LHCR / Home Health Newsletters

September 2007

ORAL MEDICATIONS

Improvement in Oral Medications (M0780) identifies the patient’s ability to prepare and take all prescribed oral medications reliably and safely, and the type of assistance required to administer the correct dosage at the appropriate times or intervals.  To correctly and consistently identify a patient’s status, consider safety and reliability, not compliance or willingness. 

One area of confusion is determining what elements of preparation should be considered and how the patient’s ability affects their status.  Tasks related to filling, reordering and obtaining medications should not be considered.  Preparation includes reading the label, opening the container, selecting the pill/tablet or measuring liquid and orally ingesting at the prescribed time(s).  Determining patient’s ability is a little more complicated.  If the patient’s ability varies, choose the response that describes the patient’s ability more than 50% of the time.  Consider total number of medications and total daily doses in determining what is true most of the time. 

Another area of confusion is determining what medications are considered oral.  Only medications whose route of administration is prescribed as oral or “po” should be considered.  Consider all medications prescribed by a health care provider whether prescription or over the counter.  Don’t forget vitamins and other dietary supplements.  Medications given per gastrostomy or other tube and medications administered by injection or intravenous route are not considered “po." 

Assessment strategies to determine the most appropriate level should include both observation and interview with patient or caregiver.  Consider cognitive, mental and functional status.  Observe patient opening medication containers and ask patient to state the proper dosage and administration times for each medication. 

Louisiana has one of the highest per capita usage of prescription medications.  Some drugs that should potentially be avoided in the elderly are:  barbiturates, belladonna alkaloids, chlorpropamide, dicyclomine, flurazepam, meperidine, meprobamate, pentazocine, propantheline, trimethobenzamide.  If your patient is taking any of the above medications, you may consider discussing the possibility of making a change with their health care provider. 

Proper and consistent assessment is important in managing your patient’s health status and providing the right care for every patient, every time.  For additional intervention tools, click here to view RESOURCES and download LHCR developed brochures and posters that may be useful for in-servicing staff on the importance of consistent assessment.