The sister comes by about once weekly (usually on the weekends when I’m not working) and visits with her (dementia) sister and the husband. The first day I worked at the home of my dementia patient, I went thru the medications and made a record of all the meds that have been prescribed, dosage, etc. when I opened up the pill organizer I found that it was completely disorganized (by the sister). It took me over an hour to get it set up correctly and I politely asked pt.’s husband to see to it that the sister not get involved anymore and I would be responsible for distributing the meds each week so that there are no more errors in proper dosing etc. he agreed. Today I come to work and once again the pills are messed up and this time she (sister) had one medication dosed at FIVE TIMES the prescribed dosage! (1/2 pill once daily... there were 3 whole pills laid out each day for morning, afternoon and night!! If that’s not bad enough, 2 of her other pills were omitted: blood pressure and thyroid. I’m absolutely furious but I don’t want to cause a problem or piss off the sister by telling her to mind her own business but this has got to stop and the husband isn’t helping matters. I think he is intimidated by the sister and is afraid to tell her to stop interfering but whatever the reason it’s not acceptable. This is a touchy situation and I’m not sure how to handle it. Any advice? Note: when I’m not there the husband gives my patient her meds as I have them properly sorted in the weekly pill organizer. Overdosing my patient is a serious concern since the husband doesn’t pay attention to the meds, he just gives her whatever is sorted in the pill organizer. You can see how the sister’s interference makes me very nervous.
You probably need to have a talk to husband to explain that perhaps sister doesn’t understand the pills, and that there are real risks to taking too many or not enough. That’s why you’ve put away the bulk supply and the full week dispenser. Husband may be intimidated, as you say, but he may not realise that sister has lost her marbles – or he may not be brave enough to have that difficult conversation with her. You say that this is how the doctor wants things to be organised, and that the doctor has given you responsibility so you have to follow doctor’s instructions. Give it a go!
I like the locked cabinet idea. Also, the locked dispenser.
Get them an automatic pill dispenser – this beeps when it's time to take the medicine and a small opening allows access to the correct pills at the right time
Rather than a “confrontational” situation - design a leaflet on PowerPoint and a poster
A reminder that only the husband and (your medical title) should be dealing with her medication as agreed.
Mention re medication in incorrect dosages can have fatal consequences
State that it has been noticed the medication had been interfered with and if not observed WOULD have caused death of the patient.
State that the medication has been preprepared with the correct medication per day for morning, afternoon and night. These should NOT be altered under any circumstance.
Put a tabled sheet per week re Monday, Tues.... morn, afternoon, night and space for initials of person who hands out each dosage.
You are doing your job correctly - therefore the husband (and sister) need to know it’s being monitored and concerns raised.
Best of luck - let us know how it goes
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