O.R. Waiting Room

The room was not fully enclosed, one wall was all glass, facing the open courtyard and one wall was just that, a wall.  The other two boundaries were the hall way corridor of the hospital, with technicians, nurses, doctors, administrators and various other folks walking past; all looking in at the family members sitting in the Operating Room Family Waiting Area. 

The OR Waiting Room was comfortable, about 15 over sized chairs in little groupings, and at 10 am on Friday morning there was standing room only.  My wife and I had arrived at the facility 90 minutes earlier, and with a process that could only be described as maximum efficiency with a friendly flair, my wife was admitted, educated, prepped and wheeled off to the operating room.

My understanding was that the procedure should be complete within two hours, so I settle in to the waiting room for a little reading and people watching.  For the next two hours I watch as friends and family show up and visit with other family members who are waiting.  It's always the same, "no, haven't heard anything yet, they're still in there, the surgeon hasn't been out yet".

There is a volunteer for the hospital in the corner at a desk who is doing his best to keep tabs on everyone in the room.  He makes the rounds, gathers names and then heads off into the recovery room to look at the "Big Board" to see where everyone is.  After a few minutes he comes back and goes around the room giving the briefest of reports to family members, letting them know whether their loved one is still in surgery or is now in the recovery room. 

It is interesting how different individuals react under stressful situations.  In the waiting room there is a gentleman who is incredibly anxious about his wife's procedure and is questioning just about everyone in the waiting room.  This well trained volunteer strategically intercepts this individual and directs the conversation back to the corner of the room where he is able to let the gentleman talk quietly with him…until he has said all he needs to say.  Skillfully done by the volunteer.

Bye now the noon hour has come and gone and one by one surgeons have been coming out of the O.R. and quietly calling out the last name of the patient they were operating on.  We talk about privacy in the hospital; however, when it comes to the O.R. Waiting Room, privacy is in short supply.  Time after time I see the surgeon approach the family, who are sitting in a grouping in the waiting room, and then begin to explain the outcome of the surgery that has just been completed on their respective family member. 

As a member of the O.R. Waiting Room, I pretend not to listen to their discussion; however, you can't help but hear the entire process because, well, they are right next to you.  Fortunately, the day I was in the O.R. Waiting Room, each and every time the surgeon came out, a positive outcome was described and gratitude was shared.   After the surgeon leaves the family gathers up their items and makes the journey onto the next stop in their hospital experience.

So here it is, nearly 3pm, and the only folks left in the waiting room are myself and the volunteer.  Over the last hour I have been dozing in and out of semi-chair-sleep and my mind has been wondering.   The understanding was that surgery was going to take two hours, and here it is, almost five hours later.  One can't help their mind from thinking something adverse has happened.  The well intentioned volunteer must have felt my dream emotions because just as I was sitting up he walked back into the room and said he had just been in checking to see where my wife was in her surgery process.

She had just been brought back into the recovery room and I would be able to see her soon.  Not more than 15 minutes after that, the surgeon walked into the nearly empty waiting room and explained that the surgery went just as planned without any complications. 

As mere mortals, we place a sense of helpless trust in surgeons as they open up our loved ones and then proceed to install devices or patch up wounds.  As we wait, we can only breathe as we wait for the surgeon to walk through the door into the O.R. Waiting Room and let us know all went as planned.   


Copyright AudibleRx (TM), all rights reserved.

The Case of Missing Identity

What is it that tells our mind we are reading one name on a prescription bottle when actually it is a completely different name?   Even more disturbing; why, when a label is old, tattered and not readable, does our brain tell us that we think we know what the contents are when actually we are just guessing?
Perhaps we are in pain and we vaguely remember the shape and size of the tablet, maybe it's late and we are tired and we don't pay close enough attention to the label, or we might even be completely distracted, thinking of something else when we are reaching for the pill bottle.
For whatever reason, be it the heat of summer, vacation schedules, or just the recent full moon, I have recently been involved with two such situations.  It is not important to go into the details of each situation; however, both ended with phone calls to the pharmacy after a series of unwanted and unexplained side effects.
Fortunately, both situations ended without visits to the hospital; however, they were both completely avoidable had they been following a few simple rules.
  1. Know the names of each of your medications.
  2. Know why you take each of your medications.
  3. Before your take your medication or fill your pill box, verify that the medication description on the label matches the description of the tablet in the bottle.
  4. If the description does not match, or you cannot read the label, call the pharmacy.
In the early 90's I was regularly involved in helping my Mom set up her prescriptions.  Mom was not unfamiliar with hospitals, having had eight children and multiple surgeries throughout her life.  My wife and I were intimately involved with my parent's life and would commonly stop by their house to visit, while also assuring the medications were all in order.
My point is, even with a pharmacist son setting up the medications on a scheduled basis, issues happen.  Mom had been having some severe gastrointestinal issues and had been prescribed a potent anti-diarrheal medication to treat the situation.  These tablets are small white round tablets that look like quite a few other small white round tablets.  Over the course of 48 hours Mom inadvertently took seven or eight heart pills, thinking they were the anti-diarrhea pills, in a failing attempt to stop her diarrhea. 
The bottle was labeled properly and the correct pills were in the bottle; however, she stated that she was sure she had the right medication because if looked and felt like what she was familiar with.  This event did result in a hospitalization.
As you can see, this topic has a deep meaning for me.  Please, take the time to follow the four simple rules of medication identification listed above.  It may mean the difference between life and death.
Copyright AudibleRx (TM), all rights reserved.

Accessible Patient Medication Information

AudibleRx had the amazing opportunity of presenting a short demonstration of Accessible Patient Medication Information at the annual American Council for the Blind annual convention in Las Vegas this summer.  Following is the script of the presentation.
10:30 AM: Accessibility to Prescription Drug Information: Devices and Approaches, Moderator: Melanie Brunson, ACB Executive Director, Arlington, VA; Mitch Pomerantz, ACB Immediate Past President, Pasadena, CA; Lainey Feingold, Attorney for Structured Negotiations with CVS.COM and Walgreens, Berkeley, CA; En-Vision America, David Raistrick, Vice President, Normal, IL; AccessaMed Inc., Chad Hazen, Director of Community Outreach, Vancouver, WA; AudibleRx, Dr. Steve Leuck, Pharm. D., Owner/President, Santa Cruz, CA

Good Morning:  My name is Dr. Steve Leuck, I am a practicing community pharmacist, and also, the president of a start-up company called AudibleRX, and I am here to discuss consumer access to Patient Medication Information.

AudibleRx provides digital/audio Patient Medication Information as an alternative to the paper handouts you receive with each prescription at the pharmacy.  We like to call it  "Medication information you LISTEN to."

AudibleRx was developed to help bridge the medication-education gap between the patient, their pharmacist and their doctor.

As stated by the ASHP, “The pharmacy profession has accepted responsibility for providing patient education and counseling, in the context of pharmaceutical care, to improve patient adherence and reduce medication-related problems.”

The issue is, patients do not always receive the education and counseling they need in order to achieve the best possible outcome from their medication therapy.   

Pharmacists are under tremendous pressure and will regularly cover the counseling points of three or four prescriptions with a patient in fewer than two minutes. 

Patients are then sent home from the pharmacy or discharged from the hospital with stacks of PMI that may be difficult for many to read or understand.  

Whether it be someone who is challenged with literacy, visual impairment, or just one of the 30% of the population that learn better by listening; many individuals will have a difficult time attempting to understand the paper PMI that they are sent home with.

As an alternative, patients may visit the AudibleRx website, or download the Android or iPhone app,  then, navigate to the medication they want to learn more about, click on the medication, and LISTEN to a 5-7 minute Medication Specific Counseling Session.  

Briefly, and in a simple to understand format, the session will describe how the medication works and what you need to know about taking that particular medication; while also highlighting all of the important required pharmacist counseling information associated with that specific prescription.

After listening to a session a patient or caregiver will have a clear idea of what they do and don’t know about their medication and will be in a much better position to take educated questions back to their own health care provider. 

Please understand, our goal at AudibleRx is not to replace the important face-to-face counseling sessions that a patient will have with their own Community Pharmacist; rather, to help educate patients and caregivers so they will be in a better position to engage their own health care practitioner in an educated discussion about their medication therapy.  

We encourage individuals to develop a relationship with a local community pharmacist they can trust.

AudibleRx is FREE to the individual user.  No logon or passwords are required.  We believe in free medication education for consumers; however, a licensing agreement is necessary in order for a health care provider or institution to promote AudibleRx as a patient education tool. 

We currently have over 250 medication counseling sessions posted, including over 95% of the top 200 prescribed medications.  Medications are organized in categories according to disease state, and a new alphabetical listing has just been added on the website version of AudibleRx.

Please, talk to your pharmacy, hospital, medical clinic, insurance company, and employer and ask them to offer AudibleRx as a medication education tool to their patients and clients. 

Visit AudibleRx.com and listen to a few sessions.  Our understanding is that the AudibleRx website works well with screen readers.  Contact us on Facebook, Twitter, LinkedIn or send us an email.  We really appreciate your feedback and suggestions.
Thanks for your time.

Copyright AudibleRx (TM), all rights reserved.

Hormonal Contraception Tricks the Body

The female menstrual cycle may be common knowledge for many of you; however, when I am counseling someone at the pharmacy counter I feel it is important to start at the beginning to assure we are all on the same page.  Understanding the basics of the menstrual cycle is key to understanding how hormonal contraception works.

In simple terms, the first day of menstruation (menses or period) is the first day of the female hormonal cycle.  The menstrual cycle is counted, in days, from the first day of menses until menses begins again. This cycle usually takes about 28 days; however, it is not uncommon for the menstrual cycle to last somewhere between 21-35 days.

After the female body has shed its uterine lining, estrogen levels will be very low.  The brain will then send out a message for the body to start developing an egg.  As the egg matures over approximately two weeks (the first half of the cycle) estrogen levels significantly increase.  With a surge of hormone, somewhere between days 10-15, the mature egg breaks through the ovarian wall (ovulation) and starts traveling down the fallopian tube ready for fertilization. 

At this point, another hormone, progesterone, starts increasing.  Progesterone helps thicken the uterine lining, preparing a home for a fertilized egg.   After about 13-16 days (the second half of the cycle), if there is no fertilized egg, the progesterone will decrease and the uterine lining will shed (menses, menstruation or period).  Here we are back at the first day of the menstrual cycle, estrogen levels are again low, and the whole process starts over again. 

Hormonal contraception therapy tricks the body.

By maintaining a moderately constant level of hormones in the body, the surge of hormones around ovulation is avoided and an egg is not released.   Hormonal contraception thickens the vaginal secretions, making it more difficult for sperm to reach an egg while also affecting the lining of the uterus, making it more difficult for a fertilized egg to attach to the uterine wall. 

Please visit the HormonalContraception patient medication education page at AudibleRx and listen to any of the seven different Medication Specific Counseling SessionsTM which cover the different categories of hormonal contraception.

Each hormonal contraceptive patient medication education session will discuss the important treatment information regarding that particular medication, including the Black Box Warnings, how the medication works, how to use it, what to expect, potential risks, side effects, adverse reactions and interactions, and importantly; what to do if you miss a dose.


Copyright AudibleRx (TM), all rights reserved.