Managing medications is a key responsibility for family caregivers. But this good deed can also be a complicated business -- and mistakes happen when you least expect them.
Medication errors are among the most common medical errors, causing harm to more than 1.5 million people a year. Why so many? The sheer number of drugs taken is one reason: More than 76 percent of adults over age 60 take at least two prescription drugs, and 37 percent use five or more, according to the National Center for Health Statistics. Add the fact that more older adults live at home, and that medications are getting more complex in terms of their delivery systems, and you have a lot of inadvertent mistakes happening, says Kristen Binaso, a pharmacist specializing in geriatric care in Clifton, New Jersey, and a senior director of the American Pharmacy Association.
Here are five common errors -- and how to avoid them:
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Caregiver medication mistake #1: Modifying pills so they can be swallowed more easily
Having trouble swallowing is common among older adults. Saliva production lowers with age, even in those who are healthy, Binaso notes. Dry mouth, a common side effect of both diseases and their treatments, can also affect swallowing capacity. And certain pills, such as some cardiac drugs and potassium supplements, can be quite large, Binaso adds.
What, many caregivers think, could be simpler than just cutting a big pill in half, or smashing it up to mix with something like applesauce?
A better way: Ask before you give the pill in any way other than with a glass of water. "It's important to find out if a medication can be cut in half or crushed or given with food before you try to do so," Binaso says. Certain medications given once a day, for example, are designed to have a timed release that occurs gradually throughout the day. Crushing them could destroy how the drug is released, causing the person to get too much all at once or none at all.
If swallowing pills is a problem, your doctor or pharmacist may be able to provide the same medication in a smaller tablet or a liquid form. Sometimes an alternate medication can be given.
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Caregiver medication mistake #2: Filling a detailed pill organizer imprecisely
If your loved one takes a lot of different medications, you might find one of the many different kinds of pill organizers appealing. These tools are getting ever more complex, Binaso says. Most are divided by day of the week, day and night, or in detailed ways that allow 6, 8, even 30 different dispensers per day. Some include alarms or other reminder systems. Pill organizers can be a big help -- but only if they're filled properly in the first place.
A 2011 study by Northwestern University's Feinberg School of Medicine found that 60 percent of paid caregivers made errors when sorting medications into pillboxes. You might reason that a family caregiver would be more careful than a paid worker, but the high number also speaks to just how complicated sorting multiple drugs with various timings for delivery can be.
A better way: Ask if your pharmacist will sort the pills for you when prescriptions are filled. Some will do this routinely, while others will do it a few times to show you the right way to get started, Binaso says. What often confounds people: figuring out how directions like "three times a day" or "every eight hours" translates into the compartments of a given pill organizer.
"The exact timing of a dose matters. If you give doses too closely together, the person may not get enough medication throughout the day," she says.
Once you know which kind of organizer suits your needs best and where to put each pill, help yourself remember by drawing out a "map" listing each drug. Refill the container at a regular time (Sunday evening, Monday morning) -- sometime when it's calm and quiet, and you can concentrate fully on the task at hand.
Caregiver medication mistake #3: Storing medications according to convenience
Many adults have always stored their medications in the bathroom medicine cabinet -- why else would it have that name? And so their loved one's medications go in there, too. Unfortunately, the medicine cabinet is one of the most misnamed items in the house.
"The bathroom and kitchen are the most common places to store medications, but they're not the best," Binaso says. "There are too many temperature changes, from hot to cold -- and in the bathroom, moisture is another problem." At the pharmacy, drugs are stored in sealed original containers. But at home, once the cap is opened, moisture, heat, and light can alter the contents.
A better way: First read the packaging on prescription medications for storage instructions. If a drug is supposed to be stored in the refrigerator, there's a reason for this.
If not, find a cool, dark place to store your loved one's medications (yours, too!). A cabinet in the bedroom is a good choice, because temperatures in the bedroom tend to be consistent. Use a cabinet out of sight if your loved one has dementia, as he or she may forget having taken a dose and try to take more at the wrong time. "Out of sight, out of mind" is good advice concerning dementia and drugs.
More common medication mistakes
Caregiver medication mistake #4: Filling prescriptions at more than one pharmacy
Another thing caregivers do in the name of convenience and to make life more comfortable for loved ones: fill prescriptions at the pharmacy nearest to the office of the specialist just seen, or to home, or to a relative's home when traveling, or near a hospital after a discharge. Finding the closest drugstore can mean less waiting time; you just stop by on your route.
The trouble lies in the potential for "polypharmacy": multiple prescribing doctors who don't know the full drug story, and then pharmacists filling the prescriptions who also don't know of the existence of other drugs.
Some drugs interact dangerously with others. Coumadin, a heart medication, is a common example.
A better way: Ideally, fill all prescriptions at one location, where there will be a complete record of all drugs taken. When someone sees several specialists, even the doctors may not have a complete record (it's a myth that doctors talk to one another about each patient and that their notes are shared by all).
An alternative that's useful if your loved one travels, such as from one relative's home to another's, is to choose one pharmacy chain system (such as CVS, Walgreens, Rite Aid, or Target), Binaso says. Large chain pharmacies tend to consolidate records, so if you know the person's name and date of birth, you have a better chance of accessing a complete medical record at any location.
Caregiver medication mistake #5: Not keeping a medications master list
Caregivers often hear this advice without fully realizing how useful it can be. A medication master list is a complete record of all the prescription drugs, over-the-counter drugs, and supplements your loved one takes, whether regularly or occasionally. It should include the actual drug name, the dose, directions for how to take it and how often, what it's used for, and (ideally) a picture of the medication.
"People often get confused and say they need more of Mom's pink pill, when actually it's beige," Binaso says. "It's important to know the details of each medication to avoid any confusion." Mix-ups caused by similar drug names account for up to a quarter of all errors reported to the Medication Error Reporting program, operated by U.S. Pharmacopeia and the Institute for Safe Medication Practices.
A better way: As your loved one's advocate, you can be a valuable safety net looking out for mistakes by physicians and pharmacies, as well as by family members. Keep a medication master list in your wallet, so you're not digging for it or forgetting it at home in the event of an emergency. According to a 2010 University of Michigan study, some 3 million emergency-room patients over age 65 receive inappropriate medications every year. It's important to ask emergency-department doctors what to expect from newly prescribed medications and how long they should be taken. Then make sure that the patient's primary care physician has been notified. At discharge, get a copy of all medications prescribed in the hospital, so you can bring this information to the regular doctor.
If you're worried about your loved one taking too many medications, ask his or her doctor to conduct a medication review, assess which drugs are really needed, and determine which might have outlived their usefulness and thus could be eliminated.
Another safeguard: When filling a loved one's prescriptions, identify yourself as the person's caregiver and ask the pharmacy to put a note in the person's profile to call you if there are questions.