The sister of my patient w/dementia interferes by setting up pill organizer in incorrect dosages, omits pills etc. How should I handle it?

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The sister of my patient w/dementia interferes by setting up pill organizer in incorrect dosages, omits pills etc. How should I handle it?

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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.

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Preferably need a locked cabinet that only you and the husband have keys for!

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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Could you possibly get the office of the doctor or doctors to interfere with this matter. If they would speak to the sister to indicate how serious this matter is and it is your job and should not be touched by anyone else other than you and the patient. I sense this is your main responsibility and the patient is capable of taking the medicine on her own in the provided organizer.

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Do you really think a doctor is going to call the OPs sister about this? I don’t.

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Just noticed that you are a friend.
In that instance - would suggest that it is implied a medical person observed the discrepancy and provided the information... etc.

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I am indeed the caregiver for this patient. It’s a fairly new client just as of last month so I’m trying to work the “bugs”out. I am not a RN but have at least 6 years experience as a caregiver. My first dementia patient though.

(3)

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By the way - please log everything like that- date, time, event so it is clear that you were doing what you could. That includes chats with husband to confirm he just hands out, requests he inform the sister, noticed medication mixed up after sister visited,.... etc .

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Thank you so much ... good advice from you and all the responders. Thank you

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It sounds as though the sister may also be having problems mentally. That’s difficult for you to deal with. One suggestion to cope with this could be to have two pill dispensers, both sorted by you. One is for the days when you are there. The other only covers the weekends when you are not there, and you fill it just for each weekend. The bulk supply of pill bottles and the week dispenser get put away somewhere that sister can’t access. Husband has the weekend dispenser. If sister gets her mits on the weekend dispenser, there is a limit to how much she can mess it up.

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!

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Thank you... very good advice and I thank you for taking the time to help me out.

(4)

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Obtain a second organiser which you can set up correctly, and as soon as you go in swap them over and take the other one away with you for setting up ready for next visit. It can be hard or even impossible to keep people away from those we care for even when we have good reason, so we just have to find ways to work around the harms they may cause. Alternatively see if it is possible to get her prescriptions dispensed in prepacked individual time doses - only thing is its not cheap.

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Are u from an agency. Maybe ur supervisor can call the sister and ask that she not "play" with the pills. That your aide is responsible for this and the agency answers to thestate. Can u get the pharmacy to give blister packets.

I like the locked cabinet idea. Also, the locked dispenser.

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Google "Locking pill dispensers".

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Its time to have a care meeting with the family. Maybe the medication could be ordered in the daily dose packs they are promoting now.

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Start taking pictures. You need one of all pills in their bottles as a “list”. Then one of each pill next to its bottle to identify it. Then take a weekly picture of the pill container as you left it and a pic as you find it when you come back. This way you have proof of what’s occurring. If the husband won’t stand up to sister he likely won’t stand up for you should the sister place blame on you. Sister could have dementia starting and/or could be taking some of the pills herself. Pill bottles should be in a locked cabinet or drawer and husband keeps the key when you are not there. Blister pacs would be ideal. And if you have a supervisor or agency they need to be made aware immediately. You need to best protect yourself here as well as your patient. This is not a nuisance issue, this could be life threatening to the patient. It could cause injury to organs leading to organ failure or worse. You should make the doctor aware as her bloodwork may shown changes as a result of missed or over dosages. Not sure how doctor could step in, but maybe that would bring in senior social services. Keep asking husband for help. He’s likely overwhelmed but his help could likely control/ stop the sisters interference. Good luck.

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And to clarify- a picture on a cell phone which would have a date and time stamp.

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I love the locking dispensers with the timers. I also agree with the respondent who said to photograph everything. Document, document, document!!!

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We had to put my wife's mom's meds in a locked cabinet in our bathroom because she'd scramble them all up every time she had access to them.

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I would not allow the sister access to the meds or the pill box. I then would get a 7 day pill box and fill it only for when you are not present. Inform her husband not to allow the sister to administer or know the location of any medications. I think a sit down with the husband and sister is in order. First, meet with the husband prior to the sit down with both of them. State to the sister firmly that you are aware of her actions and the ramifications thereof. If necessary, contact her physician and ask if he/ she would be willing to speak with the sister. Are there any other family members nearby who could administer the medications instead of the husband? Good luck.

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So you are the new paid caregiver? I have 2 ideas, first give the husband the out by saying “We are paying this person to do that now, let her be responsible we want you to just spend quality time visiting now” or if you don’t think he will do that well or she will listen take it a step further and say since medication is one of your responsibilities you need to be the only one managing medications for your own liability protection, no need to mention the mistakes just that mistakes have to be yours to make. It’s a new adjustment having a paid caregiver come in to take over responsibility the family has been managing for so long and it can take some time to adjust. Simply pointing out, gently the craziness of paying someone to do a job and then not let them do it, not getting their money’s worth will work with some but legalities or rules you need to protect yourself, it’s the way you operate... works better with others. Just be gentle not confrontational whenever possible.

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Document and call your agency to report this at once. I would lock up the meds and only you and husband have access, if things do not improve tell husband to get someone else. Sister sounds like she has major problems mentally. Your agency should support you and help with the situation, if not I would find another agency. This is not safe and could come back on you. Hope things improve.

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Explain to “medicating sister” that administering meds is one of your duties and it needs to be done accurately. Let her know she has made errors in preparing the meds for your patient that could lead to overdosing. Remain calm as she goes off. Talk to husband about purchasing a lock box for the medications and place in a location with limited access

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It sounds like the sister may also have some Dementia problems and really does not understand what she is doing with the meds. It's scary to think what medicines might be given in your absence. Maybe the family needs another paid helper to supervise meds and care on the days you are not there. Or a professional care giver may need to be on duty whenever the sister visits to make sure the sister does tamper with medicine.
Is the husband company to discuss that possibility?

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If there is a pharmacy nearby that packages meds in the "blister pack", I would get the Doctor to shift her prescriptions there. My mother-in-law's meds were done that way, and it was a HUGE help. I had to label the days with a sharpie because the lettering on the pack was too light and small, but overall, we were very happy with this arrangement. One month at a time, delivered. We had to hide her blood thinner, as that dosage varied and the pharmacy could not include it. I slipped it in myself as per instructions. Good luck, God Bless

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Much easier for all concerned and no reason for the sister to open packages unless to give a dose of meds. I like the idea of marking packs with larger writing too, making it easier for all to read. Some companies and pharmacies will do this free of charge or for a small fee. I would still only leave the weekend meds out and lock up the rest. At least if sister gets it in her head to open packs up and put in pill box she can only screw up the 2 days, not a months worth. What a can of worms you have going on. Hopefully this will straighten out as you work with the family and the wrinkles get ironed out. The medicine dispensary log is also a good idea. Let's everyone see at a glance who gave them and at what time.

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Agree with others in comments - try to get the meds put into the dose packets. If that's not possible, then only leave weekend meds out and marked with day/time and lock up all other meds...or hide them...or take them with you. Don't leave sister anything to meddle with.

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Please don’t take her meds with you. Being in possession of someone else’s prescription is not legal in many states, there are also federal laws regarding this. The meds obviously need to be kept in a safe place but you shouldn’t be taking her meds out of her house & keeping them in your possession. I don’t believe you have the legal authority to control her meds like that.

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I hadn't thought about that...ooops. With that said, she should just put out what is needed on her off day in the pill compartments/time of day. And hide the rest. Should also have a chat with hubby and the sister at same time to explain there has been a serious problem and please leave the meds alone.

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Best options are to used a timed locked dispenser and lock up the unused medication. Depending on how many times/day meds need to be dispensed, they can handle up to 4 weeks. Ensure the "key" to the dispenser is locked up with the meds and the spare key to the lock box is left with someone trusted (probably not hubby, sounds like he would just hand it over!)

If you work for an agency, you may have to check their policy on this, but I would think they would back you, because of the danger this presents!) If no agency, I would get and mark the dispenser and lock box as yours and then if/when your duty there ends, you take them with you. You'd still want to leave the spare key with someone trusted so if you are indisposed they aren't up the creek with no access to meds!

We used this lock method for mom as she wouldn't remember if she took one or twenty (the agency we used didn't allow them to touch or dispense meds, but they could point it out if she missed the alarm and didn't take her meds.) She couldn't even open it, so we ended up not locking it, but you have the issue with some able-bodied, but apparently feeble minded do-gooders to worry about!

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The best option is to get locking pill bottles. This WAS my late mother, who had a habit of dropping pills on the floor and/or taking them out of the cassettes and placing them on a small saucer with a tissue covering them. What a hassle!

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whoa! you're worried about pissing her off? I get it, but number one priority is safety/health of the patient! Does sister want to kill her?? Does sister have cognitve impairment? Hubby must say he's taken it over and put the pill box away if possible, but my guess is sister's visit is during a pill taking time she's there so long. In which case I would get hubby to check in and get the best locking automatic pill dispensing unit on the planet that YOU will set up....or failing that look into a pill delivery service where each dose is marked with pills, day/time and comes in little individual plastic bags sealed on a roll to be ripped off. If the hubby can't handle that much then someone needs to get authorities /case worker somebody involved...

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Talk to a Head Honcho at the facility in Handling this Sticky Fingers Situation.

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Thank you for your caring

How about placing a sign/note where the sister will see it on or near the pills saying - "only qualified medical persons may handle the medications .... please sign & date the log when you do" - make it as official looking as you can by printing it off on your computer use different font sizes etc

Back date for a few weeks a log of your own & use different pens to show different times - make it look semi generic so that it looks like a policy not just for her but for everyone & this isn't a bad idea to have either

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https://www.theseniorlist.com/medication/dispensers/
medacube is tamper resistant

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Why is her sister managing the meds? Can’t someone that is capable do it? Can’t she have the individual packets or is that not available?

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If you work for a agency in most if not all states A RN from the said agency is the only one except a competent family member can handle a patients meds. You as a care giver are not allowed to even hand the meds to the patient. If you are with an agency notify them right away as if anything happens you are liable.

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The sister of my patient w/dementia interferes by setting up pill organizer in incorrect dosages, omits pills etc. How should I handle it?

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