Having an accurate, up-to-date, and legible list of medications in your wallet or purse can be crucial if you end up in an emergency room, alone and unconscious. But just being awake isn't always enough.
"It's a big problem," said Dan Hyman, head of Internal Medicine at Cooper University Health Care, which has South Jersey's only Level 1 trauma center in Camden. Even when they are conscious, Hyman said, "people are sick, upset and don't remember or forget to tell us."
The nonprofit and independent Institute of Medicine estimated in 2006 that there were 1.5 million "adverse drug events" a year, but guesses that the true number might be higher. Many of those are in hospitals, but many are in homes. A study in the Lancet estimated that 7,000 people die each year from medication mistakes.
Cooper gives patients in its system wallet-sized cards listing their medication, but Hyman said getting updates and information from out-of-network doctors remains a challenge.
Jeanmarie Perrone, an emergency physician at the Hospital of the University of Pennsylvania, said a "great proportion" of the people arriving at the emergency room can't remember off the top of their head what medications they take, assuming that they are conscious upon arrival.
"They are trying to be helpful," she said, "but saying, 'It's a red pill,' doesn't help us at all."
Tremendous progress has been made in recording patient information in electronic records, but sharing and updating of information is still lacking, especially when patients get prescriptions from multiple doctors who are not in the same health-care system.
There are websites, computer programs, and apps for smartphones that can help patients keep track. But those appliances - along with taping it to the refrigerator in the kitchen - have their limits.
For emergency purposes, several doctors and others involved said lists should include the drug name, dosage and how frequently the patient takes the drug. If there is room on the list, the reason for taking the drug, and the prescribing doctor's name and phone number can help.
Knowing all of that can help patients have more intelligent conversations with doctors. Is the brand-name drug the best one or can a cheaper generic suffice? It might not hurt to ask whether the provider has any financial interest in prescribing the medicine.
Every list should also include over-the-counter medicines, vitamins or supplements that a person has taken recently or uses on a regular basis.
"Don't forget," Perrone said, "the thing you read about and bought on the Internet that was going to help you with weight loss."
The Institute for Safe Medication Practices, led by philly.com health blogger Michael Cohen, has a link on its website to eight pages of medications that are easily confused with another drug of a similar name.
"The reason you are seeking care might be related to an adverse effect of a medication you're taking," Cohen said by e-mail. "Also, current medications may impact treatment decisions. Another reason is to avoid duplicate dosing and drug interactions. For example, the doctor might want to prescribe a drug that is in the same class as one you are already taking or may interact with a current medication."
Perrone said patients frequently forget to mention one of the most commonly prescribed medications for seniors - blood thinners - and that could change emergency room treatment because of fears of internal bleeding. For example, someone not on commonly prescribed Coumadin who arrives with a "goose egg," on his head after a fall might be allowed to go home with family, Perrone said. But a person taking the drug might need further testing or an overnight stay to be sure there is no internal bleeding.
Insurers, government and private, are trying to reduce medication errors so people can avoid expensive hospital stays. Independence Blue Cross is one of the region's largest insurers and chief medical officer Richard Snyder said the company's internal pharmacy system and a partnership with 65 hospitals in the region tries to flag problem prescriptions or drug combinations.
"When medications are changed because of side effects, it is a good idea to cross out the medication on the list and write down why it was changed (e.g. caused light-headedness or simply did not work)," Snyder said by e-mail.
The Camden Coalition of Healthcare Providers, which is famous in health-care circles for innovative approaches to improving care and reducing costs for some of the most expensive patients, has nurses visit homes.
"Sometimes we see a real mess, with piles of duplicate and outdated medicine," nurse Jason Turi said. "We try to help them with pillboxes and lists and understand why they are taking them, inspect the medicine and communicate the list to providers."
Penn Medicine and Cooper also have personnel trying to help patients prepare proper and accurate lists, with the idea that it improves care and is accessible electronically by any caregiver, crisis or not.
"The pie-in-the-sky dream," Cooper's Hyman said, "is if you're here visiting from California and part of a health plan there, I can access your list of medications and see the report from the doctor you saw last week."
Open Enrollment Basics
About the program
Medicare is the federal government's medical insurance program, mostly serving seniors 65 and older. It has four main parts:
Part A - in-patient hospital care
Part B - out-patient doctor's office visits
Part C - Medicare Advantage plans through
Part D - prescription drug coverage
Tips on coverage
Medicare does not cover dental care.
Many, but not all, Medicare Advantage plans include Parts A, B and D, but ask to be sure.
Premiums, deductibles and co-pays of Medicare plans vary depending on your situation and prescription drugs you need.
The toll-free phone number for help is 800-633-4227. You will need your Medicare number.
The website is www.medicare.gov.
What to consider
Don't drop a plan until you are sure of the one you are joining.
If you are not in a drug plan and don't join one during open enrollment, there could be extra cost for joining later.
SOURCE: Centers for Medicare and Medicaid Services
A blank form to make your own medication list is available for printing at philly.com/business
Contact staff writer David Sell at dsell@ phillynews.com or 215-854-4506. Read his blog at www.philly.com/phillypharma and on Twitter @phillypharma.