Managing Medicines

The prescription covers not just the name of the medication and the dose(s) but also the time(s) of day. Make a note of your loved one's medications as they are now, and each time the prescription is changed (including when an item is stopped) make a note of that too. Taking a photo on a mobile/cell phone is a good way to do this, making sure it's in focus. Keep a file of these, in date order - it's always useful to look back and see whether a change in your loved one might potentially correspond to a change in their medication. Keep an up-to-date sheet of their medications in case they have an emergency visit to hospital (just as a care or nursing home will do), updating the copy in their hospital bag if you have one.

We also recommend keeping a list of hospital visits etc that your loved one's had (in addition to their future appointments, obviously) and a list of 'health events'. It can also be useful to keep a diary of how your loved one is, so you can look back at when a change in behaviour or health started, including whether it could be linked to something else.

A visit to hospital may mean you come away with a sheet that gives a full list of prescriptions after changes, and a list of changes - but in our experience these may be inconsistent with what was the full list of prescriptions before. If this is the case then it's sensible and fair for you to query it, to make sure the final list is correct. Ideally, this check is best done while you're at the hospital, if possible.

It's also worth checking that what's being delivered by the pharmacy is what you expect (nothing missed, nothing added, quantities and time of day the same). Even if your loved one's in a care or nursing home, we recommend asking to check periodically - politely and when they're not busy - and it's useful to note when their new supplies come in from the pharmacist (usually monthly). In our experience if a mistake's been made at the pharmacy (e.g. pills missed off) then the care home is likely to assume it's an intentional change made by the doctor. Obviously an intentional change may have been made, and if so it's useful for you to be made aware of this (and indeed the care home should be able to let you know at the time of the change if they know you'd like this sort of information).

When medications are given by visiting carers or in a care or nursing home, it's also worth checking that all medications are being given, and at the correct times. Difficulties can arise when the person giving the medication isn't available at the right time, or if your loved one's too sleepy to take medicine. For example, in a care home a general carer may need to get someone into bed when they're getting sleepy or before the carer's shift ends, but the carer authorised to give medication hasn't reached them on their rounds yet. Tell-tale signs are pills left in the weekly blister pack ('dosette box'), or the care home should note when there are significant numbers of left-over pills at the end of the month. If this is a problem then it's worth discussing with the person who prescribed the medication whether the prescribed timings can be changed.

Problems can also arise with medication being given but at far from the prescribed time. For example, in a care home many people may require medication at meal time, and some medication such as that for diabetes is likely to have a prescribed timing relative to the meal, but if there aren't enough carers authorised to give medication then some may get it quite late.

If the pills are being given by a visiting carer in your absence then it can be extremely difficult to get the message accepted that the stopped pill mustn't be given. If necessary try liaising with the carer's office, the dispensing pharmacy and the prescribing doctor's surgery until it's sorted out.

There can also be an issue if someone on diabetic medication stops or greatly reduces eating temporarily, for example due to gastroenteritis. The dose of diabetic medication may also need adjusting, so liaise with the prescribing doctor (this could be a concern with some medicines e.g. gliclazide but might not be with others e.g. metformin).

If your loved one chews pills or capsules then check with a qualified pharmacist whether this is a concern with any of their pills. If necessary you may need to discuss with the dispensing pharmacist or prescribing doctor alternative forms (such as a liquid form, soluble tablets, or the same total dose in smaller pills that might not be crunched).

For more information see the NHS website's information about crushing medicines.

We recommend against starting herbal remedies you're not already using. Certainly you'd need to check before starting a non-prescription medicine (or herbal remedy) that it's compatible with the prescription medicines and with your loved one's medical conditions. A qualified pharmacist will be able to help you do this.

Equally you should consult your doctor or a qualified pharmacist before stopping one you already use, as this may alter the performance of one of your prescribed medications. St John's wort (hypericum) in particular has strong interactions with many medications.

There are 'automatic pill dispensers', which a carer can load in advance. These typically have a rotating carousel to hold pills, with three time slots per day for a week, with a programmable time for an alarm to sound and the carousel to rotate so that the correct pills can be seen and tipped out. Of course this still requires an understanding of what the alarm means, and to tip the pills out and take them then. Obviously, liquid medicines can't be put in pill dispensers.

If necessary, the supply of medicines (including those for other people in the house, kept separate and clearly labelled) is best kept in a cupboard with a child-proof lock or in a lockable medicine box. A lockable medicine box is best to be all-metal, and do check the size and whether internal shelves can be removed if necessary. Lockable boxes are particularly useful for any medicines that have to be kept in the fridge, but do consider their weight on the fridge shelf and if they have to be lifted out to open the box. (If you're considering putting a child-proof lock on the main fridge and having a separate mini-fridge for the day's snacks then see our section on mini 'cooler' fridges.)

Consider what arrangements may be appropriate for medicine supplies delivered to the house to be given later by a visiting carer, and for any medicines that must be kept in the fridge - both in terms of ensuring they go in the fridge and in terms of restricting access to them as above.