If you’ve worked in a SNF or other inpatient rehab setting for any length of time, you probably know that medication management is an important skill clients must master before discharging home. Taking medications at the wrong time or in the wrong dosage can land a client right back in the hospital, or worse. And yet, medication management can also be difficult to assess, especially when you are working with the client outside of their home and environment. Here are some components of medication management that are important to consider before a client heads home.

Fine motor coordination and control.
Perhaps the easiest component of medication to assess (and the one we probably all think to cover) is fine motor coordination and control. If a client cannot open a pill bottle or manipulate a single pill in their hands, they will have a hard time setting up their own medications. And even if a family member sets up their pill box for them, if the client is unable to open the pill box independently and remove all of the pills from each day’s slot, then they still won’t be able to safely take their own medications.

To assess fine motor coordination and control as it relates to medication management, get samples of pill bottles from different pharmacies for clients to practice opening. Make sure to ask them where they fill their prescriptions and if these bottles are similar to those they use at home. Provide samples of pill boxes and have your clients practice manipulating pill-like objects such as candies or beads to determine if they are able to both fill and empty the pill boxes successfully and without errors. Be sure to ask what style pill box they use at home (if any) and make recommendations if you find they struggle with a particular style box.

Cognition and comprehension.
Another important component of medication management to assess is the client’s ability to comprehend and accurately follow through with the instructions on their pill bottle. They may be successful with previous medications they’ve taken for years, but what if the doctor changes their prescription? Or what if they are prescribed a new medication when they go home? Can they follow these new instructions without errors?

A good way to assess this is by providing samples of pill bottles with instructions (either old with names removed or fake labels you create) and having the client follow the instructions as they set up a pill box. If possible, try to use both familiar instructions and less familiar ones. And check carefully for errors. You can also ask your client to repeat the instructions to you in their own words or ask them application questions related to the instructions, such as “how many pills would you take in the morning?” or “would you take this medication at lunch?”

Processes and procedures.
A component of medication management that is both more difficult to assess and more easily forgotten is the overall processes and procedures that a client uses when managing their medications. These include things such as where are medicines stored, when are prescriptions refilled, what does a client do when they get a new bottle of pills, etc.

While it can be difficult to identify and address all potential safety concerns, it is important to at least make an attempt. In many cases, medication management related conversations and observations during the course of therapy sessions can help to identify potential warning signs. Does the client place the extra “pills” back in the correct bottle? If they run out, how do they handle the activity? Does the client mention anything unusual such as the label wearing off of their bottle at home, perhaps indicating they’re refilling bottles rather than replacing them? Do they have a family member with low vision who stores medications in the same cabinet they do? Do they mention saving old medications that might be left over after a short term illness? Any of these could indicate potential safety issues related to medication management.

Medication management can be a complex occupation, but occupational therapists can make a difference in their client’s performance of medication management if we take the time to fully assess their performance and are alert and attentive to potential safety concerns. By focusing on fine motor coordination and control, cognition and comprehension, and processes and procedures, we can get a better picture of how clients will be able to perform medication management tasks in the home and make appropriate recommendations and modifications for their safety.