One Simple Solution for Medication Safety

Hi I am Dr. Mike Evans and today we are talking
about medication safety. This may sound intimidating or scary or something that should only be
the concern of your doctor or pharmacist…but the reality is that you are the one who knows
best what you are taking and how your meds are affecting you. As we shall see as I run
through some of the complexities of taking medications, there is one simple solution
that provides significant clarity, reduced harm, and increased effectiveness…and that, my friend
is an up to date medication list that outlines what, and how, you are taking your meds…
that you share with your healthcare team – your doctor, pharmacist, dentist, nurse, specialist
and maybe even caregivers like family and friends who help out. I love it when a patient says to me… ”not
sure if its perfect.. but just so we are on the same page, this is exactly what I am
taking now” This will take some effort on your part but making a list of all your
prescription and non-prescription medications- is a simple and often overlooked pathway to
better health and less harm for you or your loved one. SO why is having an accurate and shared medication
list so important? Well, lets start with a reality check. Only about 25% of physicians
surveyed could easily generate a list of an individual patient’s medications. If we look at transitions to the hospital
… A systematic review by Dr. Ed Etchells and his colleagues, published in the Canadian
Medical Association Journal, found up to 2/3 of the time there was an error in medications
at the time of admission. They deemed that 41% of these errors were clinically important
and 22% had the potential to cause harm during the patient’s admission. Combine this with
the fact that 2/3 of seniors are on 5 or more prescription drugs, often prescribed by different
providers, and you can see both the opportunity for error- …but also the tremendous opportunity
to prevent errors like this with an accurate, up-to-date list that moves with the patient
across the entire continuum of care. If we look at patient end of things, there
are issues even before people start taking medications. A 2014 study published in the
Annals of Internal Medicine led by Dr. Robyn Tamblyn found that 31% of the patients didn’t
even fill their prescription in the first place. This is in Quebec where they have
a generous program of government coverage for medications, especially for lower income
people. You would think that people with more severe illnesses, recent hospitalizations,
or emergency visits would be more likely to take their medications to prevent this
from happening in the first place, but this study found the reverse to be true. When we follow people with chronic diseases,
especially “silent’ ones where we don’t see many symptoms such as high blood pressure
or high cholesterol, about 1 out every two people stop taking their medications after
a year. I have a bit of a Whaaaaat? reaction… I mean..I get that we won’t reach 100% …but
I feel a bit sad that 50% of people could be missing the opportunity to drop their chances
of having a heart attack or stroke by maybe 25% Also it’s important to know that
there are some medications, like antidepressants, where stopping them suddenly is definitely
not a good idea…how you’re taking medications can be as important as what you’re taking. We know that for a bunch of different reasons
you may not be taking medications exactly as instructed by your healthcare team. We
used to call this field medication compliance—but the word compliance seems paternalistic …..A
kind of one-way street where the doctor tells you what to do, and if you don’t comply- you
have failed.But this doesn’t get at partnership or the why we do or don’t
do things. So, for example, maybe you aren’t filling the prescription for perfectly good
reasons, maybe it’s too expensive, or you’ve thought about it and decided that
the downsides of the medicine outweigh the upsides, or you want more information before
you take it. Or perhaps you started the drug but stopped because you got better, or you
developed a side effect and you are not sure how to bring it to my attention, or are
just unsure how to take the medicine in the first place. Maybe you read or heard about
a side-effect from a friend or the internet or had a hard time putting the lengthy print
out from the drug store into perspective. Sometimes, people just stop taking their meds
and they feel embarrassed about it and don’t want to say anything. Instead of compliance, we now use the word
“adherence”. Adherence means “sticking to” a treatment, and, I think, the term
acknowledges that taking medications in the way they’re prescribed is critical, but
also acknowledges the complexities of taking medication. We do need your honesty, better systems for
monitoring and sharing information, and so on, but we also need to continue to improve
the way we talk to one another. I know its old school, but on my end if I just
tell you – “this medication lowers your blood pressure” .. well, that may not be
enough… Taking a few more seconds to tell you that I am prescribing it because “I
want to decrease your chances of having a stroke or a heart attack…” and explaining
that “when your blood pressure is high, your heart has to work harder and it becomes
more bulky and stiff- and we don’t want a muscleman for a heart – we want a long distance
runner. So by lowering your blood pressure, we make things easier for your heart… and
your brain and kidneys too… “ There are so many scenarios where poor communication
leads to serious problems. A patient is embarrassed to tell us about their meds for erectile dysfunction
and without knowing that we prescribe another medication that dilates blood vessels, and
the patients blood pressure drops drastically Or a patient gets a prescription for an antidepressant
but hasn’t told the prescriber they’re already taking st johns wort – this can
lead to a very dangerous interaction. Or maybe the dose of a diabetes medication is increased
by one doctor who doesn’t know that another doctor added a new diabetes pill last week
and the patient’s blood sugar drops. Your medication list also needs to include
the stuff we don’t prescribe: your allergy meds, cough meds, vitamins, pain pills, herbals,
Chinese medicine, and so on…2/3 of Canadians took an over the counter medication in the
last 6 months… … all of these act like medicines in your body and can cause side
effects or interact with your other medicines. And remember, medicines aren’t just pills…they
can be sprays, puffers, patches, suppositories, medicated creams, ointments,… and so on. Your healthcare provider may already have
something, but to help you keep a list, I’ll direct you to some easy to use templates and
apps at the end of this talk. These are for you to fill in and keep with you… and
will include the name of the medicine, the strength, how, when and why you are taking
it, and who prescribed it. To help complete the list, you may be asked some obvious questions
so for example if you’ve had a bad reaction or allergy to a medication in the past and
it’s especially helpful if you describe the kind of reaction you had. I also think the timing is important to keep
in mind.. medication changes tend to happen when you see different specialists, when you
come into or out of a hospital or other care facility, when you develop a new condition,
and so on. It’s at these transition points that you need to refresh your list and help
keep your team up to date. As I said before, the one constant as you
move through the healthcare system is you, and that’s also true when things go wrong.
Our system isn’t perfect and a key way we can improve is to acknowledge our mistakes.
I will give you a link at the end where you can anonymously report any concerning medication
incidents and receive more information about safe medication practices. A medication incident
is a mistake with medication, or a problem that could cause a mistake with medication,
like receiving the wrong medicine, or the wrong dose from a pharmacy or hospital. The
majority of medication incidents do not cause harm, but unfortunately sometimes they do.
We call these “adverse events” and they are often preventable. You can report any
medication incident involving the use of prescription or non-prescription medications, a device,
or a natural health product. While we are on subject of good practice I
do think its so important you ask your local pharmacist for advice. They can be incredibly
helpful. For instance, if you ask a pharmacist can often perform what’s called a “comprehensive
medication review” which can really improve your medication use and can be especially
effective when you are taking multiple medications. Finally, it’s really helpful to get all
your medications from the same pharmacy. This helps minimize the potential for overprescribing,
drug interactions and so on. SO let me just summarize by saying that we
invest heavily in finding new treatments—yet 30-50% of the time we aren’t doing a good
job in taking the treatments that have already been proven to work. As we transition through
the health care system there are many opportunities for error… so I think its time to start
owning that and realizing the importance of your own role, committing to one simple first
step of just being on the same page with an accurate and updated medication list, reviewing
the list and partnering with your healthcare team, and letting us know when there are
problems. I really hope this helps and take care.