Daily Preparedness

One of the most common medical errors that can lead to serious illness or even death is one that you can help prevent. Approximately 1.3 million Americans are injured annually due to errors in the administration of medications. Though many of these errors occur in hospital settings, many occur in our own homes. The vast majority of these errors can be prevented by YOU and those you love. What can you do to protect yourself?

1. Know that the elderly and chronically ill are the most likely to be victims of medication errors. Both groups are most likely to have a larger than average number of prescription medications prescribed for them.

2. Children may be at a higher risk because their smaller body size makes it more likely that a dosing or drug interaction error will cause serious harm or death.

3. FULLY UNDERSTAND that medication errors can be fatal.

4. When prescribed a medication, be certain that the doctor explains why you are being prescribed this medication, what the medication should do for you, what the side effects are and how you should take the medication. For instance, should it be taken with meals, before a meal, at bedtime, etc.

5. Always provide every health care professional (including the pharmacist) with a complete list of ALL prescription medications, over-the-counter medications, supplements, herbal products, homeopathic remedies and vitamins that you take. Include the name of the medication, the dosage, how long you have been taking it and the medication’s use.

6. Understand that there is limited, peer-reviewed science based research into the interaction of herbal products, supplements and homepathic remedies. Most of these substances are NOT tested by independent peer-reviewed research nor their quality and potency regulated. Be certain that you fully research any ‘natural’ product that is recommended to you. Many of these products are the ‘natural’ version of powerful prescription medications. For instance, foxglove is merely natural digitalis, which can alter heart rhythms. Echinacea can lead to permanent liver damage, especially if used in combination with other medications/supplements. Prescription medications can interact with a wide range of products and there is, again, limited knowledge as to the interaction of prescription (or over-the-counter medications) and ‘alternative therapies’. Even simple vitamins can lead to overdoses and drug interactions.

7. Before taking a new medication, know how the drug is supposed to help you and all possible side effects.

8. Know what your medications look like. If you receive a new prescription and the medication looks different, do not take it until you speak with a pharmacist. Preferably, the pharmacy will have alerted you to a change in the appearance of your medication.

9. If hospitalized, ask what each medication you are being given is and what it is for. Competent staff will tell you the name of the medication before giving it to you. If they do not, be extra cautious. Again, if the medication looks different than what you normally see, ask!! Know what the dosage prescribed is. If something seems ‘off’, stop and ask to speak to a supervisor. My daughter was nearly killed in a hospital when a nurse attempted to administer 100 times the prescribed dose of a pain killer. The nurse had ‘misread’ where the decimal point was.

10. If the dosage and frequency of taking a medication is different than your physician told you, ASK questions!

11. Be certain that you are taking your medications exactly as prescribed. Regularly review the instructions on your prescription bottles!

12. If you take multiple medications, or care for someone who does, consider using a medication minder container. Many types are available at a variety of price points. These specially designed containers can be a great help in being certain that you are taking your medications as prescribed. This is vitally important for the elderly or anyone who may have memory issues.

13. Periodically review with your physician the medications you are taking. Each office visit should include a review of your medication, including when you need a new prescription written. Again, the elderly are most likely to have too many medications prescribed for them, often creating secondary problems. If a new symptom appears, ask the pharmacist if this could be a reaction to a medication.

14. When prescribed a medication, ask if there is a generic alternative which may save you money. Often, prescribers will merely write for the newest medication when an older, proven medication may work just as well. Also ask if there is an alternative to medication. Could you achieve the same results through lifestyle or diet changes?

15. Choose carefully and use one pharmacy for all of your prescriptions. Some points to consider when choosing a pharmacy:

• Is there a pharmacist available to answer all of your questions?
• Know the role of pharmacy technicians. Though they may perform many tasks within a pharmacy, including accepting prescriptions from you, they should not be answering questions about your medication’s interactions, uses and side effects.
• Does the pharmacist have time to talk to you in person or on the phone? If not, they may be over-worked which leads to more errors. Some pharmacies evaluate pharmacists on the number or prescriptions they fill per hour, not the number of customers they serve.
• Does the pharmacist answer your questions about drug interactions? If you are on medications for serious pain, heart problems, liver disease or kidney disease (or other serious long-term illnesses), be certain that you ask the pharmacist before taking over-the-counter, herbal or supplement preparations. Pharmacists should be able to answer your questions, with the exception of some herbal & ‘natural’ remedies that have not been well researched.
• Is the pharmacy efficient? Are prescriptions filled when they say they will be? An efficient pharmacy should be able to estimate when your prescription will be ready and alert you to possible delays. If they are chronically misrepresenting the time it will take to fill a prescription, they may be over-worked, under-staffed and more prone to errors.
• Can you understand the pharmacist? You should be able to freely communicate with this important member of your health care team!
• Be certain that the pharmacy has up-to-date software that warns of drug interactions, low/high dose alerts, LASA error checking (Look alike/sound alike) and patient allergies. Be certain that the pharmacist is aware of your drug and food allergies. Some food allergies can significantly impact the medications you can be prescribed.
• Is the pharmacy concerned with your privacy? Pharmacy staff should never announce the medication they are filling for you in a way that others might over hear.
• Does the pharmacy alert you when the appearance of your medication has changed?
• Does the pharmacy provide you with an information sheet that describes the appearance of your medication, possible side effects and uses of the medication?
• Does your pharmacy communicate efficiently with your physician’s office? Some communication errors are due to delays in the doctor’s office, but pharmacy staff should be able to up date you on their progress.
• Does your pharmacist relay information to you effectively? If they say they will get back to you, do they? Do they call you if there is a problem with a refill?
• Will your pharmacist attempt to answer your questions with research? We have had multiple times where a great pharmacist will go to extraordinary lengths to be certain that a medication is safe. This has included the pharmacist calling the pharmaceutical company for further information. This type of dedication can, literally, safe your life and you SHOULD EXPECT IT!
• Remember that the pharmacist is your safe guard when it comes to medications! They should have the most up-to-date and effective means by which you can be protected from possible allergic reactions or drug interactions. They are the trained professional when it comes to medication management!

16. Keep your medication information confidential and safe. Remove prescription labels from empty bottles before discarding. Likewise, shred information sheets or other paperwork that details what medications are in your home. Do not discuss publicly or post online medications you take. Theft of prescription drugs is on the rise.

17. Teach your children to never take medication (again, including ‘natural’ products) from someone other than you or a licensed health care professional.

18. Discard of out dated medications safely. Be especially vigilant about medications you may not take regularly, such as epi-pens or inhalers. Check their expiration date and get refills when needed.

19. Store your medicaitons safely. Know if the medication needs to be refrigerated. In general, most medications need to be protected from moisture, light and extremes in temperature.

20. Don’t run out! Be certain to carry vital medications with you and refill your prescriptions BEFORE you run out. Most insurers will allow you to refill a prescription seven days prior to the day you will run out.

21. KEEP YOUR MEDICATIONS OUT OF THE HANDS OF CHILDREN! Keep all medications, including vitamins, away from children. Be certain that visitors to your home safe guard any medication they have. Many children suffer overdoses while exploring Grandma’s luggage or purse.

Though there are many medical errors we cannot prevent, medication errors can often be prevented through our own vigilance, common sense and just a bit of time. Be wise, be cautious and be healthy!

The week before Christmas and all through the land,

Folks are scurrying and feeling rather grand.

Now is the time for the wise to prepare,

So that holidays will occur without a scare!

Okay, so the poetry isn’t great, but just to make certain that your holidays are more merry than scary, remember a few last minute reminders:

SHOPPING:

• Try to go without little ones so you aren’t distracted
• Keep packages out of sight–lock that trunk!
• Be constantly aware of your surroundings
• If you must shop alone and at night, ask for security to walk you to your car, especially in a large and/or dark parking lot
• Carry valuables in your front pockets. Avoid a purse or tote if possible
• Keep your credit cards in sight when completing transactions
• Be aware of anyone looking over your shoulder while you process your transaction
• Don’t process a purchase while clerk is on the phone, especially if speaking in another language and holding your credit card
• Use internet sites that are secure
• If you are gone from home all day, ask trusted neighbor to pick up packages left at your front door.
• Keep your receipts–most merchants have tightened up return policies!
• Have some cash for emergencies and small purchases

TRAVEL

• Have cash for emergencies
• Re-read hints about winter travel
• Plan plenty of time for delays
• Keep your cellphone charged
• Check car condition before travel

HOME

• If going away, use timers on lights and talk radio channel
• Ask trusted neighbor to bring in mail and newspapers
• Don’t put gifts where others can see them through open drapes
• Be sure to practice fire safety, especially with lit candles and flammable decorations
• If having house guests, be certain their medications are up & away from little hands
• Cut up and bag boxes from high priced items when disposing of them or take to recycling center
• Practice safe food handling

Have a safe, blessed, healthy and happy Christmas!

The turkey leftovers are gone, gifts are being wrapped, and in many parts of the country, snowfall is happening. For those in warmer climates, the impending holiday season often means traveling to or through areas that may become a ‘winter wonderland’ at a moment’s notice. To make certain the bells being rung aren’t yours (when you are stuck in a snowdrift or hit by a car), prepare your car appropriately before heading out. Anyone driving where there is or might be snow, should stock their car with the following (most courtesy of the Loudoun County Virginia Sheriff’s office):

- Properly fitting tire chains
- Bag of sand or salt (or kitty litter)
- Traction mats
- Snow shovel
- Snow brush
- Ice scraper
- Booster cables – also consider when of the ‘instant’ jump devices
- Warning devices such as flares or emergency lights
- Fuel line de-icer (methanol, also called methyl alcohol or methyl hydrate)
- Extra windshield wiper fluid appropriate for sub-freezing temperatures
- Roll of paper towels
- Flashlight and a portable flashing light (and extra batteries)
- Blankets—‘space’ or emergency blankets are small and can be used for signaling.
- Extra clothing, including hat and wind-proof pants, and warm footwear
- First aid kit
- Snack bars or other “emergency” food and water. Don’t forget food for babies!
- Matches and emergency candles. Only use these with a window opened to prevent build-up of carbon monoxide.
- Road maps — Be certain you know where you are going and the current conditions of the roads ahead if you leave a major traffic artery! Do not rely solely on your GPS unit. (One springtime, my family and I were traveling in New Mexico. We left the desert floor and, using a road map, decided to take a more ‘direct route’ than the one recommended to us. The road map was not a geographic map. We ended up going from desert to snow-capped mountains very quickly. It was inconvenient in the spring, but could have been deadly in the winter, especially if we had experienced car trouble! Know what you are driving into!)
- “Call Police” or other help signs on brightly colored banners.
- Spare tire in good condition and ‘instant’ flat repair
- Necessary medications

And a few safe winter driving tips:

Always keep the gas tank topped off. When it gets to half, fill it up.

Do not travel unless absolutely necessary. If you do have to make the trip, ensure someone is aware of your route of travel. If you change your route, notify that same person! People are lost every year due to taking ‘short cuts’.

Carry a cellular phone. Your cell phone can be used during emergencies and for notifying those expecting your arrival in case there are weather delays. Make certain you have a car charger and consider purchasing one of the temporary ‘instant chargers’ for at least one cell phone.

Always buckle-up. Your seat belt can be the best protection against drivers who are tense and in a hurry because of weather conditions. All children should be properly restrained all of the time!

Clear snow and ice from all windows and lights – even the hood and roof – before driving.

Pay attention. Don’t try to out-drive the conditions. Remember the posted speed limits are for dry pavement.

Leave plenty of room for stopping.

Leave room for maintenance vehicles and plows – stay back a safe stopping distance and don’t pass on the right.

Know the current road conditions. Check with local safety officials before driving.

Use brakes carefully. Brake early. Brake correctly. It takes more time to stop in adverse conditions.

Do not pump anti-lock brakes. If your car is equipped with anti-lock brakes, do not pump brakes in attempting to stop. The right way is to “stomp and steer!”

Watch for slippery bridges, even when the rest of the pavement is in good condition. Bridges will ice up sooner than the adjacent pavement.

Don’t use your cruise control in wintry or rainy conditions in order to avoid spinning out of control! Even roads that appear clear can have sudden patches of ice or puddles of water that are unnoticeable against the pavement. These patches can instantaneously cause your wheels to lose traction - even for a split second - which causes them to spin at a faster rate. This confuses the cruise control, which misunderstands this momentary increase in rotation to mean that your speed has increased. The cruise control will then apply the brakes, which is the last thing you want to do when you start to lose traction! When the wheels suddenly increase their rotational speed, then suddenly stop, it’s this combination that then causes you to lose traction and spin out of control. When this occurs on puddles of water it’s known as “hydroplaning”, but the same principle can prove to be just as deadly on ice!

Don’t get overconfident in your 4×4 vehicle. Remember that your four-wheel drive vehicle may help you get going quicker than other vehicles but it won’t help you stop any faster. Many 4×4 vehicles are heavier than passenger vehicles and actually may take longer to stop.

Don’t get overconfident in your 4×4 vehicle’s traction. Your 4×4 can lose traction as quickly as a two-wheel drive vehicle.

Look farther ahead in traffic than you normally do. Actions by cars and trucks will alert you quicker to problems and give you a split-second extra time to react safely.

Remember that trucks are heavier than cars. Trucks take longer to safely respond and come to a complete stop, so avoid cutting quickly in front of them.

Go slow!

———-This week’s 10×100 Challenge Goals———-

78. Try a new recipe that utilizes at least two items from your long-term storage.

79. Check supply of over-the-counter medicines such as antihistamines, antidiarrheal, pain killers & anti-inflammatories.

80. Check the caulk around tubs, showers and toilets. Repair or replace as needed.

81. Check your credit cards? Current? Do you have too many?

82. Check your credit report for errors.

83. Be certain you are shredding documents with personal information such as insurance numbers, birth dates, account numbers, social security numbers.

84. Google your name to make sure someone is not using it online or writing about you in an unfavorable way.

Before you know it, the school bell will be ringing from kindergarten to the hallowed halls of advanced degrees. As summer winds down, it is time to once again set those alarm clocks, pack the lunches, fill up the backpacks and send the children off to school (or prepare for your homeschooling year).

No matter the grade or age of your learner, starting early and planning well can help make the school year a successful one for you and your student-children. Just a few pointers to help ease the transition:

1. Reset body clocks several weeks before school starts. If your summer schedule has included later-than-usual bedtimes and wake-up times, now is the time to reset those internal clocks. Begin with a few minutes each day, working toward a regular school schedule at least a week before school begins.

2. Do your back-to-school shopping NOW (if you haven’t already completed it). Be certain to get your supply lists from school and shop at home FIRST. You might be surprised how many supplies you have on hand. Take your amended list to the store and check off items as you purchase them. Label everything and pack away (far, far away if you have anxious little fingers around) so that all is ready before school begins.

3. Shop at home first for school clothes. Get the laundry caught up and see what junior already has in his/her wardrobe BEFORE you go shopping. Set a strict budget and shop the end-of-summer sales for fall clothing. Don’t forget to check sibling hand-me-downs as a potential source of clothing. Also check with friends, thrift shops, freecycle and Craigslist for clothing exchanges & great deals.

4. Include in every backpack an emergency contact card that includes your child’s name, address, phone, parents’ contact info, alternate contact person, important medical history (allergies, conditions, etc) and out-of-state contact. Laminate the card or seal in a ziploc bag. Attach to the inside of the backpack with a safety pin.

5. Label backpacks on the inside with your child’s name—not the outside. Outside names help predators befriend small children.

6. If your child has severe allergies to items that might be in the class or lunch rooms (such as peanuts, wheat, etc) be certain to speak with the school administration, school nurse and all classroom teachers that might have contact with your child (don’t forget art, music, etc). Speak face-to-face as well as present written information about the allergy, the possible reaction and medication that must be given. Don’t hesitate to check back with all you spoke to in a week or two to make certain that they remember. Ask what has been done to protect your child.

7. Do several ‘trial runs’ to elementary school with your child. If they are walking, point out the homes of friends on their route that they can seek help from. Be certain they know who to go to if they should ever come home and find no one home. The same thing goes for after school caregivers..make sure they have an emergency alternative planned.

8. Check to see what the school’s policy is concerning early dismissal or delayed starts. Do they have an emergency contact system in place that you can sign up for? Do you have childcare arranged for such instances?

9. Be certain that your older children (middle school & high school) are well versed in preventing accidents, how to extract themselves from a dangerous situation and who to report suspected or potential violence to. Have a frank discussion with them about the dangers of fire arms, weapons, drugs, hate crimes, sexual abuse and harassment (including being groped, spoken to inappropriately, etc), physical threats and abuse. Sexual abuse and harassment have become so common, that a shockingly high percentage of high school girls do not even recognize it when it happens to them,

10. Have the same frank discussion with college-bound students. Be certain that they are aware of safety precautions, the dangers of date rape, the potential for drugging of beverages (at a party or other social gathering, they should only drink from a can or bottle they open and which remains in their sight at all times), car safety and dorm safety. Know what safety procedures are in place at your child’s college campus and be certain they your student understands them.

11. Be certain that your middle and high school students understand that the effort they put into school now will affect the remainder of their life. The grades and activities they participate in now will affect their ability to be accepted to college & possibly win scholarships.

12. Establish good sleeping and eating habits for your students! Many high school students are chronically sleep deprived and their grades suffer. Look carefully at school lunches offered. Are the meals nutritious, healthful and handled carefully? If you are packing lunches, be certain to read up on safe food handling practices.

13. Be open and realistic about your expectations for your children’s academic endeavors. Be certain the child undeerstands what you expect and the consequences if they do not meet those expectations.

14. Have a frank discussion with your college-bound students about the realities of student debt. The average undergraduate leaves college with a diploma and $25,000 to $45,000 in debt. Advanced degree holders leave with debts that spiral upwards of $100,000. Be certain that your college student understands the full picture of the dangers of accruing not only student loan debt, but credit card debt. There are thousands and thousands of stories out there of college graduates with unmarketable degrees and a lifetime of debt to pay back. Explore other avenues of financing college, such as scholarships, work study programs, community college for general education credits, work-release programs and payback options through employers. If student loans are an absolute necessity, be sure that they are used only for absolutely necessary educational expenses. Be certain that the student understands that debt accumulated now will not disappear and should they marry, they may be doubling their debt.

15. Send your college student to the dorm with a mini-72 hour kit. Include foods that can be eaten without cooking, a change of clothing, emergency contact info, water, a first aid kit, a ’space’ blanket, a flashlight, a candle, a simple sewing kit, some cash in small bills and some matches.

16. Before college begins, check to see if your student is covered by your medical and dental plans. Be sure that your student has the appropriate policy identification cards and knows where to get care. If your child has a less-than-run-of-the-mill medical history, locate a physician in the college area and forward pertinent medical information.

17. Be certain that your college-bound student understands the realities of and how to prevent identity theft, including medical identity theft.

Enjoy watching your child grow up and conquer the world!

NOTE: While writing this article, I missed some VERY important information. Thankfully, Tami sent in a comment reminding me with her words of wisdom. Here is her comment:

“I just want to add to your note about preparing for college students–parents need to know that when their child heads off to college, there are privacy laws that apply to their child, and the parents do not have the legal right to get any information about grades or anything else. Also the parents do not have the right to be notified about any medical issues and do not have the right to be involved in any medical decisions. This can all be addressed legally, with medical power of attorney and other legal documents, but it’s something that all parents need to be aware of and discuss with their almost-grown children.”

And from me:

Thank you, Tami for pointing out this important item I missed! You are absolutely correct that parents (even ones paying the tuition bill) will have NO legal right to obtain information about their legal-aged child’s school or medical records. Even if your child is ill, the physician is constrained by law. He/she cannot discuss your child’s case or history without (except for possibly life & death situations) your child’s consent. Before dropping Junior off, have him/her execute a medical power of attorney which gives you permission to speak to caregivers. You can easily find a ‘fill in the blank’ form online by searching for medical power of attorney. Ideally, the form will be notarized and include express permission in compliance with HIPPA laws allowing you to speak to any medical professional caring for your child. A similar form should be completed with regards to academic records, etc. Thanks again, Tami!

For many people, decorating the Christmas tree is a favorite part of the holiday. The National Safety Council (with a few I added for good measure) offers some safety tips to make sure a mishap doesn’t spoil your holiday season.

Christmas Trees

• A real tree can add to the spirit of Christmas by filling your home with beauty and the scent of pine. But a real tree can also pose a fire hazard. Each year, more than 400 residential fires involve Christmas trees and tragically nearly 40 deaths and 100 injuries result from those fires.
• Try to select a fresh tree by looking for one that is green. The needles of pines and spruces should bend and not break and should be hard to pull off the branches. On fir species, a needle pulled from a fresh tree will snap when bent, much like a fresh carrot. Also, look for a trunk sticky with sap.
• Cut off about two inches of the trunk and put the tree in a sturdy, water-holding stand. Keep the stand filled with water so the tree does not dry out quickly.
• Stand your tree away from fireplaces, radiators and other heat sources. Make sure the tree does not block foot traffic or doorways.
• If you use an artificial tree, choose one that tested and labeled as fire resistant. Artificial trees with built-in electrical systems should have the Underwriters Laboratory (UL) label.

Tree lights

• Only use indoor lights indoors (and outdoor lights only outdoors). Look for the UL label. Check lights for broken or cracked sockets, frayed or bare wires, or loose connections. Replace or repair any damaged light sets.
• Also, use no more than three light sets on any one extension cord. Extension cords should be placed against the wall to avoid tripping hazards, but do not run cords under rugs.
• Turn off all lights on trees and decorations when you go to bed or leave the house.
• Consider placing a fire extinguisher near the tree ‘just in case’.
• Tree ornaments

• Always use the proper step stool or ladder to reach high places.
• Read labels before you use materials that come in jars, cans and spray cans.
• Never place lighted candles on a tree or near any flammable materials.
• Avoid placing breakable tree ornaments or ones with small, detachable parts on lower branches where small children or pets can reach them.
• Do not hang popcorn chains and candy canes on the tree when small children are present. They may think that other tree ornaments are also edible.
• Be cautious and considerate of your animals, too!
• Gifts
• Do not place tree in front of un-covered window. Keep curtains closed at night so that ‘outside eyes’ cannot spy the loot under your tree
• Be certain that wrapping paper and ribbons are not entangled with extension cords
• On Christmas morning, have several trash receptacles ready for the wrapping paper and ribbons.
• Be cautious about burning wrapping paper in the fire place. Much of it contains components that can spark, ‘explode’ or produce noxious fumes. The better bet is to place it all in the recycling bin.
• Be careful to protect pets from ribbons and paper. The papers can contain toxic substances for the little critters and they can become entangled (even choked) by loose ribbons.
• For re-usable wrapping, consider making or purchasing simple fabric bags that can be re-used year after year.
• Keep all of your receipts not only for returns but to protect yourself against credit card fraud. Carefully scrutinize your January credit card statement.
• Also remember that chocolate and other common Christmas treats are, in general, not good for your pets.

Enjoy a safe, happy, and well-prepared holiday season!

Using ‘plastic’ money can be a great way to track expenses and consolidate your bill paying, but that plastic should come with a bit of a warning label. Credit card fraud is on the rise, as is the fraudulent use of checking accounts. Common sense and a healthy dose of forewarning are your best protections! Keep these pointers in mind and you will be spared the agony accompanying the all-too common crime of credit card fraud:

1. Don’t let your credit card out of your sight.

2. Shield your credit card number from onlookers. A new version of credit card thief is utilizing the cameras on cell phones to capture images of credit card numbers used by others in public settings such as stores.

3. Don’t process a credit card, debit card or check transaction with a clerk that is talking on the phone, particularly in a language you do not understand. This is one of the newest ways to steal your information!  Hold your card until the clerk is done or ask for the phone call to be terminated.  Better yet, shop at stores that allow you to retain custody of your card and swipe it yourself.

4. Never provide your credit card number or the cvi code on the back of the card to someone that calls you or emails you. A common scam is to inform you through a call or email that a problem has arisen with your account and they need to verify your information. NEVER utilize a link provided in an email to verify your personal information.

5. Never provide your credit card or other personal information on a website that is not a secure site.

6. Sign credit cards as soon as you receive them.

7. Shred all credit card applications you receive. Shred expired credit cards and any piece of paper with credit card information.

8. Never leave credit cards or receipts with your credit card information lying around.  Shred them!

9. In a secure place, keep a copy of all your credit cards and numbers with the phone numbers for customer service.

10. Check your monthly statements carefully. IMMEDIATELY report any charges that appear fraudulent.

11. If you even suspect that your credit card has been out of your control for any length of time, call your credit card company. Their security department should quickly verify all activity on the card, close that account and issue new cards to you.

12. Carry only the number of credit cards that you absolutely need. When traveling, it is a good idea to carry a back up card in a location other than your wallet. When traveling with another family member, have them carry a different card than you. If one is lost, you still have one between the two of you to use until the lost one can be replaced.

13. Never sign a blank or partially filled in receipt. If there are lines for tips, etc, make certain you have filled them out appropriately and put a correct total on the bottom line.

14. Carbon paper receipts are rarely used. If you do happen across a merchant still using carbon paper, ask for the carbon and then destroy it.

15. It is often best to avoid writing checks at retail establishments or to merchants you do not know. With your routing number and checking account number it is quite easy for thieves to tap into your bank account.

16. Be particularly careful with debit cards. Most debit cards do not have the same level of protection that a credit card does.

17. Periodically, get a copy of your credit bureau report. You are entitled to a yearly free copy.

18. Ask to have passwords placed on all of your accounts. This password will be required to make any changes to your account and protect you from the address being changed without you knowing it.

19. Never lend your credit card to someone else.

20. Notify your credit card in advance of any change in your address or phone numbers.  If you do not move often, periodically check to make certain that your credit card company has your correct address and phone number.  This is particularly true if you rely on electronic statements.

21. Some credit card issuers will refuse charges from little known internet sellers or unusual spending patterns. If you are planning to make a sizable purchase on a card that you do not use often for that sort of purchase, contact your credit card company in advance.

22. Before traveling overseas, ask your credit card issuer what their charges for currency exchange are as well as your protection should your card be used fraudulently outside the U.S.

23. If your credit card is lost, IMMEDIATELY contact the provider of the card. According to federal law, you are not responsible for any charges made after you have notified the issuer of the card. (This may not apply to debit cards!) Your maximum liability according to U.S. law is $50 per credit card and some issuers will waive that for good customers.

Following these guidelines will go a long way in preventing the headaches and potential of identity theft associated with check, debit card and credit card fraud.

Preparedness and provident living extend well beyond the edible goodies in your pantry and the water safely stored!  The well-prepared home is one in which a family can shelter for at least two weeks without having to depend on outside support.  Even better, is a home that would allow you to stay in place for months if need by!  This level of preparation is not intended to fulfill some doomsday scenario, but to allow you to weather the storms of life–illness, weather events, unemployment, unexpected expenses, inflation and a wide range of small to large disasters.  A prepared and provident home takes advantage of sale prices to stock up and then uses up their ‘bargains’ until the next sale rolls around.

Hygiene: feminine products, hand sanitizer, baby or other disposable wipes (if you don’t have water, this would be your primary source of hygiene for the whole family), toothpaste, mouthwash (even if you don’t use regularly, it will keep mouth healthy & can disinfect other items), diapers, toilet paper, facial tissue, bleach, dishwashing soap (not dishwasher soap), dishwasher soap, laundry detergent, spray disinfectant, paper towels, garbage bags, basic household cleaners, disposable abrasive pads, ‘comet’ or similar powdered cleanser.

Health: vitamins, pain relievers, thermometer, cold medication, prescription medication, rubbing alcohol, cough drops, anti-diarrhea medication, laxative, a well stocked first aid kit, hydrogen peroxide, disposable latex gloves (if anyone is allergic to latex, order non-latex gloves), N-90 facial masks, antacid, & any other over the counter meds your family uses regularly.

Safety/comfort: candles (the best are those encased in glass container), matches, fire extinguisher, flashlights, batteries, battery operated radio, heat source (firewood, portable heater, etc—NEVER use a BBQ inside and NEVER store an extra propane tank inside your home or garage), smoke detectors that run on batteries, extra warm clothing, fans, sufficient blankets and/or sleeping bags, hats, mittens, rain gear

Tools: basic tool box to include a screwdriver, hammer, nails, pliers, screws, etc, tool to turn off gas line (can only be re-opened by professional), bung wrench if you store food in plastic buckets, plastic sheeting, duct tape, painter’s tape (these items can help seal up windows, etc. to keep home warmer as well as patch holes in the roof & package excess trash), snow shovel, regular shovel, paper, pencils.

Eating: disposable plates, cups, pans, & flatware, paper napkins, aluminum foil, BBQ (only outside), & camp stove.  Don’t forget extra fuel!

Car: keep at least ¼ to ½ tank of gas at all times. Have your car emergency kit packed and updated. And keep your car well maintained!

Pets: Remember to think of your pet needs as well.

Cash:  Every home needs a reasonable amount of cash in small bills (NO larger than $20) stored.  In many natural or man-made disasters, access to checking accounts, debit cards and credit cards is cut off.   All transactions are made with cash, and change is often not available.

Entertainment: Have you considered how you would keep yourself and your children busy if you don’t have electricity or cannot go out to your local ‘amusements’?  Be certain that you have books, games, hobbies and an idea of how to entertain yourself and your family at home.  Practice once in awhile–it’ll be good for your relationships and your wallet.

Information: Do you have a ‘hard copy’ of quick recipes, phone numbers, important addresses, etc?  Be wary of keeping all of your vital information electronically.  Technology is wonderful and we all rely on it, but keep at least a minimum of information in a format that is easy to access regardless of whether you have power or internet access.

Think through the specific needs of you and your family. Adapt these suggestions to meet those needs and then evaluate what you have on hand. Many of these items, such as paper towels, need only be stored in a larger than normal quantity.

In the musical “Annie”, there is that classic song with the lyrics, “Tomorrow, tomorrow, there’s always tomorrow, you’re only a day away..” The younger we are, the more we believe that our tomorrows are endless and probably merely improvements on today. As we contemplate our future, we are full of hope, enthusiasm and great plans for all that life has in store for us. Often in this type of contemplation, we don’t want to think about the realities of life, the nitty-gritty ‘what ifs’ about living; illness, dying, aging, handicaps, health issues, caring for elderly parents and hardships. But, life can deal any or all of these to without warning. Being prepared is our only true defense! Here, then, are a dozen things we all should do to prepare for anything that ‘tomorrow’ might bring, for we all know that ‘tomorrow is only a day away…’!

1. Have you granted trusted relatives the right to discuss your medical care with your physician or other medical personnel? Federal and state laws make it illegal for medical personnel to discuss your care with anyone unless you have given permission for them to do so. This is good, but could be a problem should, say your loving daughter believes you are exhibiting the signs of a stroke. If daughter calls your doctor, the doctor, legally shouldn’t discuss her with you. My Mother & I discovered this when she passed out and then was less-than-fully-functioning for a while. Her doctor had her write a letter listing those she authorized to talk to him and their contact information. The letter also gives the doctor the right to call one of us if he believes there is something we need to be aware of. This also applies to your children over the age of 18 (16 for some matters), so have them execute such an authorization before going off to college. You might want to consider granting someone a medical power of attorney. This is often part of a living trust and some wills. This gives an individual the right to make medical decisions for you in case you are incapable of doing so for yourself.

2. Have you recently checked your will or trust? A living trust greatly can reduce the process should you become incapacitated or pass away. Consider changing from a will to a trust. The trust can divide your assets as you see fit and protect you in case you are incapacitated. Periodically review the terms and see if they fit your current circumstances and wishes.

3. Do you have an Advanced Directive? This document details your wishes should you be terminally ill or if you need to be resuscitated. Your doctor, hospital or attorney can provide you with the simple form.

4. Consult an estate attorney before you add anyone’s name to any your real or personal property. Some families attempt to circumvent probate this way, but it can leave all parties open to all sorts of liability and tax issues. It may be better to form a ‘Limited Liability Corporation” if non-spousal relatives wish to own property jointly. Each state’s laws differ so be certain to contact an attorney.

5. Do you have someone you can trust to help you review your financial situation? Who will take care of your finances if you are incapacitated? Again, a trust with two executors can be a great thing.

6. Do you have your financial and insurance information in one place that someone knows about? A simple three ring binder can work. As you pay bills for insurance, etc. or receive statements, simply put one copy of each form in your notebook. You might want to add any charge accounts you have, especially those that have credit life. You don’t have to replace the copies as you receive your statements–just add any new ones you open. Photocopy the deed to your house, your car registration and any other document and put those copies in your notebook. Now, add contact information for those you would need to contact in an emergency. It wouldn’t hurt to give a copy of this to your executor. It is a great back up in case you have an emergency or lose your home.

7. Put passwords on all of your accounts—bank, credit union, credit cards, etc. Don’t open an account where they won’t let you use a password. The password will protect you from someone else changing the information on your account. This is a simple and yet effective way to prevent someone stealing your credit! If you think you won’t remember the password, chose a word and write a sentence about it in your address book. For instance, if your password were “Mercedes”, write down, “My first car was a Mercedes”. That will help you remember.

8. Do you have copies of your birth certificate, marriage license, service records, car registration, divorce decree, passport–all those pesky life documents we need? Put them with your account notebook or notate in the book where you keep them.

9. Write down your wishes for your “Final Farewell”. If we don’t speak our minds, those we love won’t know what we want and may spend more time or money than we would have wanted “Paying tribute to us.” Family feuds are often started over, “What Mother would have wanted.” For instance, I would rather my children go on a lovely cruise than spend $25,000 on a casket for me. (Did you know you could order discounted caskets online now??? Not legal in all states, but in many. For instance, you can order a traditional, tasteful, handmade casket produced by monks for as low as $695.) Shopping ahead of time is much, much better than buying prepaid funeral plans. Research burial options and decide ahead of time.

10. Be very, very, very, very cautious of anyone offering to sell you insurance, prepaid funeral plans, financial management, etc, etc. Have a trusted friend or relative who will talk through the many offers you might receive before you make a decision. Never enter into a long-term contract without taking at least 72 hours to think about it. The same is true of investments and other major purchases. Trusted, reputable institutions will never pressure you or use scare tactics.

11. If you are married, are you a full partner in knowing everything there is to know about your financial situation, the insurance you have, liabilities, etc.? If you aren’t, you should be!

12. Is your home safe for you? Before you fall, have grab bars installed in your bathroom. If you need them other places, have them installed now. Check for tripping hazards. Have a phone that does not rely on electricity. If you think you might require assisted living, start shopping early. Choose one that will accept Medicare in case you outlast your resources.

And one bonus:

13. Decide at the beginning of each year which charities you wish to support. Decide how much you can reasonably afford and then donate it. Throw ALL OTHER letters from charities into the trash BEFORE you open them. You can also decide every quarter or twice a year.

Our most common and effective source of complete protein necessary for human health is meat–beef, chicken, pork, lamb and fish. Market analysts are predicting that today’s lowered meat prices are a temporary stop on the Inflation Train. Most analysts suggest that this ’stop’ is due to meat producers increasing their sales of meat to market to avoid paying record prices for grain and other associated costs of raising and bringing meat to market. We, the consumers, can benefit from this temporary pricing downturn and stock up before prices (again according to industry analysts) rise sharply.

No matter what the cost, meat must be handled and stored properly if it is to provide safe nutrition for our families. This safety begins in the grocery store. Purchase your meat at the end of your shopping trip, thus keeping it cold longer. Consider investing in a washable insulated bag or two that can hold your meat purchases from the meat counter all the way home. This is particularly valuable in the hottest summer months.

Most grocery stores offer plastic bags in which to place your meat selections. Utilize these as well as paper towels and hand sanitizer. Place your meat in your grocery cart away from other grocery items. The bottom rung of the grocery cart is a good place, which prevents meat drippings from contaminating other items.

When choosing meats, make sure the meat feels cold in the case. Some consumers carry meat selections around the store; leave them in aisles or at the check out counter. These items have been exposed to warmer temperatures and bacteria may have begun to grow. When choosing fish, remember that if it smells too ‘fishy’, it isn’t fresh!

Look for meat items marked down. These can be a great buy! Some grocery stores mark down their meats on a specific schedule, such as 4pm every day. Ask the butcher at your favorite store if there is a mark down time and shop accordingly!

Some grocery stores will also grind meat for you. This is great for sales on roasts or whole chunks of meat that you would prefer to use as ground meat.

Watch the cashier as she packages your groceries. Do not allow them to place raw meat in bags with other food items. All store employees should be trained to follow this common protocol, but some forget or fail to follow the rules. If raw meat is placed in a bag with fresh produce, insist on replacement produce.

After getting your meat choices home, unpack the meat and frozen items first from your car and refrigerate immediately. Again, keep the meat segregated from other foods. Plastic shoeboxes, trays, dishes, etc are all good options for segregating raw meats in the refrigerator.

If you are going to freeze your meat purchases, spread them around in the freezer. Most home freezers cannot freeze ’stacked up’ packages, especially densely packed ones, quickly. If you have saved money by purchasing a ‘club’ or ‘family’ package that is too big for a single meal, it is simple to reduce the meat to meal-sized portions. First, follow safe meat handling procedures by beginning with clean hands and work surface. It is preferable to cover your work surface with a clean, washable cutting board or mat. Cut or portion the meat into your preferred size and wrap each portion in plastic wrap. Try to avoid getting the plastic wrap folded into the meat. Place multiple plastic wrapped portions into a heavy-duty storage bag and label; include the cut of meat and date purchased on your label. A permanent marker will write on most plastic bags. Work as quickly as possible, removing only the portion you can process quickly from the refrigerator. Once wrapped and bagged, place the meats in the freezer. You now have perfect meal sized portions of meat! Complete your work session by sanitizing your hands, cutting board, knife and counter top.

You can also pre-cook meat before freezing it. This works particularly well for marked down meats and ground meats. Simply cook as you normally would, stopping the cooking process just sort of ‘well done’. Cool the meat slightly, package into meal sized portions and freeze as you would the raw meat. This is a great time saver!

When defrosting meats, the preferred method is either to place the meat in the refrigerator or utilize the microwave to defrost quickly. Many types of meat can also begin cooking from their frozen state. You simply start off cooking at a slightly lower than normal temperature and increase the cooking time. Covering the pan also encourages quicker defrosting.

Canning is another option for preserving meat and extending its shelf life. If you wish to utilize this method, you MUST have a pressure canner (different from a pressure cooker) and follow guidelines carefully.

Pre-canned meats such as tuna fish have long shelf lives. They are great sources of quick meals, emergency food and good sources of protein. Store your canned meats in a cool place and periodically check their expiration dates.

Whichever cuts you prefer, shop, store and prepare smartly to ensure good quality and food safety!

(This information comes primarily from the Joint Commission on Accreditation of Healthcare Organizations, which inspects and issues accreditation to hospitals and other organizations that deliver medical care.)

The Speak Up program urges patients to get involved in their care. Research has shown that medical errors are a serious problem in the health care system. Informed, involved patients have the lowest occurrence of life-threatening errors. Remember, you are an important part of your healthcare team! By following the guidelines below, you can be your own best defense.

Speak up if you have questions or concerns. If you do not understand the answer, ask again. It’s your body and you have a right to know what is happening. Your health is too important to be embarrassed by asking for clarification. Speak up if you think you are receiving the wrong medication, test, or procedure. Ask your doctor to mark the part of your body that will be operated on. Don’t hesitate to tell the health care provider if you think they have you mixed up with another patient.

Pay attention to the care you are receiving. Don’t assume anything! Expect healthcare providers to introduce themselves, have a visible ID batch and double check your identity before proceeding. Notice whether caregivers wash their hands before tending to you and gently remind them if they fail to do so. Hand washing is the single most effective deterrent to infection. If something doesn’t seem right, STOP and ask the person to clarify. If you are not comfortable with the answer, ask for a supervisor. If you are not comfortable with the process used in a procedure, demand that the healthcare provider stop.

Educate yourself about your diagnosis, medical care and treatment plan. Ask the doctors you visit what training, certification and experience they have in treating your condition. Know what it means for a doctor to be ‘board certified’. Use legitimate websites to check your doctor’s qualifications. Gather information from your doctor, pharmacist, insurer, the library and respected websites about your condition. Thoroughly read all forms before you sign them. Make certain you understand any equipment or medications you are prescribed. Know how to use (or take) them and what side effects to watch for.

Ask a trusted family member or friend to be your advocate. This is vitally important if you must be hospitalized for out-patient or in-patient treatment. Your advocate can help you keep track of information provided to you, ask questions you may not think of, write notes of what is said and Speak Up for you if you can’t. Make certain your advocate knows your wishes regarding your care, life support and resuscitation. Ask your advocate to review consents or other forms you are asked to sign. If necessary, put in writing that your advocate can discuss your care with your providers. Your advocate should thoroughly understand the care you require when you are released.

Know what medications you take and WHY you take them. Medication errors are the most common health care mistake. Ask about the purpose of any medication you are prescribed, its benefits, side effects and potential hazards. Make certain that all prescribing doctors know ALL medications, vitamins and supplements that you take. This MUST include all herbal remedies, naturopathic medications or other things you ingest. If you do not recognize a medication (the shape, color, etc) changes or seems unfamiliar, double check that it is for you and the correct medication! Before swallowing any pill, make certain that you, your advocate and the person dispensing the pill know what you are taking. Read the contents of IV bags and know how long they should run. If you are not well enough to do this, ask your advocate to do it for you. Alter the nursing staff if the IV becomes painful, stops flowing or begins to flow more rapidly. Watch IV lines for excess air bubbles. Be certain that your physician, nurses and pharmacist know about any reactions that you have had to medications in the past. Use the same pharmacist for all prescriptions—this will help rule out adverse medication interactions. Make sure you can read the prescription handed to you. If you can’t, the pharmacist may not be able to either.

Use an ambulatory care center, surgery center, primary care or other type of healthcare organization that has been inspected and certified by a nationally recognized accreditation board such as JCAHO. Ask about the centers experience in caring for your condition. How frequently do they perform the procedure you need? If you have a choice between facilities, ask your doctor which one offers the best care for your condition. Ask them why they make that recommendation. Be certain that you understand about follow-up care and what to watch for before you leave the center. Be certain that you have numbers to call in case you have questions. Check www.jcaho.org to find out if the care center is accredited.

Participate in all decisions about your treatment! You are the center of the health care team. You and your doctor should agree on exactly what will be done during each step of your care. If you are an inpatient, be certain that nurses are following doctors’ orders. Understand why more tests or medications are being ordered. More is not always better. Keep copies of your medical records and share them with your health care team. Don’t be afraid to get a second or third or fourth opinion. Do not be afraid to change doctors if yours doesn’t want you to be actively involved in your care. Seek out others who have undergone the same procedure you are considering. Look for support groups, online message boards and reputable websites. Sharing information with others who have gone through what you are facing can be most helpful in facing what lies ahead. They can often help you prepare strategies that will ensure the best outcome possible.