Data on prescription drug sales in 2010 suggest that Americans’ major health ailments center on high cholesterol, depression, hypertension, pain, cardiac disease, and diabetes (IMS Institute for Healthcare Informatics, 2010). In 2010 the United States’ spending on medicines exceeded $307 billion, which is up from 2009; during the past month, 48% of the population has used at least one prescription medication (Centers for Disease Control and Prevention, 2010). Unfortunately, patients frequently misunderstand common instructions and warnings that accompany prescription medications, resulting in unintentional misuses and potentially lethal adverse drug events (Davis et al., 2006; Hernandez, 2008). According to Davis and colleagues, nearly half of all patients misinterpreted standard instructions when attempting to take even a single prescription medication. In addition, Wolf and colleagues (2011) found that when multidrug regimens are prescribed throughout the day patients may self-administer more times a day than necessary and often miss doses. Plus, patients with limited literacy or those who are cognitively challenged (e.g., older adults, head injury, those altered by other drugs) are at greater risk for drug misuse. Research involving over-the-counter (OTC) medications reveals that 40% to 87% of community-dwelling older adults—the most frequent users of OTC medications—take at least one OTC medication and 6% take five or more OTC medications or dietary supplements daily along with their prescribed medications (Lam & Bradley, 2006).

In the United States, children younger than 12 years are not immune to concerns centering on medication safety. Vernacchio, Kelly, Kaufman, and Mitchell (2009) argue that a wide variety of medications, both prescribed and OTC, are available to U.S. children, and the safety of pediatric medications pose an alarming and inadequately addressed public health concern. In a large national random telephone survey, Vernacchio and colleagues discovered that 56% of children in the study had taken a medication in the last 7 days. In their study, most of the OTC drugs used across all age groups were acetaminophen, multivitamins, pseudoephedrine, and ibuprofen. The most commonly prescribed medications are amoxicillin, iron, ibuprofen, multivitamin with ¨fluoride, and albuterol. As with the adult population, the most salient concerns affecting nursing interventions for children center on the literacy of parents, filling and adhering to the prescribed medication regimen, and the potential for adverse events or interactions.

Because nurses traditionally have the most consistent contact with patients and their families, are often identified as most trusted by consumers, and receive many of the patient and family’s questions, nurses need to take advantage of these important teachable moments to reduce the likelihood of medication nonadherence and unsafe practices. In addition, nurses must regularly follow up with patients regarding their medication usage. Nurses should not make assumptions or guesses regarding patient and family medication practices.

The following are suggestions for nursing interventions.

• Always perform perception checks with patients and families by consistently asking them to state what the medication is, what it is for, the importance of taking the correct dose, timing, side effects, and adverse effects when combined with other medications and foods. Provide very readable instructions (be attentive to print size, reading level, and language) so that patients with all levels of literacy, education, and language will understand them. Nurses should also consider partnering with pharmacists, physicians, drug companies, other nurses, or even nursing students to create quality improvement projects focusing on patient and family education involving medication safety.
• Whenever possible, identify a failsafe mechanism (e.g., follow-up phone call, check at next visit, general e-mail or text messages—if permitted) to determine whether patients are taking the medications as prescribed. Moreover, this follow-up contact provides an excellent opportunity to assess what other OTC medications are being taken that may interfere with prescribed medications. This critical step must occur, especially for patients who are most at risk for medication nonadherence.
• Contribute to the expansion of evidence leading to best practices involving medication safety. For example, participate in generating evidence or translating this evidence into practice pertaining to the identification of patients and families most at risk for poor understanding and medication nonadherence, as well as suggesting effective interventions to overcome these barriers.

As nurses, it is important to share our success stories to optimize patients’ adherence to their medication regimens. Nurses must recognize and appreciate their pivotal roles in monitoring what is in patients’ medicine cabinets. Taking just a few extra minutes to teach and perform perception checks to ensure patients and families understand medication regimen while assessing their actual medication-related practices can greatly improve the quality of care and medication safety outcomes.

References

Centers for Disease Control and Prevention. (2010). Therapeutic drug use. Retrieved May 12, 2011, from www.cdc.gov/nchs/fastats/drugs.htm.

Davis, T. C., Wolf, M. S., Bass, P. F., Thompson, J. A., Tilson, H. H., Neuberger, M., et al. (2006). Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine, 145, 887–894.

Hernandez, L. M. (2008). Standardizing medication labels: Confusing patients less. Washington, DC: National Academy Press.

IMS Institute for Healthcare Informatics (2010). The Use of Medicine in the United States: Review of 2010. Parsippany, NJ: IMS Institute of Healthcare Informatics.

Lam, A., & Bradley, G. (2006). Use of self-administered medications and dietary supplements among assisted living residents. Journal of the American Pharmaceutical Association, 46, 574–581.

Vernacchio, L., Kelly, J. P., Kaufman, D. W., & Mitchell, A. A. (2009). Medication use among children <12 years of age in the United States: Results from the Slone Study. Pediatrics, 124, 446–454.

Wolf, M. S., Curtis, L. M., Waite, K., Bailey, S. C., Hedlund, L. A., Davis, T. C., et al. (2011). Helping patients simplify and safely use complex prescription regimens. Archives of Internal Medicine, 171(4), 300–305.