Bill Klaproth (Host): Prescription medications can be quite helpful when taken correctly, but when taken the wrong way it can cause many different problems. Here to talk with us about medication mishaps, is Darrell Willm, director of inpatient pharmacy at Tidelands Health. Darrell, thanks for your time today. How big of a problem are medication mishaps?

Darrell Willm (Guest): Across the nation, it’s a big problem, and we know through the statistics and data that’s out there that a good proportion of our admissions are basically due to medication mishaps and taking medications the wrong way, taking medications that they shouldn’t be. Probably one of the bigger problems is patients that should be on medications, not taking them and stopping them when they should be continuing due to insurance, finances, and that kind of thing.

Bill: There’s certainly a lot of confusion around medications, especially when a patient has multiple medications today. Let’s talk about, in the hospital, how to you make sure a patient at Tidelands gets the appropriate dose at the right time?

Darrell: Pretty much, we do this through our Clinical Pharmacy program. When a medication is ordered for a patient, the physician has done his background, and he orders his medication appropriate for the patient and for the use of the disease states. From a pharmacist’s perspective, when we get that order, before they call to verify it, to be ready to be administered by nursing, so we have access to the patient’s medical record. We have access to their lab work; we have access to any microbiology, any cultures that have been taken. We have access to their renal function, their liver function, so we do a second check from the physician before the nurse actually administers it the patient to make sure it’s dosed correctly, make sure the indication is correct, make sure it’s the right medication for that indication and then once we verify it, then the nurses are able to access the medication on the floor and give it to the patient.

We have a lot of the background, and historically it hasn’t been there, but now with the computer system and how they interface with everything, we can see the patient history and physical from the physician and have a good background on what the patient’s medical condition is and is this medication not only appropriate for the patient but also is it dosed appropriately and how often it’s dosed.

Bill: Right, it’s that coordination of medication through a series of checks and verifications. How about after the patient leaves and goes home, after discharge, how do you educate the patient on the proper use then?

Darrell: And that’s been another troublesome area as far as medication mishaps, so what we do is there’s a thing called medication reconciliation. We do it on the front end when a patient comes in, that’s why it’s important for patients to bring their medication lists, so we know everything that they’ve been on, including herbals and multivitamins and that kind of thing because they do have interactions with some of the inpatient medications that we use. And on discharge, the physician will take a printout of the medications that the patients on the inpatient side and compare that to what the patient has been taking at home and if any adjustment has been made and that kind of thing, we make the adjustments and we send the patient home with a complete list of medications that are now to be taken on their way out the door. The nurses typically will verify that with the patient and review that list with the patient and send them out before discharge.

Bill: Right, and I just went through this with my dad. How do you deal with prescriptions that have similar names and can be very confusing – I know you just said you send them home with a list – how can someone avoid a mix up at home?

Darrell: A mix-up, that’s the harder part. It’s patients being aware of their medications and knowing the names of what they are, particularly now that there is a lot of generics out there, there is a lot of similar names. There are web apps and applications on the internet where they can actually just type in the pill name – the number that’s on the pill, and verify that that’s the one that they have a question. In the olden days when it was all brand names, you could tell by the color, the look, and that kind of thing, but that is a lot less likely to be able to pick up on that now because generics can – each time they get a prescription filled, one set of pills can be a totally different color than the other set, so it’s not necessarily by look, it more knows the medications, knowing their names, and comparing that to the prescription that they drop off to the information that we give them on the way out, to make sure that they are identical.

And then any time they have any questions, call their pharmacist or physician and double check it. So the question – usually you see that with mishaps in the hospital if something seems wrong if you didn’t check it then typically something will go wrong. It’s always good to have it double checked, and anytime you have a question, reach out.

Bill: Wow, that’s great advice, right. Better to ask the question than to take something the wrong way, or at the wrong time. Speaking of taking medications the wrong way, how big of a problem are people swallowing a liquid instead of a spray, for example?

Darrell: That does happen. It’s surprising. That’s the way it goes back to clear instructions and understanding, particularly on the retail side, talk to the pharmacist. A lot of times that’s harder on the retail side, they have less time, but just speak to the pharmacist and make sure they understand exactly how they’re supposed to – what they’re supposed to take, how often they’re supposed to take it, and how they’re supposed to take it before they leave the pharmacy.

Bill: And what about paying attention to expiration dates since some people may keep leftover medication thinking they can save money and use it at a later time, that’s not safe either, is it?

Darrell: It depends on the medication that’s in question, and like I said, once again, if there’s any question or any doubt that -- any medication that you get on the outside in a prescription pharmacy per se, will have a year expiration date and that’s due to it not being in light protection, moisture – it’s not in its original sealed container. Once it’s been out, there’s a chance for degradation, and basically, the medication will be ineffective, so if you’re taking an antibiotic, or some blood thinner and that kind of – blood pressure meds that you – it’s possible that you’re not going to get the full effect of the medication. And actually, there’s some antibiotics that if it degrades enough, that you’ll actually cause harm to yourself.

Bill: So a good rule of thumb is to finish all medication when it’s prescribed to you, so that way it won’t be leftover, right? And if there is leftover medication, make sure you throw it out. It’s just the safe thing to do.

Darrell: Yeah, it depends on what the medication is, but typically if it’s an antibiotic, yes, and that’s where a lot of trouble – and that’s where we have a lot of issues with resistance and causes the use of stronger and more expensive antibiotics. Once you take an antibiotic for a certain amount of time, you start to feel better, but you still have a seeding of that bacteria in your body, and it’s the stronger of the bacteria, so when you quit taking it, and you didn’t wipe it out, then it comes back a lot stronger and more resistant to the medication and the next time you get sick again and then they have to use something stronger to do it.

Another medication – blood pressure medications you should take, anticoagulants or blood thinning medications until your physician tells you not to. And then you’re correct; there’s a lot more drop off places now for – at police stations that you can drop off unused medications and particularly with the oxycodone and addiction problems that we’re having out there in Horry County. This is actually one of the highest overdose counties in the state, and we’re one of the highest states in the country. It’s getting pain medications, that kind of stuff, to the police stations and they have a drop off box right out their front door, drop that off and get that out of your way.

And for other medications, it’s good just to get rid of because there’s confusion whether you should be taking this or taking that. Like I said, once, you come out of the hospital, pretty much the only thing you should be taking is what’s on your list. If you have any questions with that – that there’s something else you should be taking, before you start taking it, check with your primary physician.

Bill: Those are some great tips. Make sure you finish your medication, then find a drop-off location and again, if you have questions, just make the call. Well, Darrell, lastly, why should someone choose Tidelands Health for their healthcare needs?

Darrell: Tidelands is a growing healthcare facility, so we have both inpatient and outpatient. The biggest thing I’ve seen since I’ve been here is the dedication to patient safety, still trying to do it right the first time. We’re always learning to form our mistakes. We’re a very dedicated healthcare team. We try to look at the patient from all aspects, and it’s been a great place to work, and I think an awesome place to come get your healthcare.

Bill: Darrell, thank you again, and for more information about Tidelands Health physicians, services, and facilities, visit TidelandsHealth.org, that’s TidelandsHealth.org. This is Better Health Radio. I’m Bill Klaproth, thanks for listening.