Managing Medications: Step 1 – Taking Stock

by Mary S on March 12, 2012

At NightingaleRx we’re collecting tips and tricks for managing multiple medications and making the tips available in an eBook.  I’d also like to share some of that information with blog readers since I think it’s really helpful and sharing is a good thing, right?  So here’s the first step we recommend for getting started managing multiple medications.

Step 1: Take an Inventory

When dealing with a new situation, it’s helpful to get a sense of the complete landscape.  This is the inventory process.  You need to see the situation for yourself, so do this next time you visit in person.  Clear some space on the dining room table, and gather the pill bottles there.

Make sure you gather all of the pill bottles.  Be sure to check bathroom drawers, nightstand, refrigerator, cupboards, vanity, and the kitchen table.  Don’t stop with just prescription drugs.  Be sure to gather vitamins, over-the-counter meds, and consumable medical supplies, too.

Now you’re ready to write it all down.  This took me a while, because I had no guide to follow.  So, I want to make it easier for you.   Here is a pill inventory template that I developed through trial and error.  I made it so you won’t overlook anything.   At the minimum, make sure you write down the name of each medication, prescribing doctor, dosage instructions, and reason for taking it.  If you have time, you can fill in the other things.   Don’t let a missing piece of information block you – move on.  Do the best you can and come back to fill in the gaps later if necessary.

In this process I encountered a lot of medical terms that were like Greek to me.  Actually, I found out that they were Latin!  So, here’s a list of common abbreviations used in prescriptions, and how they got from their Latin root words to abbreviations.

As part of your inventory, you may find that some pills are about to run out.  Make note of those and be sure to re-order them if needed.  Eventually, you will want to review the sourcing and pricing of all of these medications.  That can be a big undertaking so we’ll address that later.  First things first.

Depending on the number of medications you are sorting through, this initial inventory can take a few hours.  Watch for signs of fatigue in your patients and take a break when necessary.  If possible, schedule the inventory for a time when your patient has the most energy.  For my mom, and probably for most of the elderly, this is first thing in the morning.

Once completed, make at least two copies of the inventory.  Leave one with your mom.  Keep a separate copy for yourself.  If there are other interested family members, share a copy with them.


  • Do this step with your parent and make sure she is involved.  By doing this together you’ll get a real sense of what help she will accept and what areas you might need to approach lightly.
  • If you find loose or unidentified pills, check an online pill identifier like

If you have something found something helpful in your own journey you’d like to share, feel free to leave a comment below.

Until next time,


Nobody Has a Map

by Mary S on March 3, 2012

This past month or so has been very busy with work and personal projects. I’m a bit worried about how things are going with Mom and Dad but I haven’t made the time to keep in touch. In the last few conversations with my Mom she’s talked about not being able to remember things as well as she used to.  I’ve noticed that she is having difficulty remembering recent events and is very much in the ‘now’ of the moment.  If she were a Buddhist, that might be a really good thing, and I hope it’s a peaceful place for her.  Unfortunately it makes it very difficult for me to learn how they are really doing, what they might need, and how I can help.  The lack of historical perspective, even for the history of last week, means that I may not hear about something important that has happened.  And coupled with the shortened perspective is a longstanding reluctance to talk on the phone, which I think is shared with many of her generation.  Bring both of these together and add my living 2,000 miles away, it makes for a bit of anxiety on my part, which grows as the time between visits gets longer.

My brother and sister-in-law live much closer, but I think even they are anxious and uncertain.  We are all trying to navigate these uncharted territories of helping our aging parents.  Sometimes we try doing it together, sometimes we’re alone but none of us really have a map to show us the way.  Nobody knows. And the needs keep changing.  We’re all trying to do our parts but none of us know the right thing to do. So we’ll continue along doing what we think is right, adjust to the changing circumstances, and hope it all works out in the end.

I hope it’s going well but I just really don’t know. The best way to know for sure is to go there for a visit. So for me that means its  time to call my folks and get another trip on the calendar

Until next time,



Why is Managing Meds So Hard?

by Mary S on February 19, 2012

Why is it so hard to help aging parents manage their medications?  I wish I had an easy answer, but I guess that if the answer was simple, then it wouldn’t be so hard. But it is.

It’s complicated. There are a lot of moving parts to prescription meds and they affect each other. It’s the way medicines are prescribed; fulfilled; paid for; and administered.  On top of that drugs interact differently with other drugs and have different effects for different people.  The unfortunate reality is the people who need medications the most – the elderly – are least capable of managing the complexity of taking them safely.  The cost of failure is high.  According to the Archives of Internal Medicine, for seniors, approximately 1 out of 10 hospital admissions are the result of the incorrect use of medications.

Here’s the story from a friend of mine, Donna: “My mother, a retired health care provider herself, ended up on twelve different prescriptions from three different doctors. Nobody had a comprehensive view of what she was taking. There were negative drug interactions we didn’t know about. But we did notice that Mom changed. She got depressed. She gained weight. We didn’t know why. Finally, we took all of our pills—in a grocery bag—to one doctor.  He whittled the list down down from twelve to four eliminating eight prescriptions she didn’t need. And now she’s herself again.”

What’s the root cause of Donna’s problem?

Sorry. That was a trick question. There’s no single root cause. It’s a system issue. And much of that system is broken. It’s more complicated that it should be. People like you and me can’t fix the whole system… at least, not yet.

So, what can we do? What can we do in the face of a mess? We can give up… or we can each do our little part. This blog is one step that I am taking to do what I can. First,  I want to share what I’ve learned as a long-distance caregiver to my parents. Then, I’d like to let you know what I believe we can achieve through Together, we can begin to make a difference.

Until next time,


In the Beginning…

by Mary S on January 28, 2012

I didn’t expect to be a caregiver for my parents. But that’s what life presented to me. I try to focus on not getting upset about the way things are,  but accepting the way life is and making the best of it.  I won’t lie and say I haven’t cried about it, but I did decide to channel those tears into

According to data published by, the typical U.S. caregiver is a 46 year-old woman who works outside the home and spends more than 20 hours per week providing unpaid care to her mother.  The majority of caregivers are middle-aged (35-64 years old).  Does this sound familiar?

Most caregivers live near the person they care for. But here’s the part that hurts the most…more than 7,000,000 of us live more than an hours’ drive away. I happen to live 2,000 miles away from Mom and Dad. They’re in Illinois; I’m in California.

There’s a lot I can’t do. But here’s what I’ve learned I can do from this far away.

I strive to help Mom manage her medications. The challenge for me is to honor the way she wants to do it and to keep quiet when the way she is doing it, to my mind, is more challenging than it has to be. To watch somebody choose the hard way—that’s tough for me.  But I want to let her live her life in the way she chooses. So that’s where the tension comes in. it’s walking that balance between helping mom and letting her live her own life.

Over time, I’ve worked out a way that supports her and gives me peace of mind.  I’m assembling the tips I learned the hard way and will be putting them into an easy-to-use e-book. I want you to have it so you can learn from our struggles. I’ll post it here when it’s ready.

Until next time,