The Dangers of Medication Mix-Ups at Home

At the beginning of the New Year, it's important for each of us to examine our health and lifestyle and plan for ways to improve in 2017. For better or worse, we are a society accustomed totaking multiple medications. As we age, we tend to accumulate a list of daily prescription medications; health care professionals and pharmacists call this practice "poly-pharmacy." It's common for the average American to see several different doctors for different conditions, and for each doctor to prescribe a particular remedy. In general, there's a real risk for poor coordination of care among primary care doctors and specialists due to the fragmentation of health care – and this can lead to having multiple drugs prescribed for similar ailments. In addition, the availability of over-the-counter therapies presents the opportunity for even more drug interactions. Your doctors might not be aware of all these, if they don't know you're taking a particularOTC medicationin conjunction with prescription medications.Side effectscan range from mild to severe and can even include death. With the ongoing epidemic of opioid painkiller use in the United States, the stakes have never been higher when it comes to understanding your medications and how they can interact.

How Big Is the Problem?

Recent data from the Centers for Disease Control and Prevention, published in theJournal of the American Medical Association, suggests four visits to the ER per 1,000 adults annually are for adverse drug effects. Currently, almost 60 percent of Americans are taking at least one prescription drug, and nearly 20 percent are taking more than five prescriptions medicines. Add in over-the-counter medicines, and you have a huge potential for side effects, drug-drug interactions and negative outcomes. While the study found that on average, 1 in every 250 ER visits was due to adverse drug events, rates among the elderly are even higher. This age group is at particularly high risk for drug mix-ups, as many of them take more than 10 drugs (both prescription and OTC) at a time. Many of the drugs they take can result in confusion; plus, dementia rates in this demographic are high and can contribute to medication errors at home. In fact, in the JAMA study, researchers found that nearly 30 percent of all ER visits due to adverse drug events were seen in elderly patients. Older Americans typically have more chronic medical problems and less reserve to deal with drug side effects and interactions.

[See:How to Help Aging Parents Manage Medications.]

What Are the Issues?

The most common types of drugs seen as the cause of negative side effects in the ER varied by the age of the patient. In children, antibiotics accounted for the most problems. In adults, blood thinners, diabetes medications andopioid pain medicationswere the most common culprits. Over the past 10 years, according to the CDC, the rate for medication-related ER visits has increased from 26 to 35 percent among people over age 65. The biggest issue is that Americans tend to self-treat for many common ailments and often take multiple OTC medications in conjunction with powerful prescription drugs. These interactions can result in damage to the liver, kidney and other organ systems. In addition, certain medications can interact in a way that can elevate or lower blood levels of important prescription drugs and make them less effective – or significantly enhance their effects in ways that can negatively affect our health.

What Can We Do to Reduce Our Risk for Adverse Drug Events?

1. Communicate effectively with providers.It's essential that all your physicians know exactlywhat drugs you're taking(including both prescription and OTC medications). Carry a list with you in your wallet or on your mobile device, and verify meds at each visit. Make sure your doctor has a record of all your medications and that you discuss any concerns you have.

[See:5 Common Preventable Medical Errors.]

2. Build a relationship with your pharmacist.Working with yourlocal pharmacistcan be an excellent way to ensure you're taking the right drugs at the right time. Your pharmacist is adept at spotting potential interactions and will often contact your doctor on your behalf to question anything that seems out of the ordinary. When in doubt, call and ask.

3. Always question the need for medications annually.When meeting with your health care provider, question the need for all the medications on your list at least annually. Make sure to ask why you're taking a particular drug and how long you'll need it. A good, healthy discussion about your meds can make you a more informed patient and help improve your health outcomes through engagement.

4. Verify all new prescription bottles for accuracy.While it's rare, pharmacies do occasionally make mistakes. Verify that the label reads exactly what you're expecting to get and that the product inside the bottle is what's on the label. Your pharmacist can help you with this as well.

What's Next: Tools and Technologies Available to Help Avoid Adverse Drug Effects

With nearly 70 percent of all Americans possessing a mobile device or tablet, there's a huge opportunity for organizing your medications online. There are many medication-tracking programs available and others in development that can help you keep your medication list organized. One new application that will be available soon on both iPhone and Android is calledMyRxProfileand has several particularly unique features that can help keep patients safe.

Not only does MyRxProfile have the ability to list and track your medications, but it can also screen for potential drug-drug interactions (including prescription andOTC meds) and send users a real-time, immediate alert. The app can also scan bar codes and take pictures of bottles and serial numbers through the smartphone camera to enter medications into a patient profile quickly and effectively. While MyRxProfile is just now entering the market as a free download, developer Robert Baker says that "as a pharmacist, I realized drug interactions were becoming a medical crisis ... and I believe this app will greatly improve awareness of adverse drug interactions and ultimately save lives."

[See:8 Questions to Ask Your Pharmacist.]

It will be important that as we work to improve patient safety, tools such as MyRxApp can be used in medical research and clinical trials to determine ways we can significantly impact the increasing rates of adverse drug events – particularly among the elderly. I expect that in the future, pharmaceutical medical applications for patients will be able to interface with electronic medical record systems and help synchronize medication lists at multiple physician appointments as well as with your pharmacist. By improving communication and engaging patients and providers together in common health care goals, these new digital tools are likely to make medication errors and drug interactions much less common in 2017.

Behind the Window: What Pharmacists Do

The pharmacist?

You know him. He’s that guy who hands you your pills from behind the counter – on the surface, a vendor-like transaction. End of story? Not quite. "We consider ourselves the last line of defense before somebody takes medication," says Mark Riley, president of the National Community Pharmacists Association."The thing that separates us from all the other professions is our expertise and drug knowledge, and I think we’re going to see pharmacists injected more and more into the health care system." Here’s what you should know aboutpharmacistsand what they can do for you:

They’re well-educated.

Pharmacists are required to have a doctor of pharmacy degree, which includes a yearlong residency. Typically, that means six years of education. "People would be surprised at the level of education in terms of pharmacology that pharmacists have," says Riley, who’s also CEO of the Arkansas Pharmacists Association. "They’re the medication experts, and everything they learn in school is related to medication, how it affects disease and how it treats disease."

They have specialties.

The Boardof Pharmacy Specialties recognizes eight specialty practice areas, including ambulatory care pharmacy; nutrition support pharmacy; and psychiatric pharmacy. There are also nuclear pharmacists, who measure and deliver the radioactive materials used for MRI and CT scans, as well as other digital imaging.

They work in numerous settings.

Pharmacists don’t just work in community pharmacies – they "practice in all areas of health care, including hospitals,nursing homesand specialty clinics," says Eric Roath, a fellow of clinical services and association management at the Michigan Pharmacists Association. According to the Bureau of Labor Statistics, 43 percent of pharmacists work in pharmacies and drugstores, while 23 percent work in hospitals.

They enhance patient safety.

Pharmacists have about "15 times the pharmacology" knowledge of anyone else, including physicians, Riley says – they know their stuff. You can count on them to check whether your prescription will interact negatively with other drugs you’re taking or conditions you have. Pharmacists also instruct you on how and when to take your medicine, as well as potential side effects you should be cognizant of.

They provide medication therapy management.

This refers to one-on-one care between a pharmacist and patient – designed to ensure the best possible health outcomes. Pharmacists check in regularly to make sure patients are taking the correct medications in the correct ways, and they’ll also confirm they aren't experiencing any adverse reactions. It’s particularly important considering that more than 125,000 Americans die from medication mismanagement every year, according to the National Pharmaceutical Council and American Hospital Association.

They offer general health advice.

Pharmacists advise patients aboutdiet, exercise and other issues, and they can also recommend the best ways to treat health problems. While they aren’t trained to diagnose, it’s worth taking advantage of their expertise, Riley says. "Pharmacists are the most accessible health care person, because they’re there – you can just walk in the door and talk to them," he says, noting that he often advised patients on, for example, whether a cut might need stitches or ifover-the-counter treatmentswould suffice.

They can help you save money.

Pharmacists are familiar with insurance plans and can make sure you’re getting the most cost-effective care. If one drug calls for a $50 copay, they may suggest a similar option that costs, say, $20. A pharmacist is "the one person in the equation who knows both the therapeutics and economics of medication," Riley says. "We know what you should use for what, why it should be used and how it should be used, and we know what it costs – we know drugs that are very inexpensive and drugs that are very expensive."

They can give you vaccines.

Pharmacists give flu shots and, in most states, other vaccinations, says Fred Eckel,a professor at the University of North Carolina-Chapel Hill's Eshelman School of Pharmacy since 1966. Common vaccines include pneumonia, shingles, herpes, tetanus and those necessary for international travel. "It’s changing the image of the pharmacist from putting pills in a bottle to a direct care provider," he says. "And with that changing role, we can continue to do more."

You should only see one.

Most patients have multiple doctors – and physicians often end up treating them without full access to all the different medications they’re taking, Riley says. It can be tough to remember to mention every pill you’re taking to your doctor. "You need somebody to tie that all together, and that’s one of the pharmacist’s responsibilities,” Riley says. "You need somebody to have all that information and the drug knowledge so they can catch whether something might interact."