Meds

A Day in the Life of Your Prescription

A Day in the Life of Your Prescription        

At one time or another, we all handle prescription medicines for ourselves, our children, our older relatives.  
Here’s what to look for — and what to do if you don’t see what you should.

A Day in the Life of Your Prescription   

   

At one time or another, we all handle prescription medicines for ourselves, our children, our older relatives.  
Here’s 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, how much to take and how to take it.

“You tell parents what to do and you write it down; the pharmacist will say it again and give them instructions,” says Ramon Resa, a pediatrician in central California.

Plus, you should know WHY you’re taking the medicine, and not only that, what the drug should do and how long it should take before you see results.
Five Rights to 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

If you don’t get this vital information, ask for it.

In some ways, prescriptions are becoming easier to for everyone to understand. Latin abbreviations are almost a thing of the past. And electronic prescriptions, when available, eliminate one safety barrier:  the illegible handwriting of some physicians.  This prevents errors — and protects you.

Rebecca Snead, executive vice president of the National Alliance of State Pharmacy Associations, and a pharmacist herself, says, that electronic prescribing is “very efficient for refills but for new prescription medications, you must be cautious.”

She adds, “The new electronic prescription goes to the pharmacy [separately] and the patient goes to the pharmacy and this is often the first time they’ve heard of the benefits and risks of what has been prescribed.”

Whether a prescription is e-mailed, phoned in, or hand-carried, you need written information that you can keep and refer to as needed.  At a minimum you should get the drug name, strength, indication, what you’re taking it for, directions for use and side effects at both the physician’s office and pharmacy.

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 is a savvy patient. Years of experience as a nanny paid off for her 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.

At first, she thought her husband must not have been paying attention. Yet, the label backed up what he said.

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.

As a patient (or parent), it shouldn’t be your job to convert drug doses from ccs to teaspoons.

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 give the dose in milliliters, too.

Don’t hesitate to question a dosage that doesn’t seem right. Listen to your gut. For instance, if a label calls for you to take what seems like too many pills at once, ask the pharmacist to double-check. You might be right.

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.

Red Flags

red flag “Take as Much as You Want”

Your prescription label should clearly state boundaries of how much medicine to use and how often. USA Today reported on a Florida man who died in 2001 when the pharmacy tech mistakenly typed “as needed” instead of the “four tablets, twice daily” on the label for the narcotic pain med his doctor ordered.

No medicine – including any over-the-counter medicine – is safe in unlimited quantities.  Ask anybody who has undergone the revolting process of having their stomach pumped about the dangers of popping painkillers like Tylenol or Motrin as if they were candy.

red flag You Feel Worse, Not Better

After taking a newly refilled prescription medicine, Shirley Landis VanScoyk “woke up and actually vomited on the lawn while walking my dogs.  I was sweating, light-headed and exhausted.” Yet instead of calling her doctor, she waited to see if she would feel better. If a drug seems to be making you sick, call right away.

red flag Sound-Alike Drugs

Drugs with similar-sounding names lead to thousands medication errors each year. For example, the blood pressure medicine Clonidine has been confused with the gout drug Colchicine, as well as the antihistamine Cetirizine and the seizure drug Clonazepam, according to the U.S. Pharmacopeia Web site. Even if the name of the label is correct, if the medicine looks different than what you’re used to, ask the pharmacist why.

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 – at the one place most likely to have records of all the medicines you take from however many doctors you see, especially if you use one pharmacy consistently.

Pharmacists can be a goldmine of information, whether your question is about a prescription or over-the-counter drug.

Snead 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.”

Pharmacists can sort out problems with drug interactions: for instance, if your daily calcium supplement is making your prescription medication less effective.

Privacy concerns keep some people from taking advantage of this expertise. 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.”

Gadea says, “Most of the pharmacists I’ve come across in Connecticut will take the time to counsel patients.”  

Still, pharmacies are busy places and you have to look out for yourself.  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.

West Chester, Pa., realtor Shirley Landis VanScoyk learned that you can’t let down your guard.

Although she had been on the same trio of medicines for years, “the pharmacy assistant had given me a bag with a handwritten note saying that the insurance company had flagged the beta blocker, that they wouldn’t pay to refill it,” VanScoyk recalls.  “The assistant gave me four pills in a little bottle with no label and said, ‘This should tide you over.’”

The unlabeled vial was a red flag; another was that she didn’t recognize the pills inside. But because she was often given generic drugs from different manufacturers, this was nothing new to VanScoyk:  “My pills are always changing in shape, color and size. So I think, OK, they’ve changed the shape and size.”

VanScoyk, who became ill after taking pills in the unlabeled vial, believes it did not contain the right medicine.

Rushed communication in a busy pharmacy and a customer who just wants to get her medicine and get out: sound familiar? But you should walk away from the counter feeling clear and well-informed.

Again, 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.

In Connecticut, says Gadea, “You can’t delegate clinical-type functions to anybody but a pharmacist. Patients can talk to a tech about insurance issues or ask if a refill came in. Once you start getting into drug interactions, then you have to talk to a pharmacist.”

If you’re one of the millions of Americans who get 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.”

With mail order prescriptions, patients need to be educated as with any other drug; in addition, shipping and storage issues can arise.   For example, Snead says, drugs that require refrigeration “should be shipped with a temperature strip that will change colors if the product gets too hot.”

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.

Within the United States, most but not all mail-order drugs are dispensed through pharmacy benefit management companies (PBMs). What if you have a question about a mail-order drug?

“PBMs maintain that there are people you can call any minute of the day. They say they have phone lines. But how easy is it to reach them? How educated is that person?” says Steven Findlay, senior policy analyst at Consumers Union.

Engaged Patient: Third Chance at Safety

“Data show that accuracy is just as high if not even higher for prescriptions filled through the mail order functions of pharmacy benefit management companies,” Findlay says.

Most of the time, your prescription will be correct. Once you get home, it’s your turn to follow through by taking — and storing — your medication properly.

As a nanny, LaRowe specializes in families with “multiples” — twins or more — so it’s no wonder that she says “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.”

In Dr. Resa’s pediatric patients, the most common error he sees is “frequency. Most often it’s parents only giving one dose even if the medicine should be given twice a day. Three or four times a day, just forget it. [Fortunately] most new meds coming out are just once a day or meds that were given more frequently are being reformulated.”

On the other hand, even young children can become part of the safety solution, Resa says.

“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.”
    
 
Sources:
“Educate Before You Medicate” from the National Council on Patient Information and Education:
http://www.talkaboutrx.org/
Health Behavior News Service
 Lisa Esposito, Editor

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