LET ME: An Electronic Device to Help Elderly
Department of Computer Science and Systems,
Abstract. Recent literature reports on high adverse events rate, espe-cially among elderly people, due to bad self-administration of their drugtherapy. They make errors taking wrong drugs, or taking drugs with in-correct dosage and frequency. These “therapy errors”, in the USA, causeabout 3,000,000 hospital admissions each year. Within the medical in-formatics community, different research groups are developing computer-based support systems addressing this problem. This paper presents anovel approach in this area, and describes a device to make home drugtherapy as safe as possible. The system designed took into account thewhole process, starting from drug prescription by the general practi-tioner, to the drug acquisition to the chemist and, finally, to drug as-sumption at home.
Key words: Therapy errors, medication errors, administration errors,non-compliance, home therapy, elderly people
Since the ’60s the number of publications about errors due to wrong use of drugsis constantly increasing. Many of these papers talk about the high mortality rate,and especially among elderly people, due to bad self-administration of their drugtherapy. Recently, a number of new devices have been developed to help elderlypeople take their medicines, but the novelty of this project regards the wholecontext related to the home drug treatment: it considers the roles of generalpractitioners, specialists, pharmacists, and of course the patients themselves.
A therapy error is any predictable event that can cause the incorrect use of
a drug or a damage to a patient when the drug is under control of caregivers orthe patient himself.
These errors can happen in every moment of the drug management pro-
cess and can be classified as: prescription errors, transcription errors,therapypreparation errors, administration errors, dispensing errors. Another potentialissue of the home treatment is caused by drugs that do not require prescription. Self-medication can improve the attention for one’s own health, but it can alsoincrease the probability that self-prescribed drugs are used incorrectly, modi-fying the effects and safety, increasing the probability of ADEs (Adverse DrugEvents) due to drugs misuse.
Often elderly people self-manage their drugs, and errors are caused by mem-
ory problems, unavailable prescriptions, and/or lack of understanding of thetreatment regimen. Increasing the number of contemporary drugs or the as-sumption frequency of drugs, increase the errors that they can make[3, 2].
The organisation of the paper is: in the following section we illustrate the
project and some applications; and then we present the conclusions and futureworks.
The name of our device is LET ME (from the Italian words LETtore di pre-scrizioni MEdiche; in English: reader of medical prescriptions). The final user ofthis device will be the elderly or, in general, people with memory problems thatmust follow a home therapy, their caregivers, and people with drug allergies. LET ME is a PDA (Personal Digital Assistant), equipped with 2 reader: a barcode reader used to identify the drugs by means of a special kind of bar code,called farmacode; and an RFID reader to identify the patient, that is supposedto wear a simple wristband. This functionality is necessary when more than onepatient use the device in the same home (e.g., husband and wife). The proposedsystem needs information about drugs marketed in Italy, and so the databaseused in this project has been supplied by “Farmadati Italia S.r.l.”.
LET ME has two modalities: programming modality and user modality.
The programming can be made by the prescribing doctor or by the pharmacist.
1. Programming by the prescribing doctor. The patient goes to the doctor bring-
ing the LET ME with him. The doctor repeats for all medicines:
– using his PC, writes and prints the prescription;– then, he prints the bar codes of the prescribed drugs with the same com-
puter procedure. Referring to the pharmaceutical label, he must print thebar code on the new adhesive label representing the A.I.C. code and thedrug name. In addition, the text “LET ME PROJECT” will be printedto explain the presence of the new label, in case patient drug boxes arechecked for legal reasons. Next steps are:
• the doctor reads the A.I.C. code using the bar code reader;• LET ME recognises the code, by searching into its drug DB, and
displays it with the corresponding drug name;
• the doctor assesses dosage and time, or frequency. To make this pro-
gramming phase as much smooth, speedy and safe as possible, thedevice can: show standard dosages and timing reported in the DBfor all the pathologies/symptoms curable with this drug; allow tomodify dosages and/or timing displayed at the previous point, bypressing few buttons; verify possible presence of components that
A Mobile Device to Help People with Home Drug Treatment
can cause allergy or intolerance to the patient, possible interactionswith drugs already stored for the patient in the patient’s active list,to show possible drug-food and drug-drink interactions. • when the prescription is completed it is stored into the patient’s
active list, which is integral part of DB;
Also, the doctor can update previous prescriptions.
2. Programming by pharmacist. The programming will be done by the pharma-
cist when the patient goes to the doctor forgetting the LET ME, followingdoctor’s instructions about drugs, dosages and frequencies. If, among theprescribed drugs, there are some refundable medicines, the pharmacist re-moves the original farmacode labels, and replaces them with the ones printedby the doctor. If the patient buys drugs on his initiative, for example O.T.C. (Over-The-Counter) or S.O.P. drugs (Senza Obbligo di Prescrizione; in En-glish: without prescription obligation), the pharmacist will not do anything.
Checks. LET ME carries out four checks. With the first one, it checks whetherthe drug is already stored. The second check controls the drug components towhich the patient is allergic or intolerant (e.g. penicillin) The third check controlsthat the active principle is not in “conflict” with the other active principlesalready present in the current patient’s treatment. In this case, LET ME displaysa message which says that the drug can not be administrated combined with theother one and if the programmer is the doctor, he decides how to proceed. Ifthe programmer is the pharmacist, he will stop programming and contact thedoctor. The last check regards drug-food interaction and drug-drink interaction,in order to avoid alteration of the expected drug effects. The device verifies ifthe drug must be taken “on a full stomach” or “distant from mealtimes” and ifsome particular food and/or drinks can modify the therapeutic drug effects.
An example of a drug-drug interaction check: we suppose that among drugs
present into patient’s active list there is the “SIVASTIN 28 CPR 20 MG RIV”,the allergy list is empty, and the doctor prescribes to the patient the “LIPOZID30 CPR 600 MG”. LET ME checks if this drug is already stored in the patient’sactive list, and it is not, then it checks drug-drug interactions, and it findsthat an interaction exists between SIVASTIN active principle (simvastatin) andLIPOZID one (gemfibrozil) and so the device shows on the screen a messagesuch as: “The drug contains gemfibrozil that interacts with simvastatin, and sothis drug can not be prescribed since the patient is taking SIVASTIN 28 CPR20 MG RIV”.
When the patient is at home and he needs drug information, he turns on thedevice and moves the package near the reader. Then, LET ME shows the pre-scription stored, with the following information: name of medicine; dosage; timeor frequency; note about food and drink Pressing the AUDIO button, the dis-played information can be listened through a synthesized voice. This is usefulfor patient with eye problems, that are known to be an error source too.
If the patient uses LET ME with a O.T.C. or S.O.P. drug, we have two cases:
1. this kind of medicines were prescribed by the doctor and so LET ME has a
2. they were bought from patient on his initiative and so LET ME does not
have regimen, or they were bought in shop different from a pharmacy.
Let us focus on the second case. Patient holds the “TACHIPIRINA 20 CPR
500 MG”. Patient turns on LET ME, which reads the farmacode; LET ME seeksthe drug into the patient’s active list and does not find it. So the device makesa search into its DB to see if the drug is an O.T.C. or a S.O.P. Then, LET MEextracts the active principle of TACHIPIRINA, i.e. paracetamol, and checks fordrug-drug interaction with the medicines stored into the active list. We sup-pose that into the active list there is “TEGRETOL CR 200 30 CPR 200MG”;its active principle is the carbamazepine which interacts with paracetamol, soLET ME shows: “This drug contains paracetamol that interacts with carba-mazepine, so this drug can not be taken because TEGRETOL CR 200 30 CPR200MG is in your therapy”.
The aims of this new device called LET ME are: improving medication adher-ence and safety in the administration of medications; reducing hospitalizations,and consequently healthcare costs. Compared to the existing tools, LET ME:allows patient’s doctor to keep under control all the prescribed drugs, avoid-ing dangerous drug-drug interactions; it can be used by more than one patient,thanks to an identification wristband; it gives information about food and drinksthat could interact with the patient’s drugs.
Now, we plan to evaluate the system in two phases. First, with some subjects
volunteers, to test the reliability of the device, its usability, discovering bugs. Thesecond phase will be a trial with more subjects. These subjects will be subdividedin two groups: the first will use this device and the second one (the control group)will not use it, to prove the efficiency.
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