Giving Medication as Prescribed: Fact Sheet
This Fact Sheet accompanies the Giving Medication as Prescribed class in the classroom.
What do we mean by giving the medication as prescribed?
Giving as prescribed means the following five RIGHTS:
- The right medication
- The right dose
- The right time
- The right conditions
- The right reason
Health care professionals sometimes call this “adherence” or “compliance”. It means the patient should receive the medication in a way that matches the specific directions of the health care provider. The following provides examples how the five Rights can go wrong.
- Right Medication:
- Once a medication is taken out its prescription bottle or mixed with others it can become confusing as to which pill is which.
- Right Dose:
- Is not just how much to give and how often but what to do if you miss a dose or the patient vomits just after giving them an pill.
- Right Time:
- Does three times a day mean every 8 hours, (6AM-2PM-10PM) or could it mean 8AM-12N-4PM?
- Right Conditions:
- Should the medicine be taken with a meal, 2 hours before a meal, or on an empty stomach.
- Right Reason:
- Ativan can be used, as needed, to quickly quiet the anxious-agitated patient. Prozac can also quiet anxious-agitated patients but must be given on a continuous consistent basis. Its action is much slower, weeks, versus minute or hours with Ativan.
Why are following directions so important?
Medications may not do what they are intended to do if they are not taken correctly. This may result in the patient having to receive, even, more care for their condition.
Prescription medications are tested and approved by the Food and Drug Administration (FDA) using a very specific dosage plan. Physicians may modify this plan based on new facts or how the patient responds. The FDA or physician approved medication use recommendations provide patients with the maximum of safety and benefit.
When medications are given in a way that is different than prescribed, the ability of the drug to work and patient safety may be compromised.
Alzheimer's drug example: If more than 3 consecutive days of Razadyne (formerly Reminyl) doses are missed and then Razadyne is started back at the full dose, the patient can experience uncomfortable side effects like upset stomach and diarrhea.
It can be very difficult to admit that the patient did not receive the medication as directed. No one is at fault and we this document provides a lot of reasons why it may happen to even the most well intentioned person. Yet, it is vital to share this information because poor decisions can result from having incorrect information about how the patient is actually receiving their prescribed medications.
If a physician thinks a drug is ineffective, not knowing it has not been given, they may double the dose, start a new drug or order a whole battery of new tests. All of which may involve greater patient/caregiver stress, higher cost and frustration for all involved.
Communication among all caregivers who give the patient medication is vital. Make sure all caregivers understand their role in giving medications.
Why medications may not be given as prescribed
These reasons are often related to:
- Misunderstandings between the members of the caregiving team. It is quite a challenge for the doctors, pharmacists and caregivers to clearly understand each other. Misunderstandings about the purpose, directions, and expected results of medications, from verbal and written information, my be the results of:
- Unclear medical terms that health professionals use
- Unclear handwriting or mistyped labels, or typed information that is too small for you to read
- Unmet expectations about what the drug is expected to do for the patient and how long it will take for that to happen. An example is it may take days before there is a response to drugs like Aricept and the response may be limited to, not making the patient better, but just slowing down the rate at which they become sicker.
- Access to the medication may be prevented by factors such as:
- Cost of medications
- Schedule conflicts, caregiver’s employment demands, and inconvenience
- Transportation issues or distance from pharmacy and doctor’s office
- Caregiver and Patient factors that prevent medications from being given as prescribed:
- Symptoms of the patient’s disease that change their behavior and ability to cooperate. These include dementia, agitation, hallucinations, and the ability of the patient to swallow
- The patient is suffering from medication side affects that could be helped by changes in the current drugs.
- The caregiver’s other obligations or health may interfere with the patient from getting their medications as prescribed
Strategies to use at the doctor’s office, at the pharmacy, and at home that will help caregivers overcome these obstacles.
Prevent misunderstandings at the doctor’s visit.
Write it down
It is hard to think of questions during the office visit. Prepare for the visit by writing down your questions. Leave a space for the answers.
It is impossible to remember everything that was said. Studies show that on average people only remember only a small portion of the information that was given at their doctor’s visit.
Don’t leave without writen instructions or information.
Confirm your understanding in your own words: Say “Let me repeat those instructions back to you to see if I heard you right”.
Access to medications:
Cost of medications as an access barrier. If cost of the medication may prevent you from filling a prescription consult with your doctor. Ask the doctor for help in writing for generic’s, finding less expensive brand name drugs or free samples.
Caregiver and patient factors that interfere with your ability to give medications as prescribed
- Ask for medications that only have to be taken once a day, when possible
- Medications that come in liquid form if the patient has difficulty swallowing pills.
Some medications come in tablets that will disintegrate in the mouth and don’t have to be swallowed
- Matching your schedule to the medication administration schedule.
Ask if it is possible to adjust when medications are given to best fit your schedule and the patients.
Get it in writing you can read and understand.
Make sure prescription bottle label is readable. Your pharmacist can print in bigger letters, if needed.
Make sure you understand the medical terms that are used.
Some common prescription directions are really not very specific and open to differing interpretations. Make sure you get exact definitions and time frames. Here are some examples:
- Before meals. Determine the exact time eg. 1hour or 1 minute before a meal Or does “before meals” mean breakfast, lunch and dinner? Some people eat more than 3 meals, some people eat just one.
- Twice a day. Does it have to be every 12 hours, 8AM and 8PM or can it be 8AM and 4PM?
- On an empty stomach: Find out how long after food has been given. Generally, this means no food for 4 hours before the medication is taken and no food for 2 hours after.
Medication identification: If you are confused as to which pill is which have the pharmacy give you a picture or write a description eg. Oblong white tablet, with the company and identifying number, found on the medication.
Ask for clarification. Share information about how the medication is working and what you are experiencing.
Confirm your understanding of prescription directions and the medication information sheet that accompanies each prescription, in your own words.
Getting access to medications
Drive-thru windows - convenient when going into the pharmacy is a hassle
Automatic refills – most pharmacies can have your medications ready on a specific date every month without having to make a request. Ask your pharmacy to set this up for you. Some pharmacies allow you to set this up yourself on the pharmacy’s website
Mail delivery – Most pharmacies will mail your medication to you if you choose
Online ordering and price checking – Some pharmacies allow you to order your medications, including new prescriptions online using the pharmacy’s website
E-mail – Many pharmacies can answer your questions about medications through e-mail if you choose. You can also receive reminders and notifications about your medications through e-mail.
See the Pharmacy Services You Deserve presentation for more details on convenient services.
If purchasing medications is a financial burden or you are seeking the best cost for your medications See the "Saving Money on Medications" presentation and FACT sheet for details and more financial assistance programs that may be helpful to you.
Caregiver and patient factors your pharmacist can help solve
Vision limitations – your pharmacist can use bigger type on the prescription labels.
Easy-off caps on medication bottles – if you have a difficult time opening bottles due to arthritis or other factors, your pharmacist can offer you easy-off caps
Ask your pharmacist if there is a way to simplify the pill-taking schedule. The pharmacist can provide you with pill-boxes and reminder systems to help you organize and remember to give medications at the right time.
Misunderstandings at home when you are alone, with the patient, or have to communicate with other care providers.
Keep a written record; It can be LIFE saving during an emergency and help the other members of the caregiving team know what should happen when. Examples of the written content in your medication record should include:
- All medications, including over-the-counter and herbal medications
- What they’re for
- When they should be given
- Reactions, good and bad, to the medications.
- What to do if things go wrong which would include:
- Patients with dementia can pose a risk to themselves if they have access to their medications by overdosing or taking the wrong medication
- Decide who will be in charge of handling the medication
- Recognize when your loved one can no longer handle his or her own medicine.
- Never allow the mentally impaired patient access to more medication than could be taken safely at one time. You may need to place medications under lock and key as you would for a young child
- If the patient is taking their own medications you may have to count pills daily or weekly to see if medication is being given as prescribed.
- Make sure not to run out of medications. Order refills one week in advance in case there are problems in getting the medications and avoid missed doses