Routines with multiple medicines
Listen to patients taking multiple medicines talk about how they manage their medications in everyday life.
Many people we spoke to found that establishing a set routine was helpful in making medicines a normal part of their life and, once it was ‘second nature’ to them, their routine was easy to maintain. This could be so successful for some people that they felt that ‘something was not right’ if they forgot their medicines. However, creating these routines and acquiring this kind of comfort and familiarity take some time. Furthermore, if a well-established routine is sufficiently disrupted, it can be difficult to re-establish it; as one participant said, she needs a day to ‘get readjusted into the rhythm of them again’.
Establishing effective medication routines
People who had medicines added to their regimen gradually over time feel this helped them to adapt their usual routine. It is also particularly easy for people who take all of their medicines at once, such as first thing in the morning or with breakfast, so they can concentrate on the rest of their day.
Many people did not have to make changes to their usual routine to accommodate taking their medicines. As one participant said, ‘medicines fit in with me’. Managing medicines is also straightforward for those who are taking only a few and have a regimen that is not demanding. However, the complexity of the regimen and the potential for confusion increase as the number of medicines they need to take increases.
Jan’s medicines were introduced individually over time, which made it easier for her to maintain a routine and feel ok about her health.
Sue has a well-established routine, but minor changes are sometimes made after results of a medical test indicate something different needs to happen. There is then a ‘re-adjustment period’ before she feels comfortable again.
Complex medication regimens
Starting a routine of complex multiple medicines all at once can be extremely demanding. Most people find that they need assistance from other people and a system of strategies to help them to establish a good routine. However, the converse is also true for some people we spoke to: routines can suffer over time once they no longer need close attention and mistakes can be made almost without realising it.
The timing of complex regimens is particularly challenging for some people, particularly if they experience side effects which need to be managed; for example, diuretics mean that people need to be close to a toilet, and many medicines cause drowsiness which can have a significant impact on waking hours.
Some medicines that need to be taken at the same time each day may mean that certain activities, particularly irregular ones like sleeping in on weekends, need to be adapted to accommodate the requirements of the medicine.
Jane was assisted by starting a new medicine regimen in hospital and developed good habits when she was at home.
Helen found it easy to manage her medicines in the beginning when they were new. She has become a little complacent over time.
Orderly strategies to support medication regimens
Precise routines associated with their medicines are enormously helpful to most of the people we spoke to. This can be the way in which they fill their medication organiser or ‘dose aid’ to prevent confusion and mistakes. For example, one person always begins with the small tablets when she fills her dosette box and works up to the largest tablets, to avoid confusing tablets of the same size. A number of people are assisted by their pharmacist to organise their medicines in Webster-paks.
The actual taking of medicines in a very specific and orderly way is another helpful strategy for some of the people we spoke to. No matter what approach is used, the important thing is to find a system that works, and to be organised and disciplined enough to use it consistently.
Suzanne finds that, provided she fills her dose aid before bed as the last thing she does in a day, she generally remembers to take all of her medicines every day.
Lesley finds her medicines easy to manage because she keeps to a very precise routine.
Niall has a very precise procedure for removing his medicines from the packet, counting them and taking them to avoid making mistakes.
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Many people maintain a set routine by ‘linking’ the taking of medicines to other day-to-day tasks. This commonly includes mealtimes (particularly breakfast) and before or after brushing their teeth.
Emma associates taking her medicines with her everyday routines of getting up in the morning, having breakfast and going to bed.
Having some flexibility in the medicines routine is helpful. Some people we spoke to have confirmed with their doctor which are the ‘absolute must-have’ medicines that they cannot miss and which ones are not harmful if they do occasionally forget. Medicines that can be taken at alternative times in the day are helpful, as people can ‘make up’ for it later if their usual routine is disrupted.
Nancy finds her medication regimen easy, as it works into her day and she can take one at different times of the day.
Having prescriptions that were up-to-date and remembering to have medicines dispensed was another area that people sometimes struggled with. Most of the people we spoke to were diligent in checking that they had a prescription once they had reached the last sheet of tablets in a box; one participant marked a bottle of liquid medicine with a sticker and would check she had a prescription once the level dropped to the sticker.
Disruptions to medication routines
Even when people have a straightforward regimen that they are in the habit of following, mistakes can happen when their usual daily routine is disrupted. Being unwell, additions or changes to the medicines regimen, or even going out for an evening can all have a negative impact.
Some medical conditions are anything but ‘routine’; some conditions, like asthma and diabetes, are highly variable; and symptoms such as pain can be intermittent and unforeseen. People who have these kinds of conditions need to be prepared always. They need to carry their medicine with them and they always need to have a prescription on hand, so that they never run out. Many people often find that unexpected events in life can get in the way of their usual medication routine.
It’s very clear in Jan’s mind how many tablets she needs to take every morning and this helps her with her routine. She only finds it difficult to remember her medicines when she is really ill.
Russell often needs to work late or into lunchtime unexpectedly. He needs to anticipate these occasions and have his insulin for diabetes with him at all times.
Lesley was caught without her medicines when her husband was in hospital at the end of his life and she needed to stay with him.
However, changes in routine can be a help to maintaining medication regimens, depending on the circumstances. The regimens of some people need to change quite often for symptom or pain control; being in pain or feeling poorly will prompt them to take their medicines as needed.
Mia does shift work and consequently does not have a set routine. Her symptoms trigger her to take her medicines instead.
Helpful ‘tools’ in creating routines
Having helpful ‘tools’ can facilitate medication routines by making them easier to remember and easier to take. Some people use a pill cutter (available from pharmacies) so that they can quickly and easily break large tablets to make them easier to swallow.
Many people set an alarm for medicines that are most likely to be forgotten, often in the busiest time of their day. Others find it helpful to write down changes that are made to their regimens; this may mean typing up a schedule to refer to, or using sticky notes as visual reminders to take their medicines, until the change becomes routine.
Many people find it helpful to leave their prescription at their regular pharmacy; some of these people will receive reminders from the pharmacy if their prescription is due to be filled.
Jane uses a number of aids that work for her to remind her to take her medicines correctly.
Phoebe has easy tricks to help remember where she is up to when taking her medicines and filling her dosette box and that help her take medicines while she is out.
Other people were noted as being extremely helpful with managing medication routines (as with Jane above, whose children would tell her when her reminder alarm went off). Couples and family members who need to take their medicines at the same time often do so together, which helps them remember to take them and minimise mistakes.
Lyn calls on her pharmacist to help her manage her routine when a new medicine in introduced.
What people also talk about
The Living with multiple medicines project was developed in collaboration with
