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Wardipedia – 49. Graduated self-medication

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Managing my meds myself

Introduction

When patients return home, especially if they’re living relatively independently, they need to be able to manage their medication. Being in hospital is the perfect opportunity to refine this skill, and to learn about any new medication they might have been prescribed. As we describe below, taking medication ‘the right way’ is fraught with difficulties, but this is a reason to energetically and creatively support not avoid patients gradually taking on the responsibility for managing their meds. Some Trusts have developed very careful, stepped processes to support patients in the journey from having their medication handed over to them up to when they are safely storing it in their bedroom and successfully taking it as prescribed.

Of course, not every patient will be able to manage their own medication while in hospital and many will be moving on to supported accommodation where others will be responsible for it. But the principle is that patients should take as much responsibility for their medication as they can safely manage. For some people this may mean being brave enough to swallow a pill which they don’t like the look/feel/taste of, while other patients are independently managing their medication as they do when at home.

In addition to the cautious progress towards graduated self-medicating, hospitals are using an imaginative range of ways to help patients understand, take and cope with their medication. Pharmacists of course play a crucial role in this, and many are involved in a very pro-active and flexible way with patients, which is usually very much appreciated by patients and staff. And friends and family when pharmacists provide advice sessions for them.

It’s worth reflecting on the language used. ‘Compliance’ is just so retro! Compliance is in complete conflict with the current climate of ‘co-production’. It’s both evidence-based and common sense that the more internally motivated we are, the more likely we are to stick to a plan, especially if it’s one that we’ve actively helped to create. The term ‘concordance’ is a bit baffling as it’s hardly an everyday term. ‘Adherence’ has less of the imposition feel to it but we feel it’s best simply to talk about patients effectively managing their medication.

Ward examples

Learning

  • A medication education ‘drop-in’ (otherwise known as the ‘medication clinic’) takes place on the ward each week. This gives patients the chance to ask any questions about the medication they are taking, giving them more understanding, confidence and self-management.
  • Medication Q&A sessions with local pharmacist.
  • Friendly, jargon-free, leaflets are available on the ward about each medication.
  • Concordance training, including motivational interviewing.
  • Learn about the purpose of their medication, its side-effects, how to cope with the side-effects, the consequences of not taking it as prescribed or at all. (The Mental Health Bill adds an extra twist to not taking our medication.)
  • Patients can ask questions about their medication or simply air their feelings about it.
  • Discuss strategies for remembering to take the right doses at the right times.
  • Learn about other aspects of medication, eg the effects of combining it with homeopathic treatments or with drink/street drugs; safe storage etc

Protecting time

  • There are clocks in all bedrooms so patients know when their allocated time slot is coming up and each bedroom has a poster with their time slots. There’s a gap at the end of each medication session for people who haven’t managed to get there unprompted.
  • Inspired by Star Wards, our ward has protected medication time.
  • Quiet room with easy chair, patients come in one at a time. Chance to talk to patient at start of day.
  • If it’s legally etc necessary, nurse is present to see medication being taken and counter-sign chart. (Patient asks nurse to come into room for this.)
  • The medication process involves the Nurse being available in the clinic room throughout the medication period, this allows patients to attend for medication without queuing.

Pharmacy supporting

  • Pharmacist visits wards daily + attends ward rounds. Information about medication for psychosis is put on noticeboard.
  • Proposal to think about pharmacy technician to do drugs’ round with an unqualified staff member. Frees up qualified nurse time and better for patients who could access more experienced staff in relation to medication.
  • Pharmacy technicians support to wards. Saves a lot of ward staff time -ordering, checking, arranging pharmacist to talk to patents, and do training themselves.

Automated dispensing

  • It’s a machine stocked with individual service users’ medication which is pre packed on a dose by dose method. It is computerised and time set. A code is inserted and the meds are released and given to the person, giving the potential for greater self-medication by patients.

Remembering

  • Notebooks, diaries, Excel spreadsheet, alarms on mobile phone, alarm clock
  • Pill slicers/crushers – or whatever works for the individual!
  • Pharmacy send out an automated text message reminder to each patient telling them when to take the medication and what to take etc.

Self-dispensing

  • A number of patients have started self-medicating which seems to be working well, and has positive outcomes as it is identifying those patients that may need help with their medication after discharge e.g. Dossett boxes, Blister packs etc.
  • Patients inject creativeness and fun into their medication boxes by designing the front of the box / case. Crucial information is included:  I.E take 1, 3 times a day after a meal.  A motivational message can also be added etc.
  • People with visual impairments may require special labelling or written instructions which they can read.
  • None of our patients queue for medication.  Some of the patients have ‘dosset boxes’, which we keep, in the clinic room.
  • Service user designed bookmark with motivational rhyme!
  • Patients know when they need to take their medication (using pill alarm box or equivalent if that helps and is sustainable back home) and go to treatment/dispensing room. Nurses find them if they haven’t collected their medication within agreed time parameters. Both sign for medication.
  • Patients who can manage have keys to these and access their medication with nurse present.
  • There are individual locked compartments for each patient in the treatment room or in trolley.
  • Where there are individual bedrooms, each has a lockable cabinet for medication and valuables.

Patient examples

  • I try not to use PRN medication to help calm me down but I have learnt that each recovery tool has its time and its place. Now I try my three coping mechanisms first and if they don’t work I feel okay to ask for it.
  • I take some responsibility for my medication on the ward. It’s a gradual process and some days I struggle but it removes one of my worries about being discharged
  • My Psychiatrist discussed different medication options with me and possible side effects. It made me feel involved with my care so I felt happy to try a new medication.
  • When on weekend leave I made sure I took my medication at the correct time and took things nice and easy. I did feel like celebrating and “partying” but there was time for that in the future.
  • I asked for some information about my medication and then asked my named nurse some questions. I was then able to cope more with the side effects.
  • Medication, at times, was extremely helpful. It gave a chance to have some clarity of thinking so that I could work on the more long-standing issues.
  • When I had leave I took responsibility for taking the medication I needed and filling in a little diary sheet about it. It was a good feeling and gave me hope for a future out of hospital.
  • I liked being asked every ward round ‘how I felt about my medication?’ It stopped me feeling out of control with it and like my views were respected.
  • We had many opportunities to give feedback on our meds, and discuss any changes we would like to make. I think this is how it should be – teamwork.
  • I worry a lot about side effects of medication. But the pharmacist went through them all with me and gave me peace of mind.
  • We always joked with the staff that chocolate should be PRN!
  • There’s lot of information on the ward about how to deal with side effects, like weight gain.
  • I was offered all sorts of medication but I refused most of them. The staff tried to pursued me to take them but I said no and they were okay with that.
  • Medication has a place but staff encourage you to do other things first to deal with how you feel rather than just getting a medication fix.

A little note from Marion Janner (founder of Star Wards)

My handy hints for swallowing pills!

Obviously depends on the individual, the chemical properties of the pills and the size, shape and even colour of the pills.

  • Believing that it’s possible to get the object down one’s gullet
  • Shoulders down, head back.
  • Thinking about the second gulp of water
  • Concentrating on looking at the bottom of the glass
  • Taking it while concentrating on something else – a phone call, a radio prog…
  • Taking with ‘thicker’ liquid – milk, smoothies
  • Swallow in tea-spoon of jam or stuffed into a marshmallow.

Medication Storage

Biometric Cabinets

Biometric cabinets are keyless with secure access by means of a thumbprint. IT cabinet link provides access authorisation and an audit trail. Lock-out times are programmable to govern frequency of access and repeat access. There are different cabinets for central ward or individual bed side location.

We particularly like ones which can include not just an alarm reminder but a recordable message. But even simple 7 days a week models are a good start.

Talking Labels   
A very interesting option not just for visually impaired patients, but for those who can’t read English (including people with learning disabilities, people who don’t have English as a first language, people with wonky literacy etc.)Talking Labels attach to standard packaging and allow you to record and store a voice message, which can then be played back at any time with the push of a button. This new concept offers a solution to eliminate the risk of any possible confusion with medication by helping Patients to understand and follow important instructions. The re-recordable voice message could include the name of the patient, a description of the medication, dosage instructions and any important warning notes. A clear audible message will allow the user to identify and take their medication safely.
Medication Reminders
Surgery Connect Medication Reminders not only remind patients when their medication needs to be taken but can also provide motivation by reminding the patient of the benefits of the treatment. Instructions for taking the medication, completing the course and renewing the prescription if necessary can also be included. Affirmative reminders have proven to be effective in motivating patients in maintaining prescribed medication, thereby reducing healthcare costs and maximizing pharmaceutical company revenues.

 

Categories: Involvement, Wardipedia
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