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Isn’t It from Top to Bottom?

Dr. Neil called me. She needed stat labs for an elderly patient, June.

Esther,” Dr. Neil explained to me, “a few days ago, June took three Lisinoprils, three Metoprolols, and three aspirins, all on the same day!”

Shocked, I asked, “She didn’t bottom out or have a heart block?”

“No,” Dr. Neil replied. “I just finished a televisit with her today, and she seemed fine. But I just want to be sure by getting some labs done.”

I scheduled June for the next available slot and informed our lab, as well as Jennifer, June’s niece. Jennifer had to convince a reluctant June, who was tired and wanted to sleep, to come in to the office—but she did.

Meanwhile, I asked the pharmacist to blister-pack June’s medication, in the hope of avoiding a future medication mistake.

“Esther,” he replied, “she’s already getting her meds in a blister pack. I gave the niece a new pack last week.”

“Huh,” I said. “She may need visual cues. What do you suggest?”

“How about rubber-banding it?”

“What do you mean?”

“I mean putting a rubber band on the blister pack under each day, so they know not to go below it.”

Cool idea! And how about we draw a line with a red marker under each day, where the rubber band should go?”

“Sounds like a plan!” the pharmacist agreed.

I picked up a new blister pack from him.

Later, June shuffled into the lab, her niece Jennifer guiding her gently.

“I had to teach,” Jennifer explained, “so my mom helped her with her pills a few days ago. Instead of getting out the morning, afternoon, and night meds, which are in a horizontal row, she took out three days’ worth of morning meds in a vertical row! I didn’t realize it till the next day, when I got out the blister pack to give June her morning pills! When I asked about the empty blisters, she said, ‘Isn’t it from top to bottom?’”

I reviewed the “rubber band and red marker” method with Jennifer.

After the labs were drawn, I got June in for a same-day visit. Her vitals and EKG were perfect, and the family left, satisfied that June was safe—for now!

Later, Jennifer reported that the rubber band method was a hit at home and that June, a wannabe singer, strums on the rubber band as she waits for the water to wash down her pills!

Esther Pottoore
Yonkers, New York

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