Keep Track of Your Medications

Too Many Pills

Does the following situation sound familiar? You or a loved one take multiple medications for different conditions. Some pills you take once a day, some twice, some at bedtime only and so on. Some pills are taken only as needed. You have devised a system to remember to take your pills. A blue and red pill in the morning. The square yellow and red figure "8" shaped pill at dinner time. The oval white pill at bedtime. Maybe you even lay out your pills in advance, removing them from their original bottles and putting them is a paper cup or plastic box to make it easier to remember. These pills are also prescribed by different doctors. The blood pressure and cholesterol doctor, the diabetes doctor, the thyroid doctor, the arthritis or back pain doctor and the gynecology doctor (hormone pills).

What medicine are you taking? What dosages?

Then, one day, something happens, and you end up in the emergency room or in the hospital, admitted for an indeterminate stay. Invariably, you are asked, "what medications are you taking." Maybe you remember, but then comes the real hard question, "and what doses (strength) are these pills?" How many people would be able to answer these questions exactly right? Probably very few. You will likely remember what your pills look like, or what color they are.

As a doctor, I can tell you that I often do not know what color or shape a particular pill is, so this information may not be as helpful as you think. Unfortunately, not knowing the answers can lead to potentially serious consequences, and maybe even kill you.

If you can't answer these questions accurately, one of the following situations can occur. You might guess a name which sounds like another drug, and that other drug will be entered into your chart so you might receive the wrong medication. You might not remember the dosage, and end up with too weak, or even worse, too strong a dosage of the correct medication. More commonly, you will forget a drug altogether, and will not receive it at all unless someone diligent reviews your records. Since you get prescriptions from multiple doctors, it is possible (in fact it is typical) that any one of your regular doctors will not know all of the medications you are supposed to be taking.

What if you are hospitalized?

Once you are in the hospital, new decisions about your health will be made usually leading to changes in your medications. When you go home, you will hopefully receive some prescriptions for your new medicines. Here is the amazing part, however. The new prescriptions probably do not take into account the medicines you were already taking before coming to the hospital, leaving you extremely confused what to do next. Do you take the new pills and the old pills? Do you stop all the old pills and just take the new pills? Without expert advice, you are left to guess, leaving you open to potential danger if the wrong drugs, doses, or combinations are taken or if a vital drug is suddenly discontinued.

Do I take the old pills and the new pills, or just the new pills?

Solving this medication merry-go-round is possible, but only with tremendous effort and cooperation from many different participants in the healthcare system. Pharmacies could help by printing summary sheets for patients listing all of the medication a patient is taking, but if the patient uses multiple pharmacies, these lists will be incomplete. Doctors' office could help by documenting carefully exactly what medications a patient is on and then giving him or her a copy of this list. Hopefully you would be able to read their writing! In actuality, this is too time-consuming.

Computerization could help if some huge master computer kept track of all medications a patient is taking. Unfortunately, for many reasons, the medical profession's use of information technology today is about 20 years behind every other information-based industry such as the financial services industry, so this solution is a long way away.

Fortunately, the medical profession is fully aware of this problem and some steps are being taken to help close the (huge) gaps. The Joint Commission (JCAHO, the nation's hospital accreditation organization) has issued a new patient safety goal titled the "reconciliation of medications across the continuum of care."

Goal: Accurately and completely reconcile medications across the continuum of care.

"...develop a process for obtaining and documenting a complete list of the patient's current medications
upon the patient's admission to the organization and with the involvement of the patient. This process
includes a comparison of the medications the organization provides to those on the list.  A complete list
of the patient's medications is communicated to the next provider of service when it refers or transfers a
patient to another setting, service, practitioner or level of care within or outside the organization. "

This is a new goal that all hospitals are mandated to achieve by 2006. This may not be possible, given the woeful state of medical information technology. However, the Joint Commission wields a lot of power over hospitals, so having this goal is going to eventually make a huge impact on this incredibly common and frustrating problem in our healthcare system.

A Simple Solution

You, the patient, need to be in charge of your own medications.

  • Create a legible, up-to-date list of every medication you are taking
  • The list includes the reason, the dose, and the name of the prescribing doctor
  • You must keep this list with you at all times, and you must keep this list current
  • Furthermore, it is not a good idea to take pills out of their original bottles. It is too easy to forget which pill is which
  • If a doctor tells you to change your medications, you might not be able to do this correctly if all of your pills are in a plastic tool box (small boxes designed for storing nails and screws are often used for pills).
  • If you travel, you must take your pills in the original bottles.
  • If you know you are coming to the hospital, take all of your bottles of pills with you and show them to the doctor.
  • Periodically, take all of the pills in your medicine cabinet - many of which could be expired or no longer needed - to your doctor to get his or her advice on what to do with them.

Conclusion

Medications are being taken more often and by more people than ever and they are more potent as well. This leads to great benefits for us as people, but the price we pay is the need for vigilance. Taking the wrong drug, taking too much or too little of the right drug, suddenly stopping a needed medication, all can be potentially dangerous, and everyone, including the patient as well as the profession, needs to do their part to help keep us safe.

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