A step-by-step guide to unraveling medication concerns…
Maybe, just maybe your Mom or Dad’s medications need a review so you have no medication errors.
Medication errors can lead to behavior changes. Are they driving you nuts?
I can’t tell you the number of times as a physician assistant that I have seen daughters and sons bring their senior parent into my office on a slew of drugs.
Sometimes, there are 20 to 30 drugs and when I add on the over the counter drugs that the patient is also taking we’re up to 35 or 40.
Over 10 medications? We have a problem, Houston.
Anything over 10 drugs are going to have interactions. Either these interactions are going to nullify the effect of one drug or it’s going to enhance the effects and overdose of another drug or the side effects are going to become compounded.
Step by step review…
So I’m going to give you a step-by-step process for medication reconciliation. It’s a review that you think we do in the office but it’s far from accurate or thorough…
This means that you’re going to take all the medications (including over-the-counter medications) and you’re going to make sure that Mom or Dad:
- have to be on every single one of them
- absolutely must take them for the right reason
- going to take them with or without food,
- when they’re going to take them with other pills
- what the side effects are
- what the interactions are
- and how we can get them for less.
I promise that your mom and dad will be a new person when you do this.
You will be a new person, too, because you will come to understand why Mom and Dad are taking these drugs.
Many times, some doctor somewhere put them on them and has never taken them off.
True stories…I can’t make this stuff up…
I’ll give you two examples…
My mom had arthritis so the doctor prescribe Lortab. Now she could take Lortab as often as she liked, and he would often give her a 90-day supply at a time.
My mom would eat them whenever she felt a little pain coming on.
I’m pretty soon she had three side effects of the medication.
#1: it made her Looney Tunes
#2: it upset her stomach so she didn’t want to eat
#3: it made her constipated
Unbeknownst to me that Mom was slipping these extra drugs down her throat I figured I need to go to doctor for her upset stomach and constipation. Which of course means she got two more drugs to add on to her repertoire to help with the upset stomach and the constipation. And of course we didn’t address the Looney Tunes because Mom said, “I’m fine. Leave me alone.”
then comes the patient 92 year-old MALE who came into my family practice one day and as I was doing a medication review, he had hormone replacement therapy (estrogen) in his drug repertoire of things to take.
I asked him why he was taking estrogen.
He said that his doctor told him that if he “ever stopped taking that pill he would die.”
I knew his wife had just died a few months back at the ripe age of 90 and I also knew that she was on hormone replacement therapy which is something we used to give all women back in the day to keep them young and energized.
Somehow he’d ended up with his wife’s estrogen pills.
10 steps to change…
So here’s a few short steps and you’ll be on your way… to better medication management.
1. put all medications including over the counter medications on the kitchen table. Yep, clean out those drawers and closets.
2. get out a piece of paper and make a table
3. every medication must have:
a diagnosis (why is your parent taking it)
frequency (how often taken)
which doctor prescribed it
4. Now, let’s talk about as-needed medications. If it is in the cabinet and your parent will not get rid of it there’s a reason. What are they using it for why are they keeping it? How often do they use it : once a year twice a year? Write it down. It’s got to be included and I’ll tell you why…(#8)
5. Call the insurance company and find out exactly what pharmacies your loved one should be going to (including the mail order).
6. Call two or three different pharmacies and set up an appointment to sit down with the pharmacist and go over all these medications. Now some pharmacies might set this up for you but will also ask you send over the piece of paper first so they can look at all the interactions and then they will call you when they are ready. [NOTE: Why 2-3 pharmacists? Let’s jsut say some are not as smart as the others.]
7. Expect to spend about an hour with the pharmacist. They do not mind doing this.
8. Now why do I care about as needed drugs? Because I can’t tell you the number of times somebody has come in my office and said all of a sudden there high blood pressure pill isn’t working anymore and they want to know why and then I asked them if they’re taking any over-the-counter drugs recently and they say, “Well yes – I had this rash.” or “I had this cold and I had to get this over-the-counter”. All drugs have side effects and interactions with other medications.
9. Review the allergies. Over 90% of people who say they are alleric to a medication are not really. They only have a side effect they don’t like. The pharmacist will go over this with you.
10. When the pharmacist is through discussing all your medications, interactions, side effects, and costs, etc. you are going to visit all the doctors who have prescribed these drugs and ask them why your loved one is taking each one, what’s an alternative medication, if any is needed because of cost, side effects or interaction.
You start doing this every 6 months, and you will be shocked at how fast these medications get out of hand and the next thing you know mom’s got another drug another drug another drug and another drug.
Keeping control of how much she’s on and when she’s taking it and why and for what.
Holding the doctors accountable. Take note of how different and similar these 3 pharmacist suggestions are.
Be accountable and proactive in your caregiving.
Make sure the medications are really needed.
**Never go on or off a medication without first talking with your doctor. This is not meant to be medical advice but to only share how the professionals complete a medication reconciliation.
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