How Caregivers Can Help with Medication Compliance

Strategies for helping people with bipolar disorder manage their medications and maintain medication compliance.

Many people with bipolar disorder take multiple medications. Managing these medications can be a challenge for caregivers and the person who is taking them. A few simple strategies can make this important task manageable.

Many medical professionals use a concept known as The Five Rights which may also help you as you develop a system to ensure that medications are used correctly.

The Five Rights

• Right drug ~ Always carefully read the labels, many drugs have names which are very similar. Also, if a drug looks different than previously, don't hesitate to call the pharmacist to ensure that the correct drug was dispensed.
• Right person ~ Read the label for your care receiver's name, don't assume that you have the right bottle as another family member could be on the same medication, but a different strength
• Right dose ~ Don't give medication doses "by memory." The dose may have changed. Read the label!
• Right time ~ Although with many medications, there is generally a "two hour window," try to stay as close as possible to the scheduled dosage times. (this means that if a medication is scheduled to be given at 1:00 pm, it may be given at any time from 12:00 PM (noon) to 2:00 PM or an hour before to an hour after the scheduled time. Thus, some medications may be "grouped," and given at the same time. However care must be taken to avoid giving drugs together which are incompatible, would cause adverse side effects, or decrease their effects, if given at the same time or too close together.)
• Right route ~ of administration (oral, injection, etc). Again, read the label. An oral medication administered as an injection can have fatal (not to mention painful) consequences.

Many people have more than one doctor and may take medications that could possibly interact with each other and create a serious health risk (this is known as polypharmacy). It is vital that each health care provider is aware of what the person is taking, including over the counter remedies, vitamins, and herbal preparation.

If you accompany an older adult or someone who is unstable to a physician's office and do not believe that the person understands what the medication is and why it is important, encourage them to ask the physician for a complete explanation.

Medication Compliance

Medication compliance means taking medications as prescribed. Although medications have improved the overall quality of life for people with bipolar disorder, many people resist taking a variety of medications several times a day. People find the medication schedules confusing; they forget what they have taken; people start feeling better and stop taking the medication; or they do not feel that they can afford medications.

A common problem with medication is that the person does not clearly understand what the medication will do for them. The person needs to understand what the medication is and why it is important to take it. "Because the doctor says so" is not enough of an explanation.

Taking medications

• Keep medications visible.
• Make sure a readable clock is visible.
• Post reminders, if necessary.
• Draw a large clock and put color codes on it, if necessary.

To encourage medication compliance explain why the medication is necessary (people are more apt to do what is requested of them when they are given the reason for the request).

Managing Medications is a critical aspect of effectively treating chronic illness. A few simple techniques ensure that storing and taking medications are manageable.

Getting Organized

• Maintain and update a list of all medications, including over the counter drugs, vitamins, and herbal remedies.
• Keep the current medications list visible and available such as in the kitchen on the refrigerator, or posted on a bulletin board in an area of the home where family members and others who may come into the home could easily see.*

Create a chart or check-off system to remind the person to take medications. Examples include:

• Calendars marked with stickers or different color dots.
• A pill box with separate areas for each day of week.
• Poster board with columns and boxes drawn on it (days of the week written across the top and medications down the side).

Encourage the care receiver to have all prescriptions with one pharmacy.

Build a partnership with the pharmacist. The often act as 'gatekeepers' and will alert a person of possible side effects and drug interaction.

If you are the person who picks up medication recommend a pharmacy closer to your home than one closer to a family member who does not get out.

Maintaining Medications

Storage

• Store medications in a cool dry place such as a kitchen cabinet or on a kitchen counter. Do not store drugs in a bathroom medicine cabinet where moisture and heat could damage the medication.
• Keep medicine in its original container with the original label and tightly closed until taken or put in a pill divider.
• Use a black large tip marker pen such as a Sharpie or other large tip pen or place larger, more legible labels on bottles.
• Use an inexpensive drug divider (less than $5.00 at pharmacies and retail stores) to portion out medications:
  - For each day or each medication time.
  - No more than one week at a time.
• If the directions call for refrigeration do not freeze.
• Keep all medicine out of children's reach.

Refills

• Do not save leftover medicine to use later.
• Plan ahead for refills.
  - When you notice that you do not have enough medication for the next week, call the pharmacy for a refill.
  - Allow at least 48 hours for a pharmacy to obtain physician approval, if necessary, or for the pharmacy to fill the prescription.
• If you go to a new pharmacy, you must have a prescription; or the new pharmacist must call the doctor or the original pharmacy to see if a refill is authorized.
• When you leave a physician's office, ask the office staff to call in the prescription to the pharmacy so that it might be ready for pick-up on the way home.
• Use one pharmacy for the whole family if possible. The pharmacist then has a record of all your drugs and can communicate effectively with the doctor.

Discarding Medications

• Do not save leftover medicine to use later.
• Periodically go through all medications and discard drugs that are not taken or beyond expiration dates on the container.
• Check with pharmacist for expiration dates, if necessary.
• Dispose of medicine safely to protect children and pets.

Paying for Medications and Medication Discounts

Some people and older adults do not feel that they can afford medications and so go without. Financial assistance is available.

Communicating with Healthcare Providers

Communication and coordination with health care providers is essential to maintaining good health and managing chronic mental health problems. Building relationships with not only the physician but nurses and office staff will enable questions about medications and treatment to be answered quickly and clearly.

Tell the doctor about any unexpected new symptoms experienced while taking medicine. A change of medicine or a dose adjustment may be needed.

Be Proactive

Don't hesitate to ask questions and expect answers and clarification. Remember that health care is a service, and the bipolar patient and you, if you are the caregiver, are both 'consumers' of this 'service.'

When you speak with the healthcare provider, make sure you take written notes so that you and the patient can look back over the information as needed. If the information you wrote down is not clear call the physician's office and ask to speak to the nurse if the doctor is not available.

Finally, Always encourage the physician to talk directly to the patient. Allow the patient time to answer questions and talk directly with the physician and all healthcare providers.

Remember who the patient is. If it appears that the person does not understand then ask for clarification for them while looking directly between the patient and the health care provider.

Source:

• Grissinger, M., The "five rights". Pharmacy and Therapeutics, October 2002. 27(10): p. 481