What to Do When Patients Don’t Take Their Medications as Prescribed

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When medications aren’t taken as prescribed, facilities can rely on long-term care pharmacists to help determine the best course of action.

Despite receiving the best care from the best hands, it can still happen: A long-term care resident may receive the wrong medication, ingest the wrong quantity, or miss a dose altogether. Unfortunately, 50 percent of medications are not taken as prescribed, according to the latest data from the Food and Drug Administration.

Why does this happen, and with such frequency? “Many times, missing a medication is not preventable,” said Ben Wax of Blue Ridge Pharmacy. “For example, a resident might be at an appointment when they’re scheduled to take a dose, or they could be in the middle of a treatment or procedure.”

Another reason is because a resident outright refuses to take the medication when it’s given to them. This situation is common with patients who suffer from memory-related illnesses. Often times, difficulties in swallowing and adverse side effects of a prescription leads to refusal and noncompliance.

Equally serious situations occur when residents are given too much or too little of a prescribed drug, or they receive the wrong medication. Such mistakes negatively affect a resident’s health outcome and may lead to lawsuits and a damaged reputation for the facility.

So what steps can caregivers and long-term care facilities take to ensure all medications are taken as prescribed? Wax offers three specific suggestions.

First, contact the facility’s pharmacy and ask to speak directly to a pharmacist. The pharmacist will consult the resident’s current prescription regimen, as well as their medical history in order to determine the best course of action to take. “Contact the pharmacy even if the situation arises after normal business hours or on a weekend,” Wax said. “Some pharmacies, including Blue Ridge, have pharmacists on call 24/7.”

Second, follow the pharmacist’s advice. It’s no secret different medications have different properties. The pharmacist’s recommendation will depend on several factors:

  • The type of medication involved
  • The length of time since the last dose was taken
  • The patient’s health condition

Sometimes the best course of action is to give the medication as soon as the staff realize a dose has been missed. Other times, it is best to skip that dose and resume the schedule with the next dose. And in some situations, the resident may need a double dose. The pharmacist can also provide guidance on what to do in case of an accidental overdose.

When medications aren’t taken as prescribed, the caretaker or medical staff may need to monitor the patient’s blood pressure, blood sugar, or other vital signs for changes in condition. Whatever the next step is, “the most important thing is to have a pharmacy partner who is available to office advice quickly and clearly,” Wax said.

Third, troubleshoot the issue once it is resolved. It’s not about playing the blame game when medications aren’t taken as prescribed. But it is important, once the situation has been resolved, to take the opportunity to put safeguards in place to prevent it from happening again. This is where a pharmacy’s consulting nurses and pharmacists are an indispensable part of the patient’s care team. They can advise on quality assurance protocols, train staff on how to avoid dosage errors, and share best practices in medication administration and documentation.

For example, if patients refuse to take prescribed medications because of their uncomfortable side effects, ask the pharmacist about the possibility of altering the dosage or replacing it with a similar drug in the same pharmaceutical family. If noncompliance is due to swallowing issues, the pharmacist might be able to recommend a soft gel version of the drug or an alternative drug-delivery method, such as a suppository, patch, or nasal inhalation.

The pharmacy’s team may also be able to offer system-wide solutions, which could include:

  • Medication packaging options, such as multi-dose packs to better suit the facility’s residents, staff, and workflow
  • Better coordination of patients’ out-of-facility treatments with their dosage schedule
  • Implementation of Electronic Health Records and Electronic Medication Administration Records platforms (EMAR)

For facilities interested in a pharmacy-centric EMAR program, Blue Ridge Pharmacy offers QuickMAR, with barcode scanning and on-site training sessions for new technology users.

It might not be possible to completely eliminate all medication errors, but a 50-percent noncompliance rate is much too high in terms of health, risks, and costs. Improving outcomes by using a dedicated long-term pharmacist who is a vital part of the patient’s healthcare team can quite literally be a lifesaver.

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