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April 17, 2008

Zagar and ULM student pharmacists develop safer medication management methods for low vision patients

Understanding that patients with low vision problems may have difficulty or complete inability to read medication labels on prescription vials, ULM College of Pharmacy instructor Dr. Michelle Zagar assigned a project that would help her students relate to patients with visual impairments.

Zagar's students were assigned to wear goggles designed to simulate conditions of various low vision diseases. Low vision is an impairment that primarily affects people over the age of 65. The condition is usually the result of eye diseases such as cataracts, glaucoma, diabetic retinopathy or age-related macular degeneration and currently affects more than 6.3 million Americans. Vision related conditions may contribute to patients taking incorrect doses, thus leading to overdoses or inadequate treatment of health problems.


The goggles worn by students were actually welder's goggles with lenses altered or obscured in a manner to simulate conditions of various low vision diseases. Upon wearing the goggles, the students engaged in several medication-related tasks under the altered conditions ­ for example, drawing water out of a bottle with a syringe to simulate drawing insulin, or pouring colored liquid into a spoon to simulate taking cough syrup.

Afterwards, the students were asked to design a device, technique, routine, or other way to help low vision patients adhere to their medication regimens.

Students from each group presented their projects to members of the Low Vision Support Group at the Ouachita Council on Aging Saturday, April 5.

These are some of the distinctive methods that the students came up with:

Vial Dial

This device is for patients with Diabetic Retinopathy (spotty vision). The Vial Dial requires that a pharmacist simply combine a standard pill container located in the pharmacy with an audio recording device. These devices can be found a number of ways, ranging from the toy aisles of local superstores to versions sold on the Internet and made specifically for custom use. The group chose their recording device from because of the generic version¹s ease of use and purchase. When obtained in this manner, the voice recorder costs as little as $4. If the device were produced on a mass scale for this purpose, the price for each one would likely be even less.

Once the pharmacist obtains the audio recorder, he or she records the pertinent information for identifying which drug the diabetic retinopathy patient is about to take as well as the instructions for how to properly take the medication. The pharmacist does so by holding the device close to the mouth, pressing the record button, and speaking into the miniature microphone. Once an acceptable message has been entered into the apparatus by the pharmacist, the record button can be hidden to prevent the patient from accidentally recording their own message.

Lastly, the pharmacist attaches the recorder to the vial with any type of normal adhesive, preferably underneath the cap to avoid damage. With the playback button centered and distinctly raised on the device, diabetic retinopathy patients should have no trouble using the recorder to safely manage their medications.

For patients on multiple medications, a star or similar symbol will be placed on both the prescription cap and vial to avoid placing the wrong cap on the wrong vial at home. That way, patients will know the "star" cap goes with the "star" vial, the "heart" cap with the "heart" vial, and so on.

Third-year student pharmacist Dana Madaffari found the assignment increasing her empathy. "After this experience I was able to put myself in the patients' shoes. We came up with an inexpensive solution to a very debilitating vision problem."

Team members are: Madaffari ­ Baton Rouge, Mark Landry ­ Metairie, Leo LeBlanc ­ Slidell, and Darren LeBlanc ­ Slidell.

Sticker Project

The sticker project will be used for patients with cataracts (blurred, yellow vision) and will involve highlighting the indication and daily doses of each medication taken by a single patient.

The indication will be designated by a black-and-white sticker on the side of the vial with a picture of the intended use. For example, a blood pressure or heart medication will be indicated by a black-and-white heart.

The number of times per day the patient is to take the medication is designated by a sun (if taken once daily in the morning), by a star (if taken once daily at bedtime), or by a number (if taken more than once daily).

A chart for quick reference will also be given to each patient. The two-column chart will have the following headings: "Why am I taking this medicine?" and "How often do I take this medicine?" Under the first heading will be a duplicate of each picture appearing on the vials of the individual patient along with a description of the intended use written in large black letters. Under the second heading will be a similar legend describing the daily dosing stickers.

As the pictures will all be drawn in black marker on white stickers, this will provide a clear contrast with minimal chance of color distortions. The legend provided to each patient will aid in understanding and help to prevent confusion.

Third-year student pharmacist Holly Little said, "Studies have shown that patients have increased compliance if they understand why they are taking the medicine. The sticker chart will help the patients understand what medication they are taking and why they are taking it. This activity will definitely cause me to have more patience with visually impaired patients and will increase my effort in helping solve their problems."

Team members are: Kayla Brown - Monroe, Little ­ Winnfield, Laura Trahan ­ Monroe, and James Thibodeaux ­ Lake Charles.

Puff-Paint Project

In order to aid patients with cataracts, the group decided to use fabric paint to draw symbols on a prescription vial. On the cap, they used dots to denote how many times the medication should be taken in a day; for example, if the medication should be taken three times daily, three dots will be drawn on the cap.

The students also used the paint to draw lines on the bottom of the vial to let the patient know how many pills should be taken for one dose. If the patient is to take two pills, there will be two lines on the bottom of the bottle. If the prescription specifies that the drug should be taken in the morning or at night, a sun or moon will be drawn on the cap. If the drug must be taken with food, an "F" will be drawn on the cap.

Patients with cataracts experience blurred and distorted vision. They are still capable of seeing, but they have problems reading small details and distinguishing between colors. These methods will enable the patient to overcome the problems by allowing them to use their sense of touch to determine how the drug should be taken. In addition, the larger size of the drawings will be easier for the patients to see. The drawings make it simpler than reading the prescription label. This method eliminates the need for the patient to distinguish between pill colors, shapes, and sizes.

Team members are: Amy Jarreau ­ Erwinville, Tien Nguyen ­ New Iberia, Maghon Manuel ­ Monroe, and Tiffany Dauzat ­ Marksville.

Flip-Cap and Recorder Vial Project

This group developed a device that will allow patients with macular degeneration to use their sense of hearing to help them manage their medications.

The students will first develop a vial with a flip cap attached to it so that the cap is never separated from the vial. This is important because on the cap there will be a button for the patient to press. When they press it, he or she will hear the name and strength of the medication, its indication, and the dosing regimen. The recording will be done by a pharmacist prior to dispensing.

The students intend to market the recorder to be used on over-the-counter medications as well, ensuring that the labels on these bottles will be done in a very large print, thus allowing the patient to have a better chance of deciphering what it says. The name of the drug would not only be large, but the letters would also be raised so the patient can use their sense of touch to feel each letter. This will serve as a way for the patient to double check that they are handling the correct bottle of medication.

The group feels that this device will help patients with macular degeneration because it would minimize medication errors and improve compliance. Rather than trying to guess how many times a day the label says to take their medication, these patients would now be able to hear the directions and do as told.

As a result, therapeutic results should be positive. For instance, if these patients take their medication when and how they are supposed to, they may get their blood pressure under control. Then, once they begin getting positive results when they visit their doctor, it should be encouraging; therefore, they will continue to take their medication regularly, and patient compliance will be enhanced.

Another way this device is beneficial for this population is that it may help them feel more independent and more comfortable when taking their medications on their own. By literally hearing their pharmacist tell them how to take their medication, there will be no doubt in their minds that they are doing everything correctly. This is perhaps the most important reason, because it would likely improve their quality of life, as many elderly individuals do not necessarily like other people to help them, feeling pleasure instead in being more independent.

Team members are: Hannah Brown ­ Jena, Tamara Byrd ­ Rayville, Ashley Decoux ­ Youngsville, Jennifer Teat ­ Jonesboro, and Trey Turner ­ Eunice.

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