Warning: Emergency Room Can Be Hazardous To Your Health
Don't assume the ER knows best.
You'd think a hospital would be very good at being very careful. Maybe so -- but not necessarily when Boomers and Seniors visit the Emergency Room (ER).
In fact, it is common for older patients to receive potentially inappropriate medications when treated in an emergency room or clinic.
16.8 percent of emergency visits by patients 65 and older -- nearly 19.5 million -- received one or more potentially inappropriate medications (PIMs), revealed a University of Michigan study.
"There are certain medications that probably are not good to give to older adults because the potential benefits are outweighed by potential problems," says the study's lead author, William J. Meurer, M.D., M.S., assistant professor, U-M Departments of Emergency Medicine and Neurology.
Ten medications accounted for 86.5 percent of PIMs used in the ER. The five most common were promethazine, ketorolac, propoxyphene, meperidine, and diphenhydramine. Just two, promethazine and ketorolac, accounted for nearly 40%.
It is possible that the potential harm by medications is underestimated, because the study did not explore the possibility of medication interactions.
Dr. Meurer says further efforts are needed to educate doctors about the suitability of certain medications for older adults. He offers advice to patients:
- Make sure you talk to your primary care physician, either during or after your ER visit.
- Know what medications and supplements you are taking and make sure the nurses and doctors at the ER know.
- Talk to the ER doctors and nurses about how long the medicines they have given you will affect you.
- Ask for a list of all medications that you received while at the ER before you leave for home or to go to a bed in the hospital. The list should include information on the possible side effects of those medicines.
- If you leave the ER and then have an adverse event caused by medication, contact your physician immediately or go back to the emergency room.
- Be proactive with your pharmacy and make sure you understand what you are taking.
The problem of prescribing inappropriate medication varied by doctor, region and type of hospital, such as teaching vs. non-teaching. It was less likely to occur if a resident or intern was involved in the treatment, probably because younger doctors have recent training about medications. PIMs were less likely to occur in the Northeast and twice as likely in other parts of the country. And receiving a potentially inappropriate medication was more likely to occur at for-profit hospitals.
The study, published in Academic Emergency Medicine, spanned years 2000-2006 and looked at approximately 470,000 ER and outpatient clinic visits.