Teach patients and staff what to ask
The right questions boost medication compliance
In today’s health care environment, communication across the continuum of care connecting physician, pharmacy, and home care on senior drug compliance can be difficult. That is why it is important to educate patients on ways to manage their medication regimens and communicate effectively with their provider and pharmacist, says Nina Resch, PharmD, primary care clinical pharmacist at the Veterans Affairs Medical Center in Albuquerque, NM.
Patients need to be taught the importance of building a relationship with their pharmacist by making sure the pharmacist knows all the medications they are taking and asking about over-the-counter medications before making a purchase, she says.
It’s important to help patients understand their part in the drug regimen process, agrees Linda Mosel, MSN, RN, CS, geriatric clinical nurse specialist at Good Samaritan Hospital in Dayton, OH. Make sure patients are aware of the need to talk with their pharmacist and doctor about the natural home remedies and herbs they use so there will be no adverse interactions with their medications.
Also, let patients know that if they experience any change in function, such as being more tired than usual, or if they seem to have a memory problem, they should talk to their physician. Patients need to know that there are not just two alternatives — to stop taking the drug or to endure the side effects. The physician can change the prescription or the dosage.
Teach patients that it is OK to tell the physician they cannot afford a drug, because the physician often can prescribe something less costly. Seniors who find themselves in this situation often say nothing and then cut back on the dosage to save money or simply don’t fill the prescription, explains William A. Hopkins, PharmD, a professor at Mercer University School of Pharmacy in Atlanta. Also, patients who have trouble opening the pill containers need to know to ask the pharmacist for non-safety closing caps when they fill their prescriptions.
Staff members who educate patients about their medications play a key role in their compliance, not just by providing patients with the appropriate information but by making sure they understand it. "The most important thing that staff can do is verify the patient’s understanding of why they are taking the drug, what results they should expect, and how they are supposed to take it," says Hopkins.
How will patient schedule doses?
Ask how patients are going to take the prescription if it is new and how they have been taking the prescription if it is a refill, he advises. If the instructions state that the medication is to be taken three times a day, verify that the patient understands the directions by asking how he or she will schedule that. When the instructions state that patients should take the medication at a certain time, such as before meals, they need to understand why that it is important. For example, it will keep the drug from upsetting their stomach.
Use open-ended questions when teaching, advises Hopkins. For example, don’t ask the patient, "Have you experienced any problems while taking the drug?" Instead, ask this: "What types of problems have you had while taking the medication?"
In addition to educating patients about the medications they are taking, staff need to address other compliance issues during the education session, says Mosel. For example, to address cost and transportation issues, the nurse might ask patients how they will get the prescriptions filled and get them to their house.
When new prescriptions are part of a hospital discharge plan, it is best to educate seniors about their medications in their homes because they are more relaxed and the nurse can note factors that might hinder compliance, such as the lack of a refrigerator or working phone. "The information the patient received as an inpatient is probably not going to be absorbed until someone follows up after they are released from the hospital," says Mosel.
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