Remote medical support at home

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As people live longer with chronic disease and depend more often on complex medication regimens at home, the burden of managing home therapy continues to fall, unassisted, on the patient and family. As I sat listening to my overwhelmed and tearful friend tell me about how her father ended up in the hospital for CHF exacerbation, I couldn’t get this out of my head. He had not been taking the increased dosage of one of his heart medications that the doctor had prescribed because the information had simply gotten lost in the mix. Though my friend typically helped her parents keep track of these things, issues with her own family came up, her brother tried to help but is not well versed in medical lingo… They had each done their best but before they knew it her father’s condition had deteriorated, and here we sat.

Unfortunately, programs and services designed to support patients in the management of their chronic conditions at home have not grown at the same rate as the complexity of the home regimens themselves. Case management in the hospital focuses on medical equipment, and home health nursing services catch those patients without adequate support at home, but where is the support for everyone else? My friend is the most medically literate family member involved in the care of her father and her understanding of the medications that he takes is limited to a general understanding of what it is for (e.g. heart, blood pressure, blood thinner), where to look on the bottle to find how much he should take.

What our healthcare system needs is more robust case management that works in association with the primary care provider and regularly checks in with patients living with chronic disease, to confirm that the patient is taking the right medications, at the right dosages. This service could be staffed by nurses trained in over the phone triage that can discuss with the patient, or primary caretaker, any questions regarding their current condition, and changes to home therapy regimen made at the previous doctor’s appointment. This service would compensate for the ever decreasing amount of time that doctors can spend with their patients, would decrease the number of turn-around admissions to hospitals, and provide support to the patient’s support network… which in the end would improve everyone’s quality of life.

 

Pre-Trip

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Posted from Camarillo, California, United States.

Getting ready for the trip. Looking forward to a great trip with great people!

Medication Knowledge

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2-weekly-pill-box-photo-researchers-inc.jpg?t=1385478993000It was interesting to find out how much my family and friends knew about their medications. Many of the responses I received entailed that they knew what the medications was for and when to take their medications. One of my friends knew that medications, the purpose and time to take the medication, but was unaware of any of the side effects or what to do if they miss a dose. Another friend of mine was visited her primary physician and was sent home with codeine and a cough suppressant. My friend was not aware that the medications would cause her to be drowsy and only knew that the medication was to help her cough. I have also noticed that many of the questions with my family’s medications begin to form when they begin to take the medications at home. My family would have questions about what do when they miss medications or what they should do if they developed specific side effects of the medications.

Additionally, my family had developed their knowledge of medication through generations. A family member of mine is notorious for pulling medications from multiple bottles and putting them all in another bottle. When she offers me Tylenol I will only take the medications if it is in the labeled Tylenol bottle. It scares me when I see her pull out her bottle of medication that had many other medications mixed in the bottle and she is trying to distinguish between which medication is an over the counter medication and what her prescription. There was a time she gave another family member one of her prescription medication by accident. It was fortunate the medication did not have any damaging effects on the other family member, but it could have. Upon asking that family member about their medications they were unaware of the interactions between over the counter medications and prescriptions. She was aware of the indications, side effects she has experienced and when she should take her medications. This way of medication management can be seen through multiple generations in my family. I hope with my educational background I can alter those practices.

 

Questions about Drugs

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I asked some of my family, friends and coworkers about their knowledge of the medications that they take, regarding to pharmaceuticals, over the counters, and homeopathic remedies. I found it interesting and surprising at the respond that I was given by many of them.

Mom/Dad: My parents both do not work in the medical field but are respected professionals in their own field of work. My mom said that she takes Lipitor for high cholesterol because she had lab work that showed her levels were elevated. She did not know exactly the mechanism of how the drug worked so I educated her that it inhibiting HMG-CoA which is an enzyme that is responsible for catalyzing an early step in the synthesis of cholesterol. She knew some of the side effects to look for based off the information on the box. Her and my dad both took a daily multivitamin. My dad did not take any daily perscribed medications, but had recently taken azithryomycin when he had a cold. He had a left-over unused unexpired one that he took when he felt he was sick. I asked him if it had helped him and he said no, he was still sick. I explained to him the importance of NOT taking prescribed medications unless you are actually prescribed one because that is how individuals become drug resistant! When I asked about other the counter medications, both stated that they read the information on the box to determine side effects and correct daily dosages especially for medications such as acetaminophen which could potentially harm the liver.

Friends: The majority of my friends stated that they did not take daily medications with the exception of albuterol for asthma or a multivitamin. When discussing how over the counter medications worked such as acetaminophen or ibuprofen, they did not know the mechanism or that there was possible harmful side effects from taking these medications because they were so commonly used. I talked to them about using different electronic resources such as skyscape or epocrates (which is free) to look up drugs and become more educated about what they are putting into their bodies.

Coworkers: I work with nurses so when I asked them about medications, they all seemed to kind of giggle about it. The majority of them stated that they do in fact look medications up in electronic sources or their drug books if they are not familiar with them

I thought that it was interesting the different individuals knowledge of medications. My family was somewhat knowledgeable, but still participated in bad habits that needed re-education. My friends were not really educated about the drugs that they take and hopefully they will become more educated! Co-workers, not surprisingly, were the most educated.

Rx Knowledge

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Running Pills

For a class assignment, I took an informal survey of my family members and friends to assess their knowledge about the medications they take. To assess their knowledge, I asked a series of five questions about each medication they take.

  1. What is the name of the medication?
  2. Why are you taking that medication?
  3. How much of the medication do you take?
  4. When do you take the medication?
  5. What effects do you look for regarding this medication?

In asking these questions, I was hoping to discover whether or not they know the Trade name of their medication or the generic name; if they knew why they were prescribed each medication; if they know the dose they are supposed to take; if they know what time of day they are supposed to take their medication; and both the desired effects and the adverse effects of the medication.

I also asked them about some common over-the-counter (OTC) medications like ibuprofen (Advil, Motrin, Midol), acetaminophen (Tylenol), aspirin (Bayer, Excedrin), and naproxen (Aleve). About half of those I surveyed were very knowledgeable about the medications they take and could correctly answer most of the questions. The other half of the people I surveyed were not as knowledgably and didn’t know that ibuprofen is the same as Advil which is the same as Motrin and that acetaminophen is the same as Tylenol.

Advil-Bayer-Tylenol

When it comes to prescription drugs, whether they knew the trade or generic name of their medication depended on whether or not their prescription medication was generic or brand name. Everyone I surveyed was able to tell me at least one (generic or trade) of the names of their medications and they could tell me what they take it for. The next few questions became increasingly difficult for them to answer. Everyone could tell me how many pills they take and when they are supposed to take it but only a few could tell me the exact dose in milligrams they were prescribed. For those that knew the milligrams prescribed, I further asked them if they knew the safe dose of that medication and nobody was able to answer that. Lastly, I asked my friends and family what effects they look for when taking their medication. I asked them what the desired effect is and what some adverse effects are. Everyone could tell me the desired effect, the reason the medication was prescribed. When it came to adverse effects, most knew the typical nausea and stomach upset but most people struggled with this question.

Overall, I learned that there is a need to improve the knowledge of the community regarding prescription and OTC medications they take. As a nurse, I am going to play a key role in patient education and my goal is to make sure that all of my patients are adequately informed on the medications they are taking as well as the resources available to them if they have any follow-up questions or concerns.

PRESCRIPTION-DRUGS

Pre trip thoughts

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It is the day before departure. 

Excited and ready to head out, as well as ready for the first couple of days to be rainy. 

Who knows about drugs?

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I was fortunate enough to be able to travel and see my family this past weekend, many of whom are strongly against taking any medications (they are very familiar with generic/brand names, take herbal supplements and know to tell the doctor always, and are aware of the side effects) so I was only left with interviewing my grandfather. To start off, I asked my grandfather what he knew about his hypertension medications with which he replied, “what… I don’t have hypertension?” And I said I thought you were on high blood pressure medication and he replied, “blood pressure medication, yes… but I don’t know about hypertension.” This demonstrated to me the need to simplify the language we speak with our patients because clearly my grandfather was unaware that high blood pressure and hypertension were the same thing. My grandfather only knew that he took a cholesterol medication, high blood pressure medication, and a diabetic medication (metformin), or so he says “his essential medications.” He also takes various others but knows that these are the ones he should never skip. He knew the purpose of his medications and could recognize them by color. When asked if he knew the side effects and safe doses of his medications he replied that he was explained everything at one time when he initially began this medication regimen (5 years ago). And said that the pharmacy offers the information again when he picks up his medications, but he has little desire to speak with the pharmacist or read the information. My grandfather is opposite of most of my family who take herbal supplements as he thinks herbal supplements are not reliable and trusts doctors more than the “natural people at the healthy stores who try to get you to buy all this junk.” I taught my grandfather the essential cliff notes version of his medications (as he doesn’t really care to be educated on meds he’s taken for so long but was willing to hear me out for a few minutes). We discussed some side effects and actually spent most of our time talking about how to better manage his glucose levels and my grandfather frequently eats only once a day (which he claims is best since he should be losing weight) and I discussed with him the importance of keeping his metabolism going in addition to better managing his glucose levels by eating smaller frequent meals.

Family Education on Medications

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Education on Medications

It was fun assessing two of my family member’s knowledge on the medications that they are currently taking. One of my family members has diabetes type 2 and he is currently taking metformin HCL 500mg one tab twice a day and glyburide 5 mg daily every morning. He only knew he had to be compliant with his medication or his glucose level would get higher and told me that the medication was used to lower glucose levels. He didn’t know about side effects so I educated him on that having used my Skyscape app. I told him that Metformin HCL tells the liver to decrease the production of glucose, decreases the ability of your intestines to absorb glucose and increases the sensitivity of insulin. Also, metformin can cause abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste and hypoglycemia. Moreover, I told him that metformin helps control hyperglycemia but doe not cure diabetes. I also told him that if he experiences hypoglycemia to take a glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water, and notify the health care professional.

The second medication he is taking is glyburide. The action of this drug is different than Metformin HCL, but its main goal also is to control hyperglycemia. Basically it lowers glucose levels by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. Also, it tells the liver to decrease the production of glucose. Some of the side effects can be feeling dizzy, drowsy, feeling weak or having a headache. Moreover, it can cause constipation so I told him to drink lots of water and fiber rich foods like vegetables and fruits. It can also cause cramps, diarrhea, feeling of fullness, increases the appetite, photosensitivity so wear sunscreen when outdoors, hypoglycemia, and aplastic anemia (when the bone marrow does not make enough blood cells from the body such as RBCs that carry oxygen, WBCs to fight an infection, and platelets to control bleeding.

The second family member takes atenolol 50 mg once daily. Basically this drug decreases the BP, decreases frequency of attacks of angina pectoris (chest pain) and it prevent a heart attack (MI). Some of the side effects are fatigue, weakness, anxiety, depression, dizzy, insomnia, memory loss, blurred vision, stuffy nose, wheezing, decreases heart rate, constipation, diarrhea, nausea, vomiting, urinary frequency, and either hyperglycemia or hypoglycemia. Also, I educated her on managing her high blood pressure by loosing weight; avoid too much sodium intake, and practice stress reduction such as meditation. Overall, they were both amazed as too the many side effects that a tiny pill can cause. I loved this assignment!

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