How you can avoid unintentional overdoses
Patients takes multi doses of same meds
Elaine Marshall, RN, BSN, MHA, an ED nurse at Rex Hospital, Raleigh, NC, says that at one time, she was "as reluctant to have to complete medication reconciliation as the next ED nurse. I was content with just obtaining names of medications."
Then, a 42-year-old woman presented in severe refractory bradycardia. She was a renal patient on dialysis, being managed by multiple physicians.
"It was the nursing staff that was able to diagnose her, through clarifying her medication history," says Marshall.
The woman was taking three prescriptions for calcium channel blockers prescribed by three physicians. None of the physicians realized that the others were writing the same prescription. "She did not know that they were all the same. One physician had given her samples, another had written a prescription for the generic, and yet another had written for a long-acting version of the medication," says Marshall. "Fortunately, the patient did well after the cause of her bradycardia was determined."
Obtaining a complete list of medications from your patient sounds simple, but it can become complicated. However, Donna Bowker, RN, BSN, former director of the ED at Methodist Richardson (TX) Medical Center, says that obtaining a complete list is the single most important thing you can do to avoid unintentional overdoses. Use these practices:
Don't overlook any current medications.
Additional medications given in the ED could cause a bad outcome in your patient, warns Kathie Pulchinski, RN, an ED nurse at Ridgeview Medical Center, Waconia, MN. "They could double up on a medication that they should be decreasing, like warfarin. This could cause dangerous bleeding," Pulchinski says.
Check more than one pharmacy, if necessary.
Bowker says, "Patients who have multiple prescribing physicians will have an increased likelihood of duplicate prescriptions being taken."
Marshall says to look for pill bottles filled at more than one pharmacy. "Filling prescriptions has become a high-profit industry, with enticements for patients to change pharmacies," she says. "This means it can take multiple phone calls to get an accurate medication history. Nurses are becoming Sherlock Holmes on behalf of their patients."
Find out if medications are being reviewed by anyone.
"Any patient who sees multiple physicians should be questioned to determine if any one physician reviews all of their medications or only the ones that they have prescribed," says Marshall.
Keep an eye out for brand and generic names being taken together.
Bowker says, "I once had a patient taking furosemide from one bottle and Lasix from another, not realizing it was the same medicine."
Ask the patient a question multiple times, or in different ways, to obtain complete information.
Simply asking, "What medications are you taking?" is not sufficient, says Bowker. "Specific and direct questioning should be sought during the interview regarding non-prescription medications, supplements, or treatments," she explains.
Be especially diligent in listing all current medications for admitted patients.
Marion Schneider, RN, MBA, director of emergency services at Adventist GlenOaks Hospital in Glendale Heights, IL, says, "Unintentional inconsistencies are most likely to occur when there is transition in care. Medication reconciliation helps avoid these inadvertent occurrences." (See story with important question to ask your patient, below.)
Ask this question about patient's meds When doing a medication reconciliation, don't stop at asking your patient the name and dosage of a drug. "Patients often get names confused, especially since they hear and see medication names in commercials and print," says Elaine Marshall, RN, BSN, MHA, an ED nurse at Rex Hospital in Raleigh, NC. Instead, ask your patient why they take the medication, using body areas to jog the patient's memory. "For example, point to their eyes or nose when discussing eye drops or nasal sprays," says Marshall. |
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