I am both a registered nurse Div 1 (general nurse) and Div 3 nurse (psychiatrically trainer). During my training, “some many years ago”, liquid medications where freely available for the medical and psychiatric patient treatments. Non-compliance was, as it appeared, a less obvious problem than it is today. As a trained nurse, who was taught about ensuring the patient consumed their prescribed medication, compliance for me remains at the centre of patient care. As I progressed through my training, this was “drilled” into the staff to be vigilant in administering medications to ensure the correct patient received the correct dose.
I became qualified and Emigrated to Australia and practiced as a nurse and many senior positions and as a Director of Nursing, in many clinical areas.
I spent a significant period of time in prisons, both male and female centres, including remand centres, drug and alcohol services, child and adolescent services, those with head injuries, those suffering from Anorexia Navosa, transsexual ragenda and the list goes on.
Throughout my career, one of the most common clinical issues has continued to be patients “NOT” correctly consuming their prescribed medication. This has continued to be the most common problem across all areas. As I moved into the aged care sector, this problem continued to be reinforced. I became one of the largest private providers of aged care in Australia, running and developing hostels, special accommodation homes, retirement villages, nursing homes and home care services. I took over poorly run facilities and those which were in jeopardy of ceasing trading due to poor care.
I introduced the “happy hour” being a market leader in dementia care and the provisions of purpose built facilities. The increase of non-compliance became a major problem in providing care to the elderly as it assisted in the deterioration of many clients. Unfortunately, those medications in liquid form are not available now. While one can ask a friendly pharmacist to create a liquid form of medication, the cost is anywhere between the 5 to 500 times the cost of a tablet.
Medication management in the aged care sector is a time consuming task often carried out by the most expensive and most qualified member of staff. Nursing home residents are increasing in frailty and even in low care need assistance with being compliant with medication. In high care, the incidence of patients needing assistance is estimated to be as high as 70% of all residence; in dementia care this incidence is even higher. Nurses are spending 70% of their time “squashing” medications in a mortar and pestle, and mixing the resulting “grit” substance with jam and similar, with poor outcomes. The cost to aged care is massive, due to time and poor outcomes and a very unsatisfactory outcome for the clients.
When I reflected upon my training and extensive clinical experience in almost all areas of care, the most singular issue remains non-compliance. The problem has increased across all areas of care, with those who cannot and those who will not take their medication.
It has become increasingly obvious to me and other care-givers across a range of services that non-compliance now has become almost epidemic proportions. There are more people with dysphasia than those suffering from diabetes, and the problem is likely to grow experientially over the next 10-20 years. Many methods have been trialed to overcome the issues of non-compliance, such as medications that are designed to assist swallowing, cups to assist in swallowing medications, but there presently is no integrated system that takes a solid dose medication and changes it into an easily swallowed preparation, with a good take at a cost of a tablet, until I established myLiquitab.