To be shocked at errors in my medication dosette box?

[WiddlinDiddlin]

... Or have I been a dick for just chucking meds down my neck without looking?

I take two lots of meds, morning and night - morning is 8 pills from the box, 1 separate, evening is 4 + 1. The separate one was recently added (5 weeks back, no idea why it is not yet in the box with the others as it is permanent).

I've just gone to take tonights evening pills - I tend to open the section and just tip down my neck as I find the tipping into my open hand rather awkward (I can't twist my wrist sufficiently to hold my palm flat, so I drop pills which isn't ideal as I can't get on the floor to fetch them!).

Realised juuuuuuuuust before I did so, that there were 5 pills in there, the 4 usuals and the 1 additional... that I have also got a bottle of and was expecting to take separately.

I now have no idea if any of the doses i have had this week already were correct or contained an additional and so no idea if I've actually been taking a double dose.

The days i haven't yet had are all fine, so fingers x this is a one off.

The extra med is a blood thinner, so a double dose is not ideal!

I will ring on monday and mention it, part of me thinks I am a nob for not checking but then ... they send a dosette box out to ensure I don't miss meds or make mistakes, because I am liable to make mistakes! If I can't trust them, OR me... hmmm!

Mistakes happen. You should always check the work of another human that could impact you if you can. In this case you can, as you can see the pills.

Mistakes shouldn’t happen in those boxes. They should be checked by someone after they’ve been made up so I’m not surprised you’re shocked.

Itll be taken seriously by the pharmacy when you report it as they know those boxes often go to people who can’t check them

I would take it back to the chemist and make a formal complaint. There are a lot of people on very dangerous meds who may not have the cognitive or visual ability to know the difference.

What is the name of the blood thinner? It is very unusual to have any pills in bottles these days, so I am wondering if the bottle you mention came from the same pharmacy or elsewhere.
It usually only takes around 2 weeks to sort out putting a new med into a dosset box. As far as I remember, the names of the medication should be written somewhere on the box.

Many people on dossets can't do this, hence why they have them to help manage their medication.

Definitely complain OP so they can review their procedures, it should be checked once dispensed so there's no reason for 2 people to make a mistake without it being picked up.

If the bottle of blood thinners came from elsewhere (?hospital) it is perfectly possible that the pharmacy have no idea that OP has another supply. As far as they are concerned they are putting the prescribed medication in the pack as instructed. I can't think of any anticoagulant pills that are not packaged in blister packs and labelled boxes these days because medicines need to have the braille instructions and a patient leaflet included. Maybe aspirin I suppose.

Yes I think you should ask for this to be investigated.

There has obviously been an error on someone’s part and everyone needs to understand how it happened.

When did you last have your INR checked? Perhaps you should. (Which blood thinner is it btw?)

I don’t use pharmacy-supplied dosettes for this reason, tbh, ie mistakes. My DP collects and checks it all at the counter. We’ve lost count of the errors since 2020.

Mistakes can happen unfortunately, but really shouldn’t, as the boxes should be double checked. Have you had a medication review lately, or has your consultant changed anything? Can sometimes take a while for the changes to filter through from hospital to GP to pharmacies.
It sounds like you have trouble opening your medication and physically dealing with blister strips etc, hence why you have dosette boxes.
Do you have anyone around who can check the box for you at all? Or even prepare the weekly meds at home for you, using one of those pharmacy bought containers. That way you might feel a bit more in control.

Hardly anyone is on warfarin these days and it isn't allowed to go in dosset boxes because of INR monitoring.

I'm an Anticoagulant Practicioner.

Is your bubble pack one of the ones that has a cardboard 'front cover' like a book? On the inside cover there should be all the sticky labels for each of the medications in there. (These are the labels that would normally go on the individual tablet boxes of you didn't have a bubble pack). That should tell you whether your anticoag tablet has been in there all week and you just didn't notice, or was just in today's by accident (unusual).

Assuming your Anticoag is in the rest of your bubble pack so you have been double dosing, then get yourself to A&E or a walk in centre. Phone your Anticoagulant team for advice but I doubt they'll be in on the weekend, maybe you'll get lucky with a Sat morning opening. When did you start this bubble pack? (Because for some reason a lot of people round my area start theirs on a Thursday, which won't be too bad if you've only had 2 days extra). Don't take any more until you've been seen.

If your anticoag is Dabigatran/Pradaxa then it shouldn't be just 'naked' in your bubble pack.....it can degrade so needs to be in its own packaging until taken. The other Anticoags are fine to go in there.

To other posters saying that warfarin can't go in dosette boxes/bubble packs, that's halfy halfy right. Its safe to go in (unlike Dabigatran) but more hassle than it's worth. Guidelines are that it shouldn't, but needs must, so this can be done if a Patient doesn't have sufficient social support and can't be switched to a DOAC. It requires very fast work from the Anticoag team getting the weekly dose advice to the Pharmacist, who does the bubble pack there and then, and it's immediately driven round to the Patients house by teatime. Can only work on a weekly basis, and it's a nightmare, but on very very rare occasions it's necessary.

@WiddlinDiddlin You talk about your additional med being in
Liquid form, so that's thrown me a bit. Do you mean liquid warfarin?

Feel free to message me if you want to. Xx

Oh give over with your "hardly anyone is on warfarin these days". 😂 The 6000 people in my local area would disagree.

They must be very slow in changing people over. In my area it is very few.
No need to be rude.

@WiddlinDiddlinYou talk about your additional med being in
Liquid form, so that's thrown me a bit. Do you mean liquid warfarin?

Feel free to message me if you want to. Xx
I can't see anywhere that the OP mentions a liquid medicine.

NICE recommends DOACS as first choice treatment for Patients going into Anticoagulants, but a lot of them are older and don't have sufficient renal function to make that a viable option. We can't put valve patients onto them. Or antiphospholipid Patients. Or Patients with.....you get the idea.

As for converting existing Patients, there's a hell of a lot where it just wouldn't be a wise decision. Why would I change a patient with 100% time in range to a DOAC? At best it's going to be as good as, or sightly better. But how you can get better than 100%TTR with no history of bleeding issues? There's only the option of things getting worse. The clinical trials warfarin cohorts had a poor TTR compared to UK average warfarinated patients so for well managed Patients it's not a good comparison. Regardless of guidelines surely it's best to put individual Patient circumstances first?

This is also ignoring the fact we don't have enough time, resources of staff to do FBC and renal blood tests on every single existing Patient and review them for conversion. We've got enough to do just weeding out the Patients who have left hospital on 60mg of Edoxaban when they should have only ever been put on 30mg.

And regardless of NICE guidelines, clinical review and individual circumstances there's still a very large number of Patients who want to stay on VitKA's just because they don't trust a med that can't be monitored. They like knowing their INRs. They like coming to clinic and sitting chatting in the waiting room. You can see this with the older gentleman who come in their best suits, some actually wearing their medals (bless them!), that they don't often see other people, and that regular interaction with another human is so important to them.

Ah, she said bottle, I assumed liquid as it's really unusual for tablets to be in bottles these days. Mind you, liquid warfarin is as rare as hens teeth too! 🤣

Honestly I am not spoiling for a fight about anticoags.
I am sure the OP will get to the bottom of it.

How odd! There has obviously been a mistake and you should bring it up with them so they can can ensure this doesn’t happen again. I agree that one of the main points of having the box is to ensure correct medication is taken, so it’s rather illogical to not have it made up correctly.

Yes just mention it to the pharmacy. Also consider phoning 111 to see if you need to go to hospital now.

Isn't it most likely it's your newest boxes hence why the new med has been added? It takes approx 4 weeks to get your boxes updated so this would fit

Everyone is human and can make mistakes so yes you should always check your dosette boxes.

Some time ago, I realised needed to put my own tablets in dosette boxes but then I found that I was making too many mistakes.

My solution was to get a friend to come round once a week to prepare the boxes two weeks in advance and for me to then check them. This also has the advantage of reminding me to order new tablets in good time.

Dosette boxes are used for many people who cannot check their medication.

The OP isn’t wrong to be surprised, or even annoyed by it.

They are done and checked by one person and checked by another so the double check is already in place and shouldn’t rely on vulnerable patients to check again

Sorry for any confusion.

I had Apixaban added to my regular daily meds about 5 weeks ago. I think due to pharmacists being on holiday (I had two weeks worth in one go at around that time) and just disorganisation on their part, the change from separately supplied in a bottle to added into the dosette is yet to happen.

They are supplied by the same pharmacy and have been with the exception of the first weeks pack from the hospital.

None of the other sections on the current dosette contain anything extra, I started it on Tuesday, so I still have todays, sundays and mondays left and they are all fine so hopefully, this was the only error.

I noticed because the evening lot is only 4 tablets but I cannot swear that I would have noticed it in amongst the morning 8!

It just seems a rather odd error to make, if 14 Apixaban are going in a bottle, and everything else in the dosette... how is there a loose apixaban to go into one of the dosette sections.

I don't know why I am getting the apixaban in a bottle either, the first lot from my pharmacy (rather than the hospital) was a blister pack in a box.

I'll let them know on monday and ask why it isn't in the dosette yet, as I was expecting it to be.

@WiddlinDiddlin Did the pharmacy supply the dosette box and the bottle of apixaban at the same time or different occasions?
Does the dosette box have a label for apixaban on it?
Apixaban comes in blister packs so not sure why they would pop them into a bottle for you or do you struggle with the foil blister packs?

My old pharmacy used to send the wrong medications just for well labeled boxed ones. I would hate to think what they'd manage to mess up with dosettes. That's really bad!

Bottle of apixaban comes in the same brown baggy as the dosette tray, i too am baffled as to why they'd pick them out of the blister pack...

Nope no listing for the apixaban, I checked all over the sheet as well as looking in each section. No listing, no stray apixabans in any other bit!