Managing the Meds

Julia takes a lot of medications - at last count, she gets upwards of ten different medications each day, many of them given multiple times throughout the day.

The sheer volume of medications Julia needs means that we are measuring and dosing medications for a significant amount of time each day. To make things easier and to ensure that she gets her meds accurately and on schedule, we've spent some time developing a system that works well for all of Julia's caregivers.

There are three key components to the system:

1 - The Med Signoff Sheet

We've created a spreadsheet in Excel that lists each and every medication, including the time, dose and any special instructions (such as if the med is stored in the fridge, how much water it should be mixed with, if it needs to be given with food, etc.).  Each and every dose has a box for the person who gave the medication to initial.  That way we can track if the med was given and make sure two caregivers don't accidentally duplicate the dose. We print out a new sheet each and every week, and we keep the old sheets in a binder in case we ever need to refer back to it.  Keeping the sheets has proven to be helpful quite a few times, such as when we want to know what combination of seizure medications she was taking during a time when her seizures were better controlled or when she last had a course of antibiotics.  And, because we have in-home nursing, these sheets serve as part of Julia's medical record/nursing notes.

2 – Process for Drawing up the Meds

Julia gets medications throughout the day, with the largest number of meds being given in the morning and at bedtime. We follow the same process every time we give meds.  Each medication dosage is drawn up in the smallest syringe possible so that we can be as accurate as possible. For example, using a 20ml syringe for 2ml of medication makes it hard to measure accurately – instead, we use a 3ml syringe for a 2ml dose. Then, we line up all of the medication-filled syringes on a paper towel. Because she gets up to eight different medications at one time, we keep each medication in its own syringe so we can visually doublecheck that she’s getting the right medication and dosage. In addition, we always use a 30ml syringe for the water flush, and we use 30ml syringes for water flushes only so we don’t confuse clear medications with the water flush.

3 - Dedicated, Organized Storage

This seems so obvious now that we have the system in place, but it wasn't always this way. We used to have medications and supplies stored all over the kitchen.  Now, we have two kitchen cabinets dedicated to Julia's medications and associated supplies, such as syringes, nebulizer machine, suction catheters, scissors, etc. Her feeding supplies are also stored in one of these cabinets. The cabinets are right next to the kitchen sink, which makes it easy to mix her meds with water when necessary and to rinse all of her syringes. On a couple of shelves, we use storage turntables to maximize the space. The med signoff sheet and a pen are clipped inside the cabinet door, and the corner is well lit. This might very well be the most well-organized part of our house, and everything goes right back into its place so it all stays organized.

So, even though administering meds is not really fun, we have made the whole system as efficient and pretty as possible.  It has been well worth the effort to develop and maintain a system that really works for us!

One note/request: As I was writing this, I was once again reminded of just how many medications Julia receives on a daily basis. Rest assured that we’re regularly working with her entire medical team to make sure that she actually needs the medications she’s getting.  We realize that every medication has side effects and that medications can interact with one another. So, please, no negative comments or judgments about the number of medications. Just know that we wish she didn’t need so many, and we are working to keep her as healthy and happy as possible. 

Are you interested in getting a template of the medication signoff sheet we use so you could adapt it for your own use?  What about a video tutorial to show you how to make changes to the signoff sheet? Leave a comment if you would like more information about the medication signoff sheet or our storage system, and we’ll create some additional videos/tools  to share with you.