New Meds, New Concerns

Should occupational health managers worry about the effects of newly available OTC meds?

DRUGS in the workplace: The mere thought is enough to send bosses searching for the nearest brown paper bag. Drug users mean violence, theft, and accidents. Illicit substances, dangerous as they may be, are only one part of an employer's worry. Over-the-counter (OTC) and prescription medications remain one of the most elusive safety problems facing occupational nurses and safety professionals.

Some 30 to 40 percent of all workers are taking OTC medications at any given time, according to Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, the current vice president of the American Association of Occupational Health Nurses. Headaches, head and chest congestion, runny noses, muscle aches--all can be relieved by any number of medications that any worker can find at his or her drugstore. And most of the time, these medications will have positive effects on an employee's ability to do the job, or even show up for work at all. But for medicines to be useful, directions must be followed and warnings must be taken seriously.

We've all had days when a headache has sent bolts of pain through our heads with icepick precision. Some of us will reach for a bottle of aspirin, ibuprofen, or acetaminophen and take the recommended dose. But some of us will feel like this particular headache goes beyond the "recommended dose," and these people will take one or perhaps two extra pills to make sure the pain is dulled. But what happens when that medicine can cause drowsiness? What if it interacts with a prescription medication he is taking, causing adverse side effects? What if that worker is a crane operator, works in high places, or has others' safety in his hands? The results can be disastrous.

The problem may be getting worse. New medicines are becoming available to anyone who has the time to walk into a store and buy them. Some, such as Claritin, were once popular prescription medications that have developed a loyal following with American users. Claritin is an antihistamine used to treat allergies. Unlike almost all other medications in this classification, Claritin does not sedate patients. In short, allergy sufferers can take Claritin while at work and not worry about getting sleepy.

At first glance, this new OTC drug may sound like a godsend to workers and employers alike. But it raises serious questions about the safety of employees. Claritin might not cause drowsiness, but most antihistamines do. If a worker mistakenly takes a different antihistamine or assumes one allergy medicine is just like the next, he could be a safety concern to himself and his co-workers.

As popular as OTC medications such as Claritin, Alleve, and Pepcid AC are, prescription medications also can contribute to safety problems in the workplace. Prescription medications often can interact with many popular OTC medicines, and, because many employees never inform supervisors of prescriptions they are taking, the safety of medicated workers and those around them can be a concern.

Prescriptions for anxiety and depression are one of the fastest-growing segments on the medicinal landscape. Given that many people are reluctant to divulge they are being treated for such ailments, it's easy to see why workers who are not educated about the possible side effects could pose a safety risk. Those side effects include increased anxiety, sleep disruption, tiredness, fatigue, nausea, and headaches.

New research published by the Health and Safety Executive (Great Britain's equivalent to OSHA) details the effects of medication prescribed for anxiety and depression on working life. The study found that medicines prescribed to treat these conditions do affect work performance. Medicated workers reported many close calls and near-misses that were attributed to side effects of the prescription. More troubling, the study indicated workers with responsibilities for others, such as doctors, teachers, or managers, seem to be an even greater risk to safety in the workplace when taking these medications.

With so many employees using OTC and prescription medication, what's an employer to do to ensure his or her workers are not being endangered? This is where safety professionals step in.

Getting Involved
While a company, its occupational nurses, and its safety team cannot keep track of every medicine a worker is taking and whether or not it will cause drug interactions or other safety concerns, there are steps that can be taken to reduce the risk of an accident.

Making OTC medications available to workers not only allows for a business to know what an employee is taking, it also makes it possible to offer education and drug warnings to the employee. "Many companies offer OTC (medications) to workers," Randolph said. "There are benefits to this practice as the worker's illness/injury is treated promptly and the worker is able to stay at work, thus saving the employer money in production costs."

Fortunately for employers, there are a number of options in getting the proper medication to a worker. "Medications can be administered to workers in a variety of ways," said Randolph. "Medications can be given out in the occupational health unit, through vending machines, or self-administered medication systems."

Vending machines are a popular method of OTC drug distribution. They do not come without questions, however. According to Randolph, an OHN should be involved in selecting a proper vendor and developing an information sheet to guide workers' selection of the proper medicine. What costs employees might incur and which medications might be offered also are questions to consider.

Self-administered medication systems are similar to vending machines. An OHN should be involved in deciding which medications are offered, preparing and posting an information sheet about the medications and indications for use signed by both the OHN and physician, and monitoring the system for appropriate use, Randolph said.

She also suggested all medications be delivered in unit doses because there is important information about the medication on the package. Randolph reminds employers to follow all laws when providing OTC medicines. "If there is a licensed nurse at the worksite, then the actual administration of medications is governed by various state laws, including the Nurse Practice Act, pharmacy laws, and medicine laws," she said.

Steps to Take when Developing an OTC Medication Dispensing System

1) The OHN should evaluate which OTC medications are currently offered and available at the work site.

Are all of them necessary? Why are they offered? What are their ingredients? Many OTC medications contain compounds that induce drowsiness, impair performance, and can contribute to work-related injuries. Some warn against operating machinery or driving. Some medications contain alcohol, caffeine, sugar, salt, or antihistamines.

2) Next, decide which medications are needed based on the types of worker complaints (headache, etc.), which medication(s) workers prefer, and what the possible cost of the medicine might be.

The OHN or person in charge of the program also needs to know if a standing order for the OTC is needed.

3) Consider the effects of the medication on the employee's job.

4) Consider the interaction of the medication with other medicines the worker may be taking. This may be other OTCs, vitamins, and prescription drugs for any number of ailments, such as hypertension, glaucoma, heart disease, diabetes, etc.

5) Consider effects of other variables:

  • If the worker drinks alcohol, what effect might it have on the medication?
  • What about herbal compounds or remedies?
  • Certain foods may interact with medicines too. This could potentially make them less effective or could cause side effects.

6) Teach workers how to read labels on medications. Include where to find important information such as active ingredients, side effects, precautions, dosage, and indications for use. With more than 100,000 OTC products available in drug stores, grocery stores, hotels, etc., how do we as consumers decide which product to buy? This education is an important area that can save lives, decrease medication interactions, and promote self-care.

7) Written directions are helpful to guide workers' decisions. This also is helpful because of the diversity of workers and language differences.

SOURCE: Susan A. Randolph, MSN, RN, COHN-S, FAAOHN

Education, Dialogue Bring Success
However you decide to offer medications to employees, the common threads should always be education and an open exchange of information.

OHNs are accountable for the effects the OTC medications they recommend have on the end user. Therefore, it is critical that they evaluate an employee's needs and concerns, along with finding out what, if any, prescription medications the person is currently taking, to guide him or her accordingly.

Once a comfortable dialogue has been established, helping employees make an informed choice is essential. There is no end to the information avenues available. "A lot of information is available in newspapers, magazines, pamphlets, drug store (information sheets), et cetera," Randolph explained. "As OHNs, we have a responsibility to educate workers about medications, their appropriate use, and adverse effects that may occur if not taken correctly."

Whatever system a company chooses to set up, being proactive is the smartest move an employer can make. As baby boomers continue to age and retire later--currently, 13 percent of the U.S. population is above the age of 65--chronic conditions that require medications are going to increase. According to Randolph, that 13 percent of the population accounts for nearly one-third of all prescriptions, taking six-plus medications a day. Drug-to-drug interactions are likely to increase. The aging workforce is likely to test OTC dispensing systems even more. The need for proper education and available drug information will become critical.

But, as Randolph pointed out, the situation is not a lost cause. Most workers do not want to take any drug that might hurt them or their co-workers. And they certainly do not want to ingest any medicine that might react with a prescription medicine they are already taking. With the proper education and information, your employees can be your greatest assets in preventing medication-related accidents.

This article originally appeared in the April 2003 issue of Occupational Health & Safety.

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