Managing Medication for those with a dementia

[danny]

John,whist our policy is to use blister packs in the main we do provide a degree of flexibility when needed!We use mar sheets for all our service users and we do have to administer certain meds not in blister packs.We did set up a specialist team of community support workers last year to administer medication but no one would fund it!My team have many a sleepless night worrying about our carers giving medication,it really is not that easy,and as I mentioned before,with all the training in the world,some carers do not grasp what we are asking them to do.

[John Greene]

Angela - okay, I take your point onboard.

[JeanD]

My father's Aricept tablets were supplied in blister packs with an abbreviated day of the week on the back of each. Unfortunately these were sometimes in French or Greek ! No use to him, and my mother did not even realise they were the days until I pointed it out to her.

It would have been a useful prompt, since in the early days dad was quite capable of taking his own tablets, but sometimes forgot whether he had already had them or not.

[John Greene]

Thanks Jean - that's a useful point which I can pass on to the carers. I'll get hold of some these blisters to show them.

[JPG1]

John,

Any chance of you contacting the 'suppliers' to the UK, to ask why they cannot supply blister packs with English-language days on them? The only blister packs I've ever seen had the day of the week, and also the 'day sector' all written on the front, so I have never seen the kind that JeanD is talking about, but it must be a huge problem. Blister packs are intended to simplify medication-taking, not add to the problems!

The carers you are training won't be able to do much about that. It may help the carers to know that the days are written in Greek or French, but it won't necessarily help anyone else.

Danny/Angela: why do you think it is that your staff carers can't grasp the relative simplicity of medicine prompting? Is there a particular problem they've described to you, or that you have identified?

.

[Bristolbelle]

Not directly related to dementia but I had to use these when my son was little (diagnosed with asthma at 3 months to deliver ventolin syrup (I think it was but he's 19 now can't remember for sure) The thing I wanted to point out is that some medicines are or were delivered in a sugar based syrup. I was dispensing this into his cheek as I had been told to do, and alterntng whcih side I used - also as advised. Sadly he was on this medication for some time, and eventually suffered severe dental decay (even though I used to try and brush his teeth daily. He did used to choke and vomit a LOT as a result of the severity of his asthma and the acids would have taken their toll, but I wanted to point out the possibility of tooth decay with orally administered medication, especially as so many older people are now lucky enough to still have thier own teeth.

[John Greene]

Hi JPG1,

I'm aware of the foreign blister pack problem, but this one's beyond my control i'm afraid. The Pharmacy's are the one's buying the stock and they can buy these from other EU countries as long as they have been adaquately overlabeled in English (which the one's you came across obviously hadn't).

Best use some 'patient/customer power' and talk to the supplying pharmacist on that one.

[John Greene]

Bristolbelle - interesting feedback. I'll add this to my training on oral syringes.

If it's going to be a long term oral liquid, I'll encorage folk to get the sugar free formulations. This could be an issue with Dementia as it could be tricky getting people to methodically brush their teeth afterwards etc (would that be correct?)

[danny]

hi JPG,prompting meds is not the problem,the problems arise when they have to fill in medication administration forms!

[Jan D]

My problem is that mum who has dementia lives alone and has carers in morning and evening. How can she manage to take tablets that are prescribed to be taken four times per day? The doctor doesn't understand the problem. I used to be able to phone her and remind her to take the pills already set out in her pill dispenser. This doesn't work anymore. Even though she says she has taken them when i get there they are still sitting in pill box!
Also when i was away doc. visited Mum and left her a new prescription! I had told them that i couldn't be there to sort things out. Who would get it for her ,plus the new medication could not be taken with the pills i had carefully loaded into her pill dispenser. Who could sort it out!
Any advice on who could have helped? I don't go away very often and the GUILT is terrible.

[John Greene]

Hi Jan,

Thank you for this feedback.

I would try and get the frequency of the meds reduced from four times a day (I take it that four visits from care support workers works out too expensive).

If the doctor doesn't understand the problem then you could get what's called a 'medicines use review' (an 'MUR') from the community pharmacist. Pharmacists now get paid by the Dept of Health for these reviews (most, but not all pharmacies offer them if they have a consultation room). It's acase of booking one of these MURs with and getting the pharmacist to recommend alternative treatments (or slow release versions) which can be given less often. The pharmacist will write to the GP with their recommendations.

The doctor has a requirement to 'understand the problem' and prescribe in a way that ensures meds have the best chance of being taken. If you are not happy with the service that the doctor is providing then it would be your Primary Care Trust you need to speak to.

It sounds to me as if you need the support of a good community pharmacist. Sometimes if you use the really busy pharmacies, they find it difficult to give you the full support. Are you able to 'shop around' or are you happy with the pharmacy you already use?

Try not to feel guilty. I know it seems as if you can sometimes never do enough (my Grandfather died of Alzheimer's) but you have to look after yourself as well. The fact that you are posting on this forum shows that you are trying your hardest.

[John Greene]

Danny,

I was talking to the regulator about this (medicines charts) yesterday and will be pushing for better record keeping.

If it's okay, I'm going to use these quotes in the training. Please be assured that I am not using your usernames so they will not be attributable to you (even though this is a public forum). If any one has any objections, please let me know.

As a Health Professional I can tell you that patient feedback does have an impact on us - I see people's reactions when I use it in the training (I'm not sure if it feels that way to you)

I'll keep 'chipping away' at the red tape. Things are changing, many home care agencies now use full medicines charts when they prompt and also have come away from the "we only give from blister packs".

[butterfly1]

Hi. I am a nurse working in a home with dementia residents. I have problems giving meds every day. There are a quite few who blankly refuse all meds. I really wish there was a way to give them. As I already know it is the patients choice and right to refuse but surely their best interests play a part- but it seems not. When I explain to the residents why they need their meds thay simply don't think they have any problems. A meds round takes me nearly 3 hours so I am often way out of the 8am time to give the meds. I am very frustrated at the moment and dread the morning drug round, especially as I know I am risking my PIN for giving the meds out of the "window" time. But what can I do?

[jenniferpa]

Butterfly - welcome to Talking Point.

I was under the impression that it was now possible to get permission to administer drugs surreptiously provided an assessment has been made that a person is not mentally competent.

I hope we can help you with this - frankly it sounds like a nightmare.

[John Greene]

Hi Butterfly,

Jennifer is correct. The Nursing and Midwifery Council have issued guidelines on covert adminstration of medicines for those who lack sufficient mental capacity (for this particular decision). This is covered by the new Mental Capacity Act 2005. A descision needs to be made by the 'whole team' (relatives, carers, nurses, the prescriber (i.e. those involved in that person's care)) that the client lacks sufficient mental capacity for this particular decision. This needs to be documented and then 'covert administration' can be considered. A full treatment plan is needed and this needs regular review. Any advance descisions made by the client should be adhered to (i.e. you or I might make a decision now to refuse treatment, and this should be respected even if we later lacked mental capacity). You'll need to check on the NMC website for the full guidance. The Scottish Mental Health Commission and Royal College of Pyschiatrists also have (more in depth) guidelines. What I have stated is just a broad overview. Contact me privately if you want to run through this over the phone or in more depth (I've left my website address below)

You'd need to check with a pharmacist to see how best to give the medicines 'covertly' i.e hidden in food or drink. Obviously you wouldn't leave the food or drink with the client until you'd seen them safely take it (in case other residents finished their drink/food for them!). Also, don't crush tablets without a Pharmacists say so (the prescriber should also be notified as you'd be giving the drug in an unlicenced form)

John Greene MRPharmS