Accessible Pill Cap Dispensing/Cutting Device Team Leader: Max Michalski Communications: Ashley Huth BWIG: Bryan Fondrie BSAC: Joe Ferris Client: John Enderle, Ph.D Local Client: Mitch Tyler, Ph. D Advisor: Naomi Chelser, Ph.D

Overview Problem Statement Background Design Requirements Accessibility Current Products Designs Future Work

Problem Statement Currently, errors in medication administration and compliance are persistent problems in home medication. Common errors include skipped dosages, confusion over what pill to take at an appropriate time, and misinterpretation medication instructions. Many current pill dispensers incorporate medication reminders; however, few relay missed dosage information to medical personal. No current pill dispenser has the ability to cut pills in half. 1.Inappropriate use, or lack there of, of medication can result in direct patient harm if not addressed by clinical staff. 2. Patients suffering from a wide variety of disabilities may encounter difficulties remembering medication administration schedule or opening traditional pill bottles.

Background-Problems with adherence to medication Reported average adherence rates of 43%-78% for patients receiving treatment for chronic conditions HIV Patients Patients with Psychiatric illnesses Elderly Reasons: forgetfulness, other priorities, decision to omit dosage, lack of info, and emotional/physical factors The ability of physicians to recognize poor adherence1 which leads to worsening of disease, death and increased healthcare costs in US (100 billion dollars a year) 4

Background-Measures of Adherence METHODS Measurement of level of medicine in blood Rate of prescription refills Patient self-reports Electronic monitors ADVANTAGES Objective Objective, easy to obtain data Simple, inexpensive Precise, track patterns of taking meds DISADVANTAGES Variations in metabolism, expensive Prescription is not equal to ingestion Susceptible to error and can be distorted by patient Expensive, downloading data from medication

Design Requirements Accurately Dispense Multiple Medications Moderately Priced Dispense Varying Doses Precisely Cut Pills in Half Functional for Home or Clinical Environment Medication Alarm System Record Medication History Accessible Device

Background- Accessibility Accessible Design Adheres ADA Specifications Operable by persons with multiple, varying disabilities Sensory Motor, Physical, & Cognitive Eliminate disability-associated barriers For home & general hospital use FDA Class I Specifications 2 2

Background- Current Pill Dispensers Pill Boxes/Organizers ($5-$60) Correct # of pills for each day Do not monitor ingestion or alert caregiver in any way when missed Weekly preloaded pills3 Pill Dispensers ($500-$1500) Records daily dosages taken Contacts Caregiver if dosage skipped Monthly preloaded pills3 *Currently, there are no dispensers that can cut pills! 3 3

Background- Current Pill Cutters Small, hand held devices Uniform cutting not guaranteed Work only for certain pill shapes/sizes/compositions Cost-effective 3 3

Background- Previous Design Limitations Not universal Large Expensive Doesn’t make the “cut” 4 4

Alternative Dispensing Mechanism: PEZ™ Dispenser Use PEZ™ dispenser mechanism to release one pill at a time.

Alternative Dispensing Mechanism: Manual Measurer

Final Component Breakdown Pill Storage Motor Pill Drum Cutting Blade Half Pill Storage ½ & Full Pill Shoot Pill Funnel Pill Slide Collection Dish

Pill Cutting Mechanism 360 Rotation Cuts From Outside Pendulum Motion Rotating Blade

Universal Pill Drums Adaptive for all pill sizes and shapes Turnbuckle adjustment Self-centering Cup-holder clamp

Display and Controls Touch screen Large/broad text Program High resolution & contrast Low activation pressure Large/broad text Program Controls timed dispensing of specific quantity of pills Adjustable audible alarms Alerts off-site caregiver

Total Assembly Compact design Able to accommodate more pills if needed Each dispenser and cutting device is easily accessible

Future Work Finalize Components & Dimensions Purchase Materials Construction Mechanical Build Circuitry Programming Integration of Components Testing & Validation

References 1 Osterberg, Lars, and Terrence Blaschke. “Adherence to Medication” Drug Therapy 353: 487-497. Salzman, C. “Medication Compliance in the Elderly.” J Clin Psychiatry 56 (1995): 18-22. 2 “Americans with Disabilities Act Homepage”. <http://www.ada.gov/>. Oct 2, 2007. 3 “E-pill Medication Reminders”. <http://www.epill.com>. 2004. 4 Haggerty, Michael. “The Daily Dose”. < http://www.amdd.com>. May 2006.

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