hospital medication supervision - does this sound common?

[scatmat]

My elderly mother is ill/frail and in a private hospital with from what I've seen great care levels/professional staff.
My father visited her and said that all her medication which she was supposed to take at breakfast & then more at lunch time had been left by her bed in a container as she hadn't taken it - then the evening medication was added the same container.
He then made sure she tool all the medication before he left (i.e. breakfast, mid day and evening meds all in 1 go).
The hospital is excellent and the nurses/care staff are fantastic so this sounds very out of character.

Is this really what would happen? Would it not potentially harm someone to take 3 times worth of medication all at once? (she is on a cocktail of many meds)

I live over 200 miles away so can't just drop by every day but am worried.

As a registered nurse I can deffo say that the staff should support and supervise your poor mum with meds to ensure she takes them! It's a massive risk to just leave them on the table. For a start another patient could take them! You need to ring and ask to speak to the nurse in charge and tell them your concerns

Yes, what dalmatian said. They are supposed to supervise taking of medication at the correct times. Either you or DF need to raise it with staff. If you don't get anywhere, go to PALS.

Thanks mineofuselessinformation and dalmatianmad - what is Pals?

One angle I'm thinking of is could my father have got it wrong?

I think in this situation she should have had more support from medical staff.

Oddly I have been in private hospital in the U.K. and they wouldn't let me self-medicate - I had to hand over all my meds and have them doled out to me by nurses. And I was relatively young, used to dealing with my many meds at home and not confused at all. Their system caused some problems as they all had to be officially re-prescribed and this wasn't done correctly, leaving me without pain killers at bed time

I have also had many operations privately in Europe and was allowed to self-medicate, once they knew that I wasn't still fuzzy from the anaesthetic. They still had a list of everything I took and when but I was responsible for taking it myself. That was my choice - they would have taken charge if I'd asked. I much preferred this BUT see above being relatively young and not confused!

This is poor practice. Very poor medicines medicine management.

Im a Ward Manager - if this were my relative i would be contacting the CQC with concerns .

I wouldn't even bother with PALS - this is a more serious safety issue that needs investigating.

It's not safe to take three doses of tablets at the same time, they should never have been left on the locker in the first place, the nurse should make sure she either takes them at the time or if she doesn't then document it. This is really poor practice, I would report this to the nurse manager and also ask if the nurse signed that they had been taken. Is he saying that the evening meds were added to the daytime pot, did he see the nurses doing that, how could he be sure what tablets they were or even if they were for her. If this happens again he should not give them, he needs to speak to the nurse.

The RN should not sign for meds until taken. They should not be left on the table - this is poor practice.
It has been a problem in many areas - you could google The Andrews Report (which I must admit I do think is a bit nurse bashing).

The nurse administering the meds should not sign the drug chart till they are taken . This is a nursing not a medical error , if your father is correct.
Depending on what she is on it could be really dangerous.
Call the ward and raise your concern. Just ask for clarity, especially if your dad could be wrong.Hope she gets better soon

It is unusual for nurses to top up pots, I've never heard of that, they would normally discard the ones not taken, I would ask to speak to the nurse. It's not good to take tablets like that, she could be on a dose of something to be taken twice a day, not once a day, it all depends what tablets she is on, the nurse and doctor can look at her drug chart. Do the ward know what he told you, I would tell them. If you are worried about him visiting you can speak to the nurse and the doctor.

Erm, I would be questioning how excellent the care is if they aren't ensuring your mother takes her medications at the correct time, and it ends up with your DF giving them all to her in one go. She seems to be deteriorating now that she is being visited by your father alone - is this because she is no longer having multiple visitors during the day, and therefore supervised to take meds when they are administered, vs your father visiting towards the latter part of the day, seeing meds haven't been taken and helping her to get them all down in one go?
It may be that her deteriorating is down to double dosing of meds do yuo know what she normally takes?

When I first qualified as a nurse approx 15 years ago, this was really common in my hospital (not actually adding pills to previous ones in a pot, but leaving the pots for the patient to take their pills unsupervised, but within a few months, this became a big no-no, understandably! Any nurse signing for drugs that they had not witnessed being taken, or any which were just left on a table, would have been in serious trouble!
So yes, your DF is, sadly, probably correct, but there is no way that this is acceptable. It is so so dangerous!

I hope there was no paracetamol or codeine in with those tablets? This is really dangerous!!

I think it may well not have happened. It would be really bad practise and therefore is unlikely especially given what you have said about your father. I would phone up with concerns though just to check.

Another RN here. No that shouldn't be happening.

Ring and ask to speak to the ward sister. This should not be happening. It could have a negative effect on your mother’s health. It’s also dangerous from a point of view a visiting child could take the tablets, or another confused patient.

And the hospital won’t think you’re a crank. And even if they did then you still need to do this. Don’t just speak to a random nurse either, they could well cover it up. I know our ward sister or the matron would go nuts over something like this and put the fear of god into anyone who did it. It’s maybe become common practice on the ward and it needs addressing.

As pp, shouldn’t be happening, but would also be odd for a nurse to just add meds on top of those not taken - I’ve seen some poor medicines practice, but never seen that. Not impossible though.

As an afterthought, is there any chance your dad thinks they are nit giving your mum the right medicines and is bringing extra in from a supply at home? Just with what you say about your mum deteriorating. Is it possible for any relatives to drop in at visiting? Or go with him so he can show them how poor this is?

Phone and ask to speak to the ward manager, I'd raise your concern and explain how concerned you are that your Father then supervised her take three lots of meds at once.

I'm a deputy ward manager (RN) and honestly would have an absolute fit if this was reported to me as would my ward manager. We would treat if very seriously, and would do a full investigation. Although it will be quite difficult to prove if the nurse who has signed for the medication denies this.

The thing that struck out to me is if it was three medication rounds it's likely it would be more than one nurse administering unless it was supposed to be 09.00, 1300 and 1800.

I could see medication being left untaken ( this is very poor practice, and absolutely not acceptable) but for them to then be left and topped up is very dangerous and not something I could imagine any nurses doing. Your Mum taking them all at the same time is a serious medication error, as is them being signed for and not taken.

I'd raise concerns that she's deteriorating and ask that she have bloods taken and be seen by a medic today. ( This is normal practice after a medication error so should be done anyway)

Hope you're okay OP, must be very worrying for you especially with being so far away. Thinking of you.