Your role in medication safety
By Pat Irwin
Seniors take more medications than the rest of us. In fact, data suggests that 25 per cent of Canadian seniors are prescribed 10+ medications and as many as half of them are either taken incorrectly or are overprescribed.
It doesn’t take a rocket scientist to figure out that in the average senior this situation is a potential Molotov cocktail increasing the likelihood of adverse drug reactions, unwanted side effects and dangerous interactions.
There’s a lot of medication rattling around in medicine cabinets, on night tables and tucked away in glove compartments and handbags! But who keeps track of these pills, when and how they are administered, their renewal and their potential side effects as Mom and Dad become older and perhaps a little more at risk.
Whether you’re a paid caregiver, an adult child with aging parents or an allied healthcare professional, here are some real-life examples of how families and professions have made a difference.
Recently 78-year-old Muriel complained to her daughter that she was feeling constipated. “I can’t have my bran cereal, because I can’t have milk, because I’m on an antibiotic.” When asked, she didn’t remember why she was on the antibiotics but it had been renewed and delivered with her drugstore order.
Knowing that Muriel had no nearby support, her daughter suggested that they set up a call with the pharmacist to review all of her medications, potential side effects and renewal status.
In fact, pharmacists in Canada have assumed an expanded role in medication management for the public and are regulated by Canadian Pharmacists Association – https://www.pharmacists.ca. They can prescribe medication in an emergency, renew and extend prescriptions, order and interpret lab tests, and inject vaccines.
Muriel’s pharmacist was concerned that an antibiotic prescription for a urinary tract infection was still being refilled and delivered. She reviewed all her prescriptions and showed Muriel how many of the over-the-counter products she was taking were duplicating or counteracting her prescription medication.
The pharmacist was even more concerned when she learned that Muriel was using a walk-in clinic, as her family doctor had retired. And that her only daughter lived in another city. She set up a reminder to contact Muriel herself on a regular basis to check on her well-being and had some other good ideas:
• Order all medications from one pharmacy, so they can be easily tracked and managed for duplication, interaction, renewals, updates.
• Post a list of medications and what they’re for on the fridge for easy reference should she attend a doctor’s appointment or emergency-room visit.
• Request a blister pack for regular medications.
• Keep medications in one dry place in her home, including over-the-counter medications.
• Return expired prescription and over the counter medication at the pharmacy for safe disposal.
• Rely on your pharmacist to renew medications in sufficient quantity; don’t stockpile or hoard.
• Pre-splitting a large pill is possible before blister packing—far easier for Muriel to swallow.
Muriel’s use of the pharmacist as a resource was a good step to ensuring her wellness—and she’s enjoying her bran cereal again!
Meet Eleanor and Jack
This couple had been married for over 60 years and did everything together. Even as mild dementia and physical frailty began to cloud their days, they were able to muddle through. However, their son visited one Sunday with his wife and kids, as he was prone to do, and things had changed. The house wasn’t tidy, the fridge was empty and there were mixed up pill containers in the kitchen, bedroom and bathroom. It seemed that Jack was taking his meds with a slug of Scotch as well. After a discussion with his sister, Jack called a home healthcare agency and hired Cora, a personal support worker (PSW) for a few hours each day. He figured his job was done. Not quite.
As a PSW, Cora is not licensed to prescribe, dispense or even administer medications, but she knew managing the situation was essential. She noticed that the couple were sharing pills, not taking them each day or at the prescribed times. Cora created a well-labelled box in the kitchen where she encouraged them to store their respective pills. She made sure she was there for them to take their pills in the morning and set a reminder for the evening ones.
Cora also knew that proper nutrition and hydration were important to medication being properly absorbed so she reviewed the couples eating and shopping habits, likes and dislikes, and meal preparation options. Although she was only engaged for a few hours each day, Cora created a shopping list and asked the son to arrange delivery. It became a shared activity between the couple to help her develop menus and meal-prep kits and fresh lunches and ingredients and leftovers for dinner. She found Eleanor enjoyed helping her so meal prep became a positive time again for her rather than a burden. Cora also left a jug of lemon slices in water in the fridge and always offered tea and juice.
Over time, the son asked Cora to extend her hours to cover lunch and dinner along with laundry and day-to-day housekeeping. Molly Maid helped with bi-weekly cleaning and a grandson offered to take care of lawn mowing, garden care and snow removal. Life became much better for Eleanor and Jack; they began to take slow afternoon walks with Cora and Jack’s Scotch bottle spent more time in the cupboard.
This senior went to see a naturopath, her family doctor, a specialist or two and used a number of herbal remedies. She felt awful. Last month Joan also had a fall that was bad enough to land her in the emergency department. During her hospital stay she was diagnosed with osteoporosis and her medication regime was called into question.
Betty, was the Director of Care in Joan’s retirement complex. She had assessed Joan prior to her discharge from hospital but was surprised by the extent of the daily pills and potions she had grown accustomed to taking. After visiting her home and documenting all the meds, vitamins and over-the-counter remedies their dosages and directions, she consulted with Joan’s physician. This, they agreed, was a case of “Polypharmacy”—the use of multiple, often excessive or unnecessary, concurrent medications—common among older adults, many of whom have multiple chronic conditions such as arthritis, asthma, chronic obstructive pulmonary disease, coronary heart disease, depression, diabetes, or hypertension.
Encouraged by Betty, the family doctor chatted with Joan and her family about her moving to a more supportive level of care within the community. With additional support, three meals a day and ongoing medical care, Betty and the team hoped to see less medication side effects, increased personal safety and better healthcare monitoring.
When it became very clear that Joan had no idea she was at risk, a cross-referencing review was initiated with her support and it brought the number of meds from 20 to six. Staff agreed to looking after the medications by bringing them to her suite to fulfill her wish for privacy.
The role of the medical team in a retirement community is defined by the Retirement Homes Act of each province under the provincial ministry of health. The medical team is not judgemental or blindly driven by rules; they are there to support their residents in wellness based on solid nursing principles and standards defined by provincial governing bodies of nursing and related medical associations.
The Director of Wellness is usually a Registered Nurse (RN) whose duties in a retirement community include all aspects of medication management including:
• Prescribing – communicating with physicians on residents’ medical condition and medication needs.
• Transcribing – ensuring accurate transcription and documentation of multiple medication orders.
• Dispensing – communicating with onsite or off-site pharmacies, ensuring accurate and timely delivery of medications.
• Administering – ensuring safe administration of large volumes of medications within time constraints.
• Monitoring – assessing and evaluating residents’ responses to medication therapy.
Pat M. Irwin, BA, AICB, CPCA, is the president of ElderCareCanada and a professor of distance learning at Centennial College.