Managing forgetfulness

Individuals can have varying levels of difficulty remembering to take their medicine(s). This could be for a range of reasons from dementia and mental health issues to no specific reason at all.

It is important to consider what patients are currently doing to help them remember to take their medicines before providing alternative advice.

Simplifying medication regimens

There is evidence that reducing the number or frequency of medicines where possible can improve adherence. Healthcare professionals may find our selection of tools and resources helpful when undertaking medication review.

Reminder systems

Encourage patients to take the lead in describing their daily routine and in considering how they can fit in medication taking easily.

Reminder systems that can help include:

• positioning medication in visible places (e.g. morning medicines near toothbrush or kettle)
• associating medicine taking with meals or other regular daily activity
• fridge stickers or magnets

Telephone or text reminders

Telephone reminders from family, friends, carers or organised through telecare companies could help people remember to take medicines. There must be a robust system in place to inform those reminding the patient about changes to medicines.

Evidence suggests text messages or telephone reminders are most effective when they are personal or interactive whilst electronic drug monitors are unlikely to improve adherence without additional support from professionals.

Medication reminder charts

Medication reminder charts summarise a patient’s medicines, what they are for, and how to take them. Some areas have their own medication chart templates.

A variety of templates can be downloaded and customised:

• The British Heart Foundation has produced a personal record for patients with heart failure which includes a chart to record medications
• Asthma+Lung UK has an easy read medicines card (A5) prompt for inhaler use. An asthma action plan and other resources are also available

Computer-generated charts

Computer generated reminder charts are practical and cost effective and some pharmacies offer them free-of-charge. They can generally be produced using pharmacy dispensing systems and system providers can demonstrate how to use this functionality.

Alarm devices

Numerous alarm devices are available. It is important patients are assessed for suitability for having these since some patients may get panicked by sudden noises or vibrations. A small selection of different devices is presented here:

Talking watches

A variety of alarms are available from the Talking Watch Shop. These devices allow a number of alarms to be pre-set and are suitable for the blind or visually impaired.

Audible/vibrating alarm watches

A variety of vibrating watches are available from Malem Medical Ltd, Pivotell and TabTime. These devices allow a number of daily audible and vibrating alarms to be programmed. They may benefit the hearing impaired.

Programmable voice reminder

Voice reminders can be a useful aid for those with cognitive difficulties who can carry on living independently provided that they are prompted to perform regular and occasional tasks by a familiar voice.

The Mem-X Voice Reminder can store up to 90 ten second messages. An alarm is triggered at the pre-set times to nudge the patient to play the pre-recorded message.

Automatic medication dispensers

These devices are programmable to open sections at certain times of the day and can be accompanied by an alarm. They may be suitable for patients with stable yet somewhat complex medication regimens.  There is some evidence to support their use. However, it is important that patients are assessed for suitability for having these devices as some can be complex to use and fill.

A range of battery operated, programmable medication dispensers with audio, visual or vibrational alarms are available from Pivotell, Medimax, Lifemax, TabTime.

Before using any devices where medicines are stored outside of their original packaging, patients or health and social care professionals should consult a pharmacist regarding any potential medication stability concerns. Hospital pharmacies may not be familiar with these devices, which can cause confusion and potentially delay discharge.

Pill bottle top with indicator and alarms

Pill bottle cap timers feature a number of daily alarms that automatically indicate the last time the bottle was opened, time of day, am or pm, and day of week. Some caps also fit onto a standard 33mm thread pill bottle but are not child proof.

Smart Phone medication reminders

There are a large number of medication reminder smart phone applications (‘apps’) available with more being developed. Most work by prompting the user to take their medication at specific times of the day through a reminder notification.

Evidence suggests that people tend to link medicines taking with activities rather than times, and that people often need multiple cues. Current evidence that the use of medication reminder smart phone applications is linked to improved adherence is modest or inconclusive. The quality and integrity of information in these apps can vary and some have been criticised for presenting inadequate or inaccurate health information which may deviate from evidence-based recommendations as well as violations of privacy.

Features of better quality apps are:

• reliable content
• availability in Android and iOS
• text or other medication recognition systems,
• alerts for caregivers and useful features such as capacity to schedule dosing regimens and back up capabilities

However, some of the ‘convenient’ features might introduce risks and patients may want to look at some options before deciding on one which could help them.