236 Home Medication Tips
You probably find that some older patients need help with self-administering home medicines safely. Sometimes, that can be by suggestions to the patient, or the family 'caregiver', or by arranging a visiting nurse assessment.
Emphasize the basic "Five Rights of Medication Administration" appropriate to the situation. Good lighting and a clock are useful; nighttime doses are problematic if the patient doesn't wish to waken his partner. A small flashlight can be useful to identify the medicine with minimal disturbance. Remind for glasses to be worn when taking medicines. Each person should keep their own medicines in a space different from their partner to avoid confusion, even if one 'helps' the other one. Remind patients and families not to save left over medicines 'for the future.' Local pharmacies often will safely discard old drugs without contaminating the local landfill and watertable. You may need to explore if the patient is deliberately noncompliant due to cost or to side effects.
High-risk medicines can be cognitively highlighted with rubber bands or sandpaper on the bottle as a tactile signal. Colored marks on the label may be perceived differently at night; the tactile signal on the bottle is a better 'Aha!' distinction.
Many elders carry a bottle of mixed pills (not ideal) or a multi-chamber container for the day or the week. This makes it difficult for EMS to identify drugs without labels; — encourage affixing an up to date list of medicines and directions, allergy information is important also. 'The Classic Bag O' Meds' brought in is slow to identify, absent labels or EHR data. There are useful smart phone apps for recording health information. Complex information, including EKGs, medical imaging, and other studies, can be placed on a flash drive for those who are travelling and may need to make data available if ill.
Any drug level, lab result, or clinical finding, suggestive of abnormal intended therapeutic effect, should open discussions with family, primary physician, pharmacy, or visiting nurses, to review patient's competency to self-administer medicines.
State of Ohio, Department of Developmental Disabilities. Self-Administration Assessment. 2015.
Karch, Amy M, MS RN CNS. Preventing medication errors by empowering patients. American Nurse Today. September 2015 Vol. 10 No. 9.
Marek KD, Antle L. Medication Management of the Community-Dwelling Older Adult. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 18. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2670/. [PDF]
Fialová, D., & Onder, G. (2009). Medication errors in elderly people: contributing factors and future perspectives. British Journal of Clinical Pharmacology, 67(6), 641–645. http://doi.org/10.1111/j.1365-2125.2009.03419.x [PDF]
The Institute for Safe Medication Practices.
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