Medication Teaching

1. Medication Teaching What Parents Should Know Nadya Nalli, BSc.Phm Paediatric Academic Multi Organ Transplant Pharmacist The Hospital for Sick Children

2. Pharmaceutical Care • Pharmacist • Accepts that he/she will be directly responsible to the patient • Patient • becomes a partner in care rather than recipient of care

3. Paediatric Practice • Spectrum • Neonate  adolescent • Patient & parent/caregiver dynamics

4. Medication teaching • Who = audience • Why = purpose • When = urgency • What = content • How = media

5. WHO? / Audience • Adult vs child • Learning capacity • Age variant • Style • Several theories (adult and child) • Operational stages (Piaget) • Learning Style Inventory

6. Audience • Experience/perspective • Acute vs chronic illness • Cultural differences • Language • fluency

7. Audience • Terminology • common vs medical • definition of terms • acronyms/short forms • familiarity with system

8. Why? / Purpose • Although essential in disease management, if taken improperly, medications can also be the source of significant morbidity and mortality • Major underlying causes of patient adverse drug events have been associated with defects in drug knowledge dissemination

9. Purpose • Non-compliance and drug misadventure are more likely to occur when patients are prescribed many medications • Drug misadventure is more likely when patient medication regimens are changed. • One should not consider possible risks associated with taking particular medicines in isolation from the likely beneficial effects. For most people there will be only a single benefit that is sought, but the potential risks are often multiple.

10. Purpose • Pharmaceutical Care has been the pharmacist’s approach to improving medication use • Pharmaceutical care is the responsible provision of drug therapy designed to meet a defined outcome individualized for a specific patient.

11. When? / Urgency • Stress is a barrier to learning • Prioritize information • Flexibility • Follow-up

12. What? / Content • Reason for use • goals of therapy • time frame of effect • Schedule • dose time; potential for flexibility • drug-drug, drug-food, drug-disease issues

13. Content • Potential/expected adverse effects • monitoring at home • urgency • Management of adverse effects • plan

14. Content • Dose Administration • route (po/pr/ng,gt,jt/topical/sc/iv) • dose form manipulation • strategies • problem solving skills

15. Content • Drug coverage • ODB (Trillium/HCP/WF) or private plan • OOP (out of province) patients • fiscal year/family cap • co-pay • Rx vs OTC • paperwork (LUF vs. sect 8 approval)

16. Media • Verbal summary • Verbal + written summaries • Innovative material • Colour coding • Braille • Medication schedule

17. Teaching & Self Medications 6A/4D • Background • Paediatric Academic Multi-organ Transplant • 40+ transplants/year (heart, lung, liver, kidney and small bowel) • single or combined • Deceased donor or living related* • full organ or split*

18. Teaching & Self Medications 6A/4D • Philosophy: • learning occurs in an environment where safeguards and resources are available in order to optimize care • family-centred care • multi-disciplinary approach

19. Teaching & Self Medications 6A/4D • Consent • discuss goals of program with caregiver(s) and or patient (if age appropriate) • obtain written consent; place in chart • set a time that is mutually convenient • determine need for interpreter

20. Teaching & Self Medications 6A/4D • Teaching • initially didactic (~ 1 hour) • progression to didactic/interactive • limit setting by caregiver re: amount of information given per session • follow-up sessions as required • documentation!

21. Teaching & Self Medications 6A/4D • Medication Summary • individualized • includes standard oral/iv medications • includes name(s), reason for use, adverse effects and special instructions

22. Case • 7 yr old male; 2 weeks post renal tx • Tacrolimus 3mg po q12h • Mycophenolate mofetil 250mg po q12h • Prednisolone 5mg po daily • Trimethoprim sulfamethoxazole 60mg po q daily • Nystatin 100,000u swish/swallow qid • Ganciclovir 150mg iv daily • Magnesium hydroxide 400mg++ po bid • Phosphate sodium 15mmol po bid • Ranitidine 75mg po qhs

23. Medication Summary for Transplant Patient, July 2004

24. Teaching & Self Medications 6A/4D • Accommodation of Preferences • dose form (solid vs liquid) • dose form (size vs volume) • dose schedule (where applicable)

25. Teaching & Self Medications 6A/4D • Medication Administration Record (MAR) • individualized • double checked • updated every shift • adaptable, where possible

26. Medication Schedule for Transplant Patient

27. Teaching & Self Medications 6A/4D • Medications • individualized • 7 day supply • provided in lock box (room temp meds) • template for optimal storage

28. Teaching & Self Medications 6A/4D • Drug Plan • determine type & extent of drug coverage • if private, give DINS to parents • if ODB, identify limited use vs sect. 8 vs full • if OOP patient, identify all potential payors

29. Teaching & Self Medications 6A/4D • Drug Plan • explore compassionate supply avenues • referral to Trillium if required (Ontario patients only) • liaise with social worker (if required) and discharge planner

30. Teaching & Self Medications 6A/4D • Life Issues • concomitant/new medications • alcohol/recreational drug use • sexual activity • travel

31. Teaching & Self Medications 6A/4D • Discharge Prescription - continuity of care • ensure appropriate drug/dose • ensure optimizations/preferences included • communicate with outpatient pharmacy to ensure medication supply, convey information (patient/caregiver consent)