Managing Medication and Independence in Assisted Living

Nursing Homes, March, 2000 by Diane B. Crutchfield

Balancing quality care and resident independence in medication management is a particular challenge for assisted living facilities. Facilities can rise to the challenge with an organized approach supported by the expertise and intervention of consultant pharmacists.

Diane B. Crutchfield is the president of Pharmacy Consulting Care in Knoxville, Tennessee. For more information regarding the ASCP policies and procedures manual for assisted living or the book Assisted Living Facilities: A Resource Manual for Pharmacists.

                  Advantages and Disadvantages of Various
                     Medication Packaging Systems. [*]
                         Advantages
Traditional Multidose    Probably least expensive system for
Vial System              both the resident and the pharmacy
Unit-Dose System         Reduced risk of medication errors;
                         some systems may allow return and
                         re-use of medications, which pro-
                         vides a cost savings to the resident;
                         convenient for staff administration;
                         saves administration time
Multiple Medication      Reduced risk of medication errors;
Packaging System         convenient and safe for staff admin-
                         istration or self-medication; increased
                         compliance for residents who self-
                         administer
Hybrid Systems           Easy to identify discontinued medi-
                         cation and remove from prepack-
                         aged container; decreased risk of
                         medication errors by staff and resi-
                         dent; less financial investment for
                         pharmacy compared with automated
                         packaging machines
Patient Reminder Systems Maintain resident independence
                         Disadvantages
Traditional Multidose    Labor-intensive for the facility staff to
Vial System              administer or assist with administra-
                         tion; increased risk of medication er-
                         rors, particularly with the use of unli-
                         censed staff; lack of accountability for
                         controlled substances or for other
                         medications; increased cost to resi-
                         dent if numerous medication changes
                         occur; difficult to monitor compliance
                         for residents who self-administer
Unit-Dose System         Increased initial cost of medication to
                         the resident (compared with vial sys-
                         tem); potential increased costto phar-
                         macy if there is a need to purchase
                         additional medication carts, unit-dose
                         packaging equipment or unit-dose
                         stock
Multiple Medication      Increased risk of medication errors if
Packaging System         filling is not 100% accurate when
                         medication changes are made; some
                         systems are labor-intensive for phar-
                         macy; additional cost to pharmacy
                         for equipment and supplies; increased
                         cost to resident compared with vial
                         system
Hybrid Systems           Labor-intensive for pharmacy, in-
                         creased cost to resident compared
                         with vial system
Patient Reminder Systems Depend on resident's ability to self-
                         administer, manipulate packaging,
                         and understand and respond to pager
                         system or telephone reminders; use
                         is limited to residents capable of self-
                         administering medications; may in-
                         crease or decrease compliance, based
                         on ability of resident to use; increased
                         risk of errors with reminder contain-
                         ers, based on who is responsible for
                         refilling the containers