Module IV · Safety
Protecting yourself from polypharmacy and inpatient medical errors
Polypharmacy is defined as the simultaneous use of multiple medications by a single patient. A recent JAMA study found that more than four out of every ten adults aged 65 or older reported using five or more prescription medications. The prevalence of polypharmacy in the elderly has nearly doubled in recent decades, rising from 23.5% to 44.1%. For adults with heart disease, the rate jumps from 40.6% to 61.7%.
This explosion in medication use dramatically increases the risk of adverse drug events, cognitive impairment, and dangerous drug interactions. The root cause of polypharmacy is often fragmented care — a patient might see a cardiologist, a rheumatologist, and a primary care physician who do not communicate with each other. Patients must take ownership of their medication list and maintain a single, comprehensive master medication log that includes all prescriptions, over-the-counter drugs, and supplements.
Hospitals are inherently dangerous places — fast-paced, understaffed, and prone to communication breakdowns during shift changes. The first rule of hospital safety is to never assume the staff knows everything about the patient's history. You must bring your printed medical history summary and master medication log to the hospital. Do not rely solely on the hospital's electronic health record, as it may be outdated or missing information from outside providers.
Caregivers play a vital role here. They should monitor hand hygiene, ensuring every person who enters the room washes their hands or uses sanitizer. They must also verify every medication before it is administered. Do not hesitate to ask the nurse, 'What is this medication, what is the dosage, and why is it being given right now?' If the answer does not match the master medication log or the doctor's instructions, refuse the medication until the prescribing physician is consulted.
Case Study
Eleanor, a 72-year-old woman, was admitted to the hospital for a severe kidney infection. Upon admission, the resident doctor quickly reviewed her electronic health record and ordered a strong antibiotic — and also a daily dose of a blood thinner that was listed in her chart. However, Eleanor's primary care physician had discontinued that blood thinner three weeks prior due to a minor bleeding episode. The hospital's system had not been updated. Eleanor was too weak to advocate for herself. Fortunately, her son arrived with her printed, up-to-date master medication log. He noticed the blood thinner on the whiteboard in her room and immediately stopped the nurse from administering it. His vigilance prevented a potentially catastrophic internal bleeding event.
Self-Reflection Questions
Do I have a single, updated list of every medication, vitamin, and supplement I take?
If I were admitted to the hospital tomorrow, who would be my primary advocate, and do they know my medical history?
Am I taking any medications that I no longer understand the purpose of?
Questions to Ask Your Provider
"Can we review my entire medication list today and see if there is anything we can safely eliminate or reduce?"
"Are any of these medications treating the side effects of another medication I am taking?"
"If I am admitted to the hospital, how can I ensure the hospital doctors communicate directly with you before changing my treatment plan?"