According to Consumer Affairs, it’s estimated that 7,000 deaths occur every year because of incorrect prescriptions. And as stated in an article by Forbes.com, medication errors affect 1.5 million people every year. These are astounding statistics. And yes, I have caught a pharmacist making a very big mistake. Our son Nick was supposed to get 1 teaspoon (5 ml) of a medication, and the label said to give him 1 ml. That’s 5 times less than he was supposed to get! I had remembered what the doctor had prescribed, looked at the little tiny bottle that was given to me and wondered how I was supposed to get 30 teaspoons out of this thing. That’s when I noticed the mistake.
I’m no stranger to having to administer lots of medications. Our son Nick has been on prescription medications since birth, and he had a kidney transplant on August 15, 2000. Since then, I’ve been responsible for administering those life saving meds. There’s not much more stressful than knowing that you simply cannot forget a medication, or administer the wrong amount. I can just about do it with my eyes closed now. But when I first started I had no clue what questions I should be asking, what supplies I should have on hand, or how to stay organized so I didn’t make a mistake.
Over the past 14 years, I’ve seen mistakes made, and I’ve made a few myself. This article is about what I’ve learned along the way. It is not to be construed as medical advice, but rather personal opinion. Please check with your own doctor and pharmacist to make sure you are doing everything that you need to do in order to avoid medication mistakes.
It all starts here. There are several questions that you should be prepared to answer, and several questions that you should be prepared to ask. Every single one of them is extremely important. Keep a journal. Bring it with you to all doctor appointments.
Questions You Will Need to Answer
Patient’s medical history: It’s a good idea to keep a journal of the patient’s medical history. This should include current and past illnesses and/or medical conditions, surgeries, current and past medications, any allergies to food or medications. When visiting the doctor, a nurse will ask several questions that will help the doctor. Having a journal will ensure that you don’t leave anything out.
Family medical history: It’s also very important that you know about your family medical history. I realize that sometimes adoption is involved and it’s simply not possible. But whenever it is possible, get the family medical history for both sides of the family (maternal and paternal). So if you’re bringing your child to the doctor, you want to know both the history on your side of the family and your child’s father/mother side of the family. The Mayo Clinic provides an excellent article that will help you compile this information in the form of a family tree.
List of current medications: When you visit the doctor, you will be asked for a list of current medications, including the dose. It’s much easier to bring a list with you and just hand it over to the nurse taking the information than it is to try to remember everything right there on the spot. I like to use index cards written in pencil. He cards hold up well, you can erase pencil, and you can keep the card with the medications when you’re not using it at the doctor’s office.
Look at the medication bottle(s) and write down the name of the medication, how much (volume) you are administering and how many mg. per unit. This way the doctor will know the exact amount that is being taken. For example, if a prescription has 1 mg per ml, and you are administering 5 ml, the doctor will know that the patient is getting 5 mg .
Questions to Ask the Doctor. Write Down What the Doctor Says!
When prescribed a new medication, there are several things you will need to know. You’ll want to check what the doctor says to you against what the bottle of medication says when you pick it up at the pharmacy.
While talking with the doctor about having a new prescription filled, write down the name , the volume to be administered, and total mg’s per dose that will be administered: The bottle will probably say something like 1mg/cc. If you’re new to this, or you’re not good at math, ask the doctor exactly what the bottle that you will be getting should say. For example, if Nick gets 5 mg of Prednisolone every other day, and there’s 1 mg. per ml, then he should be getting 5 ml’s of the medication for a total of 5 mg. every other day.
1 mg./ml X 5 ml = 5 mg.
Brand name vs. generic name: If a prescription does not say ‘no substitutions’ you will most likely receive the generic version of that drug. Ask the doctor what that name would be.
What is this medication going to treat: It may seem obvious, but if you are dealing with more than one medication, you don’t want mistake one that treats high blood pressure with one that treats a headache. One that you need to take every day with one that you take only when needed.
How long will it take for the medication to take effect: It may only take minutes for it to start working, or it may be much longer than that. It’s good to know the answer to this question. Especially if it can take a couple of weeks to work!
Food, drink, herbal and drug interactions: Drinking Alcohol is an obvious substance that may interact with drugs. But did you know that grapefruit, chocolate and licorice are common as well? Herbal supplements can interact with prescriptions, over the counter medications, and the list goes on. Let both the doctor and pharmacist know what meds (prescription and over the counter) and herbal supplements are being taken. Ask what should not be taken with the prescription, including foods and beverages.
And don’t forget, before you go to buy an over the counter (OTC) medication or supplement for someone on a prescription, ask the pharmacist if that OTC item is okay to take with the meds the person is already on (both prescribed and OTC)! It’s very easy to forget to do this, especially this time of year when people catch a cold or get sick and you’re in a rush to get back home. Even though you may have been given a list of what shouldn’t be taken with the med already, you should still ask. The Pharmacist is the drug specialist. It’s what they do all day long. Just give the pharmacy a call before you even bother going to the store. Let them know what’s going on and ask them for recommendations on what you should buy. That’s what they’re there for!
Ask about side effects: You can’t turn on the TV for very long without seeing a commercial for some new medication that has come out. And then they quickly list the often large list of possible side effects. It’s important to ask both the doctor and pharmacist what they are for each medication. Sometimes even more drugs are prescribed to counter the effects of meds. Lovely, huh? Often times a medication is a necessary evil. But then there are some that may not be absolutely necessary, and you may decide against using because of an unwanted side effect.
Ask how, when and with what the medication should be taken: With or without food? If it’s with food, what kind of food? If you give all meds through a feeding tube, and you receive a tablet or capsule, can you crush it? Should it be taken at a certain time of day? A certain time before or after eating? All of these things are extremely important to know. For example, one of Nick’s meds is pretty particular and it has to be mixed with water and taken on an empty stomach, and he can’t eat for an hour after. Another one he used to be on had to be mixed in a little glass jar with water, using a metal utensil to stir it with.
Eventually you will get into a routine of when and how to administer the drugs and it won’t be such a big deal. Keep a small calendar with the meds and cross off each day as you go. If you give meds more than once a day, get a calendar where you can check a day off one, two, three or how ever many times you need to. An even bigger calendar if you need to actually write the name of the medication(s) down if that helps you to stay organized.
What happens if you miss a dose, or not all the med was taken/given for some reason?: It can happen! Should you skip it? Take it? Double up the next dose? Both my husband and I have given Nick meds through the feeding tube using the medicine port and had the feeding port blow open while pushing the med through with a syringe. At that point, we had no idea which meds, and how much of each med, actually made it into his stomach! We had to call the doctor and ask them what to do. Some meds we just skipped, others we gave to him again.
What happens if you take/give too much by accident?: This can happen, too. You get distracted and can’t remember if you already gave that med. It happened to me once, back when our oldest boy was a teen and still lived at home. He was a very difficult teen, and we were in a heated discussion while I was measuring out Nick’s meds and thought I may have given him one of the meds twice. Talk about panic! I called the poison control center and they said he’d be fine. But I never want to do that again!
How to Store the Medication: Some meds need to stay within a certain temperature. Generally you either keep them in the fridge or not in the fridge. There should be a little sticker somewhere on the medication if you’re supposed to keep it in the fridge. And it’s not recommended that you keep medications in the bathroom. Too many germs in there.
Many doctors have converted to computer generated prescriptions, but many have not. If you can’t read the prescription, chances are the pharmacists may have a difficult time as well. Be a pain in the butt, ask the doctor to rewrite the prescription so that it’s legible if you can’t read it. They should have respect for you that you care enough about making sure it is filled correctly and do as you ask without being upset about it.
Use the Same Pharmacy For All Prescriptions: It’s the pharmacist’s job to go over ALL of the medications a person is on, and make sure that they won’t interact with each other. Help them do their job and avoid mistakes by sticking with just one pharmacy. This way they can see in their computer system a list of all of the medications for the person they are filling prescriptions for. Don’t have one filled at CVS, and two filled at Walmart.
The pharmacist also needs to know: The pharmacy will also ask about allergies, and if you are new to the pharmacy, they’ll need to know what other medications (prescriptions, OTC, supplements, herbal) you are on. It may seem redundant, but it’s important that they know this information, too. They will keep record of what you tell them in their computer system. Be sure to let them know if anything changes, too.
Ask the pharmacist questions: It’s a good idea to ask the pharmacist how and when to take the medication, about interactions with other food, drinks, OTC and prescribed drugs, and about any side effects. Do this even though you have already asked the doctor.
Why do I say this? Doctors have to know about medications, but it’s the Pharmacist that’s the real expert. As an example of what can happen when you don’t find out about possible side effects: Nick was prescribed Baclofen for muscle spasms that he was having. I wasn’t on top of my game at the time, and didn’t find out until it was too late that Baclofen can exasperate seizures. Now he’s on Keppra to prevent seizures. And despite my best efforts, and with two years worth of weaning, I have been unable to completely get him off of the Baclofen.
Now it’s time to compare what the doctor said was being prescribed with what you’re being handed when you pick up the prescription. Here are some things to check:
Read the label for instructions on how to properly take the medication. Check this against what the doctor told you.
Read all those other little stickers on the bottle: there may be some other special instructions that aren’t on the regular label, such as Use caution when driving or operating heavy equipment, etc..
Read the label on the bottle for correct dosage every time a prescription is refilled: Another catch I made wasn’t so much an error on the pharmacy end, but a change in the strength of med that nobody told me about when I refilled his prednisolone. He used to get 3 cc’s once every other day. The strength of the liquid was changed at some point (new supplier maybe), and he now gets 5 cc’s once every other day. He’s still getting the same total mg., I just have to measure it out different now. But neither the doctor’s office or the pharmacy told me when the change was made. I just happened to read the label on the bottle and notice. I had to call the doctor’s office and question them on it and complain that nobody told me, the one giving him the med. Who knows how long I could have been giving him the wrong dose if I hadn’t noticed the change on the label. I’d been measuring it the same for years…I don’t need to look at the labels anymore to know how much he needs to get of the dozen meds he’s on. I really lucked out when I noticed. And by the way, it was a doctor at Boston Children’s Hospital that refilled the prescription. So don’t let the fact that a prescription is filled by a doctor at one of the top hospitals in the country sway you from being just as careful when filling prescriptions.
After taking/giving the medication, call the doctor immediately if any adverse reactions occur. A life could depend on quick action!
If a dosage is changed: Never change a dosage on your own. Always follow the doctor’s instructions. And if a dosage is change, rather than just refilling the prescription, get a new prescription so that the label will reflect the new dosage.
It’s a good idea to let someone other than a person that lives in your house where your list of medications with the doses is located. God forbid the adults get into an car accident together and are unable to tell people how to administer medications. You should also keep a list of phone numbers for all the physicians that prescribe the meds.
Syringes: When you have liquid medications, syringes are handy little buggers. Even if you’re not giving meds through a feeding tube. You can measure a medication with perfect accuracy, and you don’t have to worry about spilling it. You can also measure out a medication in advance, and even take pre-measured meds with you if you’re not going to be home when it’s time to take a med.
Often times the pharmacy will supply you with one or two if you need one for a prescription. Sometimes meds come in a box that includes syringes. I’m sure they’re just trying to keep costs down by only giving you a 
couple of syringes for a bottle of medicine that will last 30 days. But unless the writing on the syringe is blue, you can be sure that you will only be able to wash a syringe a few times before the rubber part swells up and you can’t use the syringe anymore without it breaking on you. Because I need more than what we get from the pharmacy, or what comes in the box, I get a prescription for new ones every month. I’m able to get a few of them delivered from the same company that supplies us with his G-tube and extensions. Nick’s insurance doesn’t pay for very many, though. So when I need even more, I buy them from the pharmacy. I just warn them in advance if I need a lot of them. You can also order oral syringes online from places like Amazon.
I only know about oral syringes, so I can’t speak of syringes with needles (which I’m pretty sure you need a prescription for). You can get oral syringes in many sizes. I happen to use: 1ml, 3ml, 5ml, 10ml, and 35ml or 60ml.
If you are giving a very small dose, like 0.9 ml, you should definitely use the 1ml syringe. It will be the most accurate. I use the 35ml or 60ml for giving meds that need to be mixed with a lot of water and put through the feeding tube. I just close off the medicine port and twist the large syringe into the feeding port. Again, make sure you close the medicine port or you’ll have a big mess. Ask me how I know! I also keep my thumb on that little bugger (med port) just to make sure it doesn’t open up on me. People often refer this method as bolus feeds, usually reserved for giving a patient formula or extra fluids. But it’s definitely easier to give meds mixed with lots of water using this method rather than sucking up syringe full after syringe full with a smaller syringe.
To give meds through the large syringes, I keep the syringe as low as I need to be in order to administer the medication slowly. I don’t just dump it in there. And I use room temperature water. Never cold, and certainly not too warm. Cold water will give him stomach cramps.
And as if having different sized syringes isn’t enough, you can also get different tips: One type of syringe is called a luer-lock syringe. It has a small center tip, with a screw-type outer tip. I don’t care for these syringes for two reasons: first and foremost, you can’t use them with the little rubber bottle stoppers, AKA adapters. (I go into further explanation of adapters below.) The tip of a luer-lock syringe doesn’t fit into the hole of a bottle adapter. You’d need to use something like a catheter adapter in the top of the stopper first (see below), then screw the luer-lock syringe onto the catheter adapter. I actually do use this method for one of Nick’s meds (also described below).
The second reason why I don’t care for the luer-lock is that they don’t seal nicely to the medicine port of the feeding tube, at least the ones that I have don’t. The medication leaks out. So for the one med that I do use the luer-lock syringe with, I attach a 35ml syringe to the tube and squirt the med into the larger syringe, let it drain down, and flush with the meds he’s going to get in the 35ml syringe at that time of day anyhow. You could also use the catheter adapter to put the med through the medicine port with a luer-lock syringe. You’ll definitley get a nice tight fit with the adapter.
Tip: I find that the 35ml and 60ml syringes often don’t like to stay put in the feeding port, especially when they’re new. The tips of these syringes are slippery and they fall out easily. When this happens, I just scuff the part of the syringe that goes in the port with an emery board. Works like a charm.
Another type of syringe tip is just a straight, or slip tip. The length and diameter of the tips can vary. If you’re putting it through the tube, make sure the tip is long enough and wide enough to seal nicely to the medicine port. The ones that the pharmacy give you should be fine for the 1ml. Larger ones may very well end up being luer-lock syringes. If you’re ordering from a medical supply company, just tell them what you’re using them for, and be sure to specify the type of tip you want.
Yet another type of tip is the catheter tip. It is longer, and is found on the 35ml and 60ml syringes. These larger syringes don’t fit into the medicine port. You use them in the feeding port for venting (using the fatter, venting tube), administering meds that have been mixed with a lot of water, and gravity feeding (formula and water).
Tip: to use a luer-lock syringe in the rubber medication stoppers (adapter), use a catheter adapter. Just put the adapter in the stopper, then screw on the syringe.
Pill crushers: Word of caution: don’t buy a pill crusher that has the threads on the inside of the crusher if you need to put the crushed pill in a syringe. This has to be the dumbest design I’ve ever seen. The crushed pill just gets stuck in the threads.
Regular Pill Crusher
I’m sure there are many reasons why pills need to be crushed. For us, Nick gets his med through the feeding tube, so his meds need to be liquid or crushed to a fine powder.
The regular crusher that we have actually comes to a dull point inside the little well. This helps a lot for those semi-hard pills. You don’t need to turn it as hard to crush the pill. It also has a little storage compartment in the lid for keeping extra pills. The one thing I don’t like is that the powder usually gets stuck to the bottom of the crusher a little, and I need to loosen it in order to pour it into a syringe. I don’t know if this happens with all pill crushers. I’ve been using this same one for years.
Cutter and Hard Pill Crusher
One of his pills is extremely hard and I’ve actually cracked a pill crusher trying to crush it. Then I discovered that they make pill crushers with serrated teeth specifically for crushing these little buggers. I’d imagine if you had a large, hard pill, you should cut it one or two times first, so that you don’t break the crusher. This serrated crusher doesn’t crush pills into a fine powder though. So after I use the serrated crusher, I transfer the crushed med to a regular crusher and crush it up to a fine powder. This way the med goes through the tube easily. Oh, and this serrated tooth crusher has the threads on the inside of the crusher, so I’d need to transfer the powder to my regular pill crusher before putting it into a syringe anyhow.
Pill cutters: The crusher with serrated teeth that I use is actually a pill cutter as well. I’ve used many different pill cutters, and this one has definitely held up the longest. You can see a picture of it just above (it’s red). Click on the picture and it will bring you to this item on Amazon. We bought ours years ago and hopefully the quality is just as good now as it was then. When I looked this item up on Amazon, it received a poor review. But the person was trying to crush a large pill. I would cut a large pill first, and crush half at a time. I’ve never had a problem with it when crushing small pills.
To use the adapter, you simply replace the regular cover of the bottle with the adapter, stick the syringe in the hole, tip and measure. If you’re using a small syringe, especially the 1ml syringe, you may have to draw it up, flush it back in, and repeat until you get all the air our of the syringe.
Catheter Adapter
Catheter adapters: Maybe not quite intended for what I use them for, these catheter adapters come in very handy if you’re trying to measure a liquid med and you only have a luer-lock syringe. Just put the adapter in the top of the bottle adapter and screw the syringe onto the catheter adapter.
Storage Box or Basket 
: Nick has a whole bunch of meds. A couple of them need to be kept in the refrigerator, but the rest of them are kept in the cabinet. I use a hard plastic tote that I found in the craft isle at Walmart to keep meds, syringes, pill crusher, pill cutter, a pencil and a calendar in. This way I can just grab the tote, and get to work when it’s time to do meds.
You can also buy a lock box to keep meds in if safety is a concern. Amazon has a small variety of lock boxes at very reasonable prices. Some are simply difficult to open, others actually have a combination lock on them.
Pill organizer: For years, I didn’t use a pill organizer. Then one day they were giving them away for free at the pharmacy. Now I’d hate to be without one. It’s a great way to make sure you don’t miss a dose, and also make sure you don’t give too much. Just lay out a weeks worth of pills and you’re good to go. And you can find all kinds of pill organizers. They even have them for giving doses several times per day.
After you measure the meds: As I measure each med, rather than just putting the syringes on the counter, I place them in a little hard plastic basket. That way I can bring the meds wherever I need to go, and I can wash it afterwards.
Need water for flushing meds through a feeding tube? Nick’s meds go though the feeding tube, and I use a baby bottle to hold the water I need for administering his meds. A baby bottle is particularly handy for me, not only because I don’t spill the water when I’m not using it (I give him some meds while he’s in his bed, so there’s no hard surface to place the water on), but also because he gets Miralax, which needs to be mixed with water. I can just put it in the bottle and shake it.
Don’t confuse one medication with another when the bottles look alike.: If you have more than one medicine bottle that looks same (same size and color), ask the pharmacist to put one in a different sized bottle. You could also buy large, colored stickers and use the stickers to differentiate the bottles that way. Just don’t cover up any important instructions, including the refill number. If it is a pill bottle, you could also use a permanent marker and write the first letter of the name of the medication.
Another way to not confuse medications when it is a liquid would be to use two different types of syringes on them, keeping a catheter adapter in one of them. I use the adapters that you put in the top of the bottle, tip, and measure. But for one of Nick’s liquid meds, I insert a catheter adapter into the bottle adapter and leave it there so I have to use a luer-lock syringe on that bottle, and a regular straight tip syringe tip on the other bottle. This way I know which med is which by just glancing at them, and I’m sure to never confuse one med for the other.
Here’s my biggest tip on this subject: when putting meds through the medicine port with a syringe, keep your thumb tightly clamped on the feeding port! If there’s a kink in the tube somewhere, you’ll blow out that feeding port when you flush the syringe. You can imagine what a mess that makes, not to mention that now you can’t be sure how much of a med made it into the stomach if you already had meds in the tube before it blew out.
My morning routine: I measure out all the meds and put them in my little basket. I make sure I have the baby bottle with water in it, a 5 cc syringe, a 35 cc syringe, and the feeding tube.
Sometimes I’ll fit in as much liquid medicine into the tube as I can before I even hook it up to Nick’s Mic-Key button. At the very least, the tube is filled with water, not air. I start with liquid meds, flush once, and then go on to the meds that I’ve crushed and put into a syringe. Use as big a syringe as you need when flushing through crushed meds in order to be able to add enough water so that the tube doesn’t clog. I like to give Nick his liquid meds first and flush once so that if the tube happens to get clogged with the powdered meds, at least I’ve flushed in the liquid meds into his stomach.
A little more about crushed and powdered meds: Don’t try to put through too much at once in the syringe. I dump it right from the pill crusher into the syringe and use at least a 5 cc syringe. One of his meds is a powder inside a capsule. I just open the capsule and put it in the medicine crusher. Then I dump it into the syringe. I then suck up almost a syringe full of water leaving a little bit of air in the syringe so that I can shake it and get off any powder that’s stuck to the side or in the tip. After I push the medicine and water mixture into the feeding tube, I flush it with water a couple of times using the same syringe. This gets the last little bit of medicine out of the syringe.
When the feeding tube gets clogged with meds: I never really have a problem with tubes getting hopelessly clogged anymore. If the powder does get stuck when flushing it through the tube, first I look where where the clamp for the tube is and straighten out the kink. If that doesn’t fix things, I look for a kink somewhere else in the tube. If things really get stuck, I’ll try sucking a little bit back into the syringe and try again. When all else fails, I just unhook the feeding tube and dump everything into a cup. Add a little more water, suck it up into the syringe and try again. Then I add some more water to the cup to get the residual medicine that will inevitably be left in there.
After giving Nick the crushed pill and powdered medicine, I still one more med that needs to be mixed with a little bit of water. This particular med sticks to the plastic tubing, adding water to it ensures that the majority of it makes it into his stomach. I use a 30 cc syringe in the medicine port for this one. I give him what I’ve mixed with water, then swirl a little water in the cup and put that in as well, flushing with a bit more once the syringe is empty. It all, he gets 3 – 4 ounces of water with his meds in the morning.
In the past, I’ve found that generic acetaminophen tablets dissolve better than brand name Tylenol. But if you really want to use the brand name, crush it up in a pill crusher first. The large tablets most definitely need to be administered with the large 35 cc or 60 cc syringe though the feeding port.
I always refill prescriptions as soon as insurance will allow. The exception to this would be if a prescription expires within 30 days of being filled (not within X days of being opened). Why? Who knows what could happen that creates a situation where you can’t get to the pharmacy to pick up a prescription on time. Illness, family emergency, weather, vacations, even spilling medications or losing them. I’ve had bottles of pills get blown off the counter into a pan of water in the sink on a warm, windy day! If you have extra on hand, you have some time to play with.
I always bring all of Nick’s medications with me when he goes to the Emergency Room or is admitted to the hospital. I know at this point that his prescriptions are correct. I don’t have that control when he’s in the hospital. Not to mention that some of his medications aren’t that common, and rarely does the hospital staff give him his meds on time. It’s true. He’s due for meds at 7 am. The few times I’ve left it up to the hospital staff to get his medications, he’d get some at 7, some at 8:15, some at 9. He’s even gone a whole day without one that he’s supposed to get twice per day! If you have any medications that need to be refrigerated, the hospital pharmacy will probably need to take it and repackage it into their own bottle and you will have to ask for that particular medication from the nurse. But she will bring it to you, and you can still measure it and administer it yourself.
If you find that you just can’t get the syringes you have to attach securely to the medicine port, you can use a catheter adapter. It will fit nice and snug into the feeding port, but you’ll also need a luer-lock syringe, not a slip tip syringe for this method.
As mentioned earlier, syringes with blue writing are much more durable than syringes with black writing. You can wash the blue ones over and over again before the rubber part swells up and breaks.
The absolute best stuff I have ever used to protect the skin around the G-tube is Calmoseptine Ointment. One of the uses listed on the manufacturer’s web site is for the stoma site. I keep a tube of it right in the little basket that I put my measured meds in. This way I have it with me when I’m hooking him up to the feeding tube. I apply it once I’m done, twice daily. So long as I remember to do this, the skin around his button is never red anymore.
Don’t use the syringe that comes with the button to give meds. The tip is smaller, and after washing it a few times, it will break. Then you won’t have a syringe to get the water out of the button’s balloon. You’ll need to open a new button to get a new syringe.
BTW, if you ever have problems with getting the water out of that balloon, look at the space that the tip of the syringe goes in for sucking the water out of it. There’s probably gunk in there. Just use something small to get it out. I’ve had one button in all these years where the balloon just would not deflate for me. Probably defective. Rather than making a trip to the doctor just to change a button, I wound up using the end of the cap for a Bic pen (long part) and breaking the spring in there to get it to deflate.
U.S. Food and Drug Administration
Mayo Clinic’s article on Medical History: Compiling your medical family tree
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