How nurses can help prevent at-home med errors

Jeff Richardson

Medication errors…those two words can invoke feelings of dread among nurses. We’ve all heard horror stories of colleagues who’ve made serious drug errors. Some of us have even made them ourselves. Safeguards reduce the risk as much as possible, but we still have to be cautious because it doesn’t take much to make an error.

What about the drug errors that happen at home, away from the hospital setting? Parents who give a wrong dose to their children, adults who take their prednisone on an empty stomach or the caregivers who crush a pill for their loved ones to make it easier to swallow, even though the label says “Do not crush or chew”?

Medication errors happen at home more often than most people realize. According to a 2009 study published in the Journal of General Internal Medicine, four out of five adults (average age of 49 years old) misunderstood or misinterpreted one or more of the 10 most common prescription label instructions.

This isn’t surprising. Taking a look at nursing history will give you a good idea of why mistakes at home happen.

Picture this scene: a nurse admitting a patient to the unit. The patient is pleasant and lucid, answering the nursing history questions appropriately. All’s going well until the nurse gets to the question about medications:

Nurse: Do you take any prescription medicines at home?
Patient: Yes.
Nurse: Can you tell me what you take?
Patient: Certainly. I take a little white pill every morning for my diabetes and a half a green pill twice a day for my high blood pressure.
Nurse: Do you know what the names of those pills are?
Patient: I think the diabetes pill starts with a D. Or maybe B. The blood pressure pills, I don’t know. Sorry. But it’s the green one. You know, the little one.
Nurse: Did you bring the pills with you? May I see the bottle?
The patient reaches into her bag and pulls out a pill bottle. The nurse looks at the bottle, which has an old, expired label on it and four different types of tablets and capsules inside.
Nurse: There are four types of pills in here.
Patient: Yes, there’s also one for my arthritis, and one I don’t take anymore. It was for my diabetes, but the doctor told me to stop taking it.

Sound familiar?

Prescription drug use is growing. People are taking medications now more than ever. With each prescription medication, there’s a risk of error, either intentionally or accidentally. Some people can’t afford their medicines, so they stretch them out longer than they should, making the drug ineffective.

But there are also the many accidental errors that can be life-threatening:

• Double dosing, forgetting that they already took a dose or a second caregiver gives it, not realizing a dose was already given
• Breaking or crushing pills, opening capsules that should not be broken, chewed or opened
• Taking pills on an empty stomach when they should be taken with food
• Taking pills with food when they should be taken on an empty stomach
• Taking pills together that shouldn’t be combined
• Putting eye drops in the ear or ear drops in the eye
• Cutting patches, forgetting to take off old patches
• Taking sublingual medicines incorrectly
• And so much more

Teaching our patients about their meds is a vital part of their discharge planning that should start before patients are given their prescriptions. We may take it for granted that they understand their meds, particularly if they’ve been taking them for a while, but some questioning could reveal that they aren’t quite as knowledgeable as they should be.

They also need to understand that there are reasons for the instructions. Why is it important not to eat grapefruit while taking simvastatin? Why should the long-acting diltiazem not be crushed? Why should they not drink alcohol while taking ketoconazole?

By adding this information while we dispense or administer medications throughout the patient’s hospital stay, the message will be consistent and allow the patient or their caregiver to hear the medicine’s instructions. Then, when it comes time for discharge, the patient or their caregiver isn’t surprised by the restrictions that some meds may have.

Marijke Vroomen Durning, RN, is a health writer and the author of Just the Right Dose: Your Smart Guide to Prescription Drugs & How to Take Them Safely.