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August 2006

Medication Management

As one of the top five strategies identified in the Briggs National Quality Improvement Hospitalization Reduction Study (January 2006), 59% of the participants in the study used Medication Management as a strategy for at least one year or more. According to the study, up to 30% of all hospitalizations and up to 45% of re-admissions among the elderly can be attributed to medication mismanagement. The cost can reach $3,224 per episode.

Complications that are medication-related play a major role in adults being hospitalized and are a contributing factor in accidents for our elderly patients. There are several things to be more aware of as we teach our patients about their medications that will assist in increasing knowledge and compliance.           

While doing your OASIS assessment, it is important to remember MO780 includes over-the-counter medications. Nurses can use the home health aide as an assistant in the plan of care. Instruct the aide to alert the clinician to any signs that may lead to non-compliance, such as increased difficulty swallowing.

Here are a few things to watch for while performing your assessment that may alert the clinician to possible barriers to medication management:

Does your patient have difficulty reading their drug labels due to visual impairment? If so, ask the pharmacist if he or she can print a larger label for the bottle or colored dots on the lids of the bottles. Medications may be too costly for the patient which can lead to non-compliance. Assessing your patient’s financial ability to acquire medications includes getting a social worker involved, if appropriate. Discuss alternatives with the physician and pharmacist and suggest generics . Provide the information to the patient in ways he or she understands. Allow plenty of time, prioritize teaching and reinforce it. Recommend the physician write the use of the drug on the prescription label; many times medications can have several different uses. Poor memory impairs the ability of the patient to remember what medications to take or when to take them. Whenever you can make things easier for the patient/caregiver, you will increase compliance and make medication management easier. Write out the medications schedule in large enough print so patients can see it. Use pill planners and/or a calendar. Review all medications with each visit. Try to schedule meds around routines or activities like mealtime or bedtime. If your patient has poor manual dexterity related to conditions like a stroke or arthritis, ask the pharmacist to use easy open lids and instruct the patient/caregiver to keep them out of the reach of children. Side effects are often difficult to deal with, and if they are too disturbing, they can lead to non-compliance of your patients. Determine what side effects you are dealing with, and discuss with the pharmacist/physician if there are any remedies available to assist the patient in dealing with these effects.

Medication management is important to potentially decrease the risk of hospitalization and to reduce medication errors and associated problems related to medication mismanagement.

Cyndi Rohret RN, BSN, CRNI, CHPN
Clinical Consultant Home Care, Briggs Corporation

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