When performing an assessment of a client, I evaluate their physical, mental and functional health. Also included is a thorough medication assessment.
What do I find more often than not?
A plastic bag filled with various pill bottles. Often, I do not know where the medications came from, or who prescribed them. In addition, more often than not, the medications came from more than one pharmacy, and more than one doctor.
If a patient is very lucky, they have one physician who looks through the bag and sees the whole picture. If not, they continue to take what is sometimes too much medication, causing too many side effects. Aubrey Knight, M.D, of the American Academy of Family Physicians, suggests, "Any symptom in an elderly patient should be considered a drug side effect until proven otherwise."
According to an article from the America Journal of Geriatric Pharmacotherapy, "Polypharmacy (i.e., the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly."
In fact, the elderly take more than one third of prescription drugs used in the United States. A statistic reported in HCP Live states the average elderly person is taking at least five prescription medications per day, in addition to over the counter drugs and supplements. What does this all add up to?
There is no doubt that medication errors are all too common. Multiple prescribers, multiple pharmacies, multiple names for the same drug and the same drug that changes shape or color are just some of the causes of medication errors. Who keeps it all straight and coordinates the pill-taking venture? Unfortunately, many do not keep their daily medications straight.
Too often, people are taking the same medicines with a different name or they are taking the wrong dosage. Just as importantly, there are many people who are not taking their medicines at all. No one has noticed that they starting to forget to take them.
You would be surprised to know how many times I count the pills in prescription containers, only to discover that the date dispensed is from very long time ago, so medications have expired. Usually in this situation, many pills still remain. Recently I found a prescription from one year ago with 20 of the 90 original pills remaining. The patient claimed she takes it daily. Her blood pressure reading claimed otherwise.
People are not encouraged to place their pills in weekly pill boxes. Instead they take them out of their plastic bags, and line them up, and start the daily exercise of pill popping. I am in no way suggesting that medications are a bad thing. I am saying that prescriptive medications need to be closely monitored.
Some pharmacies and drug manufacturers are not doing a good job of making the process any easier.
I had a patient with a prescription for a medication with the dosage being 25mg/two tablets once a day. When the pharmacy switched to 50mg per tablet, she started using the old 25mg with a 50mg, not realizing that the pills changed to one of the higher dosage - instead of two at the lower dosage. This type of confusion is happening all the time, with serious health consequences, and it is going unrecognized.
Dosage schedules are often unrealistic, but with so many hands in the pot, it is difficult to monitor the stress placed on the patient or caregiver trying to manage the medicine. That also leads to the discussion of the stress of paying for all the medications. Physicians may be prescribing a medication without realizing that drug plans are not covering some of theses drugs or that the co-pays are exorbitant. Often times, there are very good alternatives that are just as effective.
What can we all do to protect against drug errors?
Take your bottles to the doctor's office to be seen each time you have an appointment. Place your medicines in a weekly pillbox. If you have vision problems, have someone help you load the box. Ask your pharmacist to tell you of any changes to the pill color or shape since the last refill. Have your list of medications typed up and a pill taped beside that medication name for a visual of what they should look like. When they are rolling around the bottom of that bag (I know they are), they will be easier to identify. Have your medications reviewed by the pharmacist regularly. The Finksburg Pharmacy offers a "Simplify my Meds" program and medication reviews.