To as you what I should do re district nurses

[Ceasre]

I feel totally out of my depth at the moment and don't know how to handle things properly or whether I am over re-acting.

My wonderful mum has just been diagnosed with Alzheimers. I never expected her to have a mental decline, I always thought I would have to face a physical decline as she has many medical problems associated with Lupus and is on a large amount of medication for Lupus and heart disease.

I begged for help from GP and Social Services but they were not interested. I live an hour away.

A few weeks ago she was hospitalised after an accidental overdose of her meds. I had got the GP to prescribe them in blister packs as I thought it would help her take them properly, but she took nearly a weeks worth and then could not remember. Suddenly things started happening and a care package has been put in place with district nurses as part of it to go in morning and evening to administer medication. The medication is kept in a safe. To date the following has happened:

1. Medication was left on top of the safe, not locked in the safe. Luckily I arrived Friday morning (I had already told the district nurses I would give her the medication on the Friday morning as we had a hospital appointment and found it on top of the safe.

1. On the Sunday morning I happened to be at mums when the nurse turned up (she had phoned me early in the morning in a panic about her TV........). The nurse said to my mum that the carers could administer the meds. I said that I had been categorically told they would not and that we were trying to get into a routine. If I had not been there my mum would have agreed to anything and then forgotten. She literally forgets everything.

I spoke to the management about both issues (and the fact that the safe is now not working) and they were full of apologies and it will not happen again etc.

I have just discovered this evening that on Friday she was not given her evening medication. I read the folder every time I visit and a nurse was there at 10.15pm but has just watched my mum administer some eye drops which is not even in their notes and that is it. The tablets are still in the blister pack. I am furious as I feel I cannot trust them, but I work full time and cannot be there morning and evening 7 days a week.

What shall I do? If I make a fuss I worry about the nurse and her job, but I am worried constantly about them doing their job properly. I am finding this so hard. I have never had to deal with these sorts of issues before.

[itsmeitscathy]

Make a fuss - it's not a one off mistake, it's ongoing and regular and if it continues the result could be catastrophic. Document the evidence and keep on at them until things are done properly.
I'm not sure what you mean by blister packs- is this the same as when the pharmacist packages them up into days and times? If not, is this an option?

[debka]

That is absolutely 100% not acceptable and I would be complaining vociferously. This is neglect of your mum, which is a form of abuse. Do not worry about the nurse and her job, she is not doing her job properly and needs to be called up on it before someone is hurt.

One question though- why can the carers not administer meds? I am a carer and that is a big part of my job. We don't give injections or deal with controlled meds (such as morphine) but can give pills and liquid meds and apply patches. I would be surprised if a DN came to give medication to client of mine.

[ohldoneedtogetagrip]

In Scotland it is generally not the responsibility of the DN's to administer or to witness the taking of medication long terms. It is the responsibility of the carers.
There are too many patients needing this service and too few DN's to go round them all.

[theeternalstudent]

I don't think it has to be a nurse who dispenses the medication. In fact I know that it doesn't have to be as I have done this and I don't have a medical background. However, I have received training on this.

Is it council or a private package of care that your mother has? Either way they have a duty of care. Please complain. They are not fulfilling their legal obligations. Keep a record of things that are going wrong and make sure you feed them back in written form.

I'm so sorry you are going through this.

[Pobblewhohasnotoes]

Has she not got her meds separated into days of the week in one of those boxes? The pharmacy can do this.

[londonrach]

I don't think ds can come in every day to do this. The pharmacies can set up boxes for the month. Does your mother have a carer or a care package. Arrange to see go to discuss her needs. Not easy x

[londonrach]

Dn not ds

[londonrach]

See gp not go. Sorry my computer changing words. See the gp re your mother package of care. Age concern, ask their advice x

[saintlyjimjams]

This wouldn't usually be a district nurses job. Especially at 10.15pm. They sometimes do diabetic injections & as the carer above said, controlled medications, drivers etc - but simple pills would usually be given by carers. I can't imagine there are the DN staff to give pills. Our neighbour has a care package which includes carers dishing out the pills overseen by my mum (she divides into the day pot things and the carers dish out when they are there).

Who said they had to be given by DN's? I would query that unless they're some sort of complicated medication.

[Pobblewhohasnotoes]

What sort of care package have you got? Are you paying for it? Some care teams are more coordinated towards people with dementia and Alzheimer's. You could try talking to age uk for advice.

[Ceasre]

Thanks for your responses. The blister packs are set out into days of the week and morning, noon, afternoon and evening.

I was categorically told by Social Worker at the hospital and the care co-ordinator that carers could not give medication. They can prompt from blister packs, but they do not administer. If they want to change that then fine by me, but I think that should be discussed with the care co-ordinator and manager of the nurses, not the nurse herself asking a patient with dementia. As I mentioned I only happened to be there by accident.

Like I say, this is all so new to me I can only go by what I am told. I am finding the carers a lot easier to deal with, everything is documented so I can read what has been happening (no personal care needed, just meals as mum has not been eating). Only sad thing about carers is that it is never the same two or three, so many different ones. And mum will tell them that she has eaten when she actually hasn't. Luckily they all seem to have cottoned on to the fact and are "encouraging" her to eat. I feel like we are getting there and I think I would prefer them to give the meds to be honest.

[phoebeflangey]

Carers would prompt the medication, you can complain to the district nurses, surgery or Care Quality Commission who will advise you on best route to take.

[Ceasre]

It is a council package. Put in place to assess me for 6 weeks and then they decide what is needed. They offer help with everything, but we just need it for meds and food. I can do the shopping etc. Once 6 weeks is up we then start paying. And it is actually not carers as such but "enablers" as it is a re enablement package. I was told that as the meds are not a "goal" they will not give them. Mum will never again be able to take the meds on her own.

God I am finding this so hard.

[Ceasre]

Not me, mum (although I may need it soon). Mum is only 69 by the way.

[itsmeitscathy]

I'm so sorry Ceasre, this must be so difficult for you. I don't know anything a about it but can the pills be made a goal? Are all tablets in same blister packs or is it one from each etc?

[starfishmummy]

Carers gave my Dad his medication. The only problem we had was when the hospital put them in one of those seven day packs - but not the blister type - as they said that they needed them in their original boxes.
Fortunately they really came in to help him with his permanent catheter and meals; he was quite capable of taking his own meds so we just asked them to remind him to take them.

[phoebeflangey]

If there is Dementia involved then medication is a need that the assessment should include.

[Pobblewhohasnotoes]

Oh ok, so you're still on the six week free care. Both mine and DH's grandparents have just finished this and now have the paid care package.

Have you looked into care teams for when the six weeks are up? Some specialise in dementia care. She will think she's eaten when she hasn't. Are they coming in to cook and serve her food? As that's the only way you can be sure she's eaten.

I don't know about carers and medication, my grandad still likes to do his own.

[saintlyjimjams]

God it sounds shambolic (surely a patient with dementia needs a regular team of carers?). I suspect it's all the cuts (have a child with severe disabilities and the cuts are beginning to bite - esp in council packages)

I'd ring the DN's and talk to them. Find out how medicines such as the ones your mum needs are usually administered in your area. It would be very, very unusual to be the DN's. Then ring the Social worker (I suspect it should be the carers). If the enablers cannot give the meds then tell the SW she needs to change the package to carers who can. Do not be afraid to tell the SW you will hold her responsible for any problems your mum has due to her care package not being fit for purpose. I have found that line to be very useful when dealing with SS (I actually tell them I will hold them responsible at a personal and departmental level - it works).

Good luck - it's tough dealing with care packages etc.

[pinksancerre]

I am a community specialist nurse and ex dn. generally dn's will not administer daily oral meds. Carers absolutely will do a medication prompt. However the mistakes you state are not acceptable, and are putting your mum at risk, so definitely raise your concerns. But you do need a clear plan for her meds for the future.

[Ceasre]

Thank you all for responding. Good to find out what happens with other people so I can be prepared.

Mum is not capable of taking her own meds anymore. I will phone the care coordinator tomorrow and ask when mum will be allocated a social worker. They called me a week ago and said she was going to be allocated one and then we would have a case meeting.

I have just applied for Power of Attorney as advised by hospital Social Worker.

I am trying to deal with everything, finances, bills, shopping plus working full time with my own family. I don't begrudge it as I love my mum and she needs me, but having to deal with stuff like this on top just pushes me over the edge.

My mum is obsessive about food and will only eat if me or my husband has prepared it, or she has herself. So Phychiatrist who assessed her suggested ready meals that enablers/carers heat in microwave, but give to her in their unopened packet and she dishes it up herself which is kind of working.

Mum really has lost a lot of weight, but she loves cakes, just has no appetite for proper meals.

[Ceasre]

Hi pinksancerre, thanks for this, who should decide this? Like I say, I am being told that the enablers/carers will not give it by the Social Worker (from hospital) and Care coordinator? Who makes the ultimate decision. Like I say, I don't mind either way as long as it is given.

[Kundry]

Are you totally sure it is the district nurses administering oral medication?

This wouldn't normally be part of their job - the main reason for putting it in a blister pack is so that carers can administer it, rather than a nurse.

It is very very hard to navigate the system - funnily enough I think it will be easier after your initial 6 weeks as then the system you have will be much clearer. Keep fussing until you have got something that works for your mum.

[Ceasre]

Yes Kundry, I am 100 per cent sure it is the DN. Blue folder for DNs and Yellow one for enablers/carers. It was put in blister pack originally because I requested it as I had tried the sorting them out into one of those tablet containers (she takes 11 tablets per day) and this did not work. I also found boxes and boxes of meds that had not been used going back 3 years. I feel so guilty that I did not notice but up until Jan she seemed fine. Repetative maybe and a little forgetful, but nothing out of the ordinary. Apparently according to doctors report she has a good social veneer which is uncovered when asked probing questions.

It has all happened so quickly. She now does not even know the difference between remotes for tv and phones and is very anxious about everything. She is frustrated because she knows she is forgetting basic things.

[theeternalstudent]

The medication thing is a bit of a grey area. Re-ablement workers are not able to dispense medication as you have been advised. What they do instead is "prompt". Just semantics really - meaning that they will take out the medication for your mum and support her to take the medication of her own accord. No need and very unusual for a DN to do this.

The service you have just now is to help your mum return, as much as is possible, to an independent life but with help with her medication. When your six weeks are up a care package will be set up. Normally things settle down then and you will be given more regular carers who will have the time to build up a relationship with your mum. That's the problem with the re-ablement service, too many people going in, rarely the same face.

Anyway, they are failing their duty of care to your mum right now by leaving medication on top of the safe and failing to make sure that she is taking her medication. Please complain. This should not happen.