Wednesday, August 15, 2007

Medication errors

I was reading an article on errors in hospitals and it reminded me of how easy it is to make mistakes. It is very easy.

Doctors and nurses are quite overwhelmed a lot of the time. The patients in the hospital now are sicker than patients 20 years ago; I know that sounds odd, but it’s true. Many of the patients we had 20 years ago are now being treated on an out-patient basis or their stays in hospital are much shorter than they might have been back then. Patients are living longer with more serious illnesses and treatments and therapies are getting more complicated.

Of course, a mistake can never be excused – mistakes shouldn’t happen. The problem is, when you’re dealing with humans, they are going to happen. In most professions, an error is found and corrected, most people are none the wiser. But if a healthcare professional errs, it’s a life we’re talking about.

The general public can help protect themselves in some ways too. When I was working in the hospital, it always amazed me how people would trustingly take a cup full of pills and just pop them down without any comment. I wanted them to look at their pills, to learn what they were taking, what the pills looked like, what their names were, and what they did. When a patient questioned why they were getting a blue pill instead of the usual orange one, I didn’t just tell them to take it, I’d either answer the question (dosage change, drug company change, etc), or I’d take the pill and say, “hold on, I’ll double check for you.” I wanted the patients to know what they were taking. I know that not all nurses do that; I know of some nurses who would just brush it off, but I like to hope that they’re in the very small minority.

Pharmacists can make errors too. We had that happen when my oldest son was a baby. He was given 10 times the dose of antibiotics he should have received. It’s only because of my nursing training and the knowledge that I knew it was wrong, so we went back to the pharmacy and had it corrected. But, considering the dose he was given, he could have been killed. Thank God I was able to pick up on it.

The worst part of that situation was that the pharmacist never acknowledged or apologized for the error. Another pharmacist on duty gave us the right dosage, but despite going up the chain, to the very top, I never got an apology. That’s all I wanted.

So, you as the general public, what can you do? When your doctor gives you a prescription, ask what the paper says, have the medical-ese translated for you. Clarify with the doctor how many times a day, what dosage, what medication, and for how long. That way, if there is a problem with the prescription at the pharmacy level, you know what you were told. When you pick up your prescription, check the label to make sure it matches what you were told at the doctor’s. If it doesn’t, ask for an explanation. It could be a perfectly reasonable explanation or it could be an error. And then it’s your turn. Make sure you take the medication as directed and only as directed. And, *finish* the prescription, even if you feel absolutely wonderful after only a few days.

Here are some tips for reading prescriptions:

QD means every day.
BID means twice a day.
TID means three times a day.
QID means four times a day.

Now, QID does not mean, normally, that it has to be every six hours, just four fairly evenly spread out times in the day. In the hospital, would often be 6 a.m., noon, 6 pm and bed time. But, double check with the pharmacist to be sure.

Q1H means every hour
Q2H means every 2 hours
Q3H means every 3 hours, and so on.
QHS means at bed time

Mistakes shouldn’t happen, but we know that they do. So, we all need to do our part to prevent them or catch them when they do happen.


Crabby McSlacker said...

Really good reminder!

I also think it would be helpful if the medical profession would break with tradition and start make the dosing instructions more comprehensible to lay people. Why use latin (or whatever) when 1/day might lead to less confusion?

Val said...

The nursing shortage isn't helping matters any either. I work in staffing (yes, I'm the one who phones you at 6am to come to work), and it is so difficult to find replacements now. We regularly replace RNs with care aides. And the RNs who are there are often overworked and exhausted.

Dawn said...

I can understand why scripts were originally written in Latin but it does seem an outdated idea nowadays, particularly when you hear about some of these mistakes.

Connie said...

Thanks for the info. We're all intelligent people, but when it comes to medications, we seem to lose our faculties and rely totally on those with the DPh. I am going to print this out for myself and have passed it on to most the people I know.

colobeth said...

Great article! I've been a nurse for 30 years, and the work has tripled! Longer shifts, more patients, less help, and we are expected to really be up with the latest technology, which is great, but please find us some help!!

Honestly-agency nurses aren't the answer. They try, but that job is just waiting for a mistake to happen. Just too much for one person. I'm retiring in 1 year, I will say a little prayer for you youngins!!
It has been a journey. kathy