What is Medication Management?
These days, medications play an important role in the treatment of a wide variety of medical issues for elderly individuals. Having the right prescriptions and over-the-counter meds can either reduce or eliminate the patient’s symptoms to greatly improve their quality of life.
But the effectiveness of medications varies from one patient to the next. Doctors must account for the differences between patients and take note of relevant factors by looking closely at each patient’s medical history as well as their current medication plan.
Medication management is an important part of the overall treatment plan for elderly individuals who take multiple medications to treat multiple diseases or disorders. The management of meds makes use of the knowledge of nurses, doctors, home care aides, and other caregivers and health professionals to make certain that the patient is reaping the greatest benefit and best possible outcomes from their medications.
Medication management is a type of outpatient treatment strategy that involves an initial evaluation of the patient’s need for their medication. Prescribed drugs are carefully reviewed to look closely at the possible side effects that each could cause. Some patients may be taking medications that are no longer benefiting them or they may need a prescription for a particular medication that hasn’t been prescribed yet.
After this initial evaluation of the patient’s medications, all prescriptions and over-the-counter medications must be monitored in an ongoing, regular way that ensures that two or more medications are not having a negative interaction (polypharmacy) and none of the medications are causing side effects that are negatively affecting the patient’s quality of life. The goal of medication management is always to get the desired outcomes for the patient.
Often, patients don’t fully understand how their medication regimen affects their health and well-being. Some patients may struggle to just take their medication at the right time and in the correct dosage. But in addition to the pragmatic aspects of taking the correct medication dosages, at the correct time, it’s vital for knowledgeable health professionals to watch the patient closely for negative side effects or drug interactions that could negatively affect the patient’s recovery.
Medication Management gives healthcare providers a reason to look closely at the patient’s medication regimen to address adverse effects and drug interactions that might otherwise go undetected.
When patients are not experiencing desirable outcomes from their treatment regimen, Medication Management allows experienced healthcare providers to evaluate not only the list of medications the patient is taking, but also their use of vitamins and other supplements to understand how these different drugs interact to produce either desirable or undesirable results.
In some cases, patients may not be following the proper schedule or dosing for drugs. Instead the patient may be habitually misusing their drugs to their detriment. Medication Management brings all of these issues into focus to solve the problems and through a coordinated effort by the care team, create a more desirable outcome for the patient.
Why Medication Management Is Important
Medication Management is an essential part of the ongoing care strategy provided to elderly individuals because medications can have either positive or negative effects on the patient depending on a number of factors that may be too complicated for the patient to understand or manage by themselves.
Through Medication Management, experts take the necessary time to evaluate the condition of the patient and symptoms that have been relieved or that have manifested since the prescription of new medications. Medication Management prevents the development and persistence of serious side effects like dementia that can develop as a result of drug interactions or negative side effects.
Though doctors may prescribe the correct medications to achieve a particular health outcome, some patients may have side effects and experience health complications from the medication. Even if a doctor prescribes medications that would normally help patients recover from a particular health issue, the patient may not take the medication according to the proper schedule.
Some elderly patients will hoard medications and take doses that are too low to benefit them. Other patients take dosages that are too high. And, of course, if the patient has seen several doctors who work in different specialities and who have no communication with each other, they may prescribe medications for the patient that interact negatively to produce undesirable results. The only way to prevent this from happening is through Medication Management.
If a patient isn’t experiencing positive health outcomes or if a patient suddenly experiences a decline in health, it could be because they need Medication Management. Their prescriptions may need to be changed, or the dosages altered. Some patients may simply need to change the schedule that they’re following to take their medications.
Often, the solution to the problem is relatively straightforward. The medication dosages may need to be adjusted or the patient may simply need help to make sure that they take their meds on the proper schedule. When knowledgeable healthcare professionals do Medication Management on a regular basis to evaluate the patient’s meds and their actual health outcomes, patients are more likely to experience positive results that match the desired results they’re hoping to achieve.
Don’t underestimate the importance of Medication Management when providing care for the elderly! Pharmaceuticals are powerful medicines that can have unexpected results for certain patients. Every patient’s physiology is different so different medications may have surprising results that reflect these physiological differences.
Caregivers and loved ones who notice a change in a patient’s cognitive status, mood changes, or any strange or undesirable symptoms that emerge suddenly after a new prescription has been added to their regimen should suspect a negative drug interaction or prescription-based side effects. Rather than waiting for undesirable symptoms to emerge, it’s best to be proactive and do Medication Management prior to the development of symptoms.
How do you manage multiple medications?
When a patient is taking multiple medications, it’s important to organize their dosing schedule in a way that makes their regimen straightforward and easy-to-follow. There are tools and methods that can help you diminish the odds that you’ll give the patient the wrong medications and it’s vital that you use these tools! Giving the wrong dose of a medication to a patient or accidentally giving the patient a medication on the wrong schedule can lead to very bad outcomes.
Many people today struggle to manage their prescription medication schedule. About 40% of all elderly individuals take more than 5 prescription drugs. That leaves a lot of room for error! Below are tools that can help both patients and caregivers avoid making drug dosing and scheduling mistakes:
● Follow the doctor’s instructions for each medication.
Obviously, if a patient has been prescribed a particular medication, it is best to take that medication according to the doctor’s instructions. Some patients may try to take lower doses of a particular medication in an attempt to lower their drug costs. Other patients may take too much of a particular drug to manage pain or other symptoms. Following the doctor’s instructions is essential. Patients who don’t follow the doctor’s prescription are in danger of experiencing negative effects from the drug.
● Get all prescriptions filled at the same pharmacy.
Sometimes it may seem more convenient to get prescriptions filled at the pharmacy at the grocery store. At other times, it might be tempting to get prescriptions filled at the pharmacy nearest your home. But if the patient is taking multiple medications, it’s best to get all medication prescriptions filled at the same pharmacy every single time. Getting all prescriptions filled in the same place makes it so the pharmacist can see all the medications the patient is taking. The pharmacist is then in a position to identify the potential for negative drug interactions.
● Get your refills filled ahead of time.
When prescription meds run out, negative health outcomes become a reality for many patients. So it’s best to get all refills filled early. Check the expiration date on each drug the patient takes and get fresh refills on drugs that have expired even if there are still some pills left. And ask the pharmacist if the patient can have multiple medications on the same refill schedule to simplify things and diminish the number of trips that have to be made to the pharmacy.
● Note the development of new symptoms in patients on new medications.
It may take hours, days, or weeks for a patient to develop symptoms of polypharmacy if they’ve been given a new medication that interacts negatively with another drug. Some patients may also simply experience negative side effects from the new medication even if it doesn’t interact negatively with another drug. Whenever a patient manifests new symptoms after the prescription of a new medication, caregivers or loved ones should mention the change to a doctor and request Medication Management to determine whether the problem is caused by the interaction of meds or their side effects.
● Post a medication reminder on the refrigerator or on the cabinet door.
Taking medications should be a normal part of the daily routine for elderly patients who have been given prescriptions by their doctors. If posting a reminder on the fridge isn’t enough to remind the patient to take their meds, it might be wise to set a timer on a mobile phone. Create a routine around the medication schedule. For example, it might help to always take medications after the patient brushes his or her teeth.
● Use a pill dispenser.
A pill dispenser has one or more compartments for each day of the week. Some pill dispensers are designed with daily compartments for morning, noon, and night. These types of dispensers are particularly valuable if the patient must take pills several times a day. In some cases, the pharmacist may be able to fill the pill dispenser for the patient. A good pill dispenser makes it easy for the patient or caregiver to see whether or not the patient has taken their pills or not.
● Keep a current list of the patient’s medications.
Every patient should have a current list of their medications on hand for an emergency or just to take with them to doctor checkups. This list should include the name of the drug (both the generic and brand name), the dosage and schedule for taking the drug along with the reason why the patient is taking that particular medication. Keep this list in a place where the patient always has access to it. Never assume that the doctor or other healthcare providers have a list of these medications.
Different specialists may prescribe different medications for patients and these different doctors aren’t always in-the-know about each others’ prescriptions for the same patient. Having a list of the patient’s medications on hand can be lifesaving in emergencies and giving this list to prescribing doctors at checkups can also be a convenient way to avoid receiving prescriptions that might cause unnecessary and detrimental drug interactions. Doctors who are given this list at every checkup can quickly scan it to see if the patient’s symptoms or complaints might be related to negative drug interactions or side effects.
● Do an annual Medication Management checkup.
If you haven’t had an annual review of the patient’s medications recently, consider putting them in a bag (including over-the-counter medications) and taking them to a doctor or pharmacist to scrutinize them for possible negative drug interactions. As people age, their physiology changes and their bodies may react differently to medications that they’ve always tolerated well in the past so even if it’s been years the patients medications have changed, a medication review should be scheduled annually.
Medication Management Plan
A Medication Management Plan, also known as a pharmaceutical care plan, is an important cornerstone of medication management. Medication Management, in turn, is a vital part of the continuum of care. The goal of a Medication Management Plan is to achieve continuity of care for the patient’s healthcare team.
The Medication Management Plan is a collaborative medication strategy that’s put in place by health professionals in tandem with their patients and caregivers. This plan considers the role of the caregiving team as well as unique patient needs and it can be put to use in a variety of settings including:
● In-patient
● Out-patient
● Emergency Departments
● Non-admitted areas
● Subacute
● Primary Care
A Medication Management Plan identifies issues the patient may confront with their current medication schedule and Medication Management goals that have been agreed upon by the caregiving team, the patient, and the patient’s healthcare providers.
A Medication Management Plan should include the following:
● Assessment of current medication management
● Medication reconciliation
● Clinical reviews of the patient’s medication
● Therapeutic drug monitoring
● Adverse drug reaction information and management
A Medication Management Plan is a supportive document for healthcare professionals that makes it possible for doctors, nurses, and other caregivers to collaborate with the patient to achieve desirable health outcomes. Managing the patient’s medicines, particularly when multiple medications are involved, plays an essential role in achieving positive outcomes for the patient.
The Medication Management Plan should be documented in writing and it requires the input of doctors, nurses, pharmacists, patients, and caregivers to be truly realistic and functional. In acute and subacute treatment settings, this plan can help with the discharge or transfer of a patient to other areas of care. All healthcare professionals who work with the patient are required to document information about the patient’s medications so that the document provides a comprehensive overview of the patient’s meds.
A Medication Management Plan records the medications that were taken prior to admission to a hospital and it allows for medications to be reconciled while the patient is in care. It gives doctors a patient-specific outline of all medication issues and actions that have been taken to resolve the patient’s previous issues with their prescriptions. Doctors who have a Medication Management Plan in hand are better prepared to create beneficial medication management goals for the patient during that particular instance of care.
The minimum components that must be included in a Medication Management Plan for a patient include the following:
● Identifying information for the patient
● General information about the patient
● Medication history checklist including medications that were taken just prior to entering the hospital.
● A current list of the patient’s medications
● Medication reconciliation upon admission to the facility
● Medications that have recently been discontinued or changed
● Medication source list
● Recent medication changes
● Medication risk identification
○ Medication issues
○ Management plan
○ Medications that were changed upon admission to the facility
● Documentation of collaboration among health professionals including:
○ Communication details
○ Who received the Medication Management Plan
○ Where the Medication Management Plan was sent
● Action plan including:
○ Medication therapy goals
○ Implementation strategies
○ Preferred medicine administration methods
○ Location of the patient’s medications in their home
● A risk assessment that includes:
○ Visual impairment
○ Allergies
○ Dementia
○ Gastrostomy Tube
○ Immunization status
○ Etc.
● Medication discharge checklist
● Patient’s primary pharmacy information
● Residential care facility information (if applicable)
● Name of individual who normally administers the patient’s medications
● Recommendation for a Medication Management review or other types of follow-up
How Caregivers Can Help with Medication Management
Caregivers play a very important role in Medication Management for patients. Often, caregivers are responsible for reminding patients to take their medications at the correct dosage and at the proper time of time. Caregivers must watch patients closely to ensure that they are vigilant in adhering to their medication regimen. If patients forget to take their medications or if they double up on medications, caregivers can provide vital information to doctors and other healthcare providers about this problem in order to come up with an actionable plan to solve the problem.
Caregivers are on the front lines in providing care for patients and though they may not have the same knowledge of pharmaceuticals as doctors, they often have more knowledge and understanding of the patient than any of the patient’s other healthcare providers. Some caregivers may intuitively sense that the patient’s medications are affecting them in a negative way. This intuition may actually be solidly grounded in observations the caregiver has made about the patient over the course of many weeks, months, or years. Caregivers may act as advocates in these situations to help doctors and other healthcare providers understand what the caregiver is observing in their patient that leads them to believe that the patient’s medications are causing health problems.
When patients are doing well, caregivers can help execute on the Medication Management plan and administer the patient’s prescriptions according to the doctor’s instructions (as long as the caregiver is legally allowed to assist with this process). If the caregiver is not legally allowed to assist with the administration of the patient’s medications, the caregiver may still help the patient remember to take their medications at the appropriate, prescribed time and at the proper, prescribed dosage. Caregivers who do not, themselves, administer the medications to patients may still notice whether the patient is taking their meds according to the correct schedule and alert doctors and other members of the patient’s healthcare team about aberrations from the dosage or schedule.
Caregivers who do not suspect medications as the cause of new symptoms in a patient should still alert a doctor about changes in the patient’s overall well-being. Often, caregivers are the first to notice that the patient is experiencing new healthcare issues. When a caregiver brings new symptoms to the attention of a doctor or nurse, these healthcare providers have an opportunity to look into the patient’s current medications to determine whether these meds may be the cause of the new health issues.
What are the 5 Rights of Medication Administration?
In the U.S. alone, 7,000 to 9,000 people die each year of medication errors. Hundreds of thousands of other patients experience, but may not report, adverse reactions or other health complications due to the drugs they’ve been prescribed. The cost of these medication errors exceeds $40 billion dollars annually, but more important than the financial costs is the psychological and physical agony caused by these medication errors.
When the wrong drugs or the wrong dose of a particular medication is prescribed, patient satisfaction is decreased. Indeed, patients have lost trust in the healthcare system in part because of the seriousness of this issue and growing concerns about the rampant mistakes made by doctors and pharmacists in prescribing medications that hurt more than they help patients.
To try to avoid some of the issues associated with prescription medication, experts have created The Five Rights of Medication Administration as a guide for caregivers and healthcare providers. The Five Rights of Medication Administration include the following:
- The Right Patient
In hospitals and other healthcare settings, individuals who are responsible for administering medications should check and then double-check to make sure they are giving the right drug to the right patient.
- The Right Drug
Currently in the U.S., there are close to 6,800 different prescription medications that doctors regularly prescribe to patients. The number of over-the-counter drugs is even higher. The sheer number of medications that doctors have to know about and choose from when treating patients creates a complicated paradigm in patient care.
In order to choose the proper drug to treat a condition, doctors must be aware of possible drug interactions to avoid negative health outcomes. But often, when patients go to multiple doctors and specialists to treat different ailments, each doctor prescribed a new medicine without any knowledge of the drugs that have been prescribed by other doctors. This creates a dangerous situation that can lead to deadly drug interactions.
The right drug for a particular health condition varies from patient-to-patient on the basis of other health conditions they suffer from and the other medications that have been prescribed by other specialists. Doctors can make mistakes when prescribing drugs to patients if they aren’t fully informed about the other medications the patient is currently taking.
- The Right Dose
Nearly every substance in the world, when given at a high enough dose, is toxic (including water). A dose that’s high enough to kill a person is known as the Lethal Dose. Some medications can be given in high quantities and produce very few side effects. The Lethal Dose on these medications may be very high. Other medications, in contrast, can only be administered within a narrow dosage range to achieve positive effects. Getting the right dose of any medication is essential in order for it to have the proper effects on the body. The wrong dose of a medication can be deadly.
- The Right Route
Patients who are prescribed pills to take orally, must take the pills by mouth. Other routes of administration exist though. For example, some meds may need to be administered via injection. Others are applied as a lotion. Patients and their caregivers must be sure to administer the medications using the proper route.
- The Right Time
Most medications must be taken on a schedule in order to work properly in the body. Caregivers, nurses, and patients must make a schedule and adhere to that schedule when taking their medications.
Five Important Tools for Managing Medications
● Pill Organizer
A pill organizer allows patients and caregivers to prefill compartments (labeled by day or time of day) with the proper medications.
● Automatic Pill Dispenser
An automatic pill dispenser takes all the guesswork out of managing medications. An automatic pill dispenser can sort, dispense, and provide the proper dose to patients at the push of a button. Some even include audio and visual reminders.
● Timers and Alarms
There’s no need to break the bank on timers or alarms. If the medication schedule is simple enough, a patient can simply use a mobile phone as a reminder of when it’s time to take medications throughout the day.
● Medication List
The medication list is just a piece of paper with a list of all the patient’s meds, their dosage, and schedule of administration as well as the prescribing doctor and the health issue for which they were prescribed. It should be kept with the patient at all times.
● Timer Medicine Caps
Timer medicine caps have a special count-up feature that keeps track of how much time has passed between bottle openings. They work like a stopwatch to remind patients when to take their next dose.
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