by Kim Keller
Karen and I have been on Medication High Alert lately. As I’ve recently reported, our mom has been in the hospital for the last few weeks, and at this writing, she’s moved on into the rehab program at the same facility.
We feel fortunate that Mom is receiving such wonderful care, but we remain vigilant nonetheless. Our experience has taught us that you can never pay too much attention to the dispensing of medications, especially in a hospital.
So, in the spirit of prudence and foresight, we decided to share with you all our best medication advisements. Take a look:
- Have a complete list of all medications: prescriptions, over-the-counter meds, vitamins, herbs and otherwise — You may be surprised how valuable this list can be. Our mother has always kept an updated medication list, and it’s proved to be one of our most valuable tools. The list should include the dosage and the instructions for use (e.g., “two tablets with food in the morning”), and the reason for the medication (for example, high blood pressure). You should also include any known allergies and the reactions they cause (swelling, itching, hallucinating, violent behavior, etc.). Mom’s list has been handed out to every one of her doctors, and we also keep a copy in her hospital room for quick reference. We’ve had to refer to it many times, and the medical team has expressed gratitude for our diligence.
- Keep The List Accessible — In addition to Mom’s doctors, Karen and I each have a copy of her updated medication list, and Mom also keeps a copy in her wallet. Additionally, there is a copy of the list on Mom’s refrigerator door at home, just in case any Emergency Medical Technicians are called to the house.
- Bring All Medications To Every Doctor’s Appointment — It seems like the list would be sufficient, but bringing all medications, including prescription, over-the-counter substances and vitamins, is a great idea. We discovered that questions always come up, and the doctor is more informed when he or she can actually examine the pills.
- Medications Often Change During A Hospital Visit — Be sure to actively track this. New medications, or regular medications that have been discontinued, can both wreak havoc. When our dad started to display strange behavior — causing an uncharacteristically belligerent commotion in the middle of the night — our friend Betsy suggested, we check to see if any of Dad’s medications had been changed. Quite honestly, the very first time she said this (she eventually said it many times), we thought it was a little farfetched. After all, he was with medical professionals and they’d certainly see the connection if one existed. But we asked anyhow, and, sure enough, they had changed his sleeping meds the night of the very first incident. They missed the connection because they didn’t recognize Dad’s behavior as being uncharacteristic. As so often happens in an unfamiliar facility, the staff had no frame of reference — they thought it was his regular nighttime routine. Our dad’s medication changed frequently, and often there was some sort of odd reaction. We learned to ask: Has any medication been changed? We were surprised how many times there was very little thought given to the impact of these changes. So be diligent!
- Ask Questions About New Medications — When a doctor prescribes a new medication, be sure to ask what it’s for, how it works, what side effects are possible, and if it’s safe to take with the rest of your loved one’s medication list. You might also ask if there is an alternative, for example, drinking cranberry juice (or taking a cranberry pill) for a urinary-tract infection versus taking an antibiotic. This helps you and your loved one’s doctor to consider the critical questions regarding the medication being prescribed. Here are some more thoughtful questions you can ask the doctor.
- Make Sure Drugs Are Safe For Elders — Refer to the Beers Criteria, named after geriatrician Mark H. Beers, M.D. It’s a list that identifies potentially inappropriate medications for people over 65. First published in 1991, the list was recently updated, naming 53 drugs that should be (a) avoided altogether because of a high risk of adverse effects or limited effectiveness, (b) avoided with certain types of diseases or disorders because the drug could exacerbate the condition, and (c) used with caution. If your loved one is taking a drug that’s mentioned on the Beer’s List, then discuss it with the doctor. Keep in mind, the list is just a guide and should never preempt doctor’s orders.
- Learn About Potential Medication Interactions — Check out MediGuard.org, a free, easy-to-use service that reviews the potentially dangerous interactions of prescription drugs that your loved one may currently be taking. You provide a list of medications (prescriptions, over-the-counter drugs, vitamins, herbs, etc.), answer a few simple questions, and within minutes you’ll receive an informative report, in simple, everyday language, the purpose of which is to alert you to any potential problems regarding interactions of chemical substances. But the report goes further: it ranks the severity of the risk, notes the side effects for each individual medication, and points out the possibility of counterproductive interactions — in other words, when one prescription might be undermining the effectiveness of another.
- Be Sure Medications Are Taken Properly — It’s good to check that the prescriptions are being taken as advised. There are many reasons why people don’t take their medications as instructed. It could be that they have too many pills to keep track of, or they don’t like how the medication makes them feel, or they feel better and don’t understand why they need to keep taking the pills. For whatever reason, this is something to check if your loved one isn’t feeling as expected.
- Try A Pill Dispenser — You can use an automatic pill dispenser. We recommend the Med-Time dispenser, with 28 compartments for pills and the like, so it can handle a variety of medication routines without the need for constant refilling. As the Med-Time website points out, taking the right meds on time is as important as what meds are being taken. The dispenser also has a simple timer system that’s adjustable for each routine. Here’s a link: Med-Time Automatic Pill Dispensers from epill.com.
- Check Hospital Wristband — Be sure to double-check hospital wristbands for accurate name and birthdate. All medications should be confirmed to have the same information. Our mother, being cheeky about her age, once told the nurse that the date on her wristband was wrong. The nurse’s eyes widened with obvious concern. Luckily, I was there to explain that this was my mother’s vanity speaking, just her way of keeping her age private. The nurse was visibly relieved and then sternly explained that it wasn’t funny at all. I was grateful the nurse took it so seriously.
These are some of our best medication tips. And, importantly, we’ve discovered that the most capable doctors and nurses will welcome your vigilance.
If you have other great medication tips, please share them with In Care of Dad. We’d love to hear from you.
Kim Keller is the Co-Founder of In Care of Dad. She lives and works in New York City.