Medication management is one of the top instrumental activities of daily living (IADL) that I work on with my skilled patients in the SNF. In many instances, patients are admitted to an acute hospital following an exacerbation of a chronic illness, and usually this is because their medication and food intake has been poorly managed at home. Of course there are many ways to maximize independence with medication management, but the following are my top ways to incorporate medication management techniques into treatment sessions.
First things first…
… we work on fine motor coordination. Pills are tiny and hard to manage, so I always make sure to focus on tip-to-tip prehension in addition to sequencing and direction following. The easiest way to fit fine motor coordination training into a string of therapeutic tasks is to sort multi-colored beads. Personally, I like to hide pony beads in a sensory bin and ask the patient to sort them by color. We’ll use these in later sessions as our ‘pills’.
Everything has to be simulated.
Once we have our ‘pills’, I use empty recycled pill bottles to keep the beads/’pills’ sorted by color. Since the goal is to keep this task as realistic as possible, I re-label each bottle with the full names of the actual medications that the patient is required to take each day.
Once everything is labeled and the ‘prescriptions’ are ‘filled’, it is time to actually fill the pill boxes. Using a hard-copy of the patient’s medication list, we work together to fill the boxes. The task is graded by the amount of verbal cues and/or the amount of medications we focus on at once.
For some patients, the concept of the pill box takes a little while to grasp. So initially I might have them only sort 2-3 medications; we’ll eventually work our way up from there.
Repetition is key here. So usually we’ll perform the same exact session for 3-5 sessions in a row to increase carryover.
Critical thinking and problem solving are essential.
Patients who need to be entirely independent with medication management following discharge need to understand why/when to take PRN (or ‘as needed’) medications. It is crucial that patients understand that PRN medications should NOT be sorted into the pill box, but should be readily available if and when they are needed.
More often than not, I will ask the patient to answer specific scenario questions about their PRN medications. First, we’ll discuss the purpose of each medication; in some cases a simple cheat sheet on a single or half sheet of paper can help to improve understanding and carryover. Then we’ll discuss how these medications can be used in real-life scenarios. So for example, I’ll describe a situation in which the patient might experience increased anxiety. Then I will ask him/her to identify which medication would most appropriately fit the scenario.
This task can be graded based on the complexity of the scenario. Initially we’ll simply review what each medication does, and then we will work towards keeping track of how many times per day a PRN can be taken and how much time is required to metabolize the medication. This is when a medication log can be especially effective.
It is important to know your patient, keeping his or her overall cognition in mind.
Ultimately, if a patient is unable to demonstrate the appropriate cognitive levels needed to ensure independent and safe medication management, you as the therapist may need to advocate for further assistance following discharge home. This might mean that the patient’s family will need to fill the pill box, OR it may indicate a justified need for a medication delivery service. In either case, the use of standardized cognitive assessments are especially important, as they will definitively show how a patient’s cognitive levels will affect his or her safety with daily occupations.
In the end, the goal is to simulate medication management as much as physically and cognitively possible. For each patient it will be a little different, but ultimately the core of each task is the same.
What are your favorite ways to simulate medication management into treatment sessions?