Dr. Carl Osborne discusses how adverse events are often caused by miscommunication.
The good news is that many diseases can be controlled or eliminated by various types of medications. The bad news is that these same drugs may induce harmful—and even fatal—adverse events because of miscommunication between clients and veterinarians or the veterinary staff.
Virtually all of us involved with providing care for sick animals are aware of the risks and benefits associated with medications. A cursory evaluation of the inserts that accompany packages of prescription drugs is a constant reminder of this fact.
We also see the constant barrage of television commercials that show happy men and women while at the same time warning us about the potential adverse events associated with a wide range of drugs used to treat everything from women with urge incontinence and osteoporosis to men with erectile dysfunction, benign prostatic hyperplasia and chronic obstructive pulmonary disease.
What can we do to minimize medical mistakes associated with morbidity and mortality? One important concept is client education. In order to be effective, clients must be able to give:
1) the right drugs to,
2) the right patient,
3) at the right times,
4) in the right amounts,
5) in the right dosage forms,
6) by the right route of administration,
7) for the right duration of time,
8) with knowledge of the right responses and
9) knowledge of the right action to take if adverse reactions occur.
When appropriate, they must also
10) return to the hospital for re-evaluation on the right date.
To help clients achieve this, I strongly recommend that you provide them with the following list of medication do's and don'ts.
√ Know the generic and brand name of the drug and why it is being given.
√ Understand the type and timing of the response to therapy (desired effect) that is expected.
√ Be sure you clearly understand all instructions before starting to administer the drug, including exactly how to give it, how much to give, when to give it and whether it should be given before, during or after meals. Also have a clear understanding of how long to give the medication and what to do if problems occur.
√ Become familiar with the recommended techniques of how to effectively administer the medication. Also, carefully observe your pet to be sure that the medication was properly swallowed. If you are planning to give oral medication disguised in food, ask your veterinarian what foods or liquids are compatible with the medication and what is the likelihood that a food aversion will develop.
√ Keep a written record of the dates and times you give medications.
√ Know what to do if you forget or are unable to give the drug at the prescribed (daily, weekly, monthly, etc.) interval.
√ Understand important side effects (undesired effects) that may be associated with the drug, their likely frequency of occurrence and what to do if they occur. Before you leave the hospital, obtain a list of side effects that should immediately be reported to the doctor.
√ Ask your doctor about drug interactions if multiple medications are being given. Pharmacists often provide computer-generated instructions about drug interactions when medications are purchased by clients from pharmacies, but this information often is provided in the context of treating people. The information may not apply to different species of animals.
√ Call your doctor if the signs of the disease unexpectedly persist during therapy, especially if they become unexpectedly worse.
√ Give liquid medications via the cup or other measuring device dispensed with that medication. Errors in dosing can occur if you use a different device since the size and markings of different containers (including droppers, teaspoons, tablespoons) may not be standardized.
√ Keep the medication in its original container; don't transfer the drug to another container.
√ Know where and how to store the medication (heat, humidity and light can affect the potency and safety of drugs). If the medication is to be stored in the kitchen, store it away from the sink, stove or any heat-releasing appliances.
√ Keep medications for pets separate from those intended for people.
√ Be alert to changes in the appearance of medications when prescriptions are refilled. Contact your veterinarian or pharmacist if you notice unexpected changes.
× Mix different pills in the same container.
× Crush or break any capsules or tablets unless instructed by your doctor or pharmacist to do so. If you are instructed to split tablets, ask your doctor about the availability of commercially manufactured precision pill-splitters, which are available from most pharmacies.
× Leave the cotton plug in a medication vial because the cotton may draw moisture into the container.
× Give more or less than the prescribed amount of the drug without first consulting with your doctor.
× Suddenly stop giving the drug because the clinical signs have disappeared without first checking with your doctor.
× Wait until the medication needed for long-term care is completely depleted before requesting that the prescription be refilled.
× Give the patient medication beyond the expiration date listed on the accompanying label. Take an inventory of items in your medicine cabinet at least yearly, and discard all medications that are expired.
× Give the patient medications used to treat previous illnesses without first checking with your doctor.
× Give prescription or over-the-counter medication designed for people to your pet without a clear recommendation from your veterinarian that such medication is safe and likely to be of benefit.
Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.