Adverse drug events are one of the most common preventable reasons older adults end up in an emergency department. It is rarely dramatic. It is usually two bottles of the same drug under different names, or a pill taken twice because nobody wrote it down.

Where medication errors come from

• Duplicate therapy. The brand name and the generic sitting in the same cabinet, taken as if they were different medications.
• Post-hospital drift. The hospital changed the dose; the old bottle with the old label is still in use.
• Multiple prescribers. A cardiologist, a primary care physician, and a specialist each prescribing without a complete list in front of them.
• Over-the-counter products. Ibuprofen and naproxen with blood thinners or kidney disease, antihistamines that cause confusion and falls, and herbal supplements that interact with prescriptions — almost never mentioned unless someone asks directly.
• Look-alike pills. Several small white tablets in one organiser compartment, sorted by memory.
• Vision, dexterity, and memory. Small print, stiff caps, and a routine that depends on remembering.

A medication clean-up you can do this week

1. Gather every container in the house — prescriptions, over-the-counter medicines, vitamins, supplements, creams, eye drops, and inhalers. Everything, including the ones in the handbag and the car.
2. Make one written list: drug name, strength, dose, when it is taken, and what it is for.
3. Flag duplicates — any two products that share an active ingredient.
4. Check expiry dates and set expired items aside. Do not flush them; most communities have a pharmacy or law-enforcement take-back programme.
5. Take the list — and the flagged bottles — to the physician or pharmacist. Ask directly: is anything here duplicated, unnecessary, or interacting?
6. Set up a weekly organiser and a fixed daily routine tied to existing habits such as meals.
7. Post the final list on the refrigerator and photograph it. It is the single most useful thing a paramedic or emergency physician can be handed.

Questions worth asking about any new prescription

What is this for? What side effects should I expect, and which ones mean I should call? Does it interact with anything else on my list? Should anything be stopped now that this is starting? How long am I meant to take it? Is there a simpler or less expensive alternative?

Where a nurse changes the picture

Our nurses reconcile the full medication list at the start of care and after every hospitalisation, set up organisers, administer oral and injectable medications where that is part of the plan of care, watch for side effects and interactions, and work with the physician and pharmacy when a regimen needs simplifying. Where a client cannot manage the routine alone, an aide provides reminders and reports back on missed doses.

If you have looked in the cabinet lately and could not confidently say what is being taken and why, that is worth a phone call.