Diving in Head First: Part II
In Part I, you tackled organizing a list of providers your parent sees. This allowed you to piece together their care team and secure needed follow-up appointments. Later on, I will tackle how to get the most out of each doctor visit.
Part II of "Diving in Head First" is medication management. Your parent may have compiled a list of drugs, and will proudly hand you a list. This is a good start. To get the most accurate picture of how they are personally managing medications, visit their home. Once there, you want to roll up your sleeves, clear off a table, and drag out every bottle of medication prescribed and not prescribed (over the counter).
With each prescription in hand, you will create a grid with the following column headers:
- name of the drug,
- the dosage,
- the instructions on how and when to take,
- the prescribing provider,
- the pharmacy Rx number,
- the pharmacy phone number,
- how many refills allowed,
- the date for next refill, and
- the purpose of the medication
This is also a good time to check for any expired medications and dispose of per FDA guidelines
As you are writing the information down, ask your parent what time of day they take the drug, how often, and why the doctor prescribed it. Make no judgments or accusations if what your parent tells you differs from the information on the pill bottle. If there are differences, then note these and the doctor who prescribed the medicine to make a follow-up phone call to check. If your parent does not understand the purpose of a medication, leave this information blank. You will use future doctor appointments and trips to the pharmacy to help you fill in this column of information. For over-the-counter medicines, ask your parent how often and what symptoms prompt them to use the drug.
I recommend typing this information into a document so you can quickly update as changes are made. I print a paper copy off for my senior clients to take with them each appointment or hospital visit. I have lost count the number of times the health care worker asks my client, "Have there been any changes to your medications?" and they say no when they meant yes. I advise they just hand the list to the worker to review and compare the information to their system. Why is this so important?
Medication reconciliation is a quality metric of each heath care facility. In the age of electronic health records, sharing patient health information is easier within a health system. However, to keep this information updated and accurate is a challenge. Taking the time to ensure each provider and health facility has the correct list of medications reduces delays in care and increases the safety of your parent.
After compiling an accurate list, the next step is medication compliance. How does your parent manage to remember to take their medication? Do they use a pill box to sort out their medicines by week? Eyeballing their pill box, do you get a sense they are filling the days and times correctly according to prescribed instructions? Do you see random pills not taken? Ask your parent why they are not taking a particular medication. Is the drug upsetting their stomach? Is the pill too large to swallow? Do they just forget? You will get a sense of how well your parent is managing. I tell families there is a natural progression when it comes to medication management.
1. First, a parent may need help getting refills. Maybe they are relying on you to help them call for refills or drive to the pharmacy to pick-up their medications. If you are called upon to frequently pick-up medications or help solve issues of running out of medication, there are a couple of solutions. You can call your parent's current pharmacy to inquire about home delivery services and if there is a fee for delivery. Also, various Medicare health plans have national mail-order pharmacies willing to deliver medications to your parent's door for free. Most of the home delivery services will also proactively call your parent when due for a refill or if a doctor's renewal is needed. Realize for some medication renewals the doctor will need an appointment with your parent. This is the doctor's way to check on your parent and ensure the medication he or she takes is still needed. Prescriptions with no more refills per the pill bottle are one indicator a doctor may need an appointment. Check your list of appointments and be proactive in arranging follow-up. This will prevent any delays in medication refills.
2. The next step a parent may need assistance with is sorting out a medication schedule. You may sense they are overwhelmed managing their pill box or you begin to question if they are missing doses of medications. There are an increasing amount of innovations out there. Please comment on this article if you or a parent use one. My feeling on a lot of these technology-based innovations is they still require hands-on management from someone. The solution I connect senior clients are pharmacies who deliver a week or two of pre-packaged medicines for each day. Your parent will select the correct day and time and tear the box out along the perforated edge. Based in Indianapolis, I utilize the Healthmart East Side Prescription Shop. If inquiring about this service with your parent's current pharmacy, you will ask if they provide "blister packs" to seniors. If this is a solution you want to pursue, the folks at East Side Prescription Shop have some of the best customer service and can answer your questions. The added benefit to using blister packs is seeing which medication or doses are getting missed. This assumes your parent is not throwing pills away in the toilet!
3. Lastly, there may come a time when your parent needs a reminder to take their medications. If you or your family members are able to manage this piece for your parent, then this is the least costly option. If time is a limited resource, there are a growing number of non-medical care companies who tackle this service to keep your parent in their home. While I do not have personal experience to fully endorse the following companies, I know they do provide this service: local Indianapolis company Senior Home Companions, national chain SeniorHelpers, and the new start-up RestUp. If medication management is a small portion of the growing list of needs your parent has, then the time may be upon your family to discuss future living arragements. If you need someone to discuss these solutions, I have found A Place for Mom a wonderful resource for my clients.
The last step I want to cover in medication management is safety. If your aging parent is on more than five medications, a red alarm should go off in your head. Statistics show your parent is at much higher risk to have an "adverse drug reaction" than someone who takes less than five medications. Compiling a list is the first step in ensuring safety. If you pick up your parent's medication from a pharmacy, use their list of medications to run by a pharmacist for their quick, professional opinion. I like phrasing questions in a personal way. I like to ask, "If this was your grandmother's list of medications, would there be any concerns for you?" There are also drug interaction websites you can enter your parent's medication to check on your own. However, these will often paint a much scarier picture than necessary. Often, these websites do not know the entire clinical picture for your parent. Use with caution and what information you obtain you can use to formulate questions for future medical appointments.
Congratulations! You now have started the second step in organizing your parent's care coordination file.
Please check back next week for Diving in Head First Part III: Health confidence
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