staying in the hospital, almost 50% of the ADR cases were preventable.

What can you do to minimize the risk of adverse drug reactions?

Roberta Carson, from Zaggo, suggests the following steps:

• Be sure each physician knows ALL the medications you are taking, including over the counter medications and herbal supplements.
• Ask your pharmacist to review your list of medications, including over the counter and supplements, to determine if there is a potential issue.
• Be sure you properly understand when and how to take each medication.
• Set up a system to make sure your medications are organized, to help you follow your regimen properly.
• Use an alarm system, on your cellphone, watch or other timer that is with the patient at medication times, to be sure no medication is forgotten.
• Use the ZaggoCare Daily Medication Chart to be sure you are following your regimen (see our Home page for our downloadable chart).

Read the Jul;y 9, 2011 article by Deborah Condon, Drug side-effects ‘preventable’, on www.irishhealth.com at Drug side-effects preventable.

Over 50% of Americans do not follow their medication regimens as prescribed, which can lead to serious health issues.  This problem includes forgetting a pill, taking it at the wrong time, or not following the specific instructions for each medication.

To be safe, it is a good idea to use one of the many tools available to help you remember to take your medications.

There are many types of reminders available in stores and on-line.  One website, e-pill Medication Reminders, offers a wide variety of items to help you.   They have medication storage with built-in reminders, dispensers, timers and more.

A few of the many choices:

• e-pill Pill Bottle Multi Alarm Timer – this replaces the cap on the prescription bottle you receive from the pharmacy.  The built in timer can be set to ring an alarm for intervals as needed (for example, once a day, every 6 hours, etc.).
• Watches with built-in alarms so you can have your reminder with you at all times.  A variety of models are available, including ones that have 6,8 or 12 daily alarms.
• Pager sized alarm that you can keep in your pocket or on your belt, that will vibrate or sound an alarm up to 12 times a day.

Before you make a purchase, consider what method will work best for your lifestyle.  If you are often out of the house, then having a portable system works best.  If you have 10-20 different pill bottles, then the built-in alarm for each pill bottle could be overwhelming.

The important thing to realize is that it is much harder to remember to take your medication than you think it will be!  Some sort of system for organizing and reminding yourself is a worthwhile purchase.

Think you understand exactly what is written on your prescription labels?

Think again.

According to American Medical News, almost half of patients misinterpret dosage directions on prescription labels.   Problems can arise from several issues, including small print that is difficult to read, instructions that are vague (for examle, take 2 pills each day, without specifying when), and the use of unfamiliar terms.

The U.S. Pharmacopeial Convention, a non-governmental standards-setting group, is proposing changes in the labels to make them easier to understand.

How to protect yourself?

Roberta Carson, of Zaggo, recommends:

• Always write down the name and dosage of each medication, while at the doctor’s office.  Be sure you are spelling the medicine correctly.
• Ask detailed questions regarding how to take each medicine – when to take it, how to take it, what to avoid, possible side effects or interactions with other medications.
• When picking up medications at the pharmacy, make sure you have the right medications before you pay!

Read the article by Sandra Yin at Simpler labels recommended to boost medication adherence – FierceHealthcare.

Your medicine might be making you sick.

According to an article in AARP The Magazine, drug toxicity, the gradual accumulation of medication in your bloodstream, is a common and significant health issue.  

This can happen for many reasons, including:  

• a dosage that is too high
• a change in your body’s ability to metabolize a drug
• a body weight change 

Symptoms can include “mental disorientation, dizziness, memory loss, fainting, and falls.” 

The article states that “drug toxicity is a major public-health issue” for people in their 40s and older.   The more medications you take, the higher the chances of having a build up to toxic levels.   

Read the AARP The Magazine’s September/October 2010 article by Mary Fischer at Toxic Drugs: When Medicine Makes You Sick.

What can you do?

To minimize your risk, consider this advice from Roberta Carson:

• Keep detailed records of all medications taken, including herbal supplements and over-the-counter drugs
• Show this list to all doctors at each doctor’s appointment, particularly when a new medication is being prescribed
• If you suspect a drug toxicity problem, raise the question with your doctor – don’t assume he/she would automatically identify a medication issue – these symptoms may be confused with a worsening medical condition
• Talk to your pharmacist when picking up new prescriptions to double check for interaction issues (be sure they see your whole list of medications taken)
• Read the safety insert that comes with your medications
• Make sure you are following your medication regimens as prescribed – to make even complicated medication regimens easy to follow, download the ZaggoCare Daily Medication Chart at www.zaggocare.org

Want to make sure your medications are safe? 

Check out a new website from the The U.S. Food and Drug Administration (FDA).

This website will contain internal reports that the FDA generates on the side effects of all drugs approved after September 2007.   To look up medications you are taking or considering, visit Surveillance > Postmarketing Drug Safety Evaluations.

Read the June 16, 2010 article by Tracy Staton at FDA launches post-marketing safety website – FiercePharma.