Tools for Caregivers: the Portable & Up-to-date Medication List

At a recent retreat for family caregivers, I proposed four key tools that I recommend to caregivers who want to improve the healthcare of an older person:

• Journal/notebook, for notes and symptom tracking (see last week‘s post for more details)
• Portable and up-to-date medication list
• Organizer to keep copies of medical results and medical records
• Personal/family task organizer

In this post, I’ll explain why I always recommend caregivers make an effort to maintain a portable and up-to-date medication list. Then I’ll discuss some tech tools that caregivers can consider.

Why caregivers should maintain a portable & up-to-date medication list

One key reason to maintain an up-to-date medication list is so that you can make sure doctors and nurses have the right information, when you bring the older person in to see the doctor.

Why is this so important when it comes to better healthcare for older adults? Here’s why:

• Proper treatment of most symptoms and problems affecting an older person should be based on reviewing an up-to-date medication list.
  • Example: if an older person’s blood pressure is very high, then it’s important for the treating clinician to see what a patient has been prescribed (and is taking, which may not always be the same thing!)
  • Some problems may actually be caused by medications, especially those known to be potentially inappropriate for older adults. (See this recent post for more on spotting potentially risky medications.)
• Medication lists maintained by doctors’ offices are often either incomplete or out-of-date.  
  • This is especially common if the older person is taking more than just a few medications, or if he/she sees more than one doctor.
  • Families should never assume that doctors and hospitals have fully updated each other regarding medication changes. Although this is supposed to happen, often there are delays or errors in communication.

In my own experience, I’ve found that patients and families often think that doctors automatically get the latest information related to the medication list. Many times I’ve even been told by patients that “it’s all in the computer,” but when we’ve taken the time to look at the actual medication bottles, we uncover all kinds of changes and mismatches.

So, I generally recommend that families bring in the actual medication bottles themselves, but the next best thing is to have an accurate and up-to-date prescription list.

Caregivers should be prepared to give doctors and nurses a printed copy of an up-to-date medication list, every time the older person goes to see a medical professional.

Tools that Caregivers Can Use to Keep a Medication List

There are many different ways that caregivers can maintain a medication list. Here are the two most important issues that I recommend caregivers consider when deciding on a method:

• Make sure it’s easy to update and edit the medication list. If it’s not easy, chances are that a busy caregiver won’t keep it updated.
  • This is especially vital for those caregivers helping someone who takes many medications, or who sees more than one doctor…since these families experience lots of medication changes!
• Make sure it’s easy to bring a printed copy of the list to a doctor or nurse. It’s nice to be able to show the doctor an up-to-date list, but often doctors will want to put a copy of the list in the chart.
  • Bringing a printed list means that the doctor’s office won’t have to retype the list, which saves time and reduces errors. (I’ve had to copy a med list off a person’s smartphone; not ideal!)

How to actually maintain a medication list? Here are some options that I’ve seen caregivers use:

• Word/Excel spreadsheet. So far, this is what I’ve seen work best for caregivers. Usually people use a table format, with columns for the name of the medication, the dosage, and the instructions for taking it (i.e. “once a day” or “every night at bedtime”).
  • Pros:
    • Easy to update and easy to read.
    • Flexible: can include columns for extra information, such as the purpose of the medication, or the prescribing doctor. 
      • A column for miscellaneous notes can come in handy for keeping track of when the medication was changed, or other details.
    • Can be backed up or shared online, so easy for families to collaborate or share information.
      • Options include Google Documents, Evernote; or can use something like Microsoft Word or Excel along with a service like Dropbox.
      • These also allow documents to be viewed with a smartphone or tablet
    • Some programs, like Google Documents, maintain a history of revisions and changes, which can come in handy.
  • Cons:
    • Data is usually not encrypted, so less secure than using apps or services designed specifically for health information.
    • Caregivers still have to spend a little time entering medications, and printing the list before visits.

• Medication apps for smartphones and tablets. Many apps are now available for both iOS and Android. They include health apps with a section for listing medications, and apps specifically meant to help people remember to take medications.
  • Pros:
    • For apps created by big pharmacy chains, medications are often easily synced with pharmacy records, which means that users don’t have to spend time carefully entering medications.
      • This is only a pro if a person is using just one pharmacy chain consistently! (The list won’t be up-to-date if one uses a local pharmacy for some medications and a mail-order pharmacy.)
      • Note that pharmacies usually do a bad job of recording when medications are stopped, because doctors don’t usually report this information to the pharmacies.
        • Caregivers may need to manually correct the list when a medication is stopped.
  • Cons:
    • Most apps require people to enter medications manually, by filling in multiple fields in the app.
      • This is often slower than typing into a Word or Excel document, and can make it hard to keep the medication list updated.
    • Can be hard to print a list to bring to doctor.

• Pen and paper. This method remains popular, but I’ve found that very few families are able to keep a hand-written list up-to-date, especially if the person is taking more than just a few medications. Blank templates or tables for medication lists are often available online.
  • Pros:
    • Low-tech: no computer, Internet, or smartphone needed.
  • Cons:
    • Lists often become hard to read when families start crossing out medications or making partial edits. (I’ve seen many such lists, because people don’t want to have to rewrite the whole thing!)
    • Can be time-consuming to rewrite the list neatly.

For now, the strategy I recommend to caregivers — assuming they are comfortable with computers and have internet access — is to use either a document program or a spreadsheet, along with some method of online back-up. Google Documents (now part of Google Drive) is easy-to-use, makes it easy to share with other family members, and can be viewed on mobile devices. Plus it even keeps track of revisions, so you can easily view past versions of the list!

Families who feel especially concerned about protecting health information may want to consider dedicated services for online or mobile health information, since these routinely provide encryption. However, I haven’t yet found anything that seems quite as easy to use and update as a document or spreadsheet program.

If you are a caregiver — or work with caregivers — and have found a good way to maintain an accurate, up-to-date, and printable medication list, please share in the comments!