When arriving at a placement it is very likely that there will be medication which your client needs to take. Often, they will be able to do this themselves, with a little prompting.
Sometimes they may not be able to remove the tablets from the packaging or even have the capacity to take the right tablets at the right time and may need assistance.
Blister packs and dosette boxes – what’s the difference?
The blister pack is the original packaging that any medication comes in. It is the packaging which has been assembled when the tablets were first made and packed. For example, this is the packing that you would have to break to get a paracetamol tablet from when you first buy the box.
Dosette boxes are the containers that the tablets are assembled in when the chemist delivers them to you, or you collect them. They are made from card and have indentations for every day of the week and certain times such as morning, afternoon, and evening.
On the dosette box you will find the actual prescription along with instructions on the dosage, times, and storage. You will find a description of the medication such as ‘round yellow capsule’, along with anything else which is relevant.
A point to note here is that any medication which is taken on an ‘as needed’ basis will not be packaged in the dosette box.
One of the reasons why dosette boxes are becoming less frequently offered is that they are expensive for the chemist to assemble.
What we often mislabel as dosette boxes are in fact pill containers. Pill containers are plastic boxes with spaces for pills to be placed in and taken at set times.
They are useful to carry only the tablets you need when you go away for a few days, rather than carrying the entire collection of bottled tablets.
Pill containers do not have space to add the prescriptions or any other notes, they are merely holders to contain pills for certain days and times. You can buy pill containers at any high street shop.
Will I find pill containers at a client?
Yes, it is true that you will find these pill containers at a client. It is a very grey area as to who fills them and whether it is ethical to do so.
Who fills them?
Technically no one should be using them at your client. There are very good reasons for this, the most important one being that you as the incoming carer have no clue about what is in them and who packaged the pill boxes.
While a dosette box which has been assembled at the chemist is tamper proof, a pill box is not. Anyone can open it, check the tablets, drop the box, and rearrange the tablets as they assume they should be, thus giving tablets at the wrong time of day, or even on the wrong day of the week.
We all hope that the outgoing carer is ‘heads up’ enough to be able to fill the pill boxes correctly but remember that she has worked for some time and may be tired or just needing a break. What if she gets this wrong and you administer the wrong tablet at the wrong time?
The family may have decided that mom does not need that one tablet anymore and remove it – or worse, replaced it with something that Aunty Sue says ’really works.’ While Aunty Sue is a great person, does she have any knowledge of your client? Would you believe her rather than the doctor?
Some medications must be stored at different temperatures to others and simply adding them all to a pill box may change the effect of the medication, making it ineffective. Again, some medication needs to be kept out of the light.
Are they safe?
Unfortunately, while they may seem a good idea, they are not safe. They are not tamper-proof, neither are they child-proof. They can easily open if dropped.
A curious child may investigate the bright colored tablets and – heaven forbid – taste them. This is not a situation you ever want to find yourself in as you will have no idea which tablets the child has swallowed and what effect they will have.
If possible, you need to avoid pill boxes for no other reason than there is so much that can go wrong with them. You, being the person who is in the placement at the time will always be held accountable for a problem, whether it was an error on your part or not.
The phrase ‘cover yourself’ should always be at the front of your mind when handling medication. You should have MAR (medication administration record) sheets available in your placement. If not, you should ask your agency or at least get a notebook where you can document every tablet you give to your client.
Final thoughts
Unfortunately, you may find yourself in a placement where filling the pill box is regarded as normal. If so, try where possible to have a second person with you to double check your work. Any queries should be addressed to the doctor who prescribed the medication.
It is a good idea to avoid pill boxes if you can. Rather, ask the chemist to fill a dosette box for your client. Either way, you need to keep your own records – even with a dosette box – of the medication you have administered to your client, at what time and on which day.
Because medication is such an important part of live-in care work, it makes sense that you are as stringent with record keeping as you can be so that you are always in the clear on this.
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