Avoiding common medication mistakes

Podcast transcript

INTRO
Welcome to Docs in a Pod, presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Tamika Perry and award winning veteran broadcaster Ron Aaron will share information to improve your health and well-being. And now here are Ron Aaron and Dr. Tamika Perry.

RON AARON
Hello everybody, and welcome to the award winning Docs in a Pod. I'm Ron Aaron and IÕm delighted to have you with us. We come to you every week with a look at a variety of health and welfare issues as they affect folks of almost any age, but predominately those who are 65 and older. Our co-host, Dr. Tamika Perry is with us and as always, we are delighted to have her here. Dr. Perry is associate medical director for WellMed and works to support the providers at a number of WellMed clinics, where they deliver quality care and compassionate patient experience. She's been with WellMed for more than 10 years, and Dr. Perry earned her undergraduate degree from Prairie View A&M University, then went on to graduate from Philadelphia College of Osteopathic Medicine, where she was a National Health Service Corps Scholar. Next, she completed her family medicine residency at Methodist Charlton Medical Center, and she served as chief resident there. Dr. Perry is board certified by the American Osteopathic Board of Family Physicians. She also earned a master's in public health, with an emphasis on health management and policy from the University of North Texas Health Science Center. And there's more. Dr. Perry is a diplomat of the American Board of Obesity Medicine. When she is not playing doctor, she loves to travel. Dr. Perry, good to see you. Thanks for being here.

DR. TAMIKA PERRY
Hey, Ron. Thanks for having me, as always. I love it here. Your check is in the mail. Thank you for that introduction. It was fabulous. But I'm even more excited to hear what today's guest has to say.

RON AARON
Well, this is a great topic, and it's one that I know as a physician, you worry about this all the time. We're talking about common medication mistakes and how to avoid them. Our special guest is LaWanda Crawford. She's a nurse practitioner. She grew up in North Carolina, and Miss Crawford comes from a family of health care providers. They inspired her to pursue a career as a nurse practitioner. She chose family practice because of her passion for helping people achieve overall wellness. In her practice, Miss Crawford seeks to build strong connections and engagement with her patients and her loved ones. You can find her at WellMed at Desoto in DeSoto, Texas. Nice to see you, LaWanda. Thanks for joining us on Docs in a Pod.

LAWANDA CRAWFORD, NP
Thank you for having me. I'm so excited to be here today. Hopefully I'll be able to share some knowledge, and everyone is able to get a little insight on how to avoid common medication mistakes. So, thank you for having me here.

RON AARON
Well, when you say medication mistakes, there are mistakes in terms of perhaps the wrong medication filled at the pharmacy. There are mistakes involved in maybe the wrong medication to treat a patient. All kinds of potentials. How do you, as a practitioner, avoid those mistakes?

LAWANDA CRAWFORD, NP
One, when we have patients come in for their appointments, we ask them to bring all their medication bottles with them. And from that point, we're able to check off their medication bottles that they have on hand alongside with the medications that we have in our system for them. So, once we do a check and balance there, if there are still some discrepancies at that point, we're able to contact the pharmacy to see what they have listed as their daily medication regimen as well. One of the problems also with that is that we want to control polypharmacy. Our patients getting several different medications from different pharmacies. So, if we can some kind of way get everything going from one pharmacy, I think that would give us our overall goal in trying to avoid these mistakes.

RON AARON
Now, how do you get your patients to bring in their meds? I happen to be a WellMed patient in San Antonio, and speaking for a friend, while I don't take dozens and dozens of medications, for sure a lot more than I used to take when I was 20. And it's a pain in the butt to drag them in. So, I bring a list, and I hand that list over, and they take my word for it.

LAWANDA CRAWFORD, NP
A list will work at times, but at some point, throughout us seeing you within the year, we would just love to see the bottles. That way we're able to look to see if there's any expiration dates on the medication bottles. We're able to see if there are one but more than one bottle of the same medication. That could also sometimes cause an error. So, often if patients are able to, and if we know that they're alert and orientated times three knowing their person, place and time, we can take their word. But if it's somebody that we think that may be slightly demented or have some kind of memory loss, we would want to see those medication bottles at least once.

RON AARON
I know there's also an issue involved in what's called health literacy. There was a case in San Antonio a few years ago where a family that spoke really only Spanish were prescribed medication for their child, which said once a day they read that as unce, which would be multiple times a day. And they gave it to their child and the child died.

LAWANDA CRAWFORD, NP
Yeah. That's an unfortunate situation, and that's why I think that it's important to be clear about the medication that you're taking, the dose that you're taking and the frequency that you're taking it. So, that's the way a communication.

DR. TAMIKA PERRY
What helps us a lot now is the EMRÕs that we use.

RON AARON
WhatÕs an EMR?

DR. TAMIKA PERRY
Electronic medical records. We can print our discharge summary in Spanish or other languages, whatever's embedded into your EMR, as well as at the level of the pharmacy. They can actually print labels in Spanish or LaWanda and I can type on the label Òplease print in Spanish.Ó The page you can always request Espa–ol. And they can have labels or whatever language you're speaking to try to avoid those errors. That's why it's important for not only the physician, but also the pharmacy to be culturally in tune with your population.

RON AARON
Stay with us for just a minute. I'm going to let folks know who may have just joined us, you're listening to the award winning Docs in a Pod. We come to you every week with a look at a variety of health and wellness issues involving folks. We're delighted to have Dr. Tamika Perry, our co-host, and we're thrilled to have nurse practitioner LaWanda Crawford with us as well. I'm Ron Aaron, and we're talking about how to avoid common medical mistakes. That word ÒcommonÓ is scary. LaWanda, are some of these mistakes common?

LAWANDA CRAWFORD, NP
Yes, they are. They can be common, especially when you have different medications that sound alike. So, that can sometimes be confusing for patients or if they're taking multiple medications and don't have the education or have not been educated on exactly what each medication does and why they're taking it.

DR. TAMIKA PERRY
That sounded like medicine was really a bad situation, especially when we relied on calling in medicines or, allegedly, doctors and nurse practitioners don't have the best handwriting. So, the pharmacist was relied upon to read a prescription. There's a big difference between Klonopin and Clonidine. One is anxiety and one is blood pressure. They get confused a lot, especially if you're trying to call it in or even if you're on a prescription and you write ÒCllclin.Ó Are you trying to write Clonidine or are you trying to write Clindamycin? So, EMR has eliminated some of that error. In fact, Medicare says if you don't send in your medicines electronically, I'm going to take back some of your payment I give you for your patient, so your rate isn't as high. So, we're incentivized to do that. However, EMR you have to really careful with, too, because it'll have a bunch of preprinted instructions for one med that doesn't fit every patient. So, you're typing quickly. You got to make sure the instructions for that med are intended for that patient.

LAWANDA CRAWFORD, NP
Correct. That's also why at the end of each visit we give them that printed summary of their visit that has their diagnosis as well as each of their medications and how to take them. So, I think that's been a plus because then they have that information to take home with them. If they did not have their medication bottles with them, they're able to take that summary home with them and go over their medication list that way at home to ensure that they're taking the right medication.

RON AARON
Do they read that?

LAWANDA CRAWFORD, NP
We encourage it.

DR. TAMIKA PERRY
We encourage it. Shout-out to my MAÕs because they will highlight and circle and say, Dr. Perry wants you to do this like this. So, if we have two drugs on there that sound alike, we're going to put this one is for anxiety and this is how you take this one. This one is for blood pressure and is how you take this one. They sound alike, but they are not the same drugs. So, we were very intentional on those talking points.

RON AARON
That would be very helpful.

LAWANDA CRAWFORD, NP
Yes. At times, I've gotten the bottles and I've actually written on the bottles. So, when they go home, they have an understanding on what that medication is for.

DR. TAMIKA PERRY
Ron, you mentioned earlier having your drug list and bringing it in. Now we're relied upon you to update that drug list, or at least when you come in, allow us to give you a list that's updated because we have that capability to give you a list of meds that you're supposed to be taking. But I also encourage my patients to write on their two other columns: what it's for and who prescribed it.

LAWANDA CRAWFORD, NP
Yes.

RON AARON
That's a good point. Do you get a printout from the pharmacies that fill these prescriptions, so you know the patients actually filling it?

DR. TAMIKA PERRY
Yes, we can. There are several ways we can do that. One, the pharmacy doesnÕt voluntarily send us a printout every time a patient gets a medicine filled. But I can call and ask for all the medicines that were filled there by my patient, so I can get that from the pharmacy. But once again, going back to technology, there are medication logs that I can follow in my electronic medication record to see if it was actually filled at the pharmacy. I can look at history to see if other drugs were filled by other providers, so it gives me a clue. I've actually caught some patients at times like it says here that you just had this medication filled, but I've been giving you a different medication. Then theyÕll say, sometimes if I can't get in to you, I go to my nurse practitioner up the street. I'm like, no, no, you can't have two of us because this is how this is how harm starts. Pick the best one of us. My feelings arenÕt going to hurt, but you pick somebody.

RON AARON
LaWanda mentioned the challenge with poly pharmacies. Folks addicted to opioids often will shop from store to store to store to try to get a prescription filled. That's tougher to do now with electronic reporting, isn't it?

LAWANDA CRAWFORD, NP
Yes, it is. We do have that capability of just clicking a button in our electronic medical record to see how often this patient had this opiate or any kind of controlled medication filled. Who actually wrote the prescription, how many refills they had and where they got the medication filled. So, we are able to track that information.

RON AARON
So, big brother's watching.

LAWANDA CRAWFORD, NP
Big brotherÕs watching. Yeah. And it's in real time.

RON AARON
We're talking with LaWanda Crawford, a nurse practitioner. You find her at WellMed at DeSoto in DeSoto, Texas. Our co-host, Dr. Tamika Perry is with us as well. I'm Ron Aaron. You're listening to the award winning Docs in a Pod.

AD
WellMed and you can rely on WellMed and Optum doctors to care for and understand the health needs of older adults. Our commitment to quality is why the Institute of Health Care Improvement recently designated WellMed and Optum as an Age-Friendly Health System. This means WellMed and Optum care teams provide reliable, evidence based, high quality care to older adults. To get the benefits of an Age-Friendly care team, go to WellMedHealthcare.com to find a doctor near you.

RON AARON
We are so pleased you're sticking with us right here on the award winning Docs in a Pod. Our podcast is available wherever you get your podcasts. We're also on the radio in several markets in Texas and Florida as well. I'm Ron Aaron and our special guest today, LaWanda Crawford, is a nurse practitioner at WellMed at DeSoto in DeSoto, Texas. Dr. Tamika Perry, who is our co-host for Docs in a Pod. LaWanda, we've been talking about what you as a prescriber on one hand and a pharmacy on the other can do. What about patients like me at home? How can we avoid problems organizing our meds? I'll give you an example, and this shows you how stupid even smart people can be. Several years ago, we were going on a trip, and I said, I don't need all these stupid bottles. So, I got a Ziploc bag, and I counted out the medications I take. I put all those pills in one bag thinking I knew which was which, right? No, I did not. When I got to where we were going, I realized that was not a smart thing to do.

LAWANDA CRAWFORD, NP
Yes, please don't do that. I know often, when you're home, our patients do use the pill organizers, and those can be very helpful, especially if you're wanting to make sure that you're taking the medication on time and that you're not missing any doses. For those that are filling those organizers, I would just say when you're doing it, you have to take your time. You have to avoid any distractions that are around you to make sure that you're not putting two pills in one slot. So, definitely avoid your distractions. Then make sure that you are double checking the meds looking at their labels. If it says once a day or twice a day, make sure you're following those directions. I know it's hard when you're traveling to keep up with all of those bottles. If you're traveling, it's good to often use those pill organizers, just to make sure that you're taking your medications as prescribed.

DR. TAMIKA PERRY
Some of those pill organizers can get really, really savvy. I had a patient who was with, unfortunately, moderate dementia. Her daughter had ordered her a really savvy electronic one off Amazon in which you could fill for 30, 60 or 90 days. It would send the email to whoever when the pills were getting low for refills. It was almost like a lazy Susan that would rotate around. It dropped a Dixie cup and dropped all the pills that were for that period of time. So, it allowed two things. One, to keep the medicines organized, and two, I reiterated to the patient who was like, no, I have been taken my pills. No, ma'am, because you have a bunch of pills in your Dixie cup here or another Dixie cup has come down. So, we haven't been taking them. So, they serve a lot of really good purposes.

RON AARON
Now, where can you find those kinds of organizers? You mentioned Amazon.

DR. TAMIKA PERRY
Yeah. Amazon. A lot of Medicare Advantage plans have over the counter books in which the insurance comes with monetary benefit. So, I would actually even look in there to see if one of those type organizers is in there and you can use your insurance's monetary benefit.

RON AARON
If you can't organize the pills yourself, you can get someone to help you.

DR. TAMIKA PERRY
Most certainly. Someone that you absolutely trust. Now, you mentioned earlier, Ron, let me give you a resource that might have helped you when you were on your trip, because I can only imagine what the Mrs. was saying. Gina is my favorite. Like, I love her.

RON AARON
Gina being my wife.

DR. TAMIKA PERRY
Yes.

RON AARON
I didnÕt tell her.

DR. TAMIKA PERRY
Oh, my goodness. IÕm going to call her as soon as she listens. If you just go and Google pill identifier, the first link that's going to come up is from a website called drugs.com, and it's a pill identifier wizard. And literally, you look at your pill, and you say, is it white? Is it beige? Is it gray? Is it oblong? What's the number that's imprinted on it? Even if you just put the number that's imprinted on, if the pill says M34, it is going to give you a list of every pill that has M34 on it, and you match it up to your pill, and that's likely what you have. A lot of my friends, when we had kids that were still in school and in our homes, and then they would find random pills and be like, what is this? I'm like, I don't know. Contrary to popular belief, patients bring pills into me and LaWanda and they will say, what is this little pink pill? MaÕam I have no idea.

LAWANDA CRAWFORD, NP
Exactly. I have no idea.

DR. TAMIKA PERRY
There are millions of them. But that database will tell you what that pill is, what's the milligram and who produced it.

RON AARON
Give me that database again.

DR. TAMIKA PERRY
It's drugs.com, but within drugs.com, they have what's called a pill identifier. The easiest way to find it is Google pill identifier and the very first link will be the one that you want.

RON AARON
Perfect.

LAWANDA CRAWFORD, NP
I would say also just to kind of piggyback off of that is to always ask questions. If you don't know or if you think that you're kind of second guessing, you can always call your PCP, you could call the pharmacy. Always ask questions. Get a family member to double check you as well. That's the biggest thing. Don't just take something just thinking you're taking the right thing. No question is a dumb question, especially when it's dealing with medication.

DR. TAMIKA PERRY
No question is ever, ever a dumb question. Piggybacking off what LaWanda said, if you are unsure, like last month, your metformin was pink and oblong and this month itÕs white and square, don't just stop taking your medicine. Call the pharmacy and ask or get on a website like drugs.com to see maybe there is a different manufacturer that makes that same milligram of metformin white and square instead of pink and oblong. Your pharmacy is going to purchase from whatever generic provider is cheapest for them. So, last month it might have been generic provider A. This month is generic provider B.

RON AARON
I've seen on some of my medications a note that says this pill is a different size and color than last month.

DR. TAMIKA PERRY
Yes. That's when they just got it from a different provider.

RON AARON
So you wonÕt freak out.

DR. TAMIKA PERRY
Right. You won't think you've got the wrong pill or that you could be a very lifesaving therapy that you just all of a sudden stopped because the pill looks different.

RON AARON
LaWanda, speaking of common mistakes, this is related to it. I know at some of the senior centers in San Antonio and Florida and Dallas and across the country, folks who sit and talk and they'll be complaining about this ache in this pain. And the person will say, well, hey, here's what I take. It really works. Let me give you a couple and you should try it.

LAWANDA CRAWFORD, NP
No, sir.

RON AARON
ItÕs very common.

LAWANDA CRAWFORD, NP
It is something common, especially also when you're dealing with family members and let's say they think they have similar symptoms. I have seen that happen. I would say no, not to do that. If you have new symptoms or new aches and pains that's going on, I would say that's the time to make an appointment with your physician so you can get that checked out.

RON AARON
When you take another medication, obviously, Dr. Perry, it doesn't take into account other meds you may be taking and might conflict with that.

DR. TAMIKA PERRY
I mean, the NSAIDs work great for musculoskeletal pain. So, your friend who's 65 may be able to tolerate 800 milligram ibuprofen for a week. But you give it to the 85-year-old who has decreased renal function in addition to acid reflux, now you've caused an ulcer and acute kidney injury in that person.

LAWANDA CRAWFORD, NP
Yes.

DR. TAMIKA PERRY
Ibuprofen is technically something you can get over the counter. So, you cannot take everybody's medicine because everybody's body is different. I don't have what is going on with LaWanda, which is probably nothing, but you know what I mean.

RON AARON
She looks really healthy, Tamika.

DR. TAMIKA PERRY
I know she is. SheÕs in her office doing sit-ups while I'm eating a Snickers for lunch. But everybody is different. We absolutely, positively have to keep that in mind.

RON AARON
Let's come back to something you said before about asking questions. One of the things as patients, and that's what happened to me. You go to the provider, you sit, you talk, you leave. As you leave and get into your car, you say, oh gosh, I needed to ask about this, that and the other thing. Make a list before you go in.

LAWANDA CRAWFORD, NP
Yes. I encourage that. Now with technology, they can put it on their phones. They can write it down. If you have a family member that needs to come with you to make sure that your questions are being asked, I definitely agree with that. If they need time to think in and me sitting right there in front of them, they're not able to think, I may leave out the room and go do something real quick to kind of give them a little bit more time to get their thoughts together. So, I always try to take that into consideration.

DR. TAMIKA PERRY
Not to toot WellMedÕs horn, I'm just going to toot toot a little bit because we see mainly a WellMed population. We only see 12 to 16 patients a day, as opposed to seeing 24 or 25 patients a day. So, with the senior population, that allows us more time to talk. More time to get questions answered. You don't feel as rushed. More time to discuss things in that appointment that is vital to your health like, how are your grandkids? How are your children? That is vital to your health. In addition, tell them that there's a difference between Klonopin and Clonidine, and here are the differences.

LAWANDA CRAWFORD, NP
Yes. Something else, just going off of medication safety that I just wanted to point out is that when you're at home, you need to store your medications like they say. If it's an insulin and it says you need to store it in the refrigerator, make sure that it's being stored in the refrigerator and not sitting out on your dresser or in the bathroom for 30 days. Just make sure that we're storing everything the way that it is supposed to be stored and making sure that we're keeping all medications out of the reach of children and pets.

RON AARON
Now, you mentioned the bathroom, and I've read that it really isn't good to keep your medication in a bathroom because of the heat and humidity.

LAWANDA CRAWFORD. NP
Yeah, you have to stay away from heat, moisture, sometimes lighting. So, all of those warnings are placed on your bottles and as well as now when you get your medications from the pharmacy, you have some time set aside. I'm not going to say those minutes exactly, but the pharmacist will often ask you if you have questions about your medications. So, at that point, they can go over some of those safety issues at home as well.

RON AARON
Well, we are flat out of time. I appreciate you being here, LaWanda Crawford. You find her at WellMed at DeSoto in DeSoto, Texas. When I was a kid, that used to be automobiles called DeSotoÕs.

LAWANDA CRAWFORD, NP
That way before my time.

RON AARON
I think everything's before your time. Dr. Tamika Perry, thank you. IÕm Ron Aaron. Thank you so much for joining us on the award winning Docs in a Pod.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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