Be sure those pills you're given are the right ones
Every year, more than 1.5 million Americans are harmed by medication errors -- preventable mistakes that cost the country well in excess of $3.5 billion to treat, according to a sobering report put out this summer by the Institute of Medicine, a prestigious group of scientists who advise the government.
And that's just the people believed to be injured by drug errors. Nobody knows how many deaths are caused by medication errors. And countless other people are not harmed but could have been because they took, or were given, the wrong drug, the wrong dose of the right drug, or a drug that was appropriate but not as safe as alternatives. The report also estimated that the average hospitalized patient experiences one medication error every day.
Many of the group's recommendations to reduce errors are things that individual consumers can't do much about, such as processing all prescriptions electronically by 2010, making drug labels and inserts more intelligible, standardizing drug information, and improving access to it through the Internet and a 24-hour national telephone hot line.
``Nothing that patients can do by themselves will make them truly safe," said Dr. Albert Wu , a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore and a co-author of the report, ``but they can start doing things that can make them safer."
The most important -- to keep doctors from prescribing inappropriate drugs -- is to make a list of all your medications, including vitamins, herbal remedies, and dietary supplements, keep it up-to-date, and take it with you every time you go to the doctor's office or the hospital. Many people see multiple doctors, and it's often only the patient or a family member who knows about all the drugs.
Keeping on top of medications is especially important in the hospital. This means paying attention every time a nurse gives a medication, said Dr. Tom Rosenthal , chief medical officer for UCLA Health Care, which runs three hospitals. Nurses should match not just your name but your birth date and patient ID number with the information on the medication order. And family members should ask which medication is being given.
Just as important for family members and doctors is keeping track of hospitalized patients' kidney and liver function. Simply lying in bed for several days reduces blood flow to the kidneys and, therefore, kidney function. If the kidneys aren't processing a drug normally, a dose that is safe in someone with good kidney function may be too high in someone with poor kidney function. The same goes for liver function.
At the time of discharge, get a written list of your drugs and go over it with a nurse or doctor to make sure newly prescribed drugs won't interact adversely with drugs you are already taking. Take notes!
Similarly, when you pick up drugs at the pharmacy or open a package of mail-order medications, check right away that these are the correct medications and doses. If you are unsure, ask the pharmacist. Sometimes druggists substitute one drug for another, which may be fine, but you should notice -- and ask -- if you're suddenly getting a green triangular pill instead of the little white one you're used to.
At the doctor's office, ask the nurse or doctor to write down the name of any newly prescribed medication, what you are taking it for, and how often to take it.
In a larger, political sense, too, there's more that all of us can do, including lobbying for the systemic changes that could do the most to reduce medication errors.
Obviously, said Dr. Brent James, vice president for medical research at Intermountain Healthcare in Salt Lake City, we can't all go to the three hospitals worldwide that he deems best at reducing medication errors -- Brigham and Women's Hospital, the LDS Hospital in Salt Lake City (which is in his hospital network), and the Royal North Shore Hospital in Sydney.
But we can push our own hospitals to implement the most promising changes. For one thing, he said, we can ask hospital personnel how they're doing on medication errors. The good hospitals, he said, often report the highest error rates simply because they are keeping diligent track of such things. Over time, James said, these rates typically go down if the hospital works to correct errors.
Another change worth advocating is making sure that every dose of every drug prescribed is ordered by a doctor on a computer. Only about 15 percent of hospitals do this now, said Dr. David Bates , chief of the division of general internal medicine at Brigham and Women's and a co-author of the IOM report.
The potential advantages of this are huge, and not just for picking up potential drug interactions. Allergic reactions account for 28 percent of adverse drug events, said James, but some drugs are much more likely to cause these than others, which means that checking a computerized list of alternative drugs can be helpful.
Electronic prescribing can also reduce drug interactions outside the hospital as well as errors caused by doctors' illegible handwriting. In one large Michigan medical practice, physicians have caught 98,000 potentially harmful drug errors before they happened in the year and a half since switching to e-prescribing, said Matthew Walsh of the Health Alliance Plan, part of the Henry Ford Health System.
Gail A. Fournier , a partner at
Bottom line? Medications can heal, but they can also harm. To increase chances of the former and reduce chances of the latter, know what you're taking -- and let your healthcare providers know, too.
Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com. 
