Accessible Medication: Adaptive Strategies for Safer Management and Labeling

Jennifer Ottowitz: Welcome to OIB-TAC’s monthly webinars, where our presenters share valuable information and helpful resources to support professionals working with older adults who are blind or vision impaired. Let's check out this month's webinar. So again, welcome to our webinar, Eye2Eye: Building Connections and Resilience Through Peer Support for Vision Loss.

Hello and welcome to Accessible Medication: Adaptive Strategies for Safer Management and Labeling. I'm Jennifer Ottowitz with OIB-TAC. Medications are a common form of treatment for many types of illnesses and health conditions, and whether you take medication short term or on an ongoing basis, being able to manage the type of medication you're taking, making sure that it's in the proper amount or dose and being taken at the proper time are all vital for staying healthy.

And as professionals, we can play a vital role in helping the individuals we serve, learn adaptive strategies to effectively and safely manage their medication. Now what I'm gonna be talking about today may seem a little basic. I think it's always good to go back to basics every now and then, just as reminders, and also to make sure that we're, we're starting on a strong, solid foundation of information.

So I'm hoping that some of what I'll be talking about be very familiar to you, and I'm also hoping that you'll learn some new things along the way. The next slide please.

So medication comes in different forms. It might be in a pill form, it could be a liquid, like cold medicine or cough syrup. It might be in the form of eardrops eyedrops or nose drops. It could be injected like insulin. It could be taken by inhalers such as asthma medication or allergy medication, and it could be in the form of ointments and creams.

And today we're gonna be talking about strategies mostly related to pill form of medication, but. They could also apply to other forms of medication, and I do just wanna say that if you are interested in specific information about measuring insulin or other aspects of adaptive diabetes, self-management to please email us.

At info@oibtac.org, that's info@oiac.org and we'll be happy to share additional resources and information because insulin is a topic that deserves a lot more time and attention. More so than we can give it today. Next slide. So let's talk about medication use in older adults. So according to a study that looked at information from the National Health Information Survey in the year 2021 to 2022.

88.6% of older adults reported taking at least one prescription medication. I'm gonna say that again. 88.6%. And if we look at that age group even more closely and break it down, that number increases with age. 91.3% of people aged 75 to 84 and 91.2% of people aged 85 and over reported taking a prescription medication.

So if you are working with older adults, it's, it's a safe bet that they, they are taking some type of medication. Next slide please. Some of the common health conditions that medication might be used to treat include the following. And that same study in 2022 reported that older adults were diagnosed with the following.

So 47.9% were diagnosed with arthritis. 20.1% with diabetes,

48.1% with high cholesterol, and 58.5% with hypertension. So even if you're not. Seeing a list of all the medications your, your clients or the individuals you serve may be taking, if you know that they have one of these health conditions, just know that medication is a common form of treatment. And so addressing medication management and asking how they're managing their medication is gonna be very important.

Next slide, please. So let's talk about a term called polypharmacy. Polypharmacy means simultaneously taking five or more medications, and that seems like a lot, but when you start to add them up, it, it's really easy to reach that number because that does include not only prescription medication, but over the counter medication as well as herbal supplements too.

Another study showed that from 1999 to 2018. Polypharmacy in older adults increased from 23.5% to 44.1%. Next slide, please. So what can go wrong? Especially with polypharmacy, you can imagine that the more medication a person takes, the more complex managing them becomes, it's harder to keep track of which medications you're taking so you don't get them mixed up with something else.

Making sure you're taking 'em in the right with the right amount at the proper time, and just checking to see if they're interacting in some negative way with each other. But even if you are only taking one medication could still be some things that go wrong. Next slide, please.

So let's talk about adverse drug events. So these are defined as medication causing harm, and this can include allergic reactions, side effects over medication. Medication errors. Now, some things like allergic reactions or side effects we may not be able to control for, but if we had information that helped us know about the ingredients of a medication, for example, we may know not to take that medicine if we're allergic to those ingredients.

If we had information about the possible side effects, we might know to contact our doctor sooner if we experience any of those side effects.

Adverse drug events are also the cause of more than 600,000 emergency room visits each year for older adults.

Adverse drug events are most commonly related to the use of anticoagulants, like blood thinners, diabetic agents like insulin and antibiotics.

There's some more things that can go wrong happen when. Person has difficulty seeing or reading the prescription label. The font can be very small. There's a lot of information crammed on there, and especially with over the counter medications, sometimes the contrast may not be as good. So if we can go to the next slide, please.

We'll talk about the consequences of misreading labels. So if a person's unable to see or read a label, they may take the wrong medication. And it may be their medication family member's, medication or definitely just not the medication they intended to take. There could be dosing errors taking too little or too much.

They could take medications at the wrong time and I think of taking Tylenol PM during the day because it was mixed up with regular Tylenol, but it might even be you know, whether or not to take your blood thinner in the morning or before you go to bed. Things like that can happen. Missing doses can also be a consequence because you weren't sure how many doses you were actually supposed to take.

And then other adverse drug events. So those would be the things like the allergic reactions, like experiencing some of the side effects. Taking expired medication can also be a consequence. And this happens of course, when you're not able to see that expiration date and when you take expired medication, it can impact the effectiveness of that medication.

It could also be a delay in receiving refills. If you're not able to see that you have zero refills left and you call the pharmacy and they say you have no refills left, we'll have to contact your doctor before we can get that prescription out to you. It may cause a delay in you receiving that important medication.

Next slide, please. So let's talk about some ways that you can help the individuals you serve. Next slide, please. Then we're gonna talk about. Options for accessing labels. Now, this is not labeling techniques. We'll talk about that in a little bit, but these are some ways that your clients, the individuals you serve, can access the information on the print label.

And the first is to use low vision devices. So whether they're handheld or electronic, it's important to encourage your clients to use those low vision devices. We're always looking for real life activities to teach the use of devices and encourage our, our, our clients to use them. And this can be something.

Really important besides just reading maybe food labels, have them pull out their medication and, and practice reading the labels with the low vision devices. Large print labels. So there are thousands of pharmacies across the US and Canada that will provide label information in accessible formats.

And so you can encourage your client or the individual you're working with to contact the pharmacy and request a large print label. Audio labels are another option, and these include script talk. Spoken Rx pen friend and way around tags and the first two. These are options that the pharmacy can assist with.

Script talk is a labeling system where the pharmacy records information on a special. Tag that is attached to the medication container, and then the individual who receives the medicine is going to use an app on their smartphone or a standalone reader to just set the bottle on and push a button.

And the information that was recorded will be spoken, but the pharmacy has to help set that up. And that device is free. Everything is free. Spoken Rx is a similar product specifically used by the CVS pharmacy chain, and it also allows the individual to access the recorded information from an app or a standalone reader.

Now pen friend and way around tags. These are options that the individual may have and they might get help from someone else, a friend or family member, to read the information from the label onto the, the label, the tag if you will. And then they can use their pen friend device, they can use their app to access the way around tag information.

Braille labels are another option that some pharmacies may be able to provide. Not all pharmacies have the ability to provide a braille label, but it's always helpful to ask. And then object, identifier or visual assistant apps can be used. So apps like seeing AI, Be my AI. My Eyes and Ira. Now it's important to note that apps like seeing ai do have a disclaimer that they should not be used to monitor or diagnose medical conditions, but in this case, you would just be reading the label.

Now with any AI product, I'm, I'm always big on verifying if you can. So if it's the only. Option you have, it's great. But if there is a way to verify that, that what you've been told is correct, that, that's wonderful. With visual assistant apps like Be My Eyes and ai, you do have a person that would, you would be working with.

Who is sharing that information with you that you just wanna be careful about sharing that personal information. I know IRA agents sign a Confidentiality waiver. Waiver, excuse me, to maintain confidentiality. The last I knew be my eyes volunteers. Although they're encouraged to maintain confidentiality, they were not required to sign any form of legal documentation.

So just know that if you're using those types of apps.

Okay, next slide please. So now let's talk about the rights of medication management. And these are things that you can work with your clients and the individuals you serve on as you're addressing, you know, how are they managing their medication? So the rights of medication include the right person, the right medication, the right dose, the right time, the right route.

The right storage and the right disposal. The next slide, please. So let's talk about these in more depth. So when it comes to the right person, it may seem obvious, but it's always a good idea to double check the name on the label, especially if the person lives in a home with others, you don't wanna get the the medication mixed up with someone else, and it's helpful to store.

The client's medication separately from the meds of other family members and even the medication of their pets. You can talk to them about strategies for that. Next slide, please. When it comes to the right medication you can identify pills by their shape and size. You might identify eyedrops by the shape and size of the bottle or the color of the cap.

I know I take two eyedrops. One is you know, taller bottle. If I have them in the boxes that they came in. The one box is square. The one box is more of a rectangle. So even though I'm not able to see the color of the caps, which I believe they do have different colored caps I can still judge by the size and shape.

You also want to use organizational techniques, so the location of where things are put, your client may put their medication in a particular drawer. In a particular location on the nightstand, on the table. They may put them in baskets or some kind of a container, but just having them separated.

It could even be if there's a medicine cabinet that cold medicine is put on one shelf, pain relievers on one shelf so that you're separating those out. And that also speaks to organization, right? How, how things are organized. And you can use any one of a number of types of. Pill organizers. They come in all shapes and sizes from a daily to a weekly or monthly.

They might have one compartment, they might have four compartments. They're different styles and, and there's a lot of variety out there. And we'll talk a little bit more about that in in just a moment. And this is where I did wanna talk about the different options for labeling. So the techniques for labeling containers.

So you may use large print you could write in large print on the cap. You could write on the bottle itself, although you don't want to obscure the actual label. You might have an audio label, like a pen print sticker, or a way around sticker, or use those, you know, script talk and spoken RX options.

Or you can use tactile labels. So these could be braille, a nice braille letter. H might mean that it's your heart medication versus the letter C for your cholesterol meds. But you could also use different bump dots too. And there's so many different sizes, shapes, and textures of bump dots available.

You could also use elastic bands. Sometimes I find that I, maybe I get the cheap rubber bands, but they can dry out and fall. Off break off. So you could use Elastic hairbands as well. Next slide please.

So with the right dose, obviously you wanna make sure you're taking the amount that you, you need to take. And one technique that can be helpful is to place the nu, a number of elastic bands or bump dots on the container that correspond to how much of the medicine you're supposed to take. So if you take two pills, you put two rubber bands around, or two elastic bands, or two bump dots versus one.

Now, I've also seen that technique used for how often you take the medication, taking it twice a day versus once a day. So you can use that technique for, for different outcomes. You just wanna make sure that the client that you're working with understands what that labeling system means.

You can use a pill. I said different pill organizers to help with separating the pills, making sure you're getting the right dose. I like to fill mine up once a week for the entire week, so even if it, you just use daily pill organizers that were separate boxes, I think just filling them up at the beginning of the week is a nice, nice.

Technique to get in the habit of doing because then you don't have to worry as the week goes on. And different people will do different tricks like leave the lid up. You can arrange them in different ways just to make sure. But it's really nice to be able to tell if you've taken the medication or not.

And as you're organizing them into the, the pill organizer cases that you'll be getting the right dose. You can use an automatic pill dispenser. And you can even request blister packs or other special packaging from the pharmacist to help keep the doses that you need together in the right amount.

Another thing is that you can use a pill splitter instead of a knife to separate pills. I know I have a couple of medications that I need to use a pill splitter for and it's so much easier to use a pill splitter not only from a, you know, hand dexterity manipulation standpoint, but also it will help me better ensure that I'm getting that right dose.

Next slide please.

So the right time. So it's helpful to ask your doctor or your pharmacist when and how often to take your medications. As, as I mentioned earlier, you know, is it better to take things like cholesterol medicine, your high blood pressure medicine in the morning or at night? You're supposed to take something twice a day.

Is it every 12 hours or twice a day during the time that you're awake? Those are important questions to ask and make sure that your, your client knows the information, you know the answers to or to also ask if your medication should be taken with food. And if medications can be taken together, we always recommend that whenever possible you get your medications filled at the same pharmacy.

If you are not able to do that, make sure you, you give them a list of your medication to ask them, you know, are, are there any restrictions or. Certain medications that should not be taken together. And the same with your doctor. Make sure that they have the most current up-to-date list of all the medications you're taking on a regular basis.

And that includes over-the-counter medicine too. Again, you can use pill organizers, the ones that have multiple compartments for different times of day, maybe breakfast, lunch, dinner, and bedtime. This could help you know that you are taking the medication at the right time. And of course you can set alarms and reminders using watches, clocks.

Talking pill organizers, smart phones or smart devices. So a simple alarm could be set with a watch or clock. The other options can actually set reminders where you can actually record, take whatever type of medicine it is. So you're, you're not just wondering, why is, why is my watch beeping? And you would know what that alarm actually meant, or that reminder meant.

And of course, you can use naturally occurring events as reminders of when to take your medicine. So meals I take a certain medicine after breakfast. I take it at bedtime, and I, I have a certain time in my morning routine when I take that medicine. So just making sure that, that, taking advantage of those naturally occurring events to just make it a habit.

Next slide please. So when we talk about the right root, it may seem obvious, but medication can be taken in different ways. It could be swallowed, it could be sublingual or placed under the tongue. It could be topical, as mentioned before. It could be injected, it could be inhaled. It may come in the form of eye, ear, or nose drops.

It could even be taken rectally. And it's very important to not make assumptions. This is why on the prescription labels it will say, take one tablet by mouth. So you wanna make sure that the person understands and you know how to take the medication and to check the label, or to ask the pharmacist.

Just to confirm, you wanna avoid situations and these things actually have happened, not necessarily with people who had problems with their vision, but you wanna avoid any errors such as, you know, taking a liquid medication that was supposed to be injected by mouth. So for example, you would never want to inject insulin into your mouth to swallow it.

You also don't want to spray any medication that's supposed to be inhaled onto your skin, and you also wanna make sure that you're not putting eardrops or nose drops into your eye or vice versa. Next slide, please. So when we talk about the right storage, this is really important because it can impact the effectiveness of the medication.

You wanna avoid exposing your medication to extreme heat, cold, light, or humidity. You wanna talk with your clients and, and help them understand to try to avoid storing medication. On window sills in bathrooms. Now, I know some, a lot of times medicine cabinets are in the bathroom, but we're talking about just out on the counter or maybe on an exposed shelf.

You wanna avoid storing them above the stove in the freezer or in the glove compartment of a car.

You wanna make sure to ask the pharmacist if the medication can be refrigerated? I know a common adaptive strategy a lot of us teach is that you can place eyedrops in the refrigerator so that when you administer them, you can feel them enter your eye a little bit better, but just double check to make sure with the pharmacist that it is okay that that medication be kept cold.

Next slide please. So, the right disposal, it's really important to discard, expired, unused, or unwanted medication. And if you think about it, the less medication you have around the house, the less likely you're gonna be to get your current medication mixed up with something you no longer need.

It's important to check with the pharmacy or local authorities about community regulations for medication disposal and too. They may have a, a medication drop off day. Pharmacists may take unwanted, unused, or expired medications as well. You wanna make sure you're discarding sharps materials.

So needles lance sets in a, an approved sharps container. Or you can ad lib, make your own container with an empty laundry detergent bottle that that's heavy duty plastic and has a screw on lid. You can tape that lid shut and that will serve as your sharpes container. You can use a needle clipper to dispose of injection needles.

That's a device that will clip the needle and then store it in a contained kinda compartment, and you can dispose of pills in a plastic bag filled with something that's not very palatable, so filled with dirt, cat litter, or even coffee grounds.

You wanna encourage your clients to black out personal information or remove the labels from the prescription bottles before just discarding them or throwing them away. Next slide please.

There are many adaptive strategies out there. So we're just gonna talk about a few. The first is the use task lighting. Whenever you're reading labels

next. I wanna organize dispense pills over a cookie sheet, a tray. I've known people to use a, a contrasting colored towel, just something to help keep the pills from rolling onto the floor if they get dropped, something that'll help them stand out so you can find them a little bit easier. You can add tactile markings to a liquid medication syringe.

Those are, it's a kind of a large syringe used for dosing different types of like cold medicine, things like that. And you can use a, a knife, a file to make a tactile mark. And there's some other ways to do that as well. And it's important to keep a list of your medications, a record of the number of refills that you have.

Expiration dates and the pharmacy contact information in an accessible format. Next slide, please. So there are also a lot of adapted devices, and I'm always sharing that it's really important to remember that one size does not fit all. It's really important to have options and give choices. So you may have some of your favorite devices.

We, we've listed a couple here, but just know that it's important to check out the different types of pill organizers, for example, show your clients different. Options and let them pick what works best for them. But some of the devices we just wanted to share. The auto drop eye drop guide, this is a device that will help stabilize the bottle keeps the eye open and it'll help direct the eye drop into the eye.

There's also an auto squeeze, eye drop bottle squeezer, and it actually, you attach it to the bottle, it has little levers that make it easier to squeeze the bottle. This is really helpful for anyone who has difficulty with their hands. In addition to their vision, there's an auto, an auto pill, automatic pill dispenser that will dispense only the amount of pills that you need for that particular day.

There's an easy cut pill, splitter with a magnifier. Again, just instead of using a knife just to be able to cut the pills safely. Next slide, please. It's also helpful to encourage. Self-advocacy with your clients when it comes to their medication management. You want to encourage them to contact the pharmacy to ask about what options they have for accessing labels and the instructions for the medications that they're taking.

You wanna access information. About drug side effects. So helping them find resources that will give them that credible information. A lot of folks go online and I will say that we are sharing a handout. As part of this webinar that will be available on our website, the OIB Tech website, that will have a list of adaptive devices and some resources including an online resource to access side effect information.

It's important to encourage your clients to always ask questions. If they're uncertain, ask their pharmacist, ask their doctor. You can have them share best practices for labeling. There are some guidelines written from the US Access Board. We have a link in the resource handout that give specific information about the font size to use for large print labels, how to make an audio label, braille label, things like that.

Next slide, please. Some more ways you can help. You as a professional could present on accessible labels and medication management at a health fair, a senior fair, a support group. You might talk to healthcare providers like social workers, nurse practitioners, pharmacists. And you can share information in a newsletter article or on social media as well about the importance of accessible labels and, and making sure folks know how to effectively manage their medication.

Next slide please. Another very important resource to share is accessible pharmacy services. And this is a business that's owned by people who are blind, that their main mission is to make medication management accessible on all levels and at all steps in the process. So they are licensed in 28 states, including the District of Columbia and Puerto Rico.

It is a mail order pharmacy, and I will just say that sometimes even if your clients are using accessible pharmacy, they may have occasion to still need a local pharmacy for a prescription that they may need right away. So it's important to encourage those other advocacy, you know, tips for to help them.

Advocate for themselves with their local pharmacy as well, but they may choose to get their ongoing prescriptions and prescriptions that they maybe can wait a little bit until it comes in the mail through accessible pharmacy, because accessible pharmacy does provide accessible packaging, lots of different forms, accessible labeling.

Lots of different forms and accessible support in education. So the first step is that the person would contact accessible pharmacy. Again, we have a link on our resource list. There's team of folks talk to. The individual to find out what their needs are. They'll talk to them about insurance coverage.

They'll talk to them about labeling and packaging options. And it does not just have to be one option. Somebody may use a combination of options. So I know someone who uses accessible pharmacy. They have their medication labeled using script talk and braille labels so that they can. Immediately identify meds with the Braille label and then when they want the more detailed information from the prescription label, they can use script talk to do that.

Next slide, please. So some more about accessible pharmacy services. They do provide medication identification through the Be My Eyes app. So for anyone that uses Be My Eyes there's a spot where you can look up different I call them vendors but you can then access accessible pharmacy and talk to someone on their staff to help identify medication.

Accessible pharmacy also provides continuous glucose monitors, talking monitors for glucose. They provide online information about diabetes and even offer some virtual groups and also offer some virtual groups for both prevention and management of type two diabetes.

And then they also have different educational opportunities. They'll have online health fairs. They've had online presentations on diabetes and mental health as well. Next slide, please. So some options for you to learn more. You as a professional can learn some additional strategies for adaptations for medication management.

Hadley has a number of workshops related to labeling techniques, measuring liquid medication, administering eyedrops. I even have. Workshops on measuring insulin as well as using the spoken RX labeling system, and you can access these online. You can also share them with your clients, the individuals you serve, or you can order that, those workshops for them in large print audio, or braille formats as well.

Vision Aware has information on different labeling options and medication management. And again, we have links to all these in our resource handout. Stay Safe. RX and Envision America have identified October as medication label safety awareness months, and it's a great time to let everyone know about the importance of.

Being able to access medication labels. So they have a campaign each year and they have different graphics, social media posts lots of information that you can share.

And we'll go to the next slide please. I'd just like to wrap it up with a, a question to all of you, and that just is what adaptive strategies are you sharing for safer medication management? And I hope that you, again, have revisited some things that you already knew, but also picked up some new tips along the way.

The PowerPoint contains additional references for. The information that I was shared, and again, you'll find the resource handout on our website, OIB-TAC.org. Thank you.

This has been OIB TAC’s monthly webinar. Thanks for tuning in. Find recordings of our past webinars on our YouTube channel, and discover all of our many resources at OIB-TAC.org. That's O I B T A C .org, like us on social media, and share our resources with your colleagues and friends. Until next time.