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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.

 

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

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!

Pharma-sea

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sea of pharmaceuticals

Many of us in America are swimming in the “pharma-sea” of medications. We are a pill popping nation. Interestingly, years ago when I was dating a frenchman, whenever we’d go to France to visit his family, his mother would request certain vitamins/supplements that are not available in Europe. Apparently pharmaceuticals isn’t as “pushed” or emphasized in Europe as it is in the U.S. I found that interesting. I don’t know how it is today in Europe (that was more then ten years ago and the frenchman and I have since parted ways) but, I think it is safe and credible to say that big pharma is a big business in America.

When I have spoken to my mother-in-law about ALL the medications that she takes and ALL the ones that she is in charge of making sure my father-in-law takes, she knew the basics on what they were for. However, she wasn’t truly aware of how the medications “work” or the possible side-effects they can have. My father-in-law is the sickest person I personally know. My in-laws kitchen counter top practically looks like an apothecary! My husband believes that the years of prednisone that his father had been on for rheumatoid arthritis for years has kicked him into acquiring chronic myelogenous leukemia.  It is worth mentioning that shortly after being on prednisone, my father-in-law gained quite a big of weight and eventually acquired diabetes. Perhaps it is my mother-in-laws generation that doesn’t question what the doctors prescribe them. They just want to feel better and they trust their doctors. My husband on the other hand isn’t as trusting. He has even done much research on the many medications that his father takes and even came across an article that said taking prednisone long-term is like giving yourself HIV because of how much is suppresses the immune system. When my husband spoke to his parents about the information he found on the certain medications his parents were taking, it seemed to go in one ear and out the other. Sad.

It is prudent to say that before we dive into the “pharma-sea” of drugs out there, we should definitely get some swimming lessons or at least wear our floaties, lest we sink.

How much do they know?

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pills222

It was clear within the first few minutes of speaking to my aunt that the common person does not know much about medication. Luckily, she is pretty healthy and only has hypothyroidism, for which she takes synthroid. When I spoke to her about her medication, she did know what she was taking it for but was not aware of possible side effects or other significant drug facts. I also asked her about regular over the counter medications she takes or has taken such as the very common Tylenol. She was not aware that Acetaminophen meant the same thing or its possible side effects. More importantly, she did not know about withholding it when taking other medications with acetaminophen. It was a big eye opener, I couldn’t help but think that here I am with so much knowledge gained throughout the nursing program and I have not yet attempted to share my knowledge about things so simple yet so significant. Perhaps sharing our knowledge just for fun might actually be beneficial to some people, we can never assume what they do or do not know.

Medication Knowledge

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meds

This week I spoke with my parents and roommates about what medications they are taking. I started off by talking with my mom and dad together. Before I go further, as many of you already know, my mother is a telemetry nurse and therefore knows her fair deal about medications. She often will teach me about medications that are important to know. Therefore, I focused by survey on my dad who has diabetes, high blood pressure, high cholesterol and hypothyroidism. My dad has had these conditions for at least 10 years now and has been taking similar medications for them throughout the years. I assumed that my dad would be very knowledgeable regarding his medications but he wasn’t as knowledgeable as I thought he would be after all of these years. He understood that he was taking medications for blood pressure, high cholesterol, metabolism and his diabetes but he couldn’t specifically name each medication, the dosages or the correct times to take them. Although, I do give him credit because he is usually good about taking blood pressure and blood glucose levels before taking the medication or administering insulin to himself. I think I realized that my dad has definitely become more dependent on my mom to keep him up to date and safe when it comes to his medication regime. I encouraged my dad to learn more about his medications on his own and gave him some verbal information about the medications I was familiar with.

After speaking with my parents, I spoke with some of my roommates. Half of my roommates are really into homeopathic remedies and alternative medicine. They would rather use essential oils to relax them or do meditation to help a headache. Although on the other hand, the other half of my roommates wouldn’t think twice before taking an Ibuprofen to cure a headache. Of these roommates, I asked them what the usual dosage they take are when they have a headache. I was surprised to find that one said 600 mg and the other said 800mg meaning they were aware of dosages. One of my roommates was aware that this medication can cause stomach ulcers and the other had no idea. Overall, I think this was an interesting experience, as I had the opposite results of what I had anticipated when it came to both my parents and my roommates responses.

Who Knows About Drugs?

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I interviewed my sister, my mom, and my dad asking them about the medications they usually take. I was surprised both at what they knew versus what they needed more teaching on.

index

(They look so colorful! Who knew there was so much to know about them?)

My sister: My sister takes vitamins and birth control pills. When asked if she knew how they work to prevent pregnancy she was unsure, stating she “had been told 3 times and still not quite sure.” So she learned how they work by preventing ovulation and changing the uterine lining. She named some side effects, such as weight changes, mood swings, and potential skin changes. I gave her more information on additional side effects, especially pointing out the risk for blood clots, which she was not aware of either. She did know about potential interactions of birth control and other items, such as grapefruit, but I let her know also about medications such as certain antibiotics that would require the use of additional birth control methods.

My mom and dad: My mom is a nurse, so I expected that she would know about medications she takes. She only uses albuterol and corticosteroid inhalers when needed for asthma. She was able to state the correct steps in using them, such as coordinating the MDI with inhalation, holding your breath for 10 seconds, and rinsing your mouth after the corticosteroid. I was surprised when asking my dad about the medications he takes, which includes OTC Tums, Tylenol when needed, and Prilosec. He explained how Tums work to neutralize the hydrochloric acid in the stomach, how Tylenol can cause liver damage, especially with alcohol. He answered almost every question I had correctly. I did remind him though to check other medication labels for acetaminophen to make sure he didn’t combine multiple drugs with Tylenol.

It can be easy to forget in the healthcare profession how other people do not get the same education regarding medications that we do. Things that seem so common sense to us now are not that way to others. I think it emphasizes the importance to educate our patients on the medications they are taking as we are giving them. It is something that has been engrained in us now since pharmacology, however it never hurts to survey people every now and then to see how much they really know.

Wait What Medication Was That?

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Meds

Similar to the medication education we provide to our patients, when it comes down to our families and friends, we especially want to make sure they are fully informed about prescribed medications and over-the-counter (OTC) medications they take. Within my immediate family, my father is the only person that is taking prescription medications. Most of my family comes from a medical background. My father grew up with siblings in the healthcare field. Additionally, my father is a veterinarian technician and he has experience administering similar medications prescribed to dogs. My father has hypertension so his physician prescribed him valsartan which is an ARB. When I was taking pharmacology, I asked my father what he knew about the medication he was taking. As I expected my father knew about the classification, action, side effects, generic, and brand names of the drug. As for my mother and sister, they do not have prescribed medications, but they do use over-the-counter drugs such as Tylenol, Ibuprofen, Zyrtec, Nyquil, and Robitussin. My father usually advises my mother, sister, and I  to purchase generic names over the brand ones for pricing reasons. My mother and sister have some knowledge on identifying brand name OTC medications and their respective generic names. When my sister has any questions about medications, she usually comes to me for information and I direct her to what sources she can use to find medication information if I am not able to answer her or advise she discuss the medication with our cousin who is currently a physician. Overall, I believe that my family as a whole has a pretty good idea about the medications they often take. Whenever we don’t know what a certain prescribed medication is, we go to one another for any questions and concerns we may have as well as utilize technology.

Picture Reference: http://www.pbinstitute.com/how-to-know-if-youre-alcoholic/

Medication Knowledge

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So I actually found some humor in doing this assignment because I knew how clueless my family is regarding the medications they take. I think this sums it all up: “Isn’t tylenol and Advil the same thing!?” The first person I decided to question was my mom because she was my nurse growing up and continues to be my nurse to this day. I did a simple assessment and asked her regarding tylenol, Advil and Alendronate (which she takes for osteoporosis). She knew that both tylenol and Advil can be taken to reduce fever and pain. She did not know what was the maximum daily dose or frequency at which it should be given. Unfortunately she could not identify one side effect of either medication! I asked her if she knows the signs of an allergic reaction and she replied that you sneeze a lot (good thing I was not really allergic to these medications!). I was actually proud that she knew to take her Alendronate on an empty stomach and that it is only taken once a week. She could not identify any side effect. I also decided to interview my dad as I live in a household with only 3 people. My dad is currently only taking one medication because he chooses not to visit his doctor on a regular basis. When I asked him regarding common OTC medications he was as clueless as my mom, perhaps even a little more. He believed that tylenol was another name for Advil and that the only difference was the dosage strength! I think I just found another great reason why I chose to be a nurse.