Self Care Auxiliary Aids Pharmacy Copy Not to be given out
Index Introduction... P1 Useful Websites for Reference and Information. P2 Simple and Easy Ways to Promote Self Help.. P3 Medication Reminder Charts & Tick Charts... P4 Simple and easy ways for the Pharmacist to help P5/6 Auxiliary Aids A catalogue of aids to help disabled patients take their medication. MDS for individuals.. P7 Medicine Bottle Openers P8 Pill Extractors P9 Eye Drop Dispensers. P10/11 Medication Tube Squeezers P12 Cream Applicator... P13 Talking Labels P14 Pill Splitters and Crushers.. P15 Oral Aids P16 Inhaler Aids P17 Stocking Aids. P18 Medication Alarm... P19 Your guide to helping customers P20/21/22
Introduction This information pack has been put together to help you the pharmacist, deliver part of your essential services and net requirements of DDA contained within the New Pharmacy Contract. The information contained within this document will help you support people looking for solutions that allow self-care, specifically around accessing their prescribed medicines. Caution Prices and Websites quoted are reference only and were correct at the time of printing. They are there to help guide you. Aids may also be sourced from your normal wholesaler. Page 1
Useful Websites for Reference and Information Useful Websites for Reference and Information Information on self care and other parts of the Pharmacy Contract see the PSNC website www.psnc.org.uk Guidance for Pharmacy Contractors For the full version of the Guidance for Pharmacy Contractors document from PSNC visit: http://www.psnc.org.uk/uploaded_txt/psnc%20guidance%20 on%20the%20disability%20discrimination%20act%20051205.p df Stability of Drugs in Compliance Aids The Pharmaceutical Journal has issued a list of drugs with information provided by manufacturers as to the suitability of certain drugs being dispensed in compliance aids. For full information on this please see either Vol 276 dated 21.01.06 of the Pharmaceutical Journal or go on-line to http://www.pjonline.com/pdf/articles/pj_20060121_stable.pdf Page 2
Simple and Easy Ways to Promote Self Help Below is a list of simple ideas you can use to guide a member of the public to enable them to self-help when taking their medication: Page 3 Show them how to make a medication reminder chart. Details of these can be found on page 4. They can obtain different coloured shapes and large font stickers to put on their medication. If they wish to do this but are not sure what colours to use for each, then suggest a list of definitions for colours to make it easier. Labels can also be colour coded. Give them the information on auxiliary aids included in this booklet. They may wish to look up websites or shop around for the best prices. Advice them to get an alarm clock or an alarmed wrist watch and set it to go off each day at the same time. If a patient has problems reading their medication labels a magnifying glass could help them. Available from most household shops and chemists/opticians. Also ensure that the Ink in your printer is not low and that printing is not too faint when producing labels. Page 3
Medication Reminder Charts and Tick Charts Medication Reminder Chart A patient may need a chart to show them when to take their medication e.g. if they may be suffering from memory problems. The medication Reminder Chart is one of the simplest ways a patient can be aided in remembering such things as: What medication they are taking. Why they are taking it. Who their doctor is. When they take it. Description of the medication. Allergies they have. Vaccination due dates. What dose they are taking. If you need to obtain this chart then please contact your PCT for copies. A simple version of the chart is available from the Medicines Partnership website at: http://www.medicines-partnership.org/medication-review/room-forreview/rfr-toolkit/reminder-chart Medication Tick-Charts Medication Tick Chart Brand / Generic Names: Time Mon Tues Wed Thurs Fri Sat Sun Medication Tick Charts can be supplied to patients who may forget that they have taken their medicines or who need help with a more complex medication regime. Pharmacists can design tick charts for patients themselves, or contact their PCT for copies. Colour / Shape: Instructions: Brand / Generic Names: Time Mon Tues Wed Thurs Fri Sat Sun Colour / Shape: Instructions: Brand / Generic Names: Time Mon Tues Wed Thurs Fri Sat Sun Colour / Shape: Instructions: Brand / Generic Names: Time Mon Tues Wed Thurs Fri Sat Sun Colour / Shape: Instructions: Brand / Generic Names: Time Mon Tues Wed Thurs Fri Sat Sun Colour / Shape: Instructions: If the patient insists on taking the chart away, fill the chart in for them and explain what each box is for. Encourage them to call back if they have problems. Also ask them to bring it in when they have completed it so you can check the chart for them. Page 4 Page
Simple and Easy ways in which the Pharmacist can help There are many ways that the Pharmacist can help a member of the public take their medication. These are low cost and can be adapted for each patient. Whatever system is applied to their medication it must be thoroughly explained to the patient before they leave the Pharmacy. Stickers Patients with a visual impairment may need support reading the labels on medicines. To aid this, the pharmacist could use larger print on the label using a word processor or print the instruction on to a yellow label with black font, which is easier for people with a visual impairment to read. Larger instructions could also be hand written on the labels and highlighted with a highlighter pen. Coloured dots can be stuck on medication to indicate what the medication is. A colour-coded key must be placed on a separate sheet of paper for them to refer to. Dosage Instruction Matchsticks This is a simple way for the blind or visually impaired to tell how much of their medication they need to take. One matchstick on the side of the bottle or lid would indicate that the patient needs to take one pill a day. This can be adapted for each patient and to the dose. However, the matchstick will need to be securely stuck to the bottle and problems may arise when the patient needs to take complicated dosages e.g. 3 tablets 3 times a day, Morning, noon and evening or with a meal. Only use matchsticks for simple medicine instructions. Elastic Bands These can be used in the same way as the matchsticks but must also be securely stuck to the bottle and only used for simple instructions. Audio Recording Pharmacy can supply an audio recorder of some kind and the medication dose instructions can be recorded for the patient if they have a visual impairment. Page 5
Writing Down instructions If a person has a visual impairment then it may be easier to write out clearly on a large piece of paper in large font the regimen for taking the medication. The RNIB (Royal National Institute for the Blind) suggest Arial computer font no smaller than 14. Font size16/18 is classed as large. Larger Bottles A member of the public may find it hard to open their medicine bottles. By putting their medication in a larger bottle with a larger lid it may become easier to grip. Medication Use Reviews (MUR s) A patient may have a problem with the complexity of a treatment regimen and may benefit from a MUR to review what medication they are taking and why. An accredited pharmacist in an accredited Pharmacy can only provide the service. Please see MUR Information Booklet, which were sent to all pharmacies for further information. In addition to the enclosed list of auxiliary aids also consider services that you already offer and what self-help guides or leaflets are available to support and inform patients such as: Collection and Delivery of Repeat Prescriptions Repeat Dispensing Medication Reminder and Medication Administration Records NHS Direct self care guides in all Thompsons Local Directories There is also a library of leaflets available from Health Promotion Units and the Department of Health. Page 6 Page 9
Multi-compartment Aids for Individuals It is important to show the patient how to use the device. Watch them open it and see if they can fill the separate compartments. If they have difficulty then either then they may need a different device. Do not assume that the patient needs a multi-compartment aid for a problem as they may need a more specific device. Always offer to fill the device for them. Advantages to these systems: Can see how many pills they have taken & have left to take. Blind/visually impaired patients who can read Braille could use Braille support boxes or trays as an aid. Several different medications can be put together. The medi-wheel can be felt clicking into place for the hard of hearing. Larger systems are easier to handle then strips. Punch packs are single use & disposable, which improves hygiene. Some boxes and punch packs when dropped will not break or lose medication. Disadvantages to these systems: The font can be small It is easy for a blind/visually impaired patient to get the box round the wrong way and take the wrong day with no Braille Not all visually impaired can read Braille. Some boxes don t allow enough room for larger tablets. It is difficult to know where the medi-wheel starts and ends. Stability of medication could be an issue. Refer to page 2. Multi-compartment aids available: Punch packs pills are put in over a 28 or 7-day period. The pills are then pushed out each day by the patient (disposable). Boxes and trays come in various shapes and sizes. Holds the medication in individual labelled compartments for each day (reusable). Medi-wheel a circular device that clicks into place and is available for single use or for a week of medication (re-usable). Medi-wheel These can be obtained from W + W Medsystems Single 3.55 and Week 12.50 Tel: 01484 667822 Boxes/Trays Punch Packs Page 7
Medicine Bottle Openers Medigrip The Medigrip device will help you to open child resistant caps and ordinary caps on medicine tablet bottles. It is designed to fit 22, 24, 28, 33 and 38mm caps. Left-handed people can use this product too. Where to order: Price: 2.20 + 2.20 handling charge. Website: http://onlineshop.rnib.org.uk Child Resistant/Ordinary Cap Opener This is a simple device that can be placed on top of the medicine bottle to help those who are less able handed open their medication. Available from your normal bottle supplier Wing Caps This is a simple device that is placed onto the top of a medication bottle to help open it. Available from your normal bottle supplier Page 8
Pill Extractors The Pill Press Lightweight and portable. Can be used by Left and Right handed people Recommended for use by the (RNIB) Royal National Institute for the Blind How to use the Pill Press: 1) Place your blister pack onto the Pill Press foil side down. 2) Make sure that the pill is placed directly over the hole and press down firmly. 3) Push the pill through the foil until it falls into the hole. Where to order: Price: 5.45 (including postage and packaging) www.pillpress.co.uk Pill Punch Out Helps remove pills from blister packs. Place the blister pack between the pill you want to push out and press the long arms together. The pill then falls into the special cup. Where to order: Price: 11.99 (including postage and packing) www.disabilitysupplies.co.uk Reference No. G44419 01342 837691 Page 9 Page 1
Eye Drop Dispensers Opticare Eye Drop Dispenser This can clip on to 3 different sized eye drops bottles, including oval bottles commonly used by Glaucoma sufferers. A guide aims the drops accurately and side pads make the bottles easy to squeeze. Available on prescription Opticare Arthro 5 This device holds the bottle and on squeezing the two handles together administer the eye drops. Fits most 2.5ml and 5ml round and oval eye drop bottles. This is more suitable for patients with Arthritic conditions that affect their manual dexterity. Available on prescription Opticare Arthro 10 Fits most 10ml and 15ml round and oval eye drop bottles. This is more suitable for patients with Arthritic conditions that affect their manual dexterity. Available on prescription These products can be ordered from www.cameron-graham.co.uk or telephone: 01484 667822 Page 10
Eye Drop Dispensers Cont. Xal-Ease The Xal-Ease is specifically for the administering of XALATAN and XALACOM eye drops to the eyes. This helps with removal of bottle cap, centres XALATAN bottle over the eye and dispenses only a single drop of medication into the eye Price: Free Can be obtained from your Pfizer rep. This product is also given out from the Glaucoma clinic when treatment is initiated. Travatan Eyot The Travatan Eyot eye drop dispenser should is only to be used with TRAVATAN eye drops. Price: Free Can be obtained from your Alcon Rep. Also available from the Glaucoma Clinic. Page 11
Medication Tube Squeezers Page 1 Please note all medication tube squeezers listed below are re-usable Tube Squeezer This product not only simplifies squeezing tubes but it also reduces waste by getting all of the contents out. Accepts any metal or plastic tube up to 50mm (2") wide. Twisting the key at the side squeezes tube contents out and as the tube is emptied, it is wrapped around the key inside the plastic shell. Price: 10.32 (including postage and packaging) Reference No. AA1813 Order from: www.benefitsnoeshop.co.uk Or by telephone on 01983 529590 Easy Out Tube Squeezer Designed for one-handed use this tube squeezer allows the last drop to be extracted. Fits sized tubes up to 50mm across and come in a pack of 2. Price: 11.35 (including postage and packing) Reference No. AA1812 Order from: www.benefitsnoeshop.co.uk Or by telephone on 01983 529590 Note to Pharmacist: To make the IbuGel Forte 10% tube easier and more economical to use, a tube squeezer key is provided in the box. Once fitted to the tube (see instructions below), simply turning the key will dispense the IbuGel Forte 10% more easily for patients who experience difficulty in squeezing tubes. 1. Slide the slit in the key over the folded end of the tube 2. Carefully turn the key to roll up the tube until the required amount of IbuGel Forte 10% has been expelled Page 12
Cream Applicators Lotion Applicator Designed to help apply moisturising lotions, suntan oils, sport creams and medications on hard to reach places. The built up, ribbed handle has a thumb rest and is angled in two places for manoeuvrability. The sponge can be removed when worn and replaced with a new one. Handle is 305mm (12") long. Weight 50g. Price: 10.58 Reference No. AA186201 Order from: www.benefitsnoeshop.co.uk Or by telephone on 01983 529590 Sponge Replacements These can be ordered to replace your existing sponges for the above lotion applicator product. Price: 6.60 Reference No. AA1862 Order from: www.benefitsnoeshop.co.uk Or by telephone on 01983 529590 Page 13
Talking Labels Talking Labels provide audible guidance in identifying and taking medications. Talking Labels attach to standard medication packaging and allow the patient or the Pharmacist to record and store a voice message, which can then be played back at any time with the push of a button. The label only allows for one message at a time. Page 1 The re-recordable voice message could include the name of the patient, a description of the medication, dosage instructions and any important warning notes. Easy to use - one button to press Large play button Provides audible instructions Re-recordable and reusable Metal clip secures to box packaging Fits all standard pillbox packaging but not bottles. 60 seconds recording time Replaceable button cell batteries, which should be kept at the pharmacy. 6.99-one label (batteries included) 1.99-replacment batteries 19.99-pack of 3 labels (batteries included) Order from www.talkingproducts.co.uk Or Call: 01794 5216677 Page 14
Pill Splitters and Crushers Pill splitters and crushers should only be recommended after a safety review of a patients medicines has been involved and alternatives discussed with their Prescriber. Magnifying Pill Splitter This magnifying pill splitter enables people with poor eyesight to split their medication in two. Price: 5.94 (including postage and packaging) www.disabilitysupplies.co.uk Reference No. G44390 01342 837691 Pill Splitter A blade within a holder allows uncoated tablets to be divided in two. Tablets can be stored in front tray. Price: 3.98 (includes postage and packing) Order from www.tabtime.com Or telephone: 01270 767207 Pill Splitter and Crusher This three-piece tablet-powdering device crushes tablets into powder for consumption. Not suitable for coated or extended release formulations. If swallowing pills is a problem for the patient then a liquid alternative may be needed. Always explain the safety issues of using a crusher. Price: 9.98 Order from www.tabtime.com Or telephone: 01270 767207 Page 1 Page 15
Oral Syringes Oral Aids To measure liquid medicine from the medicine bottles and to deliver when swallowing is a problem. These can be ordered in various sizes from your normal wholesaler. Never use lever-fitting syringes Measuring Spoon Measure accurate medicine doses with this handy measuring spoon. The clear markers measure in mls with a capacity of 10mls. The spoon makes taking medicine easy without spills. Where a patient/member of the public can order them: Price: 3.95 (including postage and packing) www.disabilitysupplies.co.uk Reference No. G44377 01342 837691 Dose Cups Dose cups can be used for measuring large volumes of liquid and are not accurate on small volumes. These can be ordered in various sizes from your normal wholesaler. Page 16
Inhaler Aids Haleraid This is an aid to help patients grip and actuate the canister of the MDI. This is useful for patients who suffer from dexterity problems. The Haleraid is placed around the plastic device of the MDI and is squeezed to deliver a dose. This is available in two sizes to fit the different sized MDI s: 1) Haleraid 120 for the 120 dose MDI s e.g. Serevent 2) Haleraid 200 for the 200 dose MDI s e.g. Ventolin Not available on NHS prescription. Price: 1.48 Reference No. HAL194U Patients can order from: www.westons.com Turbohaler Grip Turbohalers are small and because they need to be twisted to activate, they can cause difficulty for people with dexterity problems. A grip has been introduced to help the user twist the haler. These can be ordered from your Astrazeneca rep. Spacers The spacers make it easier to coordinate with an inhaler. You can breathe in and out several times with the chamber, so they don't have to get all the medicine on one breath only. Types of spacers: Aero chamber, Breath-A-Tech, Fisonair, Nebuhaler and Volumatic. Available on repeat prescription. Page 17
Stocking Aids Acti-glide Compression Hosiery Application System This can be used on open and closed toe stockings. The patient will need to use two hands for this device. Acti-glide is also prescribable. Instructions provided. Available on prescription 12.76 Scholl Fitting Socklet This is for open toe only stockings Available free from Scholl from Scholl s consumer relations department on 0800 074 2040. Page 18
Medication Alarms People who find it difficult to remember to take their medication may chose to use a medication alarm if a medication reminder chart or a tick chart is ineffective. Alarms can help in the following ways: People with hearing impairment can use a medication arm with an LED flashing display instead of an audio alarm. Some alarms can be pre-set by the Pharmacist for the patient. Some alarms can provide many storage compartments for patients taking different medication and can open at separate times. There are alarms available that can be worn around the neck. Some alarms can hold up to 31 programmable alarms. There are alarms that double as a wristwatch. To help patients keep their medication safe some alarms come with a lockable key. There are many different types of alarms and some can be found on the following websites: www.tabtime.com www.dudleyhunt.co.uk Page 19
Your guide to helping customers Here are some tips as a guide on how to help patients who are: Page 2 Blind or visually impaired: Count their change aloud into their hand and offer help packing their bags. Offer your elbow if you need to guide them around the shop, walk at the same pace, inform them of obstructions, confirm the product (i.e. size and colour) and then offer to take them to the counter. Explain the payment to them and ask if they need any assistance exiting the shop/pharmacy. Deaf or hard of hearing: To attract their attention try moving nearer or tapping them lightly on the shoulder. Members of the public may find it hard to engage in a conversation if there is a lot of background noise. Try and move to a quieter area such as your consultation room. Always speak at the patient, use appropriate body language and face the light so they can see you lips move and keep your hands away from your mouth. If these techniques don t work then use a pen and paper to communicate. For those with hearing aids use a hearing loop if available and appropriate. Blind and deaf: Blind and Deaf patients will be carrying a red and white stick. Always introduce yourself. Do not assume that they will need you to guide them as not all blind deaf people have total visual or hearing loss. Look directly at the patient when talking. People who have a physical disability: Offer assistance to disabled customers entering and exiting the store. Their physical disability may mean that it is painful to stand so offer a chair and get the product for them. If they need you to take their money out to pay for something then ask permission however, make sure that they can see what you are doing and count the money out in front of them. If you still feel uncomfortable ask another staff member to watch you. Page 20
Speech and language problems: Establish the customer s needs by asking basic questions. Use simple language and concentrate on what they are telling you. If you need them to repeat what they are saying be honest and just ask. Be patient and try not to speak for them or try to correct what they are saying. Reading and writing difficulties: Always confirm that they know what the prescription is for. Read through the prescription with the patient and complete it on their behalf asking them to sign at the end. Learning difficulties: Be prepared to repeat yourself and be patient. If they have a carer ensure that you speak to the patient but allow the carer to answer. Mental health problems: Explain who you are and what you are trying to do for them. Ask simple questions such as What is your name? and Are you alone? to establish the situation. If the person is carrying a bag and may have any form of identification on them ask if you may see it. Try to find a number and see if anyone is available to collect them. Stay with the patient until someone comes and engage them in conversation. Disfigured: Try not to treat them differently or stare. Do not make them feel uncomfortable even if you are. If you are unable to carry on helping the customer then ask another member of staff to help you or take over after explaining the situation to them. Talking to patients over the phone can be difficult. These tips will help: If you cannot hear the customer well and ask them to repeat themselves. Speak clearly and directly to the telephone. Be patient and ask if there is anyone with whom you can talk to such as a carer. You could also suggest that someone collects the prescription on his or her behalf. Page 21
In wheelchairs: Keep a list of taxi numbers who can accommodate a wheelchair near to your phone. Offer the customer assistance and ask how best you can help them. Do not assume the patient wants you to push their chair. Other Points: If a disabled patient enters your Pharmacy and they approach you then proceed to help this patient and direct your staff to help the rest of the queue. Hearing dogs wear burgundy jackets. Guide dogs wear yellow jackets and sometimes have a special harness to help guide their owners. Never put a dog on an escalator use lifts or stairs. Never fuss a guide dog. In the event of a fire help disabled customers out of the store and stay calm. Leave them with a member of staff outside if going back into the shop. Page 2 Page 22
Additional Compliance Aids or information Page 23
Produced by The Community Pharmacy Team: David Onuoha Laura Holm Laura Thurston