Medication Safety 1 Ann P. Slattery DrPH, RN, RPh, CSPI,DABAT Managing Director Regional Poison Control Center ann.slattery@childrensal.org 1

Regional Poison Control Center Established in 1958 at Children’s of Alabama Covers the entire state of Alabama Receives calls about all ages from 4 hours old to 105 years old 2016 RPCC received 42,412 calls and made almost 60,000 follow up calls

Therapeutic Errors Among Older Adults Study done over 4 years saw a 14% increase in therapeutic medication errors in the 65+ age group 8.7% were already in a healthcare facility RPCC referred 17.6% to an emergency department RPCC managed 73.8% at home with follow-up calls 2016- 1667 (728) 2017 -137 thus far

What are we going to talk about today? Why medication safety is important and how you can engage in patient safety How to read an Over-the-counter (OTC) medication label The importance of knowing your medications How to prepare a medication list How to safely store and dispose of medications

Why is Medication Safety Important? Everyone has a role to play in preventing harm from medication incidents Medication incidents can occur at: Your doctor’s office Your pharmacy Your home

How do you decide which medicine is the right OTC medicine for you? Read the Drug Facts label 6

Drug Facts label Active Ingredients: The parts of the medicine that make it work What does Drug Facts tell us about each active ingredient ??? Its name How much is in each pill or teaspoon (5 mL) What it does (its purpose or job) The problems it treats (its uses) 7

Warnings What is all this? 8 The warnings section tells you: When you shouldn’t use the medicine at all When you should talk to your doctor first How the medicine might make you feel When you should stop using the medicine Things you shouldn’t do while taking the medicine. *Mention Allergic reactions 8 8

Directions for use If you have any questions about this product you can call the number at the bottom. Labels change when new information becomes available an example is acetaminophen, max dose is now 4gms 9

Other Information How to store the product Inactive Ingredients can effect allergies in some cases--- allergies due to certain types of dyes Phone number if any further questions

When taking an OTC medication… Ask a doctor or pharmacist before use Stop use if: You feel like you are having an allergic reaction – rash, itching, but if difficulty breathing call 911 Stomach pain, throwing up, dizziness If medication is not working Keep out of reach of children If someone you know takes too much medicine or the wrong medicine, call the Poison Control Center for help at 1- 800-222-1222 Some meds shouldn’t be used together ex. High blood pressure--- certain decongestants and cough medicines are not safe Young children may think medicine tastesREALLY GOOD. Medicine is not candy and can harm them if they take too much. If someone you know takes too much medicine or the wrong medicine, call the Poison Control Center for help.

Measuring Tools for Medicines Use the measuring spoon, cup, or syringe that comes with your medicine. This is the most exact way to measure your dose. If your medicine doesn’t come with a special measuring tool, ask for one at the pharmacy. A silverware spoon may hold the wrong amount of medicine. Make sure the tool can measure the right dose – always double check the markings on the tool. What do you think is the most accurate tool to use to dose your medication Ok, Lets do an experiment…. **Most accurate choice is the syringe!** **stop for any questions so far** 12

Dietary Supplements & Herbal Remedies Self prescribed, available from many sources You are responsible for choosing the correct medicine, dose, and watching for side effects Herbal remedies do not have to follow the same strict rules that prescription drugs do For herbal remedies, manufacturers do not have to prove that the product is safe, effective, or that it contains the ingredients on the label

Understanding Your Prescription Medications Ask your pharmacist!!

Before Leaving Your Doctor’s Office What is the name of the medication? (spell it) Why do I need it? I have allergies – will I have a reaction to this medication? When and how should I take it? How should I measure a liquid? Will it interact with other medications that I am taking?

Auxiliary Labels Always read these medication labels or have someone explain them to you Medication labels that contain warning, dietary information, certain instructions, or cautionary details

Keep a current medication list Full page list: this list is for you to keep your most current medications in a safe place in your home that is readily available to you. This is the list you should take with you to your doctors visits so that each doctor is aware of all of your medications and what other doctors you are seeing. Wallet size list: this list is for you to keep in your wallet in case of emergencies. This list will give doctors and emergency staff a starting point for which medications you are taking in emergency situations to prevent any further harm. List: what you are actually taking, how you are taking it and Why Include your over the counter medications **Get a list of current medications when you move from one setting of care to another **when discharged from hospital it is very important to take your discharge medication list to your PCP and your pharmacist** As a patient, YOU are the BEST source of information on the medications you are taking!

Keep a Current Medication List regularly used and “as needed” prescription medications pills, ointments, creams, liquids non-prescription medications vitamins, herbal, natural products dosages and strength (eg: 1 x 500 mg tablet) how and when you take the medication Suggested Content Key Point – Keep a current medication list. Key Point – Review what to list (see slide). Resources Core Content – Keep a Current Medication List

A current medication list helps: you learn about your medications you take your medications correctly your doctors, nurses and pharmacists know about your medications in an emergency Suggested Content Keeping a medication list helps: you learn about your medications you take your medications correctly your healthcare providers know about your medications provide important information in an emergency It is especially important that patients be given a list of their current medications when they move from one care setting to another. In Manitoba, suggest that people have an Emergency Response Information Kit (E.R.I.K). See Appendix C – Patient/Family Engagement Tools. Activities Handouts It’s Safe to Ask Medication Card - Hand out a medication card and review the sections. Knowledge is the best medicine medication record Video: Show a video. Know and Show Your Medication Card tells people why it is important to know your medications and show your medication card. How to Fill out the Medication Card demonstrates how to fill out the medication card. (see next slide. Show online or get a copy from MIPS). And/Or Show the 30 second medication safety video from the series Learn to be Safe – Patient Safety Videos http://www.safetoask.ca/?page_id=261 Resources Core Content – Keep a Current Medication List Appendix C – Patient/Family Engagement Tools

An Important Medication Safety Tip Turn on the light, put on your glasses and read the label!

More Medication Safety Tips Use the same pharmacy Ask before you cut, split, crush or open a pill or capsule Know what food or drinks to avoid with certain medications Check when medications expire Know your Poison Control Center phone number 1-800-222-1222 Important for pharmacy to be aware of all medications so no interactions are missed and we are able to provide the best possible care Some antibiotics you cant take with milk or alcohol Cholesterol- grapefruit juice

Even More Medication Safety Tips If dose is more than 3 pills at once, check with your doctor or pharmacist Do not share your prescription medications Never use someone else’s prescription medicine With OTC medicine, always check the dose The right dose for you may be different than for your friend or family member

Storing and Disposing Medications

Store Medications Safely Securely (ex. Locked cabinet) In an area free of excess heat, cold, and moisture Bathroom, car

Store Medications Safely Leave medications in original labeled containers Do not mix medications in same container Suggested Content Tell a patient story – See Appendix B – Patient Stories: Store Medications Safely. Key points - Store Medications Safely. Review slide content and provide examples. Resources Core Content – Store Medications Safely Appendix B – Patient Stories

Another Reason to Store Your Meds Safely – Your Grandchildren! Up to 38% of child poisonings involve grandparent’s medications 28% of older adults keep their medicines in easy-open containers or bottles without a child-resistant cap 42% of those who use easy-open containers also keep their medicine on a bathroom or kitchen sink, counter, table, or shelf 12% keep prescription medications on a nightstand or dresser

Dispose of Medications Safely Mountain Brook, Homewood, and Vestavia Hills police departments- Anytime Drug Take-Back Programs More information on DEA Diversion Control Division website www.disposemymeds.org If using needles to inject medication, get a biohazard/sharps container from your pharmacy Disposemymeds.org— an online resource to help you find medication disposal programs at an independent community pharmacy in your neighborhood. The FDA has great guidelines on disposal of drugs or if you are ever not sure you can call the poison control center and we can help you

When in Doubt, Check it Out! The Poison Control Center 1-800-222-1222 The Poison Center offers free, confidential medication advice 24 hours a day, 7 days a week, 365 days a year

Questions?