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Prescription- Getting instructions right crucial

By Vision Reporter

Added 12th July 2009 03:00 AM

WHEN Stella, a P.5 dropout was diagnosed with pneumonia, a pharmacist explained that she had to take one teaspoon of a syrup three times a day for seven days, as prescribed by her doctor.

WHEN Stella, a P.5 dropout was diagnosed with pneumonia, a pharmacist explained that she had to take one teaspoon of a syrup three times a day for seven days, as prescribed by her doctor.

By Frederick Womakuyu
WHEN Stella, a P.5 dropout was diagnosed with pneumonia, a pharmacist explained that she had to take one teaspoon of a syrup three times a day for seven days, as prescribed by her doctor.

However, on getting home, Stella took three teaspoons, once a day for seven days. After a week, Stella went back to the doctor, complaining that her health had not improved.

Illiterate or not, there are many people like Stella. According to Julius Monday, a clinical officer and head of Kikyo Health Centre IV in Bundibugyo district, out of five patients he prescribes drugs for, monthly, about three of them do not understand prescription instructions.

He says the illiterate make the most mistakes, though educated people are also culprits. Reading labels does not mean someone is able to interpret.

Some prescriptions read 2X3; meaning if they are tablets, two have to be taken three times a day at intervals of eight hours. But some patients take all the tablets at once.

Monday partly blames doctors for writing badly and misleading their patients. “Some people believe that doctors or physicians are trained to write badly. But this is not true.”

He says some doctors or physicians write badly, misleading pharmacists or drug dispensers into giving patients the wrong instructions.

The head of the Orthopaedic Department at Mulago Hospital, Dr. Tito Bayeza, says some doctors use complicated terms that an ordinary person cannot understand.

“After the doctor has examined a patient, he takes down notes. Medical terms like TD that doctors normally use may only be understood by a pharmacist,” Bayeza says.

He says a pharmacist or drug dispenser should interpret the instructions correctly and explain them to a patient.

“If a patient tries to interpret a doctor’s instructions, he may not understand them,” Bayeza says.

“Sometimes, a nurse, pharmacist or drug dispenser may misinterpret a doctor’s instructions. Some people are not well-trained, while others give an under dosage intentionally to cheat a patient.”

Monday advises patients to report cases of under-dosage and unethical behaviour to the health facility where they got treatment.
Poorly trained pharmacists or drug dispensers may skip necessary information that accompanies drug intake.

“Some prescriptions require one to take drugs before or after a meal. If instructions are not adhered to, the drug may not work,” he says, adding that some nurses or patients confuse drug names with trade names.

Panadol, for example, is a trade name and Paracetamol is the drug name, however, some people think the names are synonymous.

Bayeza says the problem of misunderstanding instructions is compounded by the increase in over-the-counter prescriptions.

Dangers of misinterpretation
A pharmacist at World Relief Medical Services International, Dr. Fred Musisi, warns that when one misunderstands a drug prescription, the consequences can be dire.

“Any drug is potentially poisonous. That is why pharmacists or drug dispensers are trained to do the job,” he says, adding that misinterpretation of a prescription may result in under/over dose or death.

“A drug is made to work on a certain condition in the right quantity. If you take an overdose, the drug becomes toxic, affecting the lungs and brain.

The final result would be death or long-term injuries to body organs,” Monday explains. Toxicity of a drug may also cause kidney failure or liver damage.

He says in some instances, patients who have taken an overdose become mentally unstable, deaf or blind.

“People who take many aspirins without interpreting the instructions well, develop malfunctions in their brains.

Others develop hearing impairments such as blockage of their ear drums, as a result of drug chemicals,” Monday adds.

He says taking an under-dose is also common among people who do not understand drug prescriptions.

“If you take an under dose of a drug or miss the drug at a certain interval, you may develop resistance to that drug,” he says.

The disease may never be treated because it would have failed to respond to the drug and the patient may die.

“A doctor should give clear instructions to a pharmacist or drug dispenser and in return, the drug dispenser or pharmacist should give a simple explanation to the patient,” Bayeza says.

He adds that it is necessary for a pharmacist to repeat written instructions verbally to a patient so that he or she understands.

“A pharmacist or dispenser should try to give instructions in a local language that a patient understands,” Bayeza advises.

Monday cautions patients to avoid over-the-counter drugs. “In Uganda, 99.9% of the people selling drugs in shops that sell commodities such as sugar, are not qualified to dispense drugs.

Patients should go to drug shops or pharmacies,” he says.
He calls upon the National Drug Authority (NDA) to crackdown on quack physicians, saying they contribute to about 48% of drug mis-prescriptions in Uganda.

A drug inspector from NDA, who declined to disclose his name, says fake drug shops are many, but NDA is doing their job. “In the last two years, we have closed about 300 fake drugs shops.

They contribute to about 200 cases of overdose and death
annually,” the source explains.

“We cannot fight this war alone but the public should report fake drug shops and also seek medication from hospitals or health centres.”

Monday also recommends mobilisation and sensitisation on the importance of drug prescription.

Prescription- Getting instructions right crucial

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