ED patients may be overdosing on meds

Alert them to risks

If a patient reports taking antibiotics during your medication reconciliation, you may learn these were prescribed for a urinary tract infection or dental work months earlier. "For whatever reason, they didn't take the antibiotics as prescribed, and now they will take a pill whenever they have a sore throat," says Kimberly Barker, BS, RN, CEN, an ED supervisor at St. David's South Austin (TX) Medical Center.

In this case, she says to inform the patient why this approach is harmful. "Explain that taking one [Zithromax] is not going to kill off a bladder infection. It could make it change into a more resistant bacteria and lead to a more damaging infection," Barker says. Here are other scenarios:

Patients may be taking "as-needed" medications on a daily basis.

A patient may take a nitroglycerin pill every morning because he or she thinks it will prevent chest pain, instead of only when he or she is experiencing chest pain, for example. "In this case, the patient may end up in a situation where their blood pressure suddenly drops," warns Barker. Patients may be doing something that they wouldn't be doing if they actually had chest pain, such as driving, she adds, which can lead to injuries.

Similarly, asthmatics may take rescue inhalers every day instead of only when they are short of breath. "People may get confused and decide to take pills that are supposed to prevent an exacerbation, without realizing that it doesn't work instantly," she adds.

Patients may be taking too much of a prescribed medication.

Did your patient tell you he or she takes three pills of acetaminophen and hydrocodone every two hours, when the prescription indicates one should be taken every four hours? "Make them aware of the dangers of doing that," says Barker. "Inform them that medication should be taken only as prescribed."

A patient may be seeing multiple different doctors and is receiving pain medications from both.

In this case, says Barker, "our physician needs to contact the other physicians, so that everyone is on the same page and the patient is not getting overmedicated."

The patient may have already taken medications at home that are also given in the ED.

If your ED patient reports having taken no medications, listen closely to his or her health history. "Many times I will ask, 'Are you taking any medications on a daily basis?' and the patient says no," says Barker.

The patient may then report congestive heart failure, diabetes, or asthma, in which case, Barker asks, "How are you treating this?" In some cases, patients may be getting infusions or injections of medicine, or wear transdermal patches, and may not think of this as "taking" medications, says Barker.

If you ask, "How are you treating this?" the patient may then give you a list of medications. "You have to ask direct questions," says Barker. "You may need to ask the same question in a variety of ways."

The ED physician may prescribe the patient medication they've already taken at home.

For instance, if a beta-blocker is prescribed and you know the patient is already taking this medication, ask the ED physician if he or she really intended for the patient to take both medications, Barker says.

Never give medications to lower the blood pressure of a patient in a hypertensive crisis without asking "Did you take anything before you came?" she stresses.

"A lot of times, they will take their home medicines and forget to tell you," she says. "If you don't know, you are up for a big surprise when both medicines kick in and their blood pressure plummets." (See clinical tip, below, on blood pressure medications.)


For more information on medications taken by ED patients, contact:

Kimberly Barker, BS, RN, CEN, Emergency Department Supervisor, St. David's South Austin (TX) Medical Center. Phone: (925) 779-7273. E-mail: Kimberly.Barker@stdavids.com.

Clinical Tip

Be specific about blood pressure medications

If your patient answers "no" when you ask about a history of high blood pressure, and the blood pressure is within normal limits, also ask if your patient takes medication for high blood pressure.

"Some patients think they don't have high blood pressure anymore because they're taking the medicine," says Kimberly Barker, BS, RN, CEN, an ED supervisor at St. David's South Austin (TX) Medical Center. "They don't understand that the condition isn't gone — it's just being temporarily fixed by the medication."