H(OT) 5: Medication Management

Transcript

Jenn: Hi, welcome back to the H(OT) 5 Tips and Tricks series. Today, we’re here to talk about medication management.

My name is Jennifer Ruoff. I’m the director of occupational therapy clinical services here at FOX Rehabilitation. Today with me is Rachel Read, the director of our EHR.

So some of the things we’re going to discuss today are different ways that you can utilize some adaptive equipment regarding medication management. A lot of the times when we’re going into our patients’ homes, we find that they have a really hard time managing their pills and organizing their medications.

There are a couple different things out on the market. There’s actually a ton of different pill organizers. I have a couple options to show you. But you can see the difference in these two. The contrast is a little less on the purple one. The font is a little bit smaller, but the container size is bigger. So this is for someone that has difficulty with fine motor coordination and needs a little bit of a bigger area to be able to manipulate the pills. This would probably be more beneficial.

The contrast on this one: The letters are white, more bold, but there’s a little bit of a smaller container. So maybe if a patient has more visual issues, this might be more beneficial.

This one is just a very simple white container that allows you the ability to go through. It also has braille on it, which is really nice. So if someone has visual impairments, they can utilize this.

If someone needed more ability to organize their pills for a.m. and p.m., this would also be beneficial. They have some you can even remove the containers. But this allows them to set up their pills a week ahead of time and gives them options for both morning and night, and a lot of your education would be related to either coordinating it to the color, having them understand the color, having them understand the sign of a.m. and p.m. And then this has more letters for the days of the week rather than just the initial. It actually has part of the word spelled out.

This is the simplest one: morning and night. That if someone wanted to take them or they were going out to lunch or breakfast or they were going to be gone for the day, they would take this with them.

Rachel: So I was going to say, I actually like that one as the best because I find that a lot of times are older adults have medications from a.m. and p.m. And I like that it diverts the confusion for them because you have to have it strategically placed. In order to get the p.m. meds, they have to be on this side versus the a.m. meds on this side. So it allows us to avoid that confusion.

What I don’t like, and I don’t know if you like them, are the ones that have like the four — where it’s like…

Jenn: Oh, it’s too overwhelming.

Rachel: Sometimes if you’re not taking medication four times a day, which a lot of times it’s really just morning and night, I kind of try to get rid of those ones because there are empty rows. So those are the ones that will say like morning, midday, lunch, night. I don’t even know what they are.

Jenn: And something too that’s helpful with this that we printed out as kind of a guide would be actually putting the color of the pill, the size of the pill, and what it is so that when they are setting up the actual management of their medications, they can take them out of the bottles and lay them out. That’s usually something that I’ll do as a treatment session that provides them with skilled care and how to set up their pill organizers so they’re not reliant on somebody else.

When you go out to see a patient and you notice or you talk to them and they say, “Oh, I didn’t take my pills this weekend because my daughter was away and couldn’t set them up.” Is there something I can do to help them to organize that to be a little bit more independent? So that’s really helpful to have that sheet of how they can maybe independently set up their own medication.

Rachel: I also use this sometimes because sometimes they don’t know what they’re taking and they’re like, “Oh, I don’t want to take my medicine because I don’t know what it’s for or which pills I’m taking.” And I’ve even taken to the next step where I would say, “Okay well, your Aricept is for your dementia.” And, I would put the reason why. And so if you have somebody that is resistant to taking meds because they don’t really know why they’re taking them, I find this is really useful, too.

Jenn: Awesome. Alright, the next one: Just a simple, handy-dandy dry-erase board.

I’ll use this for different reasons, whether it’s tracking on a daily basis the pills that they have taken or pills that they have to take — also too, side effects. If I have a patient that says they take their blood pressure medicine and they feel shaky afterwards or they’re feeling dizzy, I’ll tell them, “Write down everything that you’re feeling whether it be on a dry erase board or in a journal.” And then we can kind of go back to it and reflect on: “Are there some medications that you’re taking that you’re not taking them at the right time, you’re not taking them at the right dosage, that you have to eat with food or drink with water that you’re not doing.” So this is another a good resource, nice contrast, super simple.

Rachel: So I have some items over here as well. One of the things that I wanted to show was that sometimes some pharmacies, You can ask if they have any special labels because a lot of the pharmacies are starting to use more of a visual rather than like written instructions on their medication. So if you could see in this one, it has morning, midday, evening, and bedtime. Those are probably the four times that make sense. And, it’ll say how many tablets; it says morning one tablet and evening one tablet. I think that’s just a nice, easy visual cue than it being written instructions very tiny on the bottle. So I think that’s really helpful.

So I would just talk to your pharmacist on what options they have that can assist you and can assist your patients in taking medications.

Another one is a sheet kind of like this. So this is a medication list. With the older adult population, we really should be encouraging them to have a written list of their medications and the dosage that they’re taking, the route administration, and the frequency so that they can carry it from physician to physician, different doctors’ appointments, if they go to the E.R.

A lot of times I really encourage my patients, and this is again another treatment session, where we’ll go through the medications, to write them down on the list so that they could take it with them from physician to physician. Because sometimes, there’s not this great communication. So you may be going to a cardiologist to get a blood pressure medication, but you’re already on a different blood pressure medication from your primary doctor. So this is really good to use.

Jenn: Something else I do with this, is I have every patient, it sounds silly, but I have them put something on their refrigerator to say my medication list is in my freezer or wherever it may be so that it’s easily accessible for: If the EMT is ever show up, the first thing they say, “What medications are you on?” Or, “What diagnoses do you have? Do you have any thing that I should be aware of?” If they’re not conscious and something happened that they’re not able to report that, they can kind of look for that sign. So either hanging this on their refrigerator or, if they don’t want it visible to people coming in and out of the house, they could have a sign saying that it is located in their freezer and just literally putting it, rolling it up and putting it in a water bottle or something that the EMT has come to distribute and have.

Rachel: That’s a good idea. The last item I have is a pill cutter. Before you change the form of any medication, you want to have a conversation with the pharmacist or make sure that it’s appropriate for you to either cut the pill or crush the pill if the patients are having a hard time taking the medication.

Obviously, you can’t do this with gel capsules, but if you have a medicine that the patient is really having a hard time swallowing, you can get these at your local pharmacy where they can cut the pills. It’s nice because the blade is inside. So it’s going to prevent any issues from like them cutting themselves. And then also what can be done if your patients are having a hard time is that: They can crush the pills. And then sometimes, you can even take it a step further and put it in like jelly amd put it on some toast for anybody who is resistant in medications. So sometimes you may have a hard time with dementia. The patient who doesn’t want to take the medication and kind of knows that even if you cut it, it’s medicine and they don’t want to take it. You could crush it and put it in jelly, peanut butter, put it on toast and they’ll be able to eat it. And they’re taking the meds without really knowing it. I found that to be really successful. Again, you want to make sure you talk to the pharmacist though to make sure when you’re changing the form of the medication that it’s appropriate.

And then just having a conversation, like I always educate my patients to have a conversation with their pharmacist. Every once in a while any time they’re prescribed a new medication, is you know, “The meds that I’m on now and the meds with this new one, is it okay? Are there any contraindications or precautions I should know about?” Really just have an open line of conversation with their pharmacist, that’s why they’re there.

Jenn: And a lot of pharmacies have a brown bag program that if you have medications that are expired or medications that you were on before, you do have the ability to use this brown bag program that can allow you someone to go through your medications and then package up the medications you no longer use and dispose of them. So that’s also a pretty cool resource.

So yeah, that’s it. We look forward to giving you guys some more tips and tricks on our next series. Have a good one.

Rachel: Bye