Managing Medicines
MANAGING MEDICINES
Managing medicines, especially for someone who you care for, can be a daunting task. The following information will enable you to be better informed and we hope that you will feel more confident performing this task. Everything that is said below applies to the medicines you take as well.
Buying medicines
Medicines that can be bought without a prescription are known as ‘over the counter’ medicines. Although many are available from a variety of outlets, including the supermarket and corner shop, it is only at the community pharmacy where you are able to ask for professional advice about what you are buying and if it is safe to take with other medicines that are being used, particularly those that have been prescribed by the doctor. For example, paracetamol may have been prescribed by the doctor for pain, but since many cold and flu remedies that you can buy also contain paracetamol, it would be easy to take more than the recommended daily dose if you did not know this.
Also, remember that some herbal remedies are unsafe to take with certain prescribed medicines, so always check with the pharmacist before buying.
Medicines on prescription
Try to have your prescriptions dispensed at the same pharmacy.
Pharmacies keep ‘Patient Medication Records’ which are detailed records of the medicines dispensed for each patient from a particular pharmacy. The pharmacy team will get to know you, be aware of the personal needs of the person you care for and be better able to advise you about the medicines that they take.
Most medicines have two names; a brand name and a generic (ingredient) name.
For example: Ventolin is the brand name of an inhaler often used in the treatment of asthma and other conditions where patients have breathing difficulties. Salbutamol is the generic or ingredient name of Ventolin.
Doctors are encouraged to write prescriptions using the generic name of a medicine so that pharmacists can dispense a product that costs less than the branded version but is of the same high quality. This means that more money is available for funding development of new medicines and NHS services in general.
Most of the time it is not important to have the same brand of a medicine as long as you have the correct generic name.
Read the label…. This probably sounds obvious but many people do not always do this! Every medicine dispensed in the pharmacy has a ‘dispensing’ label put on to the container. This has the name of the medicine on it and instructions on how the presciber wants the patient to take the medicine including any special advice such as ‘This medicine is best taken with or after food.’ There will also be the patient’s name, date of dispensing and the name, address and telephone number of the pharmacy.
All medicines must be supplied with a ‘Patient Information Leaflet’ which is provided by the manufacturer of the medicine. This gives details of what the medicine is for, recommended dosage and side effects. All side effects tend to be listed from the very common to the more rare ones. Medicines information is also available at www.medguides.medicines.org.uk, www.patient.co.uk and www.askaboutmedicines.org. But remember, always refer to your pharmacist or doctor if there is something you do not understand or are worried about.
NHS prescription charges
The majority of people do not have to pay National Health Service Prescription charges. If the 'cared-for' person does pay, it may be worth finding out if they could be exempt from charges. Leaflet HC11, ‘Help with health costs’ gives guidance about NHS charging arrangements in England. It may be available from your pharmacy but can also be downloaded from the Department of Health website: www.dh.gov.uk.
General advice for taking/using medicines
Swallow capsules and tablets with plenty of liquid, preferably a full glass of water. Where it is advised to take medicines on an empty stomach or before food this usually means at least one hour before, or two hours after a meal. If it is advised to take medicines with food, this usually means with a meal, a snack or milky drink. However, some medicines specifically advise against taking with milk so always look out for any warnings on the dispensing label and remember to read the patient information leaflet.
Always take tablets and capsules when standing or sitting as upright as possible to prevent them from getting stuck in your throat. Tablets should be swallowed whole unless they are:
- Dispersible/soluble in water
- They are scored so that they can be halved
- You are advised differently by your doctor or pharmacist
Otherwise, in order for them to work properly, tablets should not be crushed and capsules should not be opened. If a swallowing difficulty is diagnosed by the doctor, medicine may be available in a soluble or liquid form. More information can be obtained at www.swallowingdifficulties.com
In special circumstances, particularly where medicines must be given through feeding tubes it may be necessary to crush tablets or open capsules. You should receive advice from the hospital, pharmacist or doctor.
Side-effects can be reduced by following advice provided by the pharmacist or patient information leaflet. If the person you care for does experience symptoms that you think might be side-effects, mention them to your doctor or pharmacist. Occasionally, it might be necessary to have the dose or medicine changed.
Antibiotics
Antibiotics are commonly prescribed to treat infections. However they do not work against infections that have been caused by a virus. Unnecessary prescribing of antibiotics in the past for viral infections has contributed to the fact that a number of antibiotics do not now work against some types of bacterial infection.
Many coughs, colds, sore throats and ear infections tend to be caused by viruses which usually clear up by themselves after a while. Try not to expect a prescription for antibiotics if the person you care for visits the doctor with any of these symptoms. It is unlikely that antibiotics will be prescribed unless the doctor thinks that either it is a bacterial infection or antibiotics would prevent further complications.
Other types of medicines
Eye, ear and nasal drops, inhalers and creams are also considered to be medicines. Therefore it is just as important to follow the prescribed dose and not to share them with anyone else.
Eye, ear and nasal drops
Eye drops should not be kept for any longer than one month once they are opened. This helps to prevent bacteria from getting into them. It is also important to try and prevent infections passing from one eye to the other by not touching the eye when putting in the drops.
Creams and ointments
Remember to wash your hands before and after applying creams and ointments, unless they are for your hands. Apply only a small amount (particularly important for creams and ointments containing steroids e.g. Hydrocortisone Cream, Betnovate Cream, Eumovate Cream) and massage in gently, unless otherwise directed.
The amount of cream/ointment to be applied can be measured in terms of ‘fingertip units’ which is the length from the tip of an adult first finger to the first crease. One fingertip unit is usually enough to cover an area that is twice that of a flat adult hand.
Wear disposable gloves if you are applying the cream to someone else to protect yourself from any possible harmful ingredients in the cream/ointment and to reduce the likelihood of infection.
Never share creams/ointments that have been prescribed with other people.
Inhalers
Inhalers deliver medicines directly into the lungs to help breathing, but in order for the full amount of the medicine to reach the lungs it is important for inhalers to be used properly.
The doctor, nurse or pharmacist will be able to help if the person you are looking after is one of the many people who find them quite difficult to use. If they are still having problems there may be a different type of device which would be easier for them to manage.
Safe-keeping, storage and expiry
Medicines that have been prescribed for any individual should never be shared with other people as they may be harmful to them.
Keep medicines out of the reach of children, preferably in a locked cupboard. If possible try to avoid hot steamy places like the kitchen or bathroom as medicines will last longer if they are stored in cooler, drier conditions.
Be aware that some medicines should be stored in the fridge. Ask the pharmacist if you are unsure.
All medicines have an ‘expiry’ or ‘use-by’ date. This may be stamped on the container that the medicine is in. If it is not, as a general rule, tablets and capsules should not be kept for any longer than twelve months and liquids no longer than six months. Check with the pharmacist if you are unsure.
Unwanted medicines
Medicines that are no longer required should not be saved ‘just in case’ or put out with the household rubbish. Return them to the pharmacy where they can be disposed of safely.
Do not continue to re-order medicines that the person you care for does not want, or, have been stopped by the doctor. If an unwanted repeat medicine continues to appear on the prescription order form, ask the doctor if it can be removed.
Every year in the NHS £200 million worth of medicines are wasted for all sorts of reasons. In the Birmingham East and North (BEN) PCT area alone, this amounts to approximately £3million. Stop and think before you re-order medicines that the person you care for does not want. In the West Midlands alone, the money saved could pay for:
- 7000 more hip replacements, or
- 4,900 more heart by-pass operations, or
- 49,000 more cataract operations, or
- 1,050 more community nurses, or
- 6,300 more knee replacements.
More information available on www.medicinewaste-westmidlands.com
Medication Review/ Medicines Use Review
If the person you are looking after takes medicines regularly the doctor should conduct a medication review from time to time. This is a process that helps both patient and doctor to decide if continuing with, or changing any of the medicines is necessary. They may need to have regular blood tests whilst taking some medicines to help the doctor decide if the medicine is working for them. Remember to tell the doctor if you think the medicines are not working or if you think the 'cared for' person may be experiencing any side-effects. Do not stop administering the medicines unless your doctor or pharmacist tells you that it is safe to do so.
You can also talk to your community pharmacist about the medicines of the person you care for. They may be able to conduct a Medicines Use Review with that person, which is an opportunity for them to discuss the medicines that are taken, what they do and how well they are working. Your pharmacist will advise how best to take them and send a copy of the review to your GP.
Going into hospital
If the person you care for goes into hospital, make sure they have with them all their medicines that they take, including any that have been bought over the counter. It is also a good idea for them to have a copy of their most recent repeat prescription re-order form.
Help with taking medicines
Many people find it difficult to remember to take medicines and it is just the same for those who manage this task for others. Simple things can be put in place to help, like fitting in medicines taking with the daily routine of the person you look after e.g. taking medicines at meal times (remembering to take into account any medicines that should be taken before or after food.) Reminder charts can also be used. Your local community pharmacy should be able to assist if large print labels are required or ordinary screw tops instead of child proof tops.
Some people have their medicines in monitored dosage systems (MDS) which are boxes with small compartments for breakfast, lunch, tea and dinner for each day of the week. They act as a memory aid and may be useful if someone is taking lots of medicines. However, not all medicines are suitable for storage in these types of containers. You need to bear in mind that if someone is taking several medicines, a MDS is unlikely to remind them to take the medicines that cannot be stored in it!
Your community pharmacist will be able to provide you with more information about MDS. In order to obtain one free of charge, the person who requires an MDS must meet the requirements of the Disability Discrimination Act 1995. The pharmacist is entitled to carry out an assessment in order to see if the requirements are met. They may also recommend that some other form of memory aid would be more suitable.
Contact Details
We hope that the information above has helped you and will have answered your questions. However, if you do experience difficulties getting help from the suggested sources then please contact your local Primary Care Trust.
If you live in East or North Birmingham, then contact us:
Medicines Management Team,
Birmingham East and North Primary Care Trust,
Waterlinks House,
Richard Street,
Birmingham B7 4AA
Tel: 0121 333 4113 (normal office hours)
