I told her, at that point, you would have lost all confidence in that doctor, and I would not have blamed you if you did just as your inclination suggested, thank him, left, and found another doctor.
Patients must be certain that every physician they see in consultation is aware of any medication allergies. This is the only way to avoid receiving a medication that may cause harm. No physician can know what any patient may or may not be allergic to. Prescribing medication is a gamble, and will remain so until the era of personalized medicine: medication prescribing based upon genetic profile. At this time, a doctor does not know what any medication’s effects will be on any individual patient.
Case in point:
A patient had open-heart surgery. His doctors prescribed numerous medications. Prior to surgery, his blood count was normal, and after surgery his blood count decreased. The blood loss during surgery should have resolved and gone back to normal within weeks of the surgery, but it did not; in fact, it continued dropping to lower levels. His doctor sent him to a hematologist who, thinking of all kinds of rare diseases, recommended that he have a bone marrow biopsy. The patient decided to hold off on this procedure while he did his own personal research. He went on the internet and studied his medications, all of whom had the rare potential of causing anemia. Could this be it, he thought? Is one of the medications causing this? After understanding the possible risks of delay and getting approval from his doctor, he stopped the last one prescribed that was for prostate symptoms and repeated his blood count after about a month. Lo and behold, it was back to the pre-surgical and normal fifteen grams. He had had a rare side effect of a medication prescribed for his enlarged prostate. This information now occupies a prominent place on his medical chart. He saved himself a bone marrow biopsy, and his hematologist learned something too.
If patients are allergic to any medication, it is wise to wear a wristband identifying the offending agent.
Patients must know the following when given a prescription:
•What is the medicine and what does it do?
•How long must it be taken and at what intervals?
•What are the side effects to watch out for? If they occur what must be done?
•Are there any potential drug-food interactions that may cause a problem by enhancing or hindering the action of the medicine?
•Are there any activities to avoid while on the medication?
Pharmacists must provide information about each medicine they dispense. The patient must read this information and have questions answered before the medication is taken.
With liquid medication, a marked syringe is more accurate than a kitchen teaspoon or tablespoon.
A hospitalized patient who receives an unfamiliar appearing medication must not take it without clarifying the issue first. This is critical in the era of generics when the same generic made by different pharmaceutical companies have a dissimilar appearance.
When hospitalized and receiving intravenous medication, the nurse knows how long the intravenous is supposed to drip before it runs out. Patients should be told as well and if not they should ask and inform the nurse if the run-out timetable is behind schedule.
If hospitalized, a nurse must check the patient’s identification wristband before dispensing medication. The failure to do this can not only lead to medication errors, but also testing errors, transfusion errors, and the discharge of infants to the wrong family.
Medication use during care transitions
Patients are often transferred from unit to unit within the hospital: regular room to intensive care; intensive care to regular room; acute care hospital to the rehabilitation unit; emergency department to intensive care or regular room; and so on. Medication errors occur during these transition points. This is a common occurrence and the cause of many medical errors.
Case in point:
A woman was walking her dog down a residential side street and noticed a neighbor lying unconscious on her garage floor. She rushed in, was unable to revive her, and called the paramedics who transported her to the closest hospital emergency department. Examination revealed a seventy-five year old unconscious woman with a bruised head. An emergency CT scan of the brain revealed a collection of blood under the lining of the brain known as a subdural hematoma. This hematoma was very small, so her physicians elected watchful waiting rather than surgery. The patient regained consciousness, but was very restless and agitated, a state that persisted over the next few days. She also had some difficulty in walking, lost strength in one of her extremities and required the use of a walker. She was rational, but stated she “Was jumping out of my skin.” This persisted until her physician prescribed a tranquilizer in an attempt to calm her. The anxiety improved, but the patient then became confused and disoriented. This worried her physicians who ordered further tests thinking that perhaps the hematoma had enlarged or other cerebral pathology had developed, or there were undiagnosed medical problems. There were no new findings identified. Thinking that perhaps the confusion and disorientation was due to the tranquilizer prescribed to calm his patient, the physician discontinued it. Indeed, within two days the patient’s problem had resolved. All this time the rehabilitation transfer was not possible because this requires a clear mind and a cooperative patient, neither of which was possible while she was having her symptoms. Different physicians and a new healthcare team attended to her in the rehabilitation unit. They started her on rehabilitation, but after a day or two they found her to be confused and disoriented making progress impossible. They called her hospital physician to tell him what had happened. In the meantime, she was in the rehab unit for a full week and could not make any progress due to her altered mental state. When her physician arrived, he discovered why the patient had relapsed. Somehow—and no one could tell him how—the medication that he had discontinued because it caused her confusion and disorientation had been restarted. He never found out why. This medical error caused considerable delay, set back the patient’s progress and could have resulted in serious consequences.
Patient identification
Misidentification in a hospital can cause the following:
•Wrong blood could be administered that could harm or kill
•A wrong test could be performed
•A wrong procedure could be performed
•A test could be performed that was meant for another patient
•Wrong treatment or intravenous fluids or medication meant for another patient may be dispensed
Therefore, patients must never object to wearing a wrist identification bracelet. There have been considerable identification errors, so safety measures are now in place. First, it has been determined that using two identifiers improves reliability. The possibility that there can be more than one patient in the hospital with the same name is the reason for the double identification process. The two identifiers come from the following list:
•Name
•An identification number
•Telephone number
•Address
•Photograph
•Social security number
•Other patient-specific identifiers
An example: in a surgical suite, the operating room staff should
