Posted by Cam W. on March 2, 2002, at 1:15:06
In reply to medication compliance?, posted by trouble on March 1, 2002, at 20:41:50
Trouble - It is not a good idea to double up meds. As Mark said, this can cause more harm than good in the long run. I am going to give you a partial (potential) answer to your problem, but I first need to know a bit more about all the meds that you are taking. I need to know:
• the strengths of the medication that you are taking.
• the dosing instructions.
• how often do you get refills (ie. how many days of medication does your doctor(s) normally write for)?
• how long you have been taking each medication.
• any other medications (incl. herbals and non-prescription drugs) that you are taking..
• are all the medications that you are taking prescribed by one doctor?
• do you have young children at home?Answering these questions will help me to figure out if your memory loss is medication-induced, or just old fashioned aging.
I may also be able to give you a few tips on remembering to take your meds. I strongly recommend using a blister pack or a Dosette™ (or similar package). Both are an at-a-glance way to see if you have taken a certain dose at a certain time.
I like blister packs better than Dosettes if you are not taking any "as needed" medication. You cannot accidently spill a blister pack, and you can fit a larger number of pills into one.
Most pharmacies will blister pack or fill a Dosette for free. If yours doesn't, threaten to take your business elsewhere. If they still don't budge (or say that they don't have the capabilities to blister pack), phone around and find a pharmacy that does.
Importantly, make sure that the pharmacy does not say that they have to fill a blister pack or Dosette a week at a time only. They sometimes say that this is store/company policy. That is BS. The reason that they only want to fill a week at a time is because thay will get dispensing fees for each medication every week, instead of every month (or every 3 months, depending upon how often you pick up refills).
Pharmacists (esp. owner/pharmacists) may claim that they blister pack/dosette is more work, therefore it can only be done on a weekly basis. What they are really saying is, "I am lazy and need incentive to fill compliance packaging; but my greed says that I will do it if you pay me dispensing fees every week, rather than every month." Trust me, it is not that hard to fill them, and really does not take that much extra time to fill blister pack or dosette; not enough work to justify weekly dispensing fees, anyway.
If you do find someone who will fill a blister pack dosette for a month (or more), be nice to them, since they were nice to you by filling and giving compliance packaging at no extra cost. Always give the pharmacist a few days to fill your prescriptions and refills. This way they can wait until there is a slow time in the store to fill your compliance packaging. Make sure that you tell them that you will be in to pick up the meds in a few days and you are doing this so that they won't feel rushed. This will decrease the risk of any mistakes being made in the filling of the prescriptions &/or compliance packaging, and will make you look like a nice guy in the eyes of the pharmacist (we tend to do the little extras for people who are nice to us).
Also make sure that the blister pack has "all" of the prescription labels adhered to it. This is important; it can literally be a matter of life and death. If you end up in the emergency room of a hospital and are comatose, most likely whomever brought you will not remember what medications you were taking, and when. Whether the blister pack is empty or not, it can be very time-consuming to find out vital information about what medications you are taking when there are no labels attached. Unlabeled blister packs also make it impossible to determine when you had your prescription filled last, by which pharmacy, if those filling it had made a dispensing error (dosage, drug, etc.), and if you are taking the medication properly. If a pharmacist says that he/she cannot fit all the labels onto a blister pack card, they just aren't being creative enough. On a Jones Packaging "Cold Seal™" blister pack, I can comfortably fit 14 labels with no information being covered up, nor labels being loose.
You may ask, what is "Cold Seal"? This type of newer blister packaging is relatively cheap and is a reliable (ie. does not fall apart like earlier models did) and has an adhesive covered by a protective backing on both sides. Just flip the back onto the front and press down. Voila! It's sealed! It does not use heat sealing machine, so that cost is saved. You can use an inexpensive template, that the bubbles (blisters) fix into, to ensure that the pharmacist is able to tightly seal each of the bubbles, with no pills falling out.
Also, Cold Seal (probably is known by other brand names as well) blister packs allow the pharmacist to adjust the size of the blisters. I recommend using the extra-large blisters (but not the extra-extra-large; they are too flimsy and are difficult to work with) for filling all prescriptions. The extra-large blisters are sturdy enough to offer protection to the meds contained therein (especially easily breakable capsules or gelcaps), and big enough to hold several medications.
Some pharmacies try to give blister packs with the drugs separated into their own cards. This may be convenient for some nursing home set-ups, but is almost as ineffective for compliance as vials are. Have the pharmacy package all of your medications together.
Dosettes (which also go by different names, depending upon the brands) are also available in a number of sizes, and the size that you need depends upon the number of medications one takes. Herein lies one of the problems with dosettes. On the whole, Dosettes cannot fit too many medications, especially if those medications are large. If one is taking 3 x 500mg Epival™/Depakote™ (divalproex) at bedtime, one would be hard-pressed to be able to fit anything else in the bedtime slot. It would require one to buy four of the extra-large dosettes, which are bulky and not very convenient to carry with you. The newer blister packs are able to fit several drugs in the extra-large, or if need be, the extra-extra-large. If the pills are still too bulky, there are tricks around this, as well.
Before we go any further, I would like to let you in on a little secret for opening blister packs. Never push the pills from the top and try to pop them out of the back. This is a good way to crush more delicate tablets and capsules, and to end up with small bruises on you fingers. Always scratch out the foil from the underside of the blister pack over an empty cup or your hand. In this way your pills don't get crushed, and are less likely to bounce all over the place (a sink is the worst place to pop out your pills, using either method.
Even if one is not taking many medications, the initial outlay is for 8 Dosettes. If you are not paying a weekly dispensing fee, do not expect the pharmacy to supply them for you. You need to have 4 Dossettes filled with the month of meds that you are using, plus 4 at the pharmacy to be filled. You could get away with having 5 or 6 Dossettes, if you don't mind an extra trip or two to the pharmacy.
Another beef that I have about Dosettes is that there is not enough room on them to attach more than 6 or so labels, so that they are easily readable. The little chart on the back usually lacks some vital information, such as the date of the last fill. Some pharmacies do have printers that are able to update the back chart, by printing out new ones every month. You can ask if their computer has this ability.
My biggest beef with Dosettes is the ease at which they seem to spill (especially when you turn them over to read the directions and they are still open). Doesettes also seem to break fairly easily when dropped.
If you cannot find any pharmacy to blister pack your meds, you may have to use a Dosette. You would have to fill it yourself from the vials. It might be wise to get the pharmacist to show you how to do it properly the first couple of times. Also, it is wise to get someone else to check to see if you've filled it correctly every time. This may seem like a trivial thing, but in my pharmacy, where we do hundreds of Dosettes a week (I still don't like them), I have a second tech check the Dosettes filled by the first, then I check it from a master list. Anyone can, and will, make mistakes even if ultra-careful.
Be sure to save your labels from the vials (ask the pharmacist not to stick them on the vials) if filling your own Dosette. You can save these labels in your wallet (sort of a "poor-man's" Medic-Alert™ card) or tucked into the back of the Dosette. Be sure to keep the back card of the dosette updated with each change in medication. Fill out the card in pencil, as the White-Out™ can get very thick after a while.
Mark had mentioned daily pill packs. These are okay, but only if you are extremely comfortable with taking your meds. The daily packs are similar to a Dosette (ie. they are 1 out of the 7 days of the dosette). Daily packs are convenient if you need to take a regular dose of medication with you when you leave the house (eg. midday dose when going to work). The daily pill packs are also bulky, and are not that easy to conceal in jeans or a shirt pocket. I find the daily pill pack a pain-in-the-butt because it has to be filled everday. Others may find that this helps to job their memory to take the meds, but for me it doesn't.
Trouble, the reason I asked if there were any children in your household is because one of the memory jogging ideas I have involves leaving the blister pack on the bedside table or your pillow for the night time dose. Or you could leave it beside the sink where you brush your teeth, or you could put it in the drawer with the toothpaste.
Istead of guessing where and when you take your meds, I will let you anser my above questions, and I'll try to take it from there.
I hope that this seemingly endless monologue is of some help. - Cam
poster:Cam W.
thread:96004
URL: http://www.dr-bob.org/babble/20020301/msgs/96031.html