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Drug compliance
It must be admitted that relatively few patients leave the consulting room with a clear idea of the nature and dose of the prescribed medication, partly as a result of fear of th
and partly because of the difficulties of understanding complex therapy. Here, nurses can play a valuable part in reducing difficulties and misunderstandings, particularly when dealing with the elderly and/or confused patient, and it is often helpful to ask patients to repeat the directions that they believe they have been given. Misunderstandings and errors can then be cleared
up at an early stage. The containers of the dispensed medicines should bear not
only the name of the drug, but also useful additional information such as The Heart Tablets’ or ‘The Water Tablets’. Vague directions should be avoided: whenever possible definite times for administration of drugs should be arranged. Such timing can be linked with some regular activity, such as a meal time, or a favourite TV programme may be used as a memory aid for regular dosing. With multiple therapy, patients should be encouraged to set each day’s dose aside, so that a double dose of a drug will not be taken by forgetfulness. Patients should be advised that the occasional missed dose is not always important, and a missed dose should not be made up by taking a double dose later on.
Although regular dosing is important in securing patient compliance, many modern drugs have relatively long half-lives so the regular administration of full doses for long periods may lead to overdose. The ideal dose depends on many factors, including absorption, metabolism, transport and excretion, but in many cases the margin of safety is fairly wide. In the elderly, however, reduced renal efficiency may lead to the gradual accumulation of a drug with insidious toxic effects. Many elderly patients, for example, on digoxin, may become overdivitalized because of poor metabolism and excretion of the drug. It is by no
means unknown for elderly and confused patients, once admitted to hospital for observation, to make an apparently surprising recovery from an illness that was basically due to over-medication, often as a result of following blindly a misunderstood drug regimen. It is here that the community nurse has an exceptionally valuable part to play in ensuring regular and accurate medication, and reporting any incipient signs of overdose or side-effects.
Ail increasing problem of current therapy is patient compliance with prescribed treatment. It is easy for a doctor to prescribe, but to ensure that the patient takes the prescribed drugs in the right dose is a very different matter. The magnitude of the problem has increased with the rise in multiple therapy, and the reluctance on the part of some doctors to prescribe mixed products.