Day-by-day dose card makes drug-taking easy

Aging, June-July, 1985

A Calendar Card, with individual blister-like compartments for daily dosages of drugs, is being adopted by an increasing number of pharmacists to help reduce confusion for elderly people who often have several pills to take at different times of day.

Some patients may receive four blister-pack cards, one for morning, noon, evening and bedtime. The front of each card resembles a calendar. The blister compartments for individual drug dosages are numbered from 1 to 31, with corresponding stickers denoting the appropriate day of the week. Materials for the blister card, which are assembled by the pharmacy, are produced by Automated Systems Co. of Silver Spring, Maryland.

Numerous studies have indicated that errors in drug taking, or inappropriate use of drugs, is a significant problem among the elderly and can even lead to unnecessary institutionalization.

In an article called "Drugs as A Reason for Nursing Home Admissions," which appeared in the July, 1984 issue of the American Health Care Association Journal, author Lee R. Strandberg noted that one study of the elderly living in the community indicated that 25 percent made errors in using their medications. He cited other studies of outpatients with much higher rates of drug error not only for the elderly (nearly 58 percent for those over 60) but for younger people as well (nearly 43 percent).

Strandberg said the types of errors cited most frequently by researchers are omission of doses or overdosage from taking more thna the prescribed amount or taking the same drug from two or more bottles. "Other common errors" he said "are taking the drugs at the wrong time, or in the wrong sequence, taking discontinued medications, or using another persons prescription medications."

After noting that patient problems such as forgetting to take a dose or taking too much can lead to unnecessary hospital or nursing home admissions, Strandberg concluded with the following recommendation: "Community pharmacies should disperse patients using the 31-day care system, coupled with drug therapy review, and home delivery to those in need of that service."

One pharmacy that not only uses the 31-day card but also makes home visits to evaluate drug-taking problems is Vaughn Prescriptions in Fort Smith, Arkansas.

"We try to pick out customers whom we suspect, or know, are having drug compliance problems," says Fred Stuart, Vaughn's chief pharmacist. "We may make one home visit to explain the card, or sometimes it doesn't even take a home visit if the person is referred to us by a physician or comes by the store."

Stuart credits the home visiting program to a former Vaughn pharmacist, Mary E. Holbrook, who also helped to develop a special home health care interview form for customers that is used to find out about problems in prescription drug taking and use of over the counter medications. (See an article by Ms. Holbrook in the August 1983 issue of Pharmacy Times.)

Once the interview sheet is completed and the Calendar Card explained, Stuart says he's found most people have no difficulty in following the proper drug therapy regimen.

"Sure, it takes a lot longer to put medicine in a time-control card than it does to put pills in a bottle, but the response from patients is so rewarding," comments Stuart. "Good heavens, sometimes I can't remember, myself, if I've taken an antibiotic."

"I had one lady," continues Stuart, "come in the store from the hospital across the street looking for one of those compartmentalized pill boxes. It turned out her mother was having trouble taking medication, and the lady was very grateful to learn about the Calendar Card." The woman reported to him later than her mother "loves the card" and that "it's given her a feeling of independence because she can control her own medications."

Stuart says he also has one customer using the pill card who is blind. "I put one hole in the card for the morning doses and two holes in the card with the second dose, etc."

The Vaughn drug firm is also using the Calendar Card in many area nursing homes. "It avoids medication errors and is a great time-saver for the nurses," says Stuart.

Although an increasing number of pharmacists are adopting the Calendar Card, why aren't more of them using interview forms, making home visits and keeping up telephone contact with older patients needing extra help? Stuart claims that some are "just not willing to spend the time. All they want to do is count and pour."

Stuart and others, however, believe in what Mary Holbrook calls "a dynamic role for the community-based pharmacist."