Teaching a Patient about Medication

My teaching plan for Mr. M would begin with a simple introduction of myself and the purpose of the lesson that I would be teaching him that day. I would use a printed out sheet with pictures rather than many words that help to explain the process for each of his four medications; these highly-visual and easy to follow sheets can be used to explain his medications, how to take them, when to take them, how much to take, and when he should call for help. As Cowan (2004) points out, it is important for patients who have low literacy to still have a way to understand their medication processes in clear and certain terms. These sheets would serve as teaching guides as I move along in the teaching plan for Mr. M. The following steps in the process would
Step 1: Make Sure the Patient Knows Why He is Taking the Medication
Each of Mr. M’s medications should be explained to him so that he knows what it is meant to be treating. The medications should be explained in the context of his recent hospitalization for uncontrolled hypertension and hypercholesterolemia. I would explain to Mr. M. that these medications are to help him control his stress and his cholesterol levels so that he can maintain his health better. The next step would be to explain how each of his medications helps achieve that goal.
Step 2: Review the Medications
· Metoprolol 75mg PO BID—one pill, by mouth, twice a day (recommend taking a pill after main meals, breakfast and dinner)
· Used to treat hypertension and chest pain
· Take twice daily, one pill after eating main meals—either breakfast and dinner or some other combination of meals
· Avoid mixing with alcohol
· Lipitor® 20mg PO QHS—one pill, by mouth, at bedtime
· Used to treat high cholesterol
· Terazosin 2mg PO QHS—one pill, by mouth, at bedtime 
· Used to treat hypertension
· Nitroglycerin 0.4mg SL x3 PRN for chest pain—up to 3 pills over a 15 min. period when necessary…call 911 if after three pills in 15 minutes, the pain is not eased.
· Used to treat angina—chest pain
Step 3: Brief the Patient about other Medications
· Make sure the patient knows to contact his physician before mixing other medications with his prescriptions.
· Make sure the patient knows the amount of each drug to take and where to find this information on the medication as well as on the printed sheet provided to the patient.
· Review with the patient the process of accessing his EHR online in case he loses his sheet or needs to know any other information about his prescriptions.
· Provide the patient with information on how to obtain a refill for his prescriptions and when he should seek renewal.
Step 4: Brief the Patient on the Need to Budget for the Medications so That He is Never without Them because of a Lack of Funds
Part of the budgeting process is the planning process. Review with Mr. M. the importance of marking on a calendar when each of the prescriptions will run out so that a new prescription can be ordered ahead of time to ensure that Mr. M. is never without medication.
It is also important to go over the costs of the medication so that Mr. M. knows that he must set aside “x” amount of dollars for each filling of the prescriptions. Knowing that there is a cost associated with care will help Mr. M. understand the importance of this plan. Try to gauge whether Mr. M. will have problems funding his prescriptions without being too direct or embarrassing the patient. I may say something like, “These medications will be an additional expense for you when the prescription has to be renewed. How will that fit into your finances?” An open-ended question like this will give Mr. M. room to think about it and respond appropriately. If he shows signs of not being sure whether there is room in his budget for them, schedule a follow-up call with Mr. M. with someone from financing.
Step 5: Keep the Medication Someplace Where It Will Not be Forgotten
· In the bathroom near the toothbrush is a good place
· On the window sill over the sink is another
· Or on the nightstand by the bed (for bedtime medications)
· Somewhere where it will be seen throughout the course of the day
It will also be helpful to teach Mr. M about the importance of getting into a habit or routine of taking the medications every day at a set time. Once the routine is established and the habit formed, Mr. M. will automatically take his medications without requiring much effort to think about it. This can be taught to Mr. M by explaining that the best time to take Metoprolol would be after lunch and dinner, or after breakfast and dinner, depending on when he takes his meals. This way he associates his twice-daily medication with the act of eating. Lipitor and Terazosin are already prescribed as bedtime medications so they may be taken when Mr. M is getting ready for bed and can thus be associated with his bedtime routine.
A good way to help him remember that Metoprolol is twice daily is to associate it with main meals (breakfast/dinner) by using a mnemonic device—such as the letter “M” which starts off the word “meals” and the name of the medication “Metoprolol”.
Step 6: Side Effects and When to Call 911
It is important for Mr. M. to know that he may experience slight side effects after taking his medications but that these are normal. I do not want to frighten Mr. M. into not taking his medication, but it is also important to let him know that his body might not react favorably to the drugs, in which case he needs to know what to do. As Makaryus and Friedman (2005) note, the patient has to feel like the medication is in his best interest. But he also needs to feel like he is in control. For the following drugs, I will point out what symptoms to look out for and when it is important to call 911—for an emergency.
· Metoprolol 75mg PO BID: consult your physician if you experience any of these symptoms after taking to an alarming degree:
· Depression
· Nausea
· Stomach pain
· Vomiting
· Lipitor® 20mg PO QHS: consult your physician if you experience any of these symptoms after taking to an alarming degree:
· Muscle pain
· Confusion
· Swelling
· Terazosin 2mg PO QHS: consult your physician if you experience any of these symptoms after taking to an alarming degree:
· Weakness
· Blurred vision
· Swelling
· Stuffy or runny nose
· Nitroglycerin
· Headache
· Dizziness
· Lightheadedness
· Nausea
· Flushing
Patient should be advised to call 911 if he begins vomiting or if his chest pain is not reduced after taking up to three nitroglycerin pills in 15 minutes. Any other symptoms should be recorded and discussed with his physician by phone.
Step 7: Review with the Patient His Understanding of the Medication
Once the process has been explained, I will say to Mr. M., “I have explained everything you need to know about your medications. Now let’s review your understanding of what I have said.” This approach prevents Mr. M. from feeling as though he is put on the spot. He can review his understanding with me in a stress-free manner.
Step 8: Identify Family Members to Help with Support
Bringing family members into the care process can help Mr. M. to stay on task. Something as simple as a friendly reminder from a wife, child, or in-law, can be sufficient to help provide Mr. M. with the support that every person taking medication should have.
Nursing Implications
Providing a teaching plan like this one that is simple and direct helps to give nurses a better sense of how to communicate with patients to ensure that patients understand what is required of them to care for and maintain their own health. This teaching plan can assist nurses in making home visits and in teaching patients like Mr. M. who are immigrants about the basics of medication adherence. Tips and tools to remember include: keeping calendars handy so that patients know when their medication will run out and when it is time to make a new order so that there is no lapse in medication taking; having the sheets ready so that the patient can look at them for reminders; having access to the Internet in case the patient wants to access his EHR; asking the patient to go over his understanding of the medication process; and so on. The more basic the teaching plan, the better the impact it can have for a patient like Mr. M. who does not need a great deal of intricate explanation but rather an understanding of the simple processes and steps to take. It is also important for the nurse to respond to questions and to ask along the way if the patient has any questions. A teaching plan like this can help facilitate the preventive care practice that nurses should strive to provide to patients.

References
Cowan, C. F. (2004). Teaching patients with low literacy skills. Fuszard’s innovative
teaching strategies in nursing, 278.
Makaryus, A. N., & Friedman, E. A. (2005, August). Patients' understanding of their
treatment plans and diagnosis at discharge. In Mayo Clinic Proceedings (Vol. 80, No. 8, pp. 991-994). Elsevier.