Pill counts are one kind of strategy that can be very helpful for confirming medication adherence and helping to reduce the risk of diversion.
One approach is to provide a 28-day supply so that the medication is due on a regular basis, on the same day of the week, and then prescribe so that the patient should have residual medications to bring to an appointment. Ask the patient to bring in the medications at each and every visit, and then count out the medications to confirm that they are on track with the prescribed schedule.
Things to Remember
Before the Count
- Contact your patient for the pill count by phone
- Make sure you ask them to come in the same day or the next day.
- Do not call on a Friday.
- When you cannot speak to them directly, try not to leave a message regarding the count. Instead, leave them a generic message asking them to call you.
During the Count
- Conduct the pill count in front of the patient.
- Positively identify the pills using a website like this one: http://www.drugs.com/pill_identification.html
- If needed, call the dispensing pharmacy to help with pill identification.
- Count from the day the rx was filled—not the day it was written.
- Medication should be presented for count in the container it was dispensed in by the pharmacy.
- Medication should appear clean and intact.
- Ask them the date/time of their last dose of medication and obtain UTS, if appropriate.
After the Count
You should keep records and note the following in their chart:
- Date/time they were called in for count
- Date/time they presented for count
- Date rx was filled
- Number of pills dispensed
- Number of pills presented for count
- Whether presented pills’ identity was confirmed
- Date/time of last dose
- UTS results, if obtained
- Whether pill count was correct
Note that the patient may have “extra” medication if they were inpatient at any point after the fill date.
Patients should also be informed to bring their remaining medications with them for regularly scheduled appointments.