Difficult to follow neither the right direction nor dosage!?
Sorting of medicine

Background of the research

In summer of 2009, non-seasonal flu has gone on a rampage, and we see many people on the streets wearing masks.

Not only apply to the flu, when you catch a cold or any disease, you get a checkup and get prescription from your doctor. You will then take the prescription to the drug store and purchase the medicines. Depends on the symptoms, you may be prescribed several kinds of medicines of different types, and with different time to take, at one time.

My father used to take several kinds of medicines over the long term while he was ailing before his death. There were medicines in the house that he needed to take at certain hour, or those he had to change the doses depending on his symptoms. Also, because he was in the condition where it was difficult for him to manage those medicines, my mother was the one who took on the management of them.

My mother also seemed having a hard time keeping track of those medicines, which she had to label big on each package of medicine, as well as sorting them by the hour he needed to take, so she would not make any mistake. However, there were times when he forgot to take them, or took the wrong amount.

Given this fact, for this month's HI report, we have researched the problems that occur when sorting and taking the medicines people receive from the hospital, as well as what they do to avoid those problems.

Research method

We have conducted a questionnaire survey with people who have done the sorting of medicine received from the hospital, for own or family in the past year. Those respondents are chosen from our online registrants and staff.

The content of the questionnaire is the followings:

• How they sort the medicines
• Troubles or mistake they experienced when sorting the medicines
• Troubles or mistake they experienced when they take the medicines
• What they do to avoid the mistake.

As a result, we have received answers from total of 62 people (27 males and 35 females) from age 20 to 72.

How to sort the medicines?

Firstly, we have asked the actual condition of sorting of medicines.

The study shows that more than half of the respondents have done the sorting of medicines by themselves, while 2% of them have sorted the medicines for their families. Also, it seems that 15 % of them do not do the sorting but let the hospital does the sorting.

When sorting, most of the respondents are likely to separate the press-through package of medicines with scissors, batch them and take each dose at the scheduled time.

Here, we would like to show some pictures of those who have taken of how they sort their medicines at home.

Person of the left photo is sorting the medicines into a medicine-sorting box, which you can purchase at drug store or hardware store. Also, the person of right photo has fixed the container to a medicine-sorting box by oneself, dividing with a cardboard by scheduled time.

Troubles occurred when sorting the medicines?

We have then asked what kind of troubles or problem have occurred when they sort the medicines.

For this question, there are more then half who have answered "nothing particular" or unanswered. Because it is about medicine, it seems they are all being careful on a routine basis.

By looking at the pattern of mistakes they have experienced, we can divide largely into the issues relate to the sorting or classification, and the issues occur when separate the medicines (spill the content when cutting it off, it is a pain to cut with scissors).

Issues related to the sorting and classification

We have received many comments that when they separate the medicines, they end up not be able to tell the difference of medicines. For this, a respondent has sent us the picture below.

The respondent who has sent this photo to us commented that, "By separating them off, there are medicines we end up not be able to determine what medicine it is immediately." Certainly, by looking at the photo, there are medicines with label that is readable and unreadable.

Within the medicines I have received in the past, there are those, which will not have such issue. Those are labeled in a way the users are able to read the label even after separating them. In addition, because it is also labeled directly on the medicine, we can tell what medicine it is after taking them out from the press-through package.

Issues occur when separate the medicines

The most response we receive is when they cut in a wrong direction with scissors, they tend to cut the part where the medicine is contained. I have reenacted the case with the medicine I have received in the past.

In case of tablet, it may just drop on the table or floor, but with powder, it will be scattered all over, and is out of control. When cutting off with scissors, those issues can be occurred in a high possibility.

We also have received a comment that it is a pain to cut with scissors.

By looking at several press-through package, all can either break up in vertical or horizontal, but not both, which means there is no cut line for each boundary of a tablet. This may be linked to the trouble to cut with scissors.

From what pharmacist has told us, there has been cut lines in all boundaries so each medicine can be separated, but then accidents occur where people swallow them in an unthinking moment without taking it out from the press-through package, and ended up hurting their esophagus or stomach. From that reason, pharmaceutical makers have set a rule to make a package of a form where each medicine cannot be separated.

Troubles occur when take the medicine

Now we have asked what kind of trouble or mistake they have experienced when they take the medicine.

All in all, the most response is that they "forget to take the medicine". What I think as a major problem is not the fact they forget to take, but the fact they take the wrong medicine or overdose. It seems that a decent number of people have experienced taking the wrong medicine or overdose, or taken the wrong dose.

As a reason of forgetting to take the medicines, it seems that many have "accidentally", "been busy on they way out" or "forgotten to take them along". We have received the following comments regarding the mistakes they make when take the medicine.

• Sort the medicines in a sorting box, but not notice when it somehow falls into the wrong division.
• Because of not being able to understand what those divisions stand for, my parent has taken the medicines in different division other than the one, he suppose to take.
• When I handed medicines to my parent for a day by dividing them into small portions, my parent had taken two portions at once in a morning.
• After drinking a cup of tea after meal, I forgot whether I had taken the medicines or not.
• I thought I had put medicines in my mouth, but was leaking from my mouth, and remained that way.

How to avoid the mistakes?

To avoid those mistakes, what are things people do? We have approached head and front.

Caution when sorting the medicines

• Sort one dose in a case with partitions
• Set out one type and one dose each on a wide table.
• Tape one dose
• Sort the dose for decided day, like per day or per week.
• Take along the package of medicine for a day with the note of their names and efficacy.
• Cut the written instruction of the medicines by each type, and put the same type in a bag. Then, start the sorting.
• Sort by reading the instruction of the medicine.
• Start sorting from the ones that can be easily mistaken.
• Because the label on package of medicine is small, I rewrite it in large.

Mainstream seems to sort each one without fail, or sort only the necessary dose. Some cut out the instruction by each medicine and sort them, or rewrite the name with felt pen.

Caution when take the medicines.

• Double check before take the medicines.
• Check the trash basket, and if there is a medicine package, it means the medicines have been taken.(avoid taking them twice)
• Check the remain amount of medicines
• Leave the empty package for a while after taking the medicines.

This way it may help not forgetting whether one has taken the medicine or not, even after a cup of tea.

Mistake or forget to take the medicines can affect heavily to the health, therefore we understand that many people are doing all kinds of things or giving attention to avoid mistakes, and also experience difficulties.

Cautious in regular life

• Carry around "medicine date book"
• Keep medicines for daily basis and medicines according to the symptoms, separately.
• If today is Wednesday, hide the section of other days except of the sorting box with tape.
• Try to memorize the types and names of medicines

Try to memorize the name... Well, that is a comment from hardworking person. Incidentally, I currently carry the medicine book around.

Impression

A heavy accident like swallow the package has not been reported from this questionnaire. However, they seem to have experienced more than a little of serious problems such as overdose or take wrong dose. Adverse effect can happen from that depend on the medicine, so they are the issues that definitely have to solve.

Created in 2009.10.30