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A Prescription for Side Effects

Healthcare practitioners prescribe and dispense medications every day to improve patients’ quality of life and, in many cases, save lives. The same drugs that heal, however, may have unpleasant side effects that cause physical discomfort or aggravate existing health problems. In some cases, certain side effects can even result in a life-threatening situation.

Drug side effects are unfortunately a critical issue for a large number of patients. In fact, a recent study featured in the New England Journal of Medicine notes that at least one in four patients who take prescription drugs suffers from side effects. Sometimes patients feel they have little choice but to deal with side effects; the discomfort is temporary or inconsequential in comparison to the benefits provided by the medication.

Some side effects, however, can be avoided with adjustments to the prescription. In fact, many of the patients in the NEJM study suffered simply because they were given an inappropriate drug or incorrect dosage.

Patients can help themselves

Patient-safety advocacy groups believe an important way to lower the incidence of adverse effects is to empower patients to take active roles in their own healthcare treatments. Patients who know enough to question their doctors, nurses, and pharmacists are more likely to catch medication errors and to understand what options they might have for alternate treatments.

Unfortunately, patients still find it difficult to question medical authority, says Hedy Cohen, RN, vice president of the Institute for Safe Medication Practices (ISMP). "If they were in a restaurant and were allergic to peanut butter, they wouldn't hesitate to ask if there were any peanuts in their meal,” Cohen says. “But in a healthcare setting, [they] don’t want to ‘bother’ a physician.”

The FDA and non-profit patient advocacy groups like ISMP are out to change this attitude through patient awareness campaigns. For example, the FDA has developed brochures and interactive workshops that emphasize the importance of asking questions about medications. It teaches patients to weigh the risks and benefits of medications so they can make smart, safe choices.

What’s an RN to do?

"Nurses are in a critical position to enhance patient empowerment,” says Doni Haas, RN, a director of the National Patient Safety Foundation (NPSF). “Communication is key. I mean, total communication - listening to your patient, and picking up on early signs and symptoms.”

But empowerment comes not only from informing patients about their medications and encouraging them to ask questions. Nurses also must ensure that patients truly understand the information they are given.

“Many patients are illiterate and more are health illiterate,” says Cohen, “which means they really can’t understand what ‘hypertension’ means, or other words [that] roll off our tongues. Many can’t read written information and are too embarrassed to say so.”

That’s one reason, she suggests, why it’s important to educate patients when distributing meds. Don’t just dispense pills; take the opportunity to provide crucial information about the medication. Hand out the pills on your first round and talk to patients about what they are taking. Then follow up on the next meds round with a series of questions to ensure they understand the information.

“It’s not just going in and teaching the patient, but knowing that the patient understands. That’s where the process seems to break down,” says Cohen. “We go in and tell them ‘This is the pill you’re going to be taking and this is what it’s for.’ We really don’t know if they have an understanding. They’re sick; their cognitive functions aren’t working as well as they should be, so you have to get [the information] repeated back.”

It’s also important to be very clear about the risks and side effects of the prescribed medication. Some patients are embarrassed to mention side effects if it brings up sensitive issues, like constipation or impotency. As a result, if they experience any of these adverse effects they may stop taking their medication without telling their healthcare provider. Nurses can inform patients about potential side effects and let them know they can pursue treatment alternatives if such side effects do occur.

To help nurses stay current on prescription drugs and their side effects, online resources, such as the FDA’s MedWatch site and the ISMP’s “ Nurse Advise-ERR ” newsletter, offer updated safety information about new and existing medications.

The system needs to change

Healthcare workers are human, which means nurses and other medical providers do occasionally make errors when providing medication. Haas and Cohen suggest the system of healthcare delivery is often at the root of these human errors. In the rushed world of today’s hospitals, it’s all too easy to distribute the wrong medication or miss critical warning signs of adverse side effects.

The system, they agree, needs to encourage stronger collaboration among the physician, the nurse, the patient, and the pharmacist so that everyone involved is better informed. All need to be actively communicating in order to deliver and receive competent care.

Another problem, says Cohen, is that meds have become more complex but the system has not changed to support this. What’s the answer? Technology may provide one solution. At the NPSF’s 2003 Patient Safety Congress last March, the FDA announced an initiative to require a national bar code system for medications. A bar code, which contains important details for providers, will be placed on each medication so that nurses have drug information resources right at patients’ bedsides.

But that’s only part of the solution. In addition to addressing the complex nature of medications, says Haas, nurses need to be able to work in a b lame-free environment where they can freely report errors without fear of punishment. That way, nurses and the entire medical community can learn from each other’s mistakes and put adequate measures in place to address potential medication safety issues.

“Nobody feels worse when a mistake happens than the person who made it. When that person can be involved in the solution, that’s a wonderfully cleansing thing for a professional,” says Haas. “[They can then] help other people [avoid] the same mistake.”

The ISMP also recommends that hospitals conduct yearly patient-safety training as part of their usual annual training.

An industry priority

Last year in the United States, 3.34 billion drugs were prescribed and dispensed. As an inc reasing number of patients take multiple prescriptions, the issue of adverse side effects, especially those caused by medical error, needs to be a priority for those in the medical field.

“It’s a much more complex issue than it seems on the surface,” says Cohen. “It’s more than just giving the right meds, at the right time.” Communication, patient empowerment, and collaboration are key.

The end result? Nurses can offer safe and effective patient care.