According to Consumer Affairs*, it’s estimated that 7,000 deaths occur every year because of incorrect prescriptions. These are astounding statistics. And yes, I have caught a pharmacist making a very big mistake. Our son Nick was supposed to get 1 teaspoon (5 ml) of a medication, and the label said to give him 1 ml. That’s 5 times less than he was supposed to get! I had remembered what the doctor had prescribed, looked at the little tiny bottle that was given to me and wondered how I was supposed to get 30 teaspoons out of this thing. That’s when I noticed the mistake.
I’m no stranger to having to administer lots of medications. Our son Nick has been on prescription medications since birth, and he had a kidney transplant on August 15, 2000. Since then, I’ve been responsible for administering those life saving meds. There’s not much more stressful than knowing that you simply cannot forget a medication, or administer the wrong amount. I can just about do it with my eyes closed now. But when I first started I had no clue what questions I should be asking, what supplies I should have on hand, or how to stay organized so I didn’t make a mistake.
Over the past 14 years, I’ve seen mistakes made, and I’ve made a few myself. This article is about what I’ve learned along the way. It is not to be construed as medical advice, but rather personal opinion. Please check with your own doctor and pharmacist to make sure you are doing everything that you need to do in order to avoid medication mistakes.
Beginning at the Doctors Office
It all starts here. There are several questions that you should be prepared to answer, and several questions that you should be prepared to ask. Every single one of them is extremely important. Keep a journal. Bring it with you to all doctor appointments.
Questions You Will Need to Answer
Patient’s medical history: It’s a good idea to keep a journal of the patient’s medical history. This should include current and past illnesses and/or medical conditions, surgeries, current and past medications, any allergies to food or medications. When visiting the doctor, a nurse will ask several questions that will help the doctor. Having a journal will ensure that you don’t leave anything out.
Family medical history: It’s also very important that you know about your family medical history. I realize that sometimes adoption is involved and it’s simply not possible. But whenever it is possible, get the family medical history for both sides of the family (maternal and paternal). So if you’re bringing your child to the doctor, you want to know both the history on your side of the family and your child’s father/mother side of the family.
List of current medications: When you visit the doctor, you will be asked for a list of current medications, including the dose. It’s much easier to bring a list with you and just hand it over to the nurse taking the information than it is to try to remember everything right there on the spot. I like to use index cards written in pencil. He cards hold up well, you can erase pencil, and you can keep the card with the medications when you’re not using it at the doctor’s office.
Look at the medication bottle(s) and write down the name of the medication, how much (volume) you are administering and how many mg. per unit. This way the doctor will know the exact amount that is being taken. For example, if a prescription has 1 mg per ml, and you are administering 5 ml, the doctor will know that the patient is getting 5 mg.
Questions to Ask the Doctor. Write Down What the Doctor Says!
When prescribed a new medication, there are several things you will need to know. You’ll want to check what the doctor says to you against what the bottle of medication says when you pick it up at the pharmacy.
While talking with the doctor about having a new prescription filled, write down the name, the volume to be administered, and total mg’s per dose that will be administered: The bottle will probably say something like 1mg/cc. If you’re new to this, or you’re not good at math, ask the doctor exactly what the bottle that you will be getting should say. For example, if Nick gets 5 mg of Prednisolone every other day, and there’s 1 mg. per ml, then he should be getting 5 ml’s of the medication for a total of 5 mg. every other day.
1 mg./ml X 5 ml = 5 mg.
Brand name vs. generic name: If a prescription does not say ‘no substitutions’ you will most likely receive the generic version of that drug. Ask the doctor what that name would be.
What is this medication going to treat: It may seem obvious, but if you are dealing with more than one medication, you don’t want mistake one that treats high blood pressure with one that treats a headach. One that you need to take every day with one that you take only when needed.
How long will it take for the medication to take effect: It may only take minutes for it to start working, or it may be much longer than that. It’s good to know the answer to this question. Especially if it can take a couple of weeks to work!
Food, drink, herbal and drug interactions: Drinking Alcohol is an obvious substance that may interact with drugs. But did you know that grapefruit, chocolate and licorice are common as well? Herbal supplements can interact with prescriptions, over the counter medications, and the list goes on. Let both the doctor and pharmacist know what meds (prescription and over the counter) and herbal supplements are being taken. Ask what should not be taken with the prescription, including foods and beverages.
And don’t forget, before you go to buy an over the counter (OTC) medication or supplement for someone on a prescription, ask the pharmacist if that OTC item is okay to take with the meds the person is already on (both prescribed and OTC)! It’s very easy to forget to do this, especially this time of year when people catch a cold or get sick and you’re in a rush to get back home. Even though you may have been given a list of what shouldn’t be taken with the med already, you should still ask. The Pharmacist is the drug specialist. It’s what they do all day long. Just give the pharmacy a call before you even bother going to the store. Let them know what’s going on and ask them for recommendations on what you should buy. That’s what they’re there for!
Ask about side effects: You can’t turn on the TV for very long without seeing a commercial for some new medication that has come out. And then they quickly list the often large list of possible side effects. It’s important to ask both the doctor and pharmacist what they are for each medication. Sometimes even more drugs are prescribed to counter the effects of meds. Lovely, huh? Often times a medication is a necessary evil. But then there are some that may not be absolutely necessary, and you may decide against using because of an unwanted side effect.
Ask how, when and with what the medication should be taken: With or without food? If it’s with food, what kind of food? If you give all meds through a feeding tube, and you receive a tablet or capsule, can you crush it? Should it be taken at a certain time of day? A certain time before or after eating? All of these things are extremely important to know. For example, one of Nick’s meds is pretty particular and it has to be mixed with water and taken on an empty stomach, and he can’t eat for an hour after. Another one he used to be on had to be mixed in a little glass jar with water, using a metal utensil to stir it with.
Eventually you will get into a routine of when and how to administer the drugs and it won’t be such a big deal. Keep a small calendar with the meds and cross off each day as you go. If you give meds more than once a day, get a calendar where you can check a day off one, two, three or how ever many times you need to. An even bigger calendar if you need to actually write the name of the medication(s) down if that helps you to stay organized.
What happens if you miss a dose, or not all the med was taken/given for some reason?: It can happen! Should you skip it? Take it? Double up the next dose? Both my husband and I have given Nick meds through the feeding tube using the medicine port and had the feeding port blow open while pushing the med through with a syringe. At that point, we had no idea which meds, and how much of each med, actually made it into his stomach! We had to call the doctor and ask them what to do. Some meds we just skipped, others we gave to him again.
What happens if you take/give too much by accident?: This can happen, too. You get distracted and can’t remember if you already gave that med. It happened to me once, back when our oldest boy was a teen and still lived at home. He was a very difficult teen, and we were in a heated discussion while I was measuring out Nick’s meds and thought I may have given him one of the meds twice. Talk about panic! I called the poison control center and they said he’d be fine. But I never want to do that again!
How to Store the Medication: Some meds need to stay within a certain temperature. Generally you either keep them in the fridge or not in the fridge. There should be a little sticker somewhere on the medication if you’re supposed to keep it in the fridge. And it’s not recommended that you keep medications in the bathroom. Too many germs in there.
Make Sure YOU Can Read the Prescription Before You Leave the Doctor’s Office:
Many doctors have converted to computer generated prescriptions, but many have not. If you can’t read the prescription, chances are the pharmacists may have a difficult time as well. Be a pain in the butt, ask the doctor to rewrite the prescription so that it’s legible if you can’t read it. They should have respect for you that you care enough about making sure it is filled correctly and do as you ask without being upset about it.
When You’re Ready to Have the Prescription Filled
Use the Same Pharmacy For All Prescriptions: It’s the pharmacist’s job to go over ALL of the medications a person is on, and make sure that they won’t interact with each other. Help them do their job and avoid mistakes by sticking with just one pharmacy. This way they can see in their computer system a list of all of the medications for the person they are filling prescriptions for. Don’t have one filled at CVS, and two filled at Walmart.
The pharmacist also needs to know: The pharmacy will also ask about allergies, and if you are new to the pharmacy, they’ll need to know what other medications (prescriptions, OTC, supplements, herbal) you are on. It may seem redundant, but it’s important that they know this information, too. They will keep record of what you tell them in their computer system. Be sure to let them know if anything changes, too.
Ask the pharmacist questions: It’s a good idea to ask the pharmacist how and when to take the medication, about interactions with other food, drinks, OTC and prescribed drugs, and about any side effects. Do this even though you have already asked the doctor.
Why do I say this? Doctors have to know about medications, but it’s the Pharmacist that’s the real expert. As an example of what can happen when you don’t find out about possible side effects: Nick was prescribed Baclofen for muscle spasms that he was having. I wasn’t on top of my game at the time, and didn’t find out until it was too late that Baclofen can exasperate seizures. Now he’s on Keppra to prevent seizures. And despite my best efforts, and with two years worth of weaning, I have been unable to completely get him off of the Baclofen.
When You Pick Up the Prescription
Now it’s time to compare what the doctor said was being prescribed with what you’re being handed when you pick up the prescription. Here are some things to check:
- Check the name of the patient on the bottle – make sure it’s for you! Yes, I’ve been given someone else’s medication. Correct name was on the label that was stapled to the bag, but someone else’s medication was in the bag.
- The name of the medication – believe it or not, this is one of the biggest mistakes. The names of medications can be very similar. Make sure you get the right one!
- Brand Name vs Generic Name – If a doctor writes down the brand name on the prescription, unless ‘no substitution’ is written, you’ll most likely get the generic version. It should say both the generic and brand name on the bottle. Look for them.
- Volume of medication to be given – this is how much you will measure out.
- Dosage – the total mg, that you will be giving. A bottle of medicine will say how many mg/ml, etc. is in the drug.
- Storage – check for special instructions.
- Shake or not to shake – check for special instructions. Also note: if the pharmacist needs to add water to a medication, they probably won’t do this until you’re at the pharmacy ready to pick it up. This is because the medication’s expiration date will be affected by the date the water is added. Keep this in mind an plan ahead for these prescriptions.
- Measuring devices – get syringes when ever possible. And make sure you get a size that you can actually use! Often times it’s not the pharmacist that will decide which syringes you get. You can’t accurately measure out 0.3 ml with a 10 ml syringe.
Read the label for instructions on how to properly take the medication. Check this against what the doctor told you.
Read all those other little stickers on the bottle: there may be some other special instructions that aren’t on the regular label, such as Use caution when driving or operating heavy equipment, etc..
Read the label on the bottle for correct dosage every time a prescription is refilled: Another catch I made wasn’t so much an error on the pharmacy end, but a change in the strength of med that nobody told me about when I refilled his prednisolone. He used to get 3 cc’s once every other day. The strength of the liquid was changed at some point (new supplier maybe), and he now gets 5 cc’s once every other day. He’s still getting the same total mg., I just have to measure it out different now. But neither the doctor’s office or the pharmacy told me when the change was made. I just happened to read the label on the bottle and notice. I had to call the doctor’s office and question them on it and complain that nobody told me, the one giving him the med. Who knows how long I could have been giving him the wrong dose if I hadn’t noticed the change on the label. I’d been measuring it the same for years…I don’t need to look at the labels anymore to know how much he needs to get of the dozen meds he’s on. I really lucked out when I noticed. And by the way, it was a doctor at Boston Children’s Hospital that refilled the prescription. So don’t let the fact that a prescription is filled by a doctor at one of the top hospitals in the country sway you from being just as careful when filling prescriptions.
If a dosage is changed: Never change a dosage on your own. Always follow the doctor’s instructions. And if a dosage is change, rather than just refilling the prescription, get a new prescription so that the label will reflect the new dosage.
It’s a good idea to let someone other than a person that lives in your house where your list of medications with the dosage is located. God forbid the adults get into an car accident together and are unable to tell people how to administer medications. You should also keep a list of phone numbers for all the physicians that prescribe the meds.