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Reporting a Medication Error

Use Your Pre-Admission Testing Appointment to Prevent Errors

7e58113966c67085953dd45e2ed189c9 MIf you are scheduled in advance for surgery or a procedure, you will need to go to the hospital for a pre-admission testing appointment. You might need blood tests, a physical exam, and instructions about what to do before the procedure. This is a great time to go over your current list of medicines with the nurse or doctor.


Some medicines need to be stopped several days or even a week before the surgery or procedure. This includes over-the-counter medicines like aspirin and herbal products (e.g., garlic, ginger, ginseng, gingko). If you are admitted to the hospital after your surgery or procedure, your doctor may need to prescribe these medicines for you during your stay. Since there are many medicines with names that look and sound alike, you should bring a neatly printed or typed list of your medicines with you when you go for your pre-admission testing appointment. Carefully check each prescription bottle or medicine label to make sure you have spelled the drug names properly. Include the dose of the medicines and how often you take each one. If possible, also bring all your medicine bottles with you for the nurse or doctor to review during your appointment. A legible list of all the medicines you take is also important because some drug names are very hard to pronounce. Simply mispronouncing a drug name has led to mistakes.

In one case, a woman mispronounced the medicine she took for osteoporosis, Actonel (risedronate), placing the emphasis on the middle part of the name (ac-ton-nel). The medicine was misunderstood as the heart and blood pressure medicine, Tenormin (atenolol), which is pronounced as a-ten-a-lul. In another instance, Plavix (clopidogrel) was misheard as Paxil (paroxetine). Plavix slows blood clotting and Paxil is used to treat depression. This mix-up could cause problems since Plavix may need to be stopped before surgery.

Accurate communication about your medicines with nurses and doctors before surgery can boost your safety and help to avoid serious mistakes.

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