Notes on Medication Management in Medical Settings

Medical Externship Seminar: Medication Management

Introduction

• Focus on medication management in a medical setting.
• Discuss the role of medical Speech-Language Pathologists (SLPs) in medication management.

Medication Nonadherence

• Definition: Medication nonadherence is not simply the act of not taking medication; it encompasses a range of behaviors and beliefs that prevent proper adherence.
  • Types of Nonadherence:
  • Non-fulfillment: Patient never picks up medication prescribed by their doctor.
  • Discontinuation: Patient stops taking medication believing it's no longer necessary or effective.
  • Forgetfulness: Patient occasionally forgets to take their medication.
  • Incorrect Usage: Patient takes medication at the wrong time or in the wrong manner (e.g. taking medication at night when it should be taken in the morning, or taking with food when it should be on an empty stomach).
  • Pill Splitting: Patient splits pills without physician advice, prolonging the life of their medication improperly.

Reasons for Medication Nonadherence

• Possible reasons for patients not taking their medications:
  • Forgetfulness: Simply forgetting to take pills.
  • Health Care Literacy: Lack of understanding about importance of medication; patients may feel well and believe they do not need to take medication.
  • Financial Constraints: Inability to afford medication can lead to nonadherence.

The Role of Medical SLPs

• Education:

  • Importance of medication adherence should be communicated to patients, especially first-time pill takers or those who recently experienced significant health events (e.g., stroke).
  • Collaborate with pharmacy and nursing staff to help educate patients about new medications, including how and why to take them.

• Tools for Adherence:

  • Use of pill organizers to promote medication adherence.
  • Practical activity recommendation: Create exercises with actual medication names and empty pill bottles to practice filling pill organizers.
  • Train patients to understand medication labels:
  • Interpret specific instructions such as "one tablet two times a day" versus "two tablets one time a day" and the meaning of "as needed" (PRN).

• Cognitive Training:

  • Retraining patients post-stroke on how to manage pill taking and possible mistakes in organization.
  • Encourage patients to set up a system for asking questions regarding their medications (e.g., who to talk to about concerns).

• Providing Materials:

  • Create and distribute educational materials for patients, such as:
  • Wallet cards listing medications, dosages, times, emergency contacts, and medical history.
  • Laminated materials for durability and ease of use.

• Collaboration with Healthcare Team:

  • Collaborate with pharmacy, physicians, nursing, and case management to ensure patients have sufficient support at home after discharge.
  • Identify gaps in support systems for patients who may struggle with managing medications independently at home.

Examples of Tools and Resources

• Pill Organizers:

  • Obtainable via Amazon and retail stores, facilitating organized medication management for patients.

• Educational Materials:

  • Sample wallet card created by students for previous patients, emphasizing key information relevant to medication management.

• Prepackaged Medications:

  • Discuss with pharmacies about prepackaged medication options where pills are organized in packets for specific times. Examples include:
  • Exact Pack and Docudose.
  • Insurance or Medicare coverage should be confirmed with case managers.

Collaboration with Pharmacy

• SLPs should work closely with pharmacy staff:
  • Implementing a program targeting education for stroke patients, including administering questionnaires regarding medication adherence.
  • Post-education questionnaires to assess changes in patients' feelings towards their medication adherence after receiving pharmacy education.
  • Goal to expand successful initiatives beyond just stroke patients to the wider hospital population.

Conclusion

• Emphasize the critical role of SLPs in medication management and patient safety.
• Highlight the importance of collaboration among healthcare professionals, patients, and their families to support medication adherence and overall patient outcomes in a medical setting.