Hospitals are dangerous places. Our ancestors intuitively knew that and generally tried to stay out of the hospital if at all possible.
These days we like to think of hospitals as sterile, safe and high tech. They are unquestionably high tech, but there is still a long way to go before hospitals are truly safe and infection free.
Hospital-acquired infections are a huge problem. People who are relatively healthy when they enter a hospital may leave with persistent, even life-threatening, diarrhea caused by a bacterium called C. difficile.
But the biggest concern may be medication mistakes. In one study, one dose out of every five administered was in error (Archives of Internal Medicine, Sept. 9, 2002). The wrong drug, the wrong dose, the wrong time or omitting a drug completely are common problems.
You might think that patients would be able to keep watch on the drugs they are taking to help avoid some of these lapses. They should be motivated, since inaccurate drug administration can have life-threatening consequences.
Before patients can serve as the final safety checkers before a medication is given, however, they must know what they should be taking, when and at what dose. A new study shows that most people do not (Journal of Hospital Medicine, online Dec. 10, 2009).
The investigators questioned 50 alert patients within the first day of hospitalization. They spoke English, had no cognitive impairment and knew what medications they were taking at home. In the hospital, they had been prescribed an average of 11 medicines. When asked to complete a list of these in-hospital drugs, only 2 of the 50 could name every one. On average, patients did not know at least half of the drugs they were taking.
Older patients were even more vulnerable. When queried, they left out 88 percent of their hospital medications.
These results should not be attributed to indifference or stupidity on the part of the patients. The investigators discovered that “the majority desired a more active role in learning about their hospital medications and believed that their involvement might prevent hospital medication errors from occurring.”
Hospital procedures are designed to maximize efficiency for staff. Taking time to educate patients about what pills they are expected to swallow or which medicines are being injected may be seen as unproductive.
If a patient or family member questions a medication, it may seem to nurses or physicians as a challenge to their authority. And some people may fear being labeled a “bad patient” and punished if they ask too many questions.
As important as it is to know about benefits and risks of drugs when you are an outpatient, it is even more critical to know about your medications when you are hospitalized. To assist in gathering this important information, we offer our free Drug Safety Questionnaire.
For patients to participate as partners in making the hospital a safer place, they must be well informed. The staff may find that improving patient safety through education is worth every extra minute spent.

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  1. Raymond
    Reply

    In October 2009, I underwent major spinal surgery. I was given a combination of pain meds as I have an unusually high threshold of pain. When I left the hospital, I had prescriptions for hydromorphone, darvocet, and hydrocodone. I took these for about a week.
    Then one evening, I was in the kitchen feeding my terriers and my legs suddenly gave away on me. I tried in vain to pull myself up with my arms, but to no avail. The nearest telephone was in the living room, about 15 yards away. I started trying to crawl but kept passing out. I thought I was having a stroke. I was on a hardwood floor for some 3-4 hours before I finally could reach the cord for the phone and pull it off the table. By now it was roughly 1 a.m. in the morning. I called the rescue squad immediately and described what had happened. They came, determined I was not having a stroke or heart attack and took me to the EM of my hospital.
    After 2 days in the hospital and many tests, it was concluded that the combination of strong pain meds had caused me to have a seizure and collapse. I was told that had I been on that hard wood floor much longer that I would have suffered severe kidney and muscle damage and that I was fortunate. Intravenous drips and hospital rest plus a correction of meds saved me. I can only warn all of your listeners/readers of this danger and to be extremely careful about meds. The doctor is not always right. Sincerely, Ray W

  2. Liz
    Reply

    In my recent hospitalizations I found that hospital pharmacies do not stock every med. If they don’t have one of your usual meds on hand, they might bring you another med used to treat the same condition. They may or may not check to see if the new drug is contraindicated for your situation, and they probably won’t tell you the difference unless you ask.
    If you live in or near a large city, you have a choice of several hospitals. If you ask the medical professionals you know, they’ll tell you which are better.
    In a hospital, the quality of care depends mostly on the nursing staff. Nurses are among the most dedicated, hard-working people in the world. But some of them are more competent than others. And some nursing supervisors will tolerate more mistakes in their staff than others. A nursing error can literally mean life or death for a patient.
    Another problem area is the way doctors communicate their instructions to the nursing staff. Doctors are often in such a rush that their instructions are garbled. This can result in serious errors. It’s possible that this is the cause of some “nursing errors”.

  3. Dolores
    Reply

    It’s not only in the hospital that you must be diligent. You must also be on your toes in a nursing home. Recently when I was in the hospital and a nursing home for hip replacement surgery, I routinely had to give a list of medications that I took at home. That is what I was to be given in the hospital and nursing home in addition to anything else the doctors ordered. I had to always check and look at what I was taking, ask what it was, and what it was for when I saw something that looked different.
    Both places might use different suppliers so the medications might look different. And, of course, since everything is generic you really have to be on your toes. With injections you can’t tell. But I had an experience that if I hadn’t been awake for a procedure and heard the doctor talking and questioning an injection before checking with the hospital pharmacy as to why it wasn’t what he ordered, I wouldn’t have known it. So, I never want to be knocked out if at all possible so that I can hear and see what is going on. Otherwise you are just at the mercy of whoever and/or whatever.

  4. PP
    Reply

    There is another problem with hospital-administered medications: you don’t get to read the warnings, contraindications, etc. One friend had the course of rabies shots, which of course can only be administered in a hospital setting. No one told her of possible reactions, and a few days later she was VERY sick with flu-like symptoms.
    After recovery from this episode she lost most of her strength and was continually in a weakened condition. After several doctor appointments, it was determined that she had a not-infrequent reaction to the rabies shot which severely damages the nerves, not unlike muscular dystrophy. If she had had the paper which we all get with our pharmacy prescriptions she would have been able to read about what was happening and been treated for the reaction. As it is she has a permanent disability! Yes hospitals are dangerous places.
    If given medications in the hospital, not only ask for the name and dosage, but also the medical alerts!

  5. mer
    Reply

    Invaluable, as usual, from People’s Pharmacy! Thank you.

  6. dwd
    Reply

    Computers seem to be helping hospitals, at least in continuity of meds when one transfers from one area to another in the hospital. Over 10 years ago, my father had his second knee replacement operation. From our experience with the first knee we knew he could not tolerate morphine, that anesthesia slowed down his system and caused congestive heart failure. Knowing this kept him out of ICU for the second knee, but he still landed in CCU for a couple days. So he went from one night in hospital room after surgery, transfer to rehab, transfer to ccu, transfer back to rehab.
    Everything was on paper and all if it did not transfer with him each time. He ended back up with morphine as being ok. I hate to say I made a nurse cry. I later apologized for my manners, but told her that her feelings were secondary to my dad’s health. I also cornered his surgeon and cardiologist. Both tried to say it was a hospital problem. I told them that if they were there treating him, then it was their problem as well. They got quiet after that.
    I wished I had also complained directly to hospital administrators, but I settled for sounding off in all 5 of the patient surveys he got. He had 5 because each area of the hospital saw him as a new patient, not a patient transferred to 5 areas of the same hospital.
    I have had two stays in the hospital in the past 18 months for atrial fibrillation. I did not find any drug mistakes by the hospital, but I did have one instance where I was being put on Tikosyn, and I had to point out to them that my normal HZTZ was not compatible with it. They had it on the list, but over looked that fact, but switched me to lasix when I pointed this out.
    I found it difficult to keep track of my meds in the hospital, and I am quite active in what pill I am being given. If I have spend more time in the hospital I think I will take a small notebook, have it list my meds I was on before I entered, then the modifided list in the hospital, and log my meds during the day. That way my wife or kids could double check when they visit.

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