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Massachusetts Medical Society's
Physician Focus

July 2011

All Those Medicines

PROGRAM HIGHLIGHTS:

  • Adverse drug events cause over 700,000 emergency department visits and 120,000 hospitalizations each year, according to the Centers for Disease Control.

  • An estimated 53,000 children less than 5 years old are brought to emergency departments each year because of unsupervised ingestions of medicines.

  • Adults 65 and older are twice as likely as others to go to the emergency department for an adverse drug event.

  • 82 percent of Americans take a least one prescription medication; 29 percent take five or more medicines.

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 ADDITIONAL RESOURCES

ConsumerMedSafety.Org

Institute for Safe Medication Practices

Mass. Coalition for the Prevention of Medical Errors

U.S. National Library of Medicine: National Institute of Health

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All Those Medicines PSA

Standing, Bruce Karlin, M.D., Seated, Mary Anna Sullivan, M.D.
hi-res photo
promo slide

Walk into any pharmacy, looking for relief from a headache, pain, or the common cold, and you may become overwhelmed with the choices. Aisles are lined with shelves containing scores of over-the-counter medicines, in different dosages and different formulations, made by different manufacturers.

The number of commonly-prescribed prescription medications is vast - more than 1,100 according to the latest version of the Physicians’ Desk Reference, a commercially published volume of information on drugs. The list of herbal medications is lengthy, and vitamins of all kinds are available for the asking.

American medicine seems blessed with a plethora of antidotes for a multitude of ills. But there’s a downside as well, and there lies the challenge.

“Medication errors are among the highest number of errors we encounter in medicine, in the hospital and in the home,” says Mary Anna Sullivan, M.D., President of the Massachusetts Coalition for the Prevention of Medical Errors.

Dr. Sullivan, who is also Chair of the Department of Psychiatry and Chief Quality and Safety Officer at Lahey Clinic in Burlington, Mass., discussed the critical issue of medication safety in the July edition of Physician Focus, the Massachusetts Medical Society’s monthly patient education television program, with program host Bruce Karlin, M.D., a primary care physician in Worcester, Mass.

The challenge of medication safety, however, doesn’t just lie in the numbers of bottles, pills and capsules available to patients. Dr. Sullivan cites many other factors that come into play: drug interactions with other medicines, alcohol or certain foods; patient compliance (or noncompliance) – and confusion – in taking the medicines; medications with similar sounding names; and huge amounts of advertising – for both prescription and over-the-counter drugs – reaching directly to consumers, sometimes convincing them that they need the purple or blue or red pill.

But there’s more. The nation’s population is aging, the rates of chronic diseases such as diabetes and arthritis are rising, and new medicines are constantly being developed.

The result of all these conditions: many more people are taking a lot more medicine.

“Patients are on so many more medications than they use to be,” says Dr. Sullivan, “and with the burgeoning knowledge in medicine, along with the boom in medications, come the possibilities of making mistakes when taking these complicated medicines.”

Patient understanding is also important. “Patients have the erroneous conception that over-the-counter drugs are somehow safer or not as potent as what doctors prescribe,” Dr. Sullivan says, “but some of these are quite potent. Any of the over-the-counter medicines can be good in small amounts, and bad in large amounts.” As an example, she cites the common pain reliever acetaminophen, which in large doses can be toxic to the liver.

Dr. Sullivan says critical factors in medication safety are communicating and sharing information. “It is essential,” she says, “that your doctor and pharmacist know any medication you’re taking and that includes things you buy over the counter.”

Dr. Sullivan advises patients to maintain an updated medication list, describing the medicine, the dosage and frequency, and the reason for taking the medication. (A pocket-size pamphlet to do this is available free from the Massachusetts Coalition for the Prevention of Medical Errors.) The list should be reviewed at every visit with every physician. It’s a tool that could prevent harm and even save lives, she says. Patients should also develop good relationships with their pharmacists, who are “absolutely invested in medication safety.”

“Medication safety is really a team sport,” says Dr. Sullivan, “with the physician, patient, and pharmacist all playing key roles.”

Watch the accompanying video for more information, including conversation about what physicians take into account when prescribing medications for patients, considerations for giving medicines to children, how electronic prescribing can help to reduce medication errors, and how to obtain free materials on medication safety from the Massachusetts Coalition for the Prevention of Medical Errors. 

Text:
MMS/Richard Gulla