Medication setup is a topic we often discuss with our clients. I came across an excellent article on medication management this weekend I wanted to share. This is a topic of great importance for several reasons. Medication compliance is one of the top drivers of readmission (and admission) to skilled care (Hospital or Rehab). Medication changes color, dosages change, timing can change as well as numerous other aspects that can affect longstanding routines we have for managing our medication routines.

I grew up in my father’s pharmacy. He retired about five years ago and, like many, is on numerous medications. The last time I went to visit I was struck with how complicated the process was for him, a registered pharmacist, every two weeks to parse out the medications and fill his weekly pill boxes.

Based on that experience, we implemented a medication set-up service for our clients. This is particularly useful when one comes home from the hospital or skilled rehab and there are numerous new medications to reconcile.

The article on provided 14 practices to implement to make this complicated area more manageable:

  1. Understand the Medication: Find out as much as possible about every medication: the name, dosage, frequency and side effects. Understand why it has been prescribed, and ask the doctor to write down instructions for its use.
  2. Have Complete Medical Records: Make sure to provide complete medical records to your loved one's health care providers. Medical history records should contain surgeries, immunizations, allergies and family health history (i.e. diabetes, colon cancer). Records can be sent by a previous provider if needed.
  3. Follow the Directions: Following the directions of the medication is imperative to ensure safety. Read all instructions carefully. Dispense only the recommended dosage at one time and finish the entire prescription if instructed. There may be foods or drinks to avoid while taking the medicine. Or the medicine may have to be taken with food or a whole glass of water. The average older adult takes five or more prescriptions drugs each day. In addition, many elderly people take various over-the-counter medications, such as antacids, laxatives or pain killers, which are often used without informing their physician. The drugs may conflict and interact poorly with each other – basically going to war against each other in the body, leading to serious side effects and even life-threatening conditions.
  4. Use Only One Pharmacist: Fill all prescriptions at the same pharmacy. This way, the pharmacist will be aware of all medications your parent takes, and can look out for potential drug interactions.
  5. Make a List of All Medications; Make sure that every physician involved with your loved one's care knows about all prescribed and over-the-counter medications. Ask the physician to check for possible drug interactions. Keep a detailed list including the drug name, size of dosage (usually in milligrams) recommended dosage (daily, for example), and any cautions stated on the package. Carry a copy of this list with you in your wallet or purse at all times. This record will be invaluable in the event of a serious drug interaction or overdose. Share the lists with your doctors. Also, use the same pharmacy to fill all prescriptions, so the pharmacist can keep an eye out for dangerous interactions.
  6. Watch for Social or Physical Changes It is also important to notify the health care provider of any social changes, including sleeping patterns, work schedules, and special diets. This will assist the health care provider in determining if it is necessary to adjust the medication. After the drug has been administered, watch how your loved one reacts to it. If symptoms seem unusual or rare, contact an emergency number immediately.
  7. Don't Self-Treat; Sometimes medicines affect older people differently than younger people. Let the doctor know if the medicine doesn't seem to be working or if it is causing problems. It is best that your loved one not to stop taking the medicine on his or her own. Under no circumstances should your loved one change dosages or stop taking the medication without first consulting the physician. In addition, never share or give medications to another person.
  8. Keep Drugs Separate Keep medications in their original containers. Do not mix different medications together in one container. This will avoid mixJups.
  9. Watch Expiration Dates When a medication reaches its expiration date, discard whatever is left in the bottle. Contact your physician for a refill if necessary.
  10. Be Candid and Direct: Use clear, simple language to help your loved one understand the kinds of medications he or she is taking and why. In addition, offer clear instructions such as, "Here's the pill for your high blood pressure. Put it in your mouth and drink some water."
  11. Develop a Routine: Giving medications in a specific way at specific times of the day will help reduce conflicts. Never assume the individual will take medications on his or her own. It may be necessary to check and see whether the medicine has been swallowed.
  12. Adapt to the Person: If your loved one has problems swallowing pills or spits out the pills, ask your physician if the medication is available in some other form, such as a liquid. Some medications can be crushed and mixed with food. However, no pill or tablet should be crushed without first consulting your physician or pharmacist. Crushing some medications may cause them to be ineffective or unsafe.
  13.  Get a "Brown Bag Checkup": As a safety measure, ask to schedule a "brown bag checkup" with your prescribing doctor or pharmacist. Gather all current medications and over-the-counter products into a brown bag and bring them to the doctor or pharmacist so he/she can look for potential problems.
  14. Be Prepared for Emergencies Research the names and telephone numbers of pharmacies and emergency care centers that are open on the weekends. Keep the number of your local poison control center or emergency room handy. If you suspect a medication overdose, call poison control or 911 immediately

Here is a list of questions for caregivers to ask whenever a doctor prescribes a new medication for their elderly loved one:

  • Why is this medicine prescribed?
  • How does the medicine work in the body?
  • What are the common side effects? What should I pay attention to?
  • Will this medicine interact with other medications—prescription and nonprescription—that my loved one is taking now?
  • When will the medicine begin to work?
  • What should I do if my loved one misses a dose?
  • Should he/she take it with meals?
  • Does he/she need to drink a whole glass of water with it?
  • Are there foods, drugs, or activities he/she should avoid while taking this medicine?
  • Are there any foods or beverages to avoid?
  • Is it safe to drink alcohol while on this medicine?
  • How long will he/she have to take the medicine? Will we need a refill? How do I arrange that?
  • Do you have written information about the medicine that I can take home with me?

I hope you find this information helpful. As I said, we are often asked if we can help with medication setups. We can and often do. There is a per visit service fee for medication setup. One of our nursing staff will perform this task monthly (more frequently such as bi weekly or weekly for constantly changing medication.) We provide 4 times per day 7 day a week pill boxes. If you would like to learn more about the medication set up services or would like one of our pillboxes, please call the office at 617J500J6999.  We are happy to provide you one.

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