by Kim Keller
If you were to listen in on some of the conversations I’ve had with my sister Karen during the last 10 years, you might very well hear us talking about medications, and it would probably not be in a positive light.
The disenchantment began with our dad. As a result of having so many doctors contributing to his care, he was saddled with too many meds, some of which were ineffective and even unhealthy. Duplicative prescriptions, improper substances for patients over 65, too many adverse side effects, confusing dosage instructions . . . The list goes on and on.
Then, after Dad passed away, our mom’s health suffered (no surprise there, since she was Dad’s primary caregiver for so long) and the same kind of medication problems started cropping up. The lesson? Be ever vigilant about medication regimens.
Our latest concern is trying to limit the escalation of Mom’s prescription-drug intake. It’s a challenge to find the balance between the meds she really needs and the meds that are being casually prescribed to her.
In general, there are thirteen points we focus on:
- We keep updated list of all her medications — prescribed and over the counter, including vitamins, supplements and herbs. The list includes: (a) the name of the substance, (b) dosage instructions (for example, take one 10 mg pill before bed every night), (b) the reason for taking the medication (e.g., high blood pressure), (c) the start date of the regimen (say, August 2008), and (d) any special instructions (like, “take with food”). The main list also contains known allergies and/or drugs that have caused an adverse reaction.
- We review this updated medication list with all of her doctors, other medical professionals involved with her care, as well as with her pharmacist. Mom keeps her updated list in her day planner, which goes everywhere with her. Karen and I also have a copy, and we attach another copy to Mom’s refrigerator, so it can be easily found in case of emergency.
- Each time Mom visits a new doctor, or if she is entering a health facility, such as a hospital or rehab, she brings her medication list, along with all her actual medications. We’ve found that bringing her medications to these first visits is extremely valuable to the doctors and/or nurses reviewing her prescriptions.
- We pay special attention to the medications during all periods of transitions — to and from the hospital, rehab, doctor’s appointments, etc. In the hospital, especially, medications can get jostled, accidentally mixed up, and even switched around. Surgery often requires dramatic medication changes — certain meds can be eliminated before surgery, others are added (painkillers, of course), and then a whole new regimen may be started after surgery, depending on the nature of the operation. We remain watchful and diligent, asking questions at each transition. A good medical team appreciates this kind of attentiveness.
- When entering a new facility, such as a hospital or rehab, we make sure to doublecheck Mom’s wristband to confirm the accuracy of her name and birthdate, and we insist that the nursing staff asks Mom for her name and birthdate before administering any meds. Usually a nurse will tell you what each med is and what it’s for, but, if the nurse fails to do so, we make sure to ask.
- When a loved one is in a care facility, like a rehab, we make sure that special instructions for all medications are assiduously followed. Our dad was in a rehab for several weeks after one of his hospital stays. He had been on the common blood thinner, Coumadin, for several years, a regimen that requires regular blood testing. During one of my visits, I happened to notice how unmarked his arms were (they were usually bruised from all the blood tests), and I came to discover that he hadn’t received any of his twice-weekly blood tests during the entire five weeks of his stay! Yikes! Now we make sure that special instructions, even those that seem so simple and routine, are always followed.
- If Mom has a new symptom of any kind — such as, dizziness, nausea, itchiness, depression — we first ask the doctor: Could it be a side effect of one of her other medications? And, quite often, the answer has been Yes! With this simple question, we’ve avoided the addition of another unnecessary med.
- When a doctor wants to prescribe a new medication, we ask this list of questions:
(a) What specifically is this drug for? (b) What are the potential side effects? (c) Will this new drug interact properly with her other meds? (d) Is this drug absolutely necessary? (e) Can we try a change in diet or exercise first? (f) Is this drug safe and effective for someone over 65? (g) How long before the drug becomes effective? (h) How long do you anticipate Mom being on this drug? (i) Can you please spell the name of the drug for me to make sure the pharmacist is clear? (j) Are there any special instructions for taking this medication (such as take with food, always before bedtime, etc.)? and (k) What happens if Mom misses a dose?
- When it comes to gathering information, we do our own research. We use these two helpful and reliable websites: the Mayo Clinic and MediGuard. The Mayo Clinic is a highly respected, world-famous medical facility in Rochester, MN — we use their website as our go-to resource for all medical research. We use MediGuard specifically for medication information. The website offers a very handy feature which allows you to plug in whatever medications you’re curious about. The tool synthesizes the information and responds with all critical data regarding potential adverse interactions for the substances you entered. This is a fabulously useful apparatus.
- We also check the Beers Criteria, which is a list of medications that should not be prescribed to patients over the age of 65 because the drugs are either risky or not effective. Named after the late geriatrician Mark Beers, the primary purpose of the Beers Criteria is to guide healthcare professionals who are treating older adults.
- Mom doublechecks her medications whenever she picks them up from the pharmacist. Luckily, she has a wonderful pharmacist who is extremely diligent and often spots issues on her own. It’s important to confirm that the right prescription is being picked up and to read all of the enclosed information about each particular drug.
- Mom has a useful routine for taking her daily meds. Her vials are clearly labeled and kept organized in a logical fashion. At the start of each week, she puts the medications in a daily AM/PM dispenser, and she takes these pills with her breakfast and dinner. Her medications before bed are kept on her bedside table. The routine is particularly helpful in making sure she takes her medications properly and faithfully. Your loved one may need a more strictly controlled system for taking their meds — there are a variety of dispensing tools available. We’ve always liked the e-pill Medication Reminders. Take a look.
- Lastly, we try to maintain a persistent focus on limiting Mom’s medications only to those that are truly necessary. Easier said than done, of course, but a very worthwhile pursuit. Our society has gotten much too comfortable with popping a pill every time there’s the slightest problem. We would all be better off trying to limit that approach to healthcare.
Kim Keller is the Co-Founder of In Care of Dad. She lives and works in New York City.