According to a recent report from the National Center for Health Statistics, 40 percent of visits to the emergency room (ER) by nursing facility residents were “potentially preventable.” With a heightened focus on reducing those preventable trips to the ER, one area that comes under scrutiny is that of medication management.
Self-administration of medication is an area that is frequently overlooked when attempting to reduce the amount of preventable trips to the ER. Often, elderly clients have several physicians and specialists who all have prescribed one or more medications to manage chronic conditions.
Sometimes the sheer amount of medications can be overwhelming for a patient to remember proper dosages and correct dates and times to take certain pills. Being able to adhere to a medication regime independently will reduce de-compensation of chronic conditions and improve health maintenance.
The ability for therapists to gain insight into the cognitive deficits many patients exhibit is critical to providing quality patient care. It is necessary for therapists to assess a patient’s ability to manage administration of their medications safely and accurately in order to assure a safe discharge. One tool that assesses this area is the Medbox Medication Assessment, which is part of the Cognitive Performance Test developed by Theresa Burns, OT.
The Medbox Assessment evaluates the patient’s ability to set up a weeks worth of medication using daily pillbox containers. They must follow the instructions on the labels of sample medication bottles. The assessment scores patients by the cognitive-functional level on the ability to interpret and follow medication labels along with being able to identify inaccuracies with the prescribed medications and how to correct the errors. The complexity of the task is adjustable to match the cognitive ability of the patient.
An example of the test is for a therapist to instruct a patient to follow the directions of four bottles of dummy medication and two pillboxes. The therapist then assesses the patient’s ability to accurately follow the instructions on the medication label. The test leaves some room for error, such as missing a single dosage, which allows for the patient’s care plan to be adjusted according to the level of adherence with the assessment. Results of the test are used to predict the performance of the patient’s individual regime by linking the cognitive ability of the patient with the complexity of the patient’s medication regime. It helps identify what amount and level of assistance the patient will require for medication management once discharged. This information can then be presented to families and caregivers.
Maxwell Perkins, Director of Clinical Services, M.S, OTR/L, says The Medbox Assessment correlates with the Allen Cognitive Levels (ACL), which is the corner stone of Infinity Rehab’s cognitive performance assessments. Both the Medbox Assessment and the ACL are tools that help therapists gain insight into cognitive deficits someone may have and how that cognitive deficit affects them functionally.

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