“Guilty Until Proven Innocent” — Why We Should Start Asking More Questions About the Medications We Take

It’s time to grill your pills.

Grill, as in ask some hard questions about your medications. The answers could improve your life, save your life and at the least, save you money.

Begin by lining up your medications, read the labels and ask yourself…

  • Do I know what this pill does inside my body?
  • Is it helping me?
  • Have I noticed any new symptoms since taking this pill?
  • How is it interacting with my other medications?
  • How old is the prescription?
  • Does my entire medical team know I’m taking this and have the full list of my current meds?
  • Do I still need this medication?

Is Your Pill Guilty of Causing a New Symptom?

We all know that medications can be lifesaving but very often fewer meds mean less risk of hospitalization and improved quality of life.

“We want you to take fewer medications which may seem like the last thing you hear from a pharmacist,” laughs Terri Fagan, board member of the American Society of Consultant Pharmacists and senior care pharmacist. “But it’s true. Our society has got to stop running to a pill every time we have an ache or pain. If we experience a new symptom, think of the pills you’re taking as ‘guilty until proven innocent.’ Make sure the symptom is not a side effect of a medication before adding a new pill. Know what you’re taking, how it interacts with other medications and whether you even need that med.”

Terri is also the director of clinical services for Consonus Pharmacy, sister company to Marquis. She coordinates all clinical programming, transition care and clinical reviews with her team of pharmacists in six states and is an expert on safe medication management.

She’s going to share some easy tips that will make you an expert too, but first, let’s quickly see why medication mismanagement is taking so many lives.

  • According to the National Institutes of Health, nearly 10 thousand people die every year in the US, as a result of a medication error. Hundreds of thousands of other people experience but don’t report adverse reaction to their medications.
  • Adverse drug events (ADEs) cause about 1.3 million emergency room visits and 350,000 hospitalizations each year.
  • Errors also lead to increased hospitalizations, poor mental and physical health, disabilities and birth defects.
  • The cost of caring for these individuals exceeds $40 billion each year.
  • 82% of Americans take at least one medication. 29% take five or more.
  • More than 40% of ambulatory ADEs may be preventable.

Q: Terri, you say consumers need to understand a phrase pharmacists use, the “prescribing cascade.” It really paints a picture of how fast medications can pile up and harm us. Can you describe this cascade?
A: Certainly! Imagine the prescribing cascade this way: Let’s say you start on a high blood pressure medication that has a side effect like edema. Your ankles start swelling, so the doctor puts you on a Lasix drug and as a result you experience urinary incontinence. You’re then given a medication that decreases the incontinence but leads to dry mouth, constipation and confusion. Before you know it, you’re taking a dementia drug that decreases your appetite. And so goes the cascade of prescriptions.
Instead of running to another pill, we all need to pause and take a step back and review whether our medications are helping or harming us.

Q: Is it true that even some “harmless” foods can interact with certain drugs?
A: A perfect example of that is for some people it can be lethal to drink grapefruit juice if they also take calcium channel blockers used to treat coronary heart disease and high blood pressure. Grapefruit juice can raise the level of the medicine in the blood.

Q: Before we get to your consumer tips, what are some pharmacies, like Consonus Pharmacy doing to make sure their patients are managing their medications?
A: Speaking for Consonus Pharmacy, we’re hyper focused on this subject. For instance, we’re partnering with the American Medical Directors Association to deprescribe medications –– and yes, deprescribe is actually a word.

Our goal is to reduce the number of prescriptions by 25%!

We do that through a team approach, scrutinizing the medication plan for each patient in our long term care facilities.

We’ve also identified the medications that are often overprescribed or are given in the hospital, but no longer need to be taken when the patient is discharged. We have the tools and expertise to help patients slowly taper off or quickly discontinue use of these drugs.

Our program is giving structure and awareness to deprescribing and the importance of working as a team on behalf of each of our patients. And we’re formalizing and tracking with data so we can keep improving our patients’ results.

Q: How important is a medical review of drugs and how often should this be done?
A: In Marquis facilities, thorough medication reviews are done at the time a patient is admitted, when there’s a change in the patient’s condition and at least once a month. More frequent reviews may be done for those on high-risk medications or with chronic conditions like congestive heart failure. These are conditions that can result in hospitalization if medications are not managed well. Before any new medication is prescribed, we pause and review the existing medications. Depending on the condition, we try to use non-pharmaceutical solutions like heating packs, ice packs even something as simple as elevating the patient’s legs.

Again, we appreciate what medications can do, but when we see an opportunity to eliminate them, we know we’re giving that patient a better chance of staying out of the hospital and that improves quality of life.

This all takes an intentional, collaborative approach. We involve the patient’s whole team –– nurse, social services, therapy, pharmacist, nurse practitioner and physician.

We also have on-demand medication regiment reviews. So, if a patient has a change in condition, the nursing staff can request a review with the pharmacist to make sure the change isn’t due to a medication.

Q: Thanks Terri! Let’s get to those consumer tips on how to safely take – or stop taking –some prescribed medications.
A: Let’s do it! First…

  1. Reconcile your medication list. When I think about medication safety, I know that one of the riskiest times is transition of care. For instance, when you leave the hospital or a skilled nursing facility to return home, get together with your pharmacist or doctor and review all the medications you’re taking. Even a slight addition or change can cause problems.
  2. Know if you’re on a high risk medication. Again, here is where the slightest change can have a huge impact on safety. Here are four examples of high risk categories of medications: diabetes/hypoglycemics; blood thinners like warfarin; opioids like morphine or oxycodone; and meds for hypertension or high blood pressure. Here’s a situation we often see: Let’s say you go into the hospital and the medication you take at home isn’t in that hospital’s formulary –– in other words, it isn’t stocked by the hospital. The hospital will give you the version they stock. That switch in medication needs to be noted, especially upon discharge so you aren’t taking the hospitals version and your version when you get back home.
  3. Constantly monitor and ask questions. If you’re doubting the effectiveness of a medication or if you’re experiencing a new symptom, be bold. Call your doctor or pharmacist (remember, retail pharmacists are free). Ask if you can discontinue the medication or if there’s a non-pharmaceutical solution. Remember our phrase, “guilty until proven innocent.”
  4. Find your resources. My go-to is the American Society of Consultant Pharmacists’ Help With My Meds. Patients, caregivers and families will find excellent resources online, printable fact sheets, a video library and more. You can also connect with senior care board certified pharmacists and ask questions. We see through a different lens and know how these drugs affect seniors. It’s like going to a cardiologist rather than a general practitioner if you’re having heart problems. For families who want to monitor a loved one’s medications but live at a distance, there are many great high tech tools. You can check out this Marquis blog for more.
  5. Establish a system. Basically, this is how you’re going to take your medications. I recommend keeping it basic, which I recently did for my mother-in-law. Create a current medication list then line up all your meds. Start by going through each medication on that list. Familiarize yourself with what it is, why you take it, when you take it and the dose. Keep your medications in the original bottle until you place the daily or weekly dose in a pill box. As far as remembering if you took the pill that day, I know this sounds silly, but I use the “Silly Pat” system. Associate something silly with taking your medications. Take the pill then pat your head and rub your tummy, as an example. Make your Silly Pat something different every day. You may feel ridiculous but believe me, it works!

We hope you’ll visit our Marquis blog page for other ideas on how to live a vital senior life. We’ll see you next time for more tips!