Counseling patients who are blind or visually impaired
One to One
One goal of FDA’s Safety and Innovation Act is to increase access to medications for all populations. This past year, the U.S. Access Board created a series of recommendations focusing on one group of patients who were included in the 2012 revision of the act: those who are blind or visually impaired.
This patient population, many of whom are older than 60 years, may be more likely to take multiple medications and have caregivers or family members helping administer their prescriptions. Pharmacists can play a role in ensuring that patients with visual impairments take the correct medication in the right amounts at the proper time.
FDA recommendations only cover labeling, not adjunct materials or patient information, but Ray Bullman, Executive President of the National Council on Patient Information and Education, said the recommendations are a good way to help pharmacists become aware of the needs of this patient population. “This is a fairly siloed issue, and I think this effort by the U.S. Access Board is a good first step,” Bullman said. “This is the point where medication ends up going into the patients’ hands, so it makes sense it would be one of the push points.”
Helping patients can begin with paying attention. If a patient is having difficulty reading a label, take a moment to ask if he or she would be helped by counseling or education. Offer to help patients and their caregivers list all their medications, vitamins, and supplements. “This reinforces the importance of face-to-face, direct patient consultations,” Bullman said. “If, just at a minimum, it is counseling on a high-risk or new medication and going over its warnings and precautions.”
Create an environment where patients are encouraged to ask for assistance. One way to help is through innovative labeling techniques. Make sure patients with visual impairments know that options are available to them, and work with them to provide the one that best fits their needs.
One possibility is offering Braille or large-print labels on medication containers. Electronic equipment is also available. Digital recorders attached to a container provide a voice recording of the label information when a patient presses a button. RFID (radio frequency identification) tags on containers announce the information on the container when the device is placed above it. Computer or other electronic devices can be used if a pharmacist encodes the drug container label for the patient.
Patients may be able to feel their medications and recognize the different shapes and sizes. Tell patients to keep medications in their original containers and, if possible, learn which tablets are kept in the bottles. Some containers can be differentiated by size or shape, such as OTC medications or unusually shaped bottles.
Recommend strategies patients can use at home to organize medications, such as placing them in alphabetical order and keeping them where they take them (e.g., evening medications on the nightstand and morning medications at the breakfast table). Patients can also use their own system to track medications. One inexpensive option is to mark the bottles with rubber bands. If three different medications are in bottles that look alike, mark each bottle with a different number of rubber bands to distinguish between them.
Here are a few other tips pharmacists can suggest to patients:
- Throw away medication once it is expired. This will help reduce the number of bottles sitting around unnecessarily.
- Use dark trays, as they provide the best contrast against most medications.
- Keep a light or magnifying glass near where you take your meds each day.
At the least, pharmacists should have some resources available on hand, Bullman said. Resources would include a list of community service organizations for patients who are blind or visually impaired, names of local contractors that provide Braille translation, and places people can access electronic labeling devices. Vision Aware offers information for living independently with visual impairments. The National Eye Institute offers a tip sheet for patients who are visually impaired. And finally, keep a copy of the U.S. Access Board report handy for reference.