Developing an Organized Medication System at Home

 

Caregivers can be overwhelmed with the number of medications that their loved ones need to take on a daily basis. Medication errors are too common, with administration of drugs accounting for 38 percent of errors. According to the ALARIS Center for Medication Safety and Clinical Improvement, at least 7,000 deaths annually are blamed on medication errors.

There are many options on the market for organization system. Deciding which one is right for your family needs to be the driving force behind the system that you ultimately choose. Most all of us are familiar with pill organizer boxes with various slots for time of day and days of the week. There are other options, though, that can be just as effective when implemented consistently.
There are many issues to consider when setting up an organization system for your loved one. Some of these include:

• How old is the person who is taking medication? Are they old enough to take their own medication or do they need someone else to give it for them?

• Are they capable of taking their medication independent of your help? Perhaps your loved one needs help in keeping track of which medications need to be given at a particular time of day, but they may be capable of choosing the correct medication from the shelf.

• Do they have impaired eyesight? Would it help to have larger print on the bottles?

• Does your loved one understand why they take each medication? (NOTE: Patients with some level of dementia and even children may not be able to comprehend the medications given.) It is important that persons understand the reason behind the medication to the best of their ability. As people age the answer, “because the doctor said so,” may not be acceptable.

• Will others who may assist with caregiving be able to understand the system readily? If you leave town or are a long-distance caregiver, the system needs to be readily understandable to other friends, family, or even paid caregivers who may be in the household while you are away.

• Is the system flexible so that changes in medications and dosing schedules can be adjusted? It is not uncommon for doctors to change medications when there are chronic conditions involved. Be sure to develop a system that can adapt to these modifications and be implemented without confusion to your loved one.

No matter what system is chosen, proper storage of medications is essential. Keep medicines stored in a cool, dry area away from moisture or heat. The kitchen cabinets often serve as a favorite place to keep medicines. Be sure that the cabinets chosen aren’t subject to the moisture or heat changes near refrigerators, dishwasher steam, or even steam from the kitchen sink. The holds true for bathroom cabinets as well.

Also, keep medications in their original container until they are ready to be administered or placed into a pill organizer. It is okay to make notes on the bottle with a black marker, such as a Sharpie®, to make instructions more clear for your loved one or other caregivers. When moving medicines into a pill organizer, make sure not to take out more than one week’s worth.

The Canadian National Institute for the Blind recommends some of the following methods when considering a system to organize medications:

• Using a pill organizer with one or more sections for each day. If your loved one is taking multiple medications, it may be best to associate these with a meal or event rather than a particular time of the day. You can “re-label” the time slots with the event to make it more user-friendly.

• There are electronic pill organizers which can dispense medications on a set schedule. Some of these only have beepers or other reminders to let individuals know when medications need to be dispensed. Others can dispense medications on a pre-programmed schedule. The only caution with these is the programming and being certain that the device helps in your particular environment. The elderly may or may not be receptive to their use.

• Organizing medication on one shelf alphabetically or according to their frequency of use. If you choose this method, be sure that your loved one can read the labels on the bottle and that they are able to open the bottles without help. Also, you may need to set reminders to let them know when it is time to take each dose.

• Using personal markers or even colors on the top of the bottle so each medication can be readily identified. Blind persons can even put Braille wording on the top of the cap to make sure that each medication is taken accurately.

• Changing pill bottle shapes or sizes to differentiate between medications.

• Also, putting rubber bands on the bottle to indicate how many doses need to be taken each day. Each time a dosage is taken, remove a rubber band and at the end of the day, replace them.
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Learning More About Medicare’s Drug Plan

Medicare’s long-awaited prescription drug plan is scheduled to be in full implementation in January 1, 2006. Many seniors have started receiving mailings about the drug program and there are some conflicting messages out there.

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Formally known as Medicare Part D, several advocates in the system have dropped the “Part D” connotation in favor of a new name: Medicare RX. Many Medicare recipients get confused when they hear Part D, in part because they don’t understand what Parts A, B, or C cover. By referring to it as Medicare RX, advocates are hoping that Medicare recipients can easily identify the new benefit.

What is Medicare RX?
Medicare RX is optional program that will save individuals who are enrolled in Medicare money on their prescription drugs. With some exceptions, there is no obligation to join the program. There is a premium for the coverage as well. Individuals who are currently enrolled in Medicare can sign up for RX coverage starting November 15th. Plan coverage needs to be selected by May 15th. It is possible to join after May 15th; however the monthly premiums will go up. Individuals who enroll in a plan before December 31, 2005 will begin the program on January 1, 2006. Individuals who enroll in the plan after December 31, 2005 will start on the first of the month after their enrollment date. For example, someone who signs up for coverage on April 12th will start on May 1st.

In addition to premiums, there are co-pays as well. The amount of the co-pay varies depending on the drug coverage plan that you choose. Private contractors will work with Medicare to provide plans to Medicare beneficiaries. Depending on where you live, there may be more than one plan option. You will need to weigh your co-pay costs and your own health condition to decide which plan is appropriate.

What happens to my Medigap coverage?
You can keep your Medigap coverage as long as you don’t enroll in Medicare RX. Check with your Medigap provider to find out if your plan covers as much as or the same benefits as Medicare RX in order to make a decision. Your Medigap provider should be mailing information to you this fall concerning your coverage limits. You can use this to compare to Medicare’s prescription plan.
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What if I have RX coverage through an employer or retirement program?
As with Medigap, your insurance provider should mail you a comparison package explaining their benefits and how they line up with Medicare RX. Since Medicare RX is a voluntary program, you do not have to give up your existing plan to enroll in Medicare’s plan.

What if I need help paying for the coverage?
The Social Security Administration (SSA) has started mailing out letters to potential low-income beneficiaries in June 2005 letting them know that they may qualify for assistance with the premium and some of the drug co-pays. The Medicare website (www.medicare.gov) refers to this assistance as “extra help.” Qualifying for extra help is determined by your income and assets (not including your home). The amount of help that you can receive is also determined by income and assets.

Most importantly in applying for the extra help is the letter SSA mailed to those who are potentially eligible. When you get ready to enroll in a drug plan, the provider will ask for a copy of this letter. If you have received any mail from SSA that you do not understand, contact your local Area Agency on Aging and ask to speak to a benefits counselor. They can help you understand the letters you have received as well as answer any questions you may have about the drug coverage plan.

I think I qualify for extra help, but I didn’t receive a letter.
If you are single and have yearly resources less than $11,500 ($23,000 for married couples), you can still apply for extra help coverage even if the SSA did not identify you as someone who is potentially eligible. You can apply online at https://s044a90.ssa.gov/apps6a/i1020/main.html. Be prepared to provide information about your income and other assets you may have. Remember that your home does not count as an asset for qualification purposes.

Medicare will qualify some individuals depending on their income or other benefits they may be receiving. These individuals include:

• Those already receiving Supplemental Security Income (SSI) benefits and who have Medicare;
• Those who have Medicaid prescription benefits; or
• Those whose state pays their Medicare premiums.

If any of those conditions apply, you will automatically receive extra help and be enrolled in a qualifying prescription drug program for Medicare.

How much will I have to pay?
Medicare has established out of pocket maximums depending on your income range and the amount of your assets. For example, let’s look at someone who is married with income between $16,862 and $18,734 with assets less than $20,000.
• Premiums – up to $35 each month on a sliding scale.
• Coverage starts after they pay $50 out of pocket.
• Will pay 15 percent of drug costs after the initial $50.
• Will pay approximately $800 out of pocket before co-pays drop to $2 for generic medications and $5 for name brand medicines
• Co-payments will increase after 2006.
This same scenario applies to an individual who is single with an income between $12,569 and $13,964 with personal assets less than $10,000.

What happens to my prescription drug discount card?
If you enrolled in the discount program in 2004 that helped offset the cost of prescription medications, Medicare RX replaces those programs. You will now apply for the program directly through SSA and choose a plan according to your specific needs. The discount cards expire on December 31, 2005.

Where can I find more information?
The “Medicare & You” booklet published by Medicare will be mailed to program recipients in October 2005. Review the information in this booklet for the latest in benefit information. You can also call 1-800-MEDICARE (TTY users should dial 1-877-486-2048) to speak to someone directly about the program. Finally, your local Area Agency on Aging can also provide information about the program or direct you to a local source of information.

Keeping Track of Medications Safely

 

The over 65 population in America purchases and consumes more medications than any other age group. According to the Food and Drug Administration, they purchase more than 30 percent of all prescription medication and more than 40 percent of over the counter (OTC) medicines. Estimates are that as many as 90 percent of seniors use either herbal remedies or vitamins.

Interactions:

Drug interactions are especially a concern for seniors. Some experts estimate that seniors take an average of four to five medications on a daily basis. If physicians aren’t aware of all medications a senior is taking, there is the potential for dangerous drug interactions.

To guard against an interaction, make a list of all medications, vitamins and herbal remedies that your loved one is taking. Also, beside each medication, write the contact information of the physician who prescribed the medicine. Some physicians may not realize how many other doctors their patients are seeing. Take this list to each doctor appointment and be sure that it is kept current.

Avoid Pharmacy Shopping:

With the rising cost of medications, many seniors choose to shop for the cheapest price without realizing the benefits of staying with one pharmacy. Poly-pharmacy, the “technical” name for pharmacy shopping, is often a source of confusion and drug interactions. The patient frequently overlooks the pharmacist as someone who can be of tremendous help to them. Pharmacists can often spot drug interactions, possible problems, and can possibly recommend OTC medications that can safely be taken with prescription medicines. Include the pharmacist’s information on the medication list that you provide toe ach doctor. When doctors call in a prescription, make sure that they use the same pharmacy each time.

Throw away Outdated Medicines:

Some people prefer to keep medications longer to save money on prescription costs. Don’t. Some medicines degrade over time with exposure to light and heat. Plus, you may need a different medicine the next time. If you rely on medications you have at home instead of advice from your physician, you could be headed for trouble. Be sure to call your physician before using medication that you have at home.

A special word about antibiotics: These are meant to be taken in their entirety when they are prescribed. Saving some for the next infection may cause serious health problems. Bacteria may become resistant to antibiotics and need even stronger medication the next time. Plus, for the second infection, a different class of antibiotics may be used in order to prevent resistance build-up.

Watch for Side Effects:

Seniors especially can be sensitive to new medications. Ask your doctor about possible side effects of the medication and how it may react with other medicines that you are currently taking. Most pharmacies hand out leaflets with information about drug side effects and when to contact the doctor. Read these leaflets and keep them in a safe place for future reference, especially if you have to take the medicine long-term. Caregivers need to be aware of how to cross-reference these and hand-carry them to the doctor if necessary to be sure that the right medication is being prescribed.

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Medication Management in Disaster Planning

 

A family disaster plan can be of valuable assistance to every member of the family. In order for it to be effective, however, it needs to encompass all aspects of your current living situation. When considering a home or family disaster plan, it is easy to overlook medications and the special needs of family members. Instead of waiting for an event to occur, think ahead to these important areas:

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1. Know what types of disasters are most likely to affect your area. By learning what to expect in a “typical” disaster, you are more likely to have a plan that will meet the needs of you and your loved ones, especially those with special needs. With the news media bombarding us with messages of terrorism, you may want to concentrate more on the unlikely event instead of looking to the natural disasters that could occur. Are you in a floodplain? Are tornadoes common in your area? Examining these issues now will prevent headaches later. 

2. Have an emergency list of physicians and special medications needed. In the event that you need to evacuate an area, this list will become increasingly important. More than ever, communities are developing special shelter hubs for families who have individuals with special needs. When evacuating your community, this list needs to be included in the evacuation kit. Physicians at shelter hospitals can respond more effectively when this information is listed in one place with appropriate contact information if questions arise. 

3. If your loved one has a communication barrier, make certain that this information is included in your evacuation material. Disaster workers at the special shelter hub will need to know this information in the event that you are not able to respond immediately. Disaster means chaos for all family members, especially those who are incapacitated in some way. If a communication issue exists, spell it out in detail to avoid adding more confusion to the mix. 

4. Provide exact names, dosages, and other pertinent information on all medications that you and your loved ones are currently taking. It may not be possible to take the medication with you. What happens if your supply is exhausted and your regular pharmacy is unavailable for some reason? Medications that are involved in a fire, for example, may not be suitable for use afterwards. Having written documentation of all medications will eliminate the guesswork and legwork needed to track this down later. 

5. Are there any allergies or sensitivities that disaster personnel need to know about? It is sometimes too easy to overlook this important piece of information. Drug interactions and other reactions to medication need to be listed as well. Food allergies are another area that can be overlooked. If your loved one is on a special diet, you may want to pack a few nonperishable items and periodically rotate these out of your disaster kit. It will help ease hunger pangs later when it could take time to locate specialized foods. 

6. Does your loved one need any special adaptive equipment? In a disaster, this equipment may either be difficult to locate if it is not known in advance. Keep special manufacturer information in the disaster kit if the equipment is especially hard to find. If possible, purchase additional equipment that is easy to pack and move in the event of an evacuation

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7. What if you have to shelter in place? Sheltering in place means that an emergency event is forcing you to remain where you are for the moment. Do you have everything you need for a three to five day stay in one location? Is it possible to keep an extra supply of medications? Are they perishable? If they need to be mixed with bottled water, do you have extra? Make sure to spell out these details in advance to prevent panic at a later date when it may be extremely difficult, if not impossible, for emergency personnel to reach you. 

8. Talk to your doctor and pharmacist about the shelf life of medications, both prescription and over the count (OTC). Having this information in advance will be helpful to you, especially if you are planning to store extra medication for a long period of time. Some medications can be easily stored, while others are impossible to keep for long periods of time. Are there alternative medications that can be stored in lieu of the original prescription? How hard would it be to obtain replacement prescriptions if you had to leave town suddenly without notice? 

9. Add disability related supplies to your emergency kit. Some of these supplies include hearing aid batteries, patches for wheelchair tires, an extra walking cane, incontinence supplies, pet supplies (if you have a service animal), magnifying glass, and any other supplies that may be necessary. If you use a motorized wheelchair, see if it is possible to get a manually operated replacement in the event that a power source is not available. Develop a list of supplies and shop for them periodically to be certain that your kit is well stocked. 

10. If your community has a registry of persons who need special attention during evacuation procedures, make sure that you and your household are listed. This registry is normally a listing of where you live, how many persons in the household will need assistance during an evacuation, and the type of assistance that you would normally need. Your local emergency management service would be able to direct you to the agency that is in charge of the registry service. During an evacuation, emergency personnel can concentrate on persons who are in the registry, and you don’t want to be overlooked if you need extra time or attention to evacuate.

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The Center for Improving Medication Management

The Center for Improving Medication Management serves as a center for excellence. The Center is a collaborative forum that establishes project specific priorities to demonstrate the value of pharmacy interoperability with both patients and physicians for the purpose of improving the medication management process. The aspects of the medication management focused on are

• Best practices as it relates to processing prescriptions electronically and

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• Improving patient compliance with physician medication orders by utilizing electronic communications between the patient, pharmacist, and physician.

 

The Center educates clinicians and their staff on the best approaches to implementing prescribing technology and integrating it with the day-to-day workflow. The Center implements programs that accelerate the automation of the prescribing process. Core to automating the prescribing process is the adoption and use electronic prescribing technologies with physician-pharmacy interoperability as well as the testing of innovative approaches to improve patient compliance with prescribed medications.  Targeted research projects overseen by The Center will evaluate and establish best practices in support of these purposes.

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The future with electronic medical records: Effective, flexi

Private practice physicians within a hospital are in an odd position. They don’t work for the hospital, but without them the hospital would find it difficult to remain open. Because physicians rarely are tied to any one hospital, they might visit several hospitals during the course of a day or week. And at each hospital, physicians have to work within that hospital’s clinical information system (CIS).

Clinical information systems and electronic medical records are used in hospitals and physician offices to record information about a patient’s condition, the treatment course, any prescription drugs the patient is taking (or should not take), vital signs, and so on. These systems have great potential to improve access to key healthcare information, boost patient safety, and reduce administrative costs.

However, the hospital setting holds a number of challenges. Consider a physician who, during the course of a day, visits two, three, even four hospitals to care for patients. Chances are, each hospital has its own proprietary system. It simply isn’t feasible for a physician to be fluent in every system out there. So the work slows down as the physician tries to remember how to enter or find a particular piece of patient data.

Pitfalls of hospital clinical information systems

In some cases, systems are so poorly designed and introduced that physicians refuse to use them. In 2002, at Cedars-Sinai Medical Center, physicians were so unhappy with a new order entry system that they forced the hospital to abandon it. In the worst cases, real harm can be done. Two studies in 2005 (one published in the Journal of the American Medical Association and the other in Pediatrics) indicated that poorly designed clinical information systems actually can lead to an increase in medical errors. This is ironic given that these systems are intended to reduce errors.

Many of the systems installed in hospitals in recent years are not only proprietary, they can be horrendously expensive. It’s not unusual for a 500-bed hospital to spend $150 million US to install a clinical information system. And hospital CIOs can tell you that the cost of acquiring such a system is small in comparison to training costs.

Imagine the expense to pull hundreds of highly-paid, in-demand clinical workers (from physicians down) from their responsibilities and put them through many hours of training. And keep in mind that training might be duplicated by physicians when they work at other hospitals. Physicians already commit time and expense to acquire and learn how to use the clinical systems in their own offices.

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An alternative: Design systems around physicians

It would be ideal if physicians could walk into a hospital and use the same password and log in that they use at other medical facilities. They would see an intuitive, familiar interface that has data about patients from other hospitals or from other doctors the patient has seen, whatever is relevant. As a bonus, such a system could be rules-based, depending on who signs in. Physicians could choose from a set of options about how to use the system. Nurses could choose from another set of options. Pharmacists and other medical technicians could choose from a third. This ideal system could be based on software that is more intuitive and adaptable than many systems on the market today. And every system doesn’t have to be identical or part of a larger system that attempts to tie all hospitals together or handle all tasks with a single company solution.

Such a solution is already in use by tens of thousands of ambulatory physicians who work in practices outside the four walls of the hospital. Called electronic medical records (EMR) systems, these systems streamline and automate the everyday activities of clinicians such as documenting patient visits, ordering lab tests, viewing results, and billing for services. EMR systems also enhance patient safety by alerting physicians when they fail to follow best-practice guidelines or prescribe a drug that can cause an adverse reaction in the patient.

TouchWorks EHR software designed by Microsoft partner Allscripts is one example of how ease-of-use and intuitive design can benefit the healthcare industry. Designed to work with mobility devices such as Pocket PCs and standard desktop and notebook computers, the Web-based TouchWorks EHR enables a physician to create electronic patient records in his or her office, and then easily access them using the Microsoft Internet Explorer Internet browser in a hospital setting—either through portable computers or a personal computer. Patient records, charges, drug interactions, lab orders all can be easily recorded and saved.

TouchWorks also helps control costs by enabling physicians or physician groups to purchase only those modules that meet a particular business or clinical need.

TouchWorks isn’t designed to replace the big, hospital-centric systems now found in many hospitals. But it shows how a flexible, modular system that is centered on physicians’ needs can begin to streamline and simplify how medical records are collected and kept. And TouchWorks doesn’t try to force all clinics to use the same suite of products. As Dr. Peter Geerlofs, Allscripts chief medical officer, tells me, “The monolithic approach doesn’t meet market demand. The world is going to a best-of-breed place, where people can use the best products for particular clinic needs. In TouchWorks, our architecture supports a plug-in concept, so it can be used with third-party devices and software, or particular bits of code.”

In the years to come, we could see adaptable systems that work across geographic or hospital system lines, what Geerlofs calls a decentralized federated model. In such a system, all clinical data stays within the hospital or physicians’ system that first created it. But it’s tracked by some type of record-locating service, which knows where information for particular patients is stored and enables physicians to call it up when needed (provided security parameters are met). This way, even records in New York can be read by physicians in California should a patient move or end up needing medical services far from home. Now, for example, Allscripts markets a records tool called HealthMatics ED in use by over 150 emergency departments nationwide. The data can be linked between hospitals in a community, making it faster and easier to recognize emerging problems such as a widespread virus.

Thanks to initiatives now underway to make every electronic medical record interoperable, no matter what hospital a physician visits, he or she can quickly figure out how to use it, and perhaps be able to take advantage of a common log in. I compare this challenge to that of creating airplane reservation sites. All of the major airline and travel sites look a little bit different—sometimes a lot different. But they all work very much the same. And once you use one, it’s a safe bet you can use the rest. Electronic medical records systems can profit from this example.

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Microsoft tools offer connectivity and a common interface

Microsoft has already created a number of software products that help make it possible to develop flexible, affordable, and more intuitive clinical records systems. Microsoft .NET Framework for connected healthcare Web services, for instance, enables a wide range of data-keeping systems to exchange information. Microsoft Pocket PC and Tablet PC technology help physicians take information with them and access it when and where they need it. And Microsoft Office products, such as Microsoft Office InfoPath—along with Microsoft SQL Server and other data management products—benefit from a consistent interface that makes them easily accessible to new users, reducing training and improving productivity.

Microsoft sees a future in which a physician in a hospital calls up a patient records and instantly sees a dashboard of relevant information drawn from all the patient records going back many years. It can require a lot of coordination to make this happen, but the tools are becoming available now. Meanwhile, Microsoft is working hard to help its partners improve the clinical systems being designed today, while building a road to a future where healthcare information is seamlessly connected across the entire healthcare ecosystem.
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Medication reminder for elderly

It is a common scenario: you are on medication but you forget to take it — or worse, you cannot remember whether you took the pill you were due to take an hour ago.

A design graduate has come up with a solution to the problem by using smart card technology, which prompts patients to take the correct medication at the correct time.

London-based Katrin Svabo Bech, 22, plans to market her invention, called PillAid and aimed particularly at helping the elderly, to the pharmaceutical industry.

Bech’s creation involves a smart card and a dispenser. She developed it during her final year studying design at London’s Brunel University.

“It’s an automated medicated management system for elderly people, aimed to improve communication between all groups involved in the process — including GPs (general practitioners), hospital doctors, pharmacists, the patients themselves and carers,” she told CNN.

When the patient goes to the doctor, they hand them a personalized smart card.

The doctor has a smart card reader and loads any prescription information onto the card.

The patient then takes the card to their pharmacist, who also has a smart card reader, and using information on the card, dispenses the prescribed medication into a dispenser.

The dispenser has a tiny microchip inside, which can read information on the card when it is inserted into the dispenser.

It automatically alerts the patient when it is time to take their medication and informs them whether they need to take their pills with food or water.

“The patient’s GP can also have a look at the smart card to see whether they have been taking their medication at regular intervals,” Bech said.

Bech came up with the idea after visiting her grandmother, who had recently had a stroke, last summer.

“She was on a lot of medication and I thought it would be great to create something that could make her life easier, so that she could keep her independence … so she could feel confident in herself.”

Bech is due to start a Masters in strategic healthcare design early next year.

Jim Kennedy, of Britain’s Royal College of General Practitioners, said any initiative which helps patients to take the appropriate levels of medication is welcome.

But he said the device would need to be thoroughly tested before being used on patients and cost may be an issue.

“There are a number of inexpensive methods patients can use as a means of assisting them in remembering to take their medication.”

These include writing down their medication on a calendar or getting someone to send them a text message to remind them, he added.

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Millions skip meds, don’t take pills correctly

WASHINGTON – Consider it the other drug problem: Millions of people don’t take their medicine correctly — or quit taking it altogether — and the consequences can be deadly.

On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week. It calls the problem a national crisis costing billions of dollars.

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The government is preparing new steps to try to persuade patients and their doctors to do better.

But with contributors that range from too-hurried doctor visits to confusing pill bottles, there’s no easy solution.

“We go into this with some humility,” says Dr. Carolyn Clancy, director of the Agency for Healthcare Research and Quality, which is planning what she calls an “in your face” campaign to improve medication adherence. “It’s really pretty appalling how badly we do.”

This goes far beyond the issue of affording prescriptions. Often people buy their drugs but misunderstand what they’re supposed to take, or how. Or forget doses. Or start feeling better and toss the rest of the bottle. Or skip doses for fear of side effects.

It’s not just a problem of poverty or poor education. Even the rich and highly educated skip their medicine. Perhaps the most high-profile example is former President Bill Clinton, who stopped taking his cholesterol-lowering statin drug at some point and later needed open-heart surgery to avoid a major heart attack. Statins offer significant heart protection, but about half of patients on statins quit using them within a year.

Supervising TB patients and their pills

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