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Medication Safety at Home: Practice the Five Rights

Common-sense steps can help you and your family avoid medication errors


When Dad was living with us due to advanced dementia, I gave him all his medications. But one day he woke up earlier than I, decided to dose himself, and took his night-time meds instead of his morning pills. In another incident, I sprang from the bed one morning, chugged down my thyroid pill while still half-asleep, and then realized: “Wait a minute. I don't take my thyroid pill directly from the bottle.” As it turned out, I'd taken my sleeping pill instead.
 
I share these two “oops!” moments to emphasize that there are different kinds of medication mistakes, and they can happen to anyone — even a nurse. And while neither Dad nor I were harmed in these two events, that's not always the case with others.
 
A 2008 study reveals a sharp increase in fatal medication errors in the home over the past 20 years, especially when patients combined medications with alcohol or street-drug use. Easy accessibility to over-the-counter medications, mixing up family member prescriptions, and pharmacy errors also can contribute to medication mistakes. 
 
Keeping medications — be they prescription and/or over the counter — in an open location or together in the medicine cabinet can be problematic, especially if you live with a loved one with Alzheimer’s disease or dementia. When Dad lived with me, I often found him poking around in the cupboard looking for an aspirin, despite the fact he took a prescription NSAID (non-steroidal anti-inflammatory drug) for arthritis pain. Taking aspirin (also an NSAID) on top of the prescription drug could have caused him to experience serious side effects, like a brain hemorrhage or bleeding in his stomach. Because these drugs act like blood thinners, taking too many can cause bleeding. A couple of times, Dad found my thyroid pills and wondered if they were something I should be giving him.
 

Steps you can take to prevent mistakes

  • Keep your over-the-counter drugs under lock and key in an a closet or drawer that is difficult to access.
  • Keep each family member’s prescription medications in a separate container, preferably in a separate location in your home, and also under lock and key. We ultimately decided to keep Dad's medications in a locked wooden box in the kitchen. I moved my thyroid pills to a closet in the master bathroom. My husband kept his medication in his nightstand. Physically separating our medicines made it difficult for any of us to take someone else's pills by mistake.
If it’s your job to give prescription medication to a family member, use the same rules nurses employ in the clinical setting: The Five Rights.  
  1. The Right Patient. Double-check the label on the pill bottle to make sure it has your loved one's name on it before you give medication to him or her. Be aware, too, that pharmacies occasionally make mistakes; once I came home with what I thought were Dad's pain pills only to discover I had someone else's blood pressure medication.
  2. The Right Drug. Again, double-check the label to make sure you have the correct medication in hand. Given that many pill bottles look alike, don't rely on visual cues, like the size of the container. Make sure the labeling matches the drug you are supposed to be giving. Also don't rely on visual cues — size, color — to identify pills. If you use a weekly pillbox, make sure you know which pills to give, when. It's easy to become confused when a bunch of pills from different containers are sitting in the pillbox. You may be better off using a different system (for example, a daily checklist) that doesn't involve taking pills out of their original containers.
  3. The Right Dose. My dad took hydromorphone (an opioid) for pain. The doctor prescribed 8 milligrams every four hours, and the pharmacy normally dispensed 8-milligram pills. Sometimes, though, the pharmacy only had 4-milligram tablets in stock, so I had to give two at a time. Before you give someone a pill, verify its strength and compare that with the prescribed dosage to be taken. Read the prescription label carefully. Does it say take one pill? Two pills? Half a pill? If you're in doubt, call your pharmacist.
  4. The Right Route. “Route” describes the way a medication is taken. Is it taken by mouth? By injection? By patch? Most home medications consist of pills or capsules, but people with diabetes or those on blood thinners may take prescriptions by injection (for example, insulin or lovenox, an anticoagulant given by injection). Cancer patients may use narcotic patches, like fentanyl for pain relief. Talk with your doctor or pharmacist to make sure you understand how to administer a particular medication before you give it, and write the information down so you don't forget. For example, you must remove one fentanyl patch before applying another one or the person may overdose on the medication.
  5. The Right Time. Unless a prescription label says to take “as needed,” be sure to heed the timing instructions. Giving medications — especially antibiotics — on a haphazard schedule can vastly reduce their effectiveness. The same is true for pain relievers and certain blood pressure medications, such as ACE inhibitors.
By storing medicines wisely and taking a professional approach to my Dad’s medication administration, we protected our whole family from any additional medication errors at home.

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