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With allergy season’s extended stay and cold and flu season having just begun, you may soon find yourself seeking relief through several different kinds of over-the-counter medications. Know what precautions you need to take when fighting multiple symptoms with multiple medications. When you’re too sick to go to work but not sick enough for a doctor’s visit, over-the-counter medicines are a welcome relief to help alleviate that fever, runny nose or allergies. But because those medicines aren’t signed off on or managed by your doctor and pharmacist, it’s crucial that you’re especially mindful of what you put into your body. Whenever you pop a pill, you want to make sure you’re taking the right dosage, waiting the right amount of time before taking another dose and not mixing certain medicines together. Recent stories like this one detail dangerous over-the-counter medicine combinations, and we’re following suit: Here is a quick go-to guide about potentially harmful over-the-counter combinations. Too Much Tylenol/Acetaminophen Tylenol — or acetaminophen — is a popular pain reliever for many, but too much can be bad for your liver. “Our bodies have a finite ability to metabolize Tylenol,” says Andy Wright, clinical pharmacist at Renown Rehabilitation Hospital. “When too much builds up in the liver, it becomes toxic. In patients with medical conditions like cirrhosis of the liver or hepatitis, this could be disastrous.” Remember, acetaminophen is in more than just Tylenol and generic pain relievers. You may also see acetaminophen in flu, cold and cough medicines, like Nyquil, and some prescription medications including Norco and Percocet. Keep a list of the medications you take, and limit daily acetaminophen use to 3,000 mg per day. When you’re scanning medicine bottle contents, remember acetaminophen is also referred to as APAP, AC, acetam or paracetamol. Mixing Painkillers When you’re dealing with pain and not getting any relief, taking a different medication may seem like the easy solution. Maybe you take some Aleve — a form of naproxen — for a headache, but it isn’t working, so you switch to Motrin, an over-the-counter form of ibuprofen. Not a smart idea. Ibuprofen and naproxen along with aspirin are known as nonsteroidal anti-inflammatory drugs (NSAIDS). Because these medicines work in similar ways, they should never be combined or used in larger doses or more frequently than directed. Otherwise your risk of side effects can increase, which range from mild nausea to severe gastrointestinal bleeding. It’s also important to consider your family history when taking NSAIDs because, “recent studies have shown NSAIDs may have greater cardiovascular risks for people taking blood thinners or those with hypertension,” explains Andy. “A good example is ibuprofen: It has a relatively low gastrointestinal bleed risk while it has a moderate to high cardiovascular risk. The opposite is true for naproxen.” Rather than experimenting with multiple medicines, figure out which drug works best for you. You may find muscle soreness improves with aspirin, whereas when a headache hits, naproxen is best. Keep in mind that these medications aren’t always best for everyone in the family. “Aspirin in children and teens is not recommended unless under the supervision of a doctor,” Andy says. And pregnant and lactating women should generally avoid NSAIDS due to risk of birth defects and bleeding. “In both of these cases, acetaminophen or Tylenol are preferred but only if approved by an OB/GYN.” Fighting Allergies Over-the-counter antihistamines like Claritin, Zyrtec and Allegra have made fighting itchy eyes and runny noses a little easier. But these daily medicines — when taken inappropriately or in the wrong combinations — can also have an adverse effect. Similar to acetaminophen, you need to watch for antihistamines in other products. Sleep aids — like Tylenol PM and Unisom — commonly use an antihistamine known as diphenhydramine, which may increase your risk of overdose. “Combining antihistamines, or overdosing, can cause many adverse effects including dry mouth, blurred vision — even arrhythmias,” Andy says. “Only take these medications on their own.” If you’re still struggling with symptoms, you can talk to your doctor about adding an over-the-counter nasal steroid. Andy confirms the importance of closely following the directions listed on antihistamine (and all medicine) bottles. He has seen extended release nasal decongestants cause significant arrhythmias requiring medical care after a patient took the medicine with warm fluids. “The decongestant in question is designed to slowly release, but it can dissolve suddenly in the presence of warm liquids like coffee,” Andy explains. “This can cause the pill to deliver 12 to 24 hours of medication all at once.” Taking an Antidiarrheal with Calcium Calcium supplements and antidiarrheal medicines are another harmful combination. Calcium firms up your stool, but if taken with an antidiarrheal, can cause severe constipation. If you need to take an antidiarrheal, take a break from your calcium for a few days until you’re back to normal. Another consideration when taking calcium supplements or calcium-based antacids is gas. “I’ve had several patients report cases of excessive gas using Tums or calcium carbonate-based supplements.” Andy suggests instead “trying Maalox or Mylanta for indigestion and Citracal as a supplement.” Talk with Your Doctor or Pharmacist About Your Medications If over-the-counter drugs aren’t providing the relief you need, it’s time to see your doctor. And remember, for your safety it is important to keep your doctor and pharmacist up-to-date with any medications — prescribed or over-the-counter — that you are taking.

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I am regularly amazed by medical advancements and innovation in the United States. However, even as we make significant progress in many areas of medicine, there is still much more work to be done in others. One such area is patient safety.   What is Patient Safety? When we talk about patient safety, we are discussing how hospitals and healthcare organizations protect patients from errors, injuries and infections. Anyone can make a mistake at work, but in healthcare these mistakes can result in serious outcomes. In 1999, the Institute of Medicine released a report that estimated 98,000 deaths per year result from medical examination or treatment. The most recent study in 2013 suggested these numbers could range from 210,000 to 440,000 deaths per year. Many of these deaths result from preventable medical errors. This is inexcusable and shows how much more work our industry still needs to do to improve patient safety. Making Patient Safety a Priority Patient Safety is our number one priority at Renown Health. We dedicate a lot of time to establishing, reviewing, and revising our processes to prevent errors. Despite the obvious importance of patient safety, this issue is largely left to individual hospitals and health systems to manage. There is a surprising lack of national attention around this truly important issue. However, a silver lining of the COVID-19 pandemic is that it is igniting interest in hygiene and infection prevention. Patients want to learn more about the processes that are in place to prevent the spread of infections. In addition to the many protocols that guide our treatment of injuries and illness, Renown Health has implemented the following measures to prevent the spread of communicable diseases: Requiring everyone entering Renown sites to wear a mask or face covering. Establishing new processes to help patients and visitors practice social distancing. Limiting the number of visitors in our facilities. Screening all employees and patients for symptoms. Enhancing our already-thorough cleaning and disinfection processes. I hope patient safety and infection prevention remain in the national spotlight long after the COVID-19 pandemic has ended. The healthcare industry must come together to develop stronger systems and regulations to minimize preventable medical errors. We have a responsibility to our patients to do better.

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In recent years, workplace violence against healthcare workers has been on the rise. According to the Occupational Safety and Health Administration (OSHA), about 75 percent of nearly 25,000 reported annual workplace assaults occur in healthcare and social service settings. Those who don’t work in healthcare may be surprised to learn that violent altercations are so common in our field. Hospital settings can create fear and stress for patients and their families. Pain, mind-altering medications and drugs, and difficult prognoses can amplify these feelings. While inappropriate responses may be understandable, violence cannot be tolerated. As the leader of a health system, protecting our employees is an issue that I take seriously. Reporting Workplace Violence Unfortunately, sometimes employees don’t report dangerous incidents fearing they might be blamed, or not realizing it’s a reportable offense. At Renown Health, we take these events seriously. We have clear, mandatory policies and protocols for reporting and investigating violent incidents. Each incident is investigated to ensure follow through and accountability. We also teach de-escalation skills to our hospital security teams, clinicians, and other frontline employees. As an added layer of protection, Renown Health has a first-rate security team that closely monitors activity on our campuses, addressing potential issues before they escalate. Our organization values our partnerships with community organizations including local law enforcement agencies like the Washoe County Sheriff’s Office and the Reno Police Department. Renown Health maintains a close relationship with these partners, and we alert them when our care teams experience an increase in violent incidents. I also recognize that workplace violence is a national problem that demands collaborative solutions. That’s why I am also proud to serve as a member of the American Hospital Association’s Hospitals Against Violence Advisory Committee. Nurses, doctors, paramedics, and frontline health workers care for us every day. It’s our responsibility to support them by ensuring they feel safe at work.

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Without a doubt, taking medications can not only be expensive, but also confusing. In the United States, generic prescriptions are widely used, with 9 out of 10 people choosing them over a name brand. Pharmacists are a great resource to help us understand the benefits and side effects of any medication. We asked Adam Porath, PharmD, Vice President of Pharmacy at Renown Health, to answer some common questions about generic drugs. What is a generic drug? A generic drug has the same active ingredients of brand-name drugs. Brand-name drugs have a patent (special license) protecting them from competition to help the drug company recover research and development costs. When the patent expires other manufacturers are able to seek approval for a generic drug. However, the color, shape and inactive elements may be different. Per the U.S. Food & Drug Administration (FDA), a generic medicine works in the same way and provides the same clinical benefit as its brand-name version. Why do they cost less? Generic drug makers do not have the expense of costly development, research, animal and human clinical trials, marketing and advertising. This savings is passed on to the public. Also after a patent expires, several companies will compete on a generic version of a drug, further driving down prices.

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