From the March 2005 issue

• In our December 2004 article, Acetaminophen toxicity: Are your patients at risk?, we asked readers to share initiatives and ideas for preventing acetaminophen toxicity. As mentioned in the article, patients may not realize the danger in taking multiple acetaminophen-containing products and may unknowingly exceed 4 g daily, putting them at risk for liver toxicity. Here's what a few readers are doing at their site to raise patient awareness.
  
  A nurse working in a pain clinic explained that when the physician prescribes a new pain medication, a nurse reviews the medication with the patient before he/she leaves. If an acetaminophen-containing product is prescribed, the patient is counseled regarding the maximum number of doses per day, the danger of exceeding 4,000 mg/day of acetaminophen, and its availability in many OTC products. However, after reading in our article that patients may not know how to look for acetaminophen on OTC product labels, she said her next project was to develop a handout that illustrated how to do this.
  
  A community pharmacist from Arizona wrote to tell us that in addition to counseling patients who receive new prescriptions for acetaminophen-containing products, his computer system is programmed to automatically print out an auxiliary label with these medications. It warns, "This medication contains acetaminophen. Taking more acetaminophen than recommended may cause serious liver problems," which has prompted patients to ask questions.
  
• In our January 2005 article, Changes in medication appearance should prompt investigation, we advised that pharmacists proactively communicate with patients about the appearance of their medication by showing them the medication during counseling and by alerting them whenever a change occurs. One reader contacted us and told us how his pharmacy attempts to combat this issue. When generic products are dispensed, the name of the manufacturer whose product was most recently dispensed to that patient is entered on a comment line that appears in the computer system each time that medication is refilled. Pharmacy staff know to look at this comment line when processing generic products. If a change in manufacturer occurs, the manufacturer's name is updated on the comment line, an auxiliary label stating that a change in appearance has occurred is placed on the medication container, and these prescriptions are stored in a separate bin. This alerts clerks that a pharmacist needs to speak with the patient. As a result of this initiative, patients expect to be informed about any changes in appearance and do not hesitate to notify the pharmacy when an unexpected change has taken place.