For Patients: How To Avoid Medication Errors

  1. Have your doctor explain what is written on any prescription given to you.
  2. Be certain the prescription is legible and includes the purpose of the medication.
  3. Use a reliable pharmacy which keeps a list of all medications you take in their computer. Avoid unregulated Internet pharmacies.
  4. Keep medications in their original, labeled containers or use a pill box or pill reminder1 to avoid errors and better organize your medications.
  5. Do not take medication in the dark where you can easily pick up the wrong container.
  6. Read the label every time you take a dose of medication to confirm you have the correct drug and are taking it properly.
  7. Never take medication which was prescribed for another person.
  8. Do not store medication in direct light, heat, or humidity.
  9. Do not store ointments near toothpaste where an easy mix-up could occur.
  10. Do not take expired medications.
  11. Learn how to dispose of your old, expired or unused medications2 in a safer, more environmentally-friendly way.
  12. When taking liquid medications use only the measuring cup it came with.
  13. Keep a list of the name, dose, and frequency of all medications you take including over-the-counter drugs, vitamins, herbs, and supplements particularly since some herbs can have adverse reactions with prescription drugs.
  14. Make sure your medication list matches your doctor's records and the list the pharmacy has to avoid dangerous drug interactions.
  15. Obtain printed information about any new medication you receive from the pharmacy.
  1. Learn more about and better understand the medications you are taking.
  2. Be very familiar with the appearance of your drugs and notice if or when it changes.
  3. Only take your medications as instructed by your doctor.
  4. Always consult with your doctor before stopping a medication or when considering a new treatment.

For Patients: Preventing Medication Mixups & Complications

Herbs and Foods May Lead to Complications If You Take Them with Drugs


Many people have the mistaken notion that, being natural, all herbs and foods are safe. This is not so. Very often, herbs and foods may interact with medications you normally take that result in serious side reactions. It is always a good practice to tell your doctor or health practitioners what you are taking so that they can advise you of possible complications, if there is any. You should also keep an eye for unusual symptoms. Very often, this may foretell the symptoms of a drug interaction.

Experts suggest that natural does not mean it is completely safe. Everything you put in your mouth has the potential to interact with something else. The medication that is taken by mouth travels through the digestive system in much the same way as food and herbs taken orally do. So, when a drug is mixed with food or another herb, each can alter the way the body metabolizes the other. Some drugs interfere with the body's ability to absorb nutrients. Similarly, some herbs and foods can lessen or increase the impact of a drug.

bulletAlcohol is a drug that interacts with almost every medication, especially antidepressants and other drugs that affect the brain and nervous system.
bulletSome dietary components increase the risk of side effects. Theophylline, a medication administered to treat asthma, contains xanthines, which are also found in tea, coffee, chocolate, and other sources of caffeine. Consuming large amounts of these substances while taking theophylline increases the risk of drug toxicity.
bulletCertain vitamins and minerals impact on medications too. Large amounts of broccoli, spinach, and other green leafy vegetables high in vitamin K, which promotes the formation of blood clots, can counteract the effects of heparin, warfarin, and other drugs given to prevent clotting.
bulletDietary fiber also affects drug absorption. Pectin and other soluble fibers slow down the absorption of acetaminophen, a popular painkiller. Bran and other insoluble fibers have a similar effect on digoxin, a major heart medication.

As more and more people discover new herbs, there is more and more potential for the abuse of these herbs and the patients may end up in serious problems.

I was attending an herb meeting a few weeks ago and a person came to the speaker and told her that she had very good luck with St. John's Wort to control her depression. St. John's Wort has been shown to have great potential to control minor depression. The National Institutes of Health is conducting a clinical study to determine the effect of St. John's Wort scientifically. This person, however, continued saying that she is now trying St. John's Wort for her OCD (Obsessive Compulsive Disorder). Now, this is getting into unproven uncharted territory. If you are taking prescription medication for this disorder, you can get into trouble due to drug interaction. As shown under the discussion on St. John's Wort, the herb can be quite dangerous, as it acts similar to MAO inhibitors. They have severe side reactions, and if not careful, can even lead to death.

High-risk patients, such as the elderly, patients taking three or more medications for chronic conditions, patients suffering from diabetes, hypertension, depression, high cholesterol or congestive heart failure, should be especially on the lookout for such side reactions.

The following are the examples of known interaction between popular herbs, foods, and prescription and over-the-counter drugs.

Hawthorn, touted as effective in reducing angina attacks by lowering blood pressure and cholesterol levels, should never be taken with Lanoxin (digoxin), the medication prescribed for most for heart ailments. The mix can lower your heart rate too much, causing blood to pool, bringing on possible heart failure.

Ginseng, according to research, can increase blood pressure, making it dangerous for those trying to keep their blood pressure under control. Ginseng, garlic or supplements containing ginger, when taken with the blood-thinning drug, Coumadin, can cause bleeding episodes. Coumadin is a very powerful drug that leaves little room for error, and patients taking it should never take any medication or otherwise before consulting a qualified health professional. In rare cases, ginseng may overstimulate resulting in insomnia. Consuming caffeine with ginseng increases the risk of overstimulation and gastrointestinal upset. Long tern use of ginseng may cause menstrual abnormalities and breast tenderness in some women. Ginseng is not recommended for pregnant or lactating women.

Garlic capsules combined with diabetes medication can cause a dangerous decrease in blood sugars. Some people who are sensitive to garlic may experience heartburn and flatulence. Garlic has anti-clotting properties. You should check with your doctor if you are taking anticoagulant drugs.

Goldenseal is used for coughs, stomach upsets, menstrual problems and even arthritis. However, the plant's active ingredient will raise blood pressure, complicating treatment for those taking antihypertensive medications, especially beta-blockers. For patients taking medication to control diabetes or kidney disease, this herb can cause dangerous electrolyte imbalance. High amount of consumption can lead to gastrointestinal distress and possible nervous system effects. Not recommended for pregnant or lactating women.

Feverfew, believed to be the natural remedy for migraine headaches, should never be taken with Imitrex or other migraine medications. It can result in the patient's heart rate and blood pressure to rise dangerous levels.

Guarana, an alternative remedy being used as a stimulant and diet aid, contains 3 percent to 5 percent more caffeine than a cup of coffee. So, if you are taking any medication that advises you against taking any drink with caffeine, you should avoid taking this stimulant. It may cause insomnia, trembling, anxiety, palpitations, urinary frequency, and hyperactivity. Avoid during pregnancy and lactation period. Long term use of Guarana may lead to decreased fertility, cardiovascular disease, and several forms of cancer.

Kava, a herb that has antianxiety, pain relieving, muscle relaxing and anticonvulsant effects, should not be taken together with substances that also act on the central nervous system, such as alcohol, barbiturates, anti depressants, and antipsychotic drugs.

St. John's Wort is a popular herb used for the treatment of mild depression.

The active ingredient of St. John's Wort is hypericin. Hypericin is believed to exert a similar influence on the brain as the monoamine oxidase (MAO) inhibitors such as the one in major antidepressants. Mixing MAO inhibitors with foods high in tyramine, an amino acid, produces one of the most dramatic and dangerous food-drug interactions. Symptoms, which can occur within minutes of ingesting such foods while taking an MAO inhibitor, include rapid rise in blood pressure, a severe headache, and perhaps collapse and even death. Foods high in tyramine include aged cheese, chicken liver, Chianti (and certain other red wines), yeast extracts, bologna (and other processed meats), dried or pickled fish, legumes, soy sauce, ale, and beer.

Some patients report that Saint Johns Wort caused excessive stimulation and sometimes dizziness, agitation and confusion when taken with other antidepressants or over-the-counter medications like Maximum Strength Dexatrim and Acutrim. It also caused their blood pressure to shoot up.

White Willow, an herb traditionally used for fever, headache, pain, and rheumatic complaints may lead to gastrointestinal irritation, if used for a long time. It exhibits similar reactions as aspirin (aspirin is derived from white willow). Long term use may lead to stomach ulcers.

Drug Interaction and Food

Drug interaction risk isn't limited to herbal supplements. Certain foods can interact with medications.

People taking digoxin should avoid Black licorice (which contains the ingredient glycyrhizin). Together, they can produce irregular heart rhythms and cardiac arrest; licorice and diuretics will produce dangerously low potassium levels, putting a patient at risk for numbing weakness, muscle pain and even paralysis. Licorice can also interact with blood pressure medication or any calcium channel blockers.

Aged cheese (brie, parmesan, cheddar and Roquefort), fava beans, sauerkraut, Italian green beans, some beers, red wine, pepperoni and overly ripe avocados should be avoided by people taking MAO antidepressants. The interaction can cause a potentially fatal rise in blood pressure.

And because Saint Johns Wort contains the same properties as these MAO antidepressants, it stands to reason that people ingesting the herb should avoid these same foods.

Grapefruit juice interacts with calcium channel blockers (including Calan, Procardia, Nifedipine, and Verapamil), cholesterol control medications, some psychiatric medications, estrogen, oral contraceptives and many allergy medications (Seldane, Hismanal). The juice modifies the body's way of metabolizing the medication, affecting the liver's ability to work the drug through a person's system. More Information.

Orange juice shouldn't be consumed with antacids containing aluminum. 'The juice increases the absorption of the aluminum. Orange Juice and milk should be avoided when taking antibiotics. The juice's acidity decreases the effectiveness of antibiotics, as does milk.

Milk also doesn't mix with laxatives containing bisacodyl (Correctol and Dulcolax). You might find the laxative works a little "too well" in the morning.

Large amounts of oatmeal and other high-fiber cereals should not be eaten when taking digoxin. The fiber can interfere with the absorption of the drug, making the act of swallowing the pill a waste of time.

However, don't stop eating your cereal right away, because that could cause digoxin levels in your system to soar to toxic levels. A professional should make the dietary changes after carefully examining the digoxin levels.

Leafy green vegetables, high in vitamin K, should not be taken in great quantities while taking Coumadin. These vegetables could totally negate the affects of the drug and cause blood clotting.

Caffeinated beverages and asthma drugs taken together can cause excessive excitability. Those taking Tagament (Simetidine), quinolone antibiotics (Cipro, Penetrex, Noroxin) and even oral contraceptives should be aware these drugs may cause their cup of coffee to give them more of a Java jolt than they expected.

Grilled meat can lead to problems for those on asthma medications containing theophyllines. The chemical compounds formed when meat is grilled somehow prevent this type of medication from working effectively, increasing the possibility of an unmanageable asthma attack.

Regularly consuming a diet high in fat while taking anti-inflammatory and arthritis medications can cause kidney damage and can leave the patient feeling, drowsy and sedated.

Alcoholic beverages tend to increase the depressive effects of medications such as benzodiazepines, antihistamines, antidepressants, antipsychotics, muscle relaxants, narcotics, or any drug with sedative actions.

It's a good idea to not consume any alcoholic beverages, or at least scale way back, when taking prescription medications. Antioxidant and beta-carotene intensify alcohol's effect on the liver.

Other commonly used over-the-counter medications can cause interaction problems also.

Aspirin can modify the effectiveness of arthritis medications, strong prescription steroids and diuretics. Combining aspirin with diabetic medications can drop blood sugars to dangerous levels. Aspirin can also cause toxicity when taken with glaucoma and anticonvulsant (anti-seizure) drugs and cause bleeding episodes when combined with a blood thinner, like Coumadin.

Acetaminophen can also cause interaction complications when overused. Heavy drinkers who take acetaminophen for hangover relief risk liver damage. Taking high doses of acetaminophen with Coumadin can cause bleeding episodes.

Antacids taken with antibiotics, heart and blood pressure or thyroid medications can decrease drug absorption by up to 90 percent.

Over-the-counter antihistamines - sold under the names Actifed, Theraflu, Dimetapp, Benadryl and Comtrex should be avoided if you are taking antianxiety or antidepressant medications.

Oral contraceptives are less effective when taken with barbiturates, antibiotics, anti-fungal or tuberculosis drugs.

Turnips contain two goitrogenic substances, progoitrin and gluconasturtin, which can interfere with the thyroid gland's ability to make its hormones. Although moderate consumption of goitrogens is not a hazard for healthy people, they can promote development of a goiter (an enlarged thyroid) in persons with thyroid disease.

Tomato contains small quantities of a toxic substance known as solanine that may trigger headaches in susceptible people. They are also a relatively common cause of allergies. An unidentified substance in tomatoes and tomato-based products can cause acid reflux, leading to indigestion and heartburn. Individuals who often have digestive upsets should try eliminating tomatoes for 2 to 3 weeks to see if there is any improvement.

Strawberries, Raspberries, Spinach, and Rhubarb: These contain oxalic acid, which can aggravate kidney and bladder stones in susceptible people, and reduce body's ability to absorb iron and calcium.

Raspberries contain a natural salicylate that can cause an allergic reaction in aspirin sensitive people.

The seeds from fruits such as Apple, apricot, and Quinces contain amygdalin, a compound that turns into Hydrogen Cyanide in the stomach. Eating large amount of seeds can result in cyanide poisoning.

Potatoes: Avoid potatoes with a green tint to the skin, and remove any sprouts; they will taste bitter and may contain solanine, a toxic substance that can cause diarrhea, cramps, and fatigue.

Plums, Peaches, Apricots, and Cherries: These fruits may produce allergic reaction in individuals with confirmed allergies to apricots, almonds, peaches, and cherries. People who are allergic to aspirin may also encounter problems after they have eaten plums or peaches as they contain salicylates. The pits of plums, peaches and apricots contain a compound called amygdalin.  When consumed in large amounts, amygdalin breaks down into hydrogen cyanide, a poison.

Horseradish: Very high doses of horseradish can cause vomiting or excessive sweating. Avoid if you have hypothyroidism.

Turmeric: Should be avoided by persons with symptoms from gallstones.

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For Professionals: Preventing Medication Errors

From MEdQuest

During every shift of every day, a vast array of medications are administered to what may be hundreds of nursing home residents, most of whom take multiple medications. Add to this the increasing numbers of sicker residents and subacute subacute /sub·acute/ (-ah-kut´) somewhat acute; between acute and chronic.

Between acute and chronic.
 patients with even more complex pharmaceutical needs, and it's little wonder that many of the lawsuits arising in nursing homes are due to medication errors medication error Malpractice An error in the type of medication administered or dosage.

In order to prevent legal actions and other serious problems, licensed nurses need to be cognizant of methods intended to prevent costly mistakes when administering medications. The following tips should help to reduce and eliminate medication errors:

1. Follow the "five rights" in giving medications at all times, i.e., right drug, right dose, right route, right time, right patient.

2. Read the medication label three times prior to administering the medication.

3. Be very careful when responding to emergencies. Many well-meaning nurses have tried to help in an emergency, only to harm the resident because nurses unfamiliar with the resident can make serious mistakes. During an emergency, communicate openly with all nurses, especially if you happen to be the nurse who is unfamiliar with the patient. Write down times and other pertinent information so that the data can be charted as soon as possible, and seek clarification of any unclear order.

4. Be extra cautious when more than one nurse is assigned to give medications to the same group of residents (realizing that the staff nurse may have a routine that does not include others giving medications to her assigned residents). Again, ensure open communication so that such errors will not occur.

Special note for teaching nursing homes: It is easy to make errors when student nurses are administering medications, especially since the staff may not be accustomed to utilizing students and may even forget that they are present.

5. If a medication is to be withheld, write a note to that effect in clear view on the medication record. Ensure that all nurses concerned are aware that the medication is to be withheld.

6. Be sure to refer to the medication record prior to administering any medication. Don't rely on memory, as doctors' orders may -- and often do -- change.

7. Assign reliable licensed nurses to review all doctors' orders daily. This will prevent an error from continuing for several days or even months. Many facilities assign this duty to the licensed nurse on the night shift. In any event, the nurse must be thorough and careful to pay attention to detail.

8. If you are unable to read a doctor's order, seek clarification from the doctor who wrote the order. Anyone else would be second-guessing the prescribing physician.

9. Notify the doctor when a medication is withheld without an order, as can happen when a patient has a bad reaction or develops a swallowing disorder swallowing disorder 1 Dysphagia, see there 2. Any of a group of problems that interfere with the transfer of food from the mouth to the stomach . Some medications cannot be abruptly discontinued dis·con·tin·ue  
v. dis·con·tin·ued, dis·con·tin·u·ing, dis·con·tin·ues
1. To stop doing or providing (something); end or abandon:
. Dilantin, phenobarbital phenobarbital /phe·no·bar·bi·tal/ (fe?no-bahr´bi-tal) a long-acting barbiturate, used as the base or sodium salt as a sedative, hypnotic, and anticonvulsant.

, prednisone prednisone (prĕd`nĭsōn): see corticosteroid drug. , and coumadin are examples of medications that, when withheld without tapering Tapering
Gradually reducing the amount of a drug when stopping it abruptly would cause unpleasant withdrawal symptoms.

Mentioned in: Narcotics

, have the potential to lead to serious consequences.

10. Utilize a standard abbreviation abbreviation, in writing, arbitrary shortening of a word, usually by cutting off letters from the end, as in U.S. and Gen. (General). Contraction serves the same purpose but is understood strictly to be the shortening of a word by cutting out letters in the middle,  list (i.e., do not make up your own abbreviations). In cases resulting in litigation An action brought in court to enforce a particular right. The act or process of bringing a lawsuit in and of itself; a judicial contest; any dispute.

When a person begins a civil lawsuit, the person enters into a process called litigation.
, lawyers frequently request the "standard abbreviation list." If such a list is not available, write out the information in full rather than using made-up abbreviations. For example, "Sub.q 2 hrs. before surgery" could be interpreted as: "give sub. every two hours before surgery" or "give subq. two hours before surgery." Needless to say, a misunderstanding can lead to serious harm.

10. Know the medications being administered. Know the side effects Side effects

Effects of a proposed project on other parts of the firm.
 and know when to withhold medications and notify the physician.

11. Never give medication without an order. Don't be afraid to call a doctor for an order.

12. Be familiar with methods for giving injections. Know the Z-tract method -- pushing back excess skin before giving intramuscular injections Noun 1. intramuscular injection - an injection into a muscle
injection, shot - the act of putting a liquid into the body by means of a syringe; "the nurse gave him a flu shot"
 to avoid skin trauma Skin trauma is when the skin or multiple layers of epithelial tissues experience serious and altering physical injury. This can be in the form of cuts, burns, sickness or other injury.  -- and when it should be used.

13. Be aware of dangerous drug interactions. Seek information from texts and qualified medical personnel.

14. Administer A.C. medications (before meals) and P.C. medications (after meals) on time.

15. Crush only those medications that can be crushed. Your pharmacy keeps specific lists of these, and the lists should be consulted. Don't mix medication with a vehicle, such as apple sauce, until just prior to administration. Some medications lose their effectiveness when mixed too far ahead of time.

These 15 tips, though not all-inclusive, should help staff nurses to administer medications safely and correctly, and to prevent many common medication errors that compromise the quality of care we provide and the financial well-being of our facilities.

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