Would you re-use medicines returned to the NHS?

I have seen a number of cases of elderly patients hoarding medicines, and all were intelligent people. One told me that it was as a habit developed during wartime shortages! The worst example was a relative who must have accumulated about two years’ supply of about 8 drugs and continued to ask for repeat prescriptions despite my best efforts. That person actually had a recent copy of the British National Formulary on the bookshelf, and this gives the approximate price of drugs. Fortunately none of the drugs were expensive and the user had them carefully stored in date order.

My present GP uses the prescription counterfoil to indicate when the next prescription is due. I could accumulate certain drugs where I vary the dose in agreement with my GP, but I avoid accumulating more than I need to cover for holidays. I hope that most GPs now do the same to help discourage the drug hoarders.

Having heard about the state of some houses from speaking to people like service engineers and health visitors I would not like to use anyone’s left over drugs. Better to focus on avoiding unnecessary prescriptions, I think. I urge everyone to have a look and see what your parents and elderly friends have in their cupboards.

Hospitals prescribe and change patients’ medications when in hospital. A medication record card is sent home with the patient. Unfortunately in our experience this often does not agree with the medications sent home with the patient. A discharge note is also sent home and a copy of this is also sent to the GP. So medication record card and discharge note need comparing as well as drugs brought home TOGETHER with the repeat prescription note which is what the patient uses to order their drugs.

If the Doctor’s Surgery READ the discharge notes they would be able to make the alterations to the repeat prescription note. My impression is that they just file them (but I don’t even know that).

Unfortunately patients are now being discharged from hospital when they are not well enough to attend the local Doctor’s Surgery to discuss their medication. These patients are often elderly with hearing and eyesight problems as well as mobility problems – and possibly memory problems as well. (Don’t forget that good eyesight and hearing also aids memory.) So discussion needs to be face to face.

Patients therefore rely on the pharmacy to deliver the drugs as they no longer drive. They don’t like to burden friends and family with this and also don’t want to change their routines once established.
Endless strange people seem to charge into the house in a great hurry and nobody knows exactly who they are and where they came from and what exactly their job is and if they had to explain each time they would never get anything done. In one county the “District Nurse” is seven qualified nurses; in another 11 most of whom are Health Care Assistants. We don’t all live in one county – we never have – and we also move from time to time.

When you can’t hear properly and can’t see properly and have been married for more that 60 years you tend to depend on each other so you like to go to appointments together. Then you can discuss exactly what you heard AND understood from the meeting. Hospital transport won’t allow this. Hospital appointments are sent out at times that hospital transport can’t get you there and this causes the unnecessary angst and trouble of telephone calls dealing with strange telephone systems. Too many hospital appointments are a waste of time – they’ve lost your notes so can’t comment; you need to come back in; you don’t need to come back in. Many of these family have accompanied you on – major logistics and time taken off work for and a long wait (1hr) for 3 minutes of consultants’ time. You don’t know who you are meeting; and afterwards you argue over who you met – you thought the consultant you met last time was the man himself. What a complete waste.

Different people bring in equipment and medication and then when you are running out you are told to order from the Surgery only you don’t know what exactly to order. You don’t know the technical names – eg lancet – or what size because the previous ones didn’t come in any packaging showing this.

You end up not knowing who has prescribed what, for what and whether it should be on a repeat prescription or not.

I can understand why people hoard and why people end up taking the wrong drugs.

My father had an operation about a year ago and had about 6 boxes of unopened packets of bandages and plastic tubing etc. all packed, sealed and in unopened boxes.

I took them to the local pharmacy attached to the medical practice and they said they were not allowed to use or dispense them but they would dispose of them.

I can understand the worry about medication and how it may have been stored – but sealed bandages etc. ?? A terrible waste.

Drugs are even more complicated now because we are using generic ones – so the packets and names on the outside may not be the same from one packet to another.

They also don’t seem to come in the same numbers – or because they come in strips you don’t get a month’s supply of each of them. I have seen, but rarely, a few odd pills cut of a strip to that the correct number are given. When you have all the right number for a month you can order “all of them” off the repeat prescription as you will be running out of them all together and won’t have to struggle with all their names.

When pills were loose and people could multiply and count it was easier to get the right amount!

With some of these pills now you need a course in how to get into the packaging. The change to the packaging of Lansoprazole last year resulted in a mass of hundreds and thousands type little balls all over the dining table and: “Can you have a look at that packaging to see why I am now having so much difficulty with it?” Why? Several pills lost there.

Actually you will find that they sometimes have to find and use “spare” pills in hospital because it is so difficult to get patients’ pills – so there can be an amount of passing on of pills that isn’t official or officially recognised. Wouldn’t it be better to teach people to look out for different strengths and names and to understand their drugs rather than: “Don’t take anyone else’s drugs”? People need to be checking that they are getting the right drugs from the pharmacy. I’ve had an inhaler that was “to be swallowed with a glass of water”. They also need to be reading about possible side-effects and be aware that you might need to report these and anything you else you think might be a side-effect on a special form available from your pharmacy. Are you diabetic and taking a drug which depletes your body of the vitamin B12 for instance? Is your Doctor doing anything about this? etc etc.

Yesterday I collected a prescription from Boots. At home I opened the box and found one of the 14 day blister packs had been cut into pieces. I had assumed this had either been tampered with or someone had previously used the product and returned it.

Boots say that it is now common practice to make up boxes from spare ‘off-cuts’. Previously if a doctor had prescribed 20 tablets, but the tablets are only available in quantities of 28 then 8 tablets were wasted.

What they do now is to cut off the 20 for the patient and mix the spare 8 with other off-cuts to make up a full box of 28 again.

This is incredibly dangerous and there is some money grubbing going on with this too. It seems that since 1st July 2012 pharmacists are now paid 10p per split box. They can claim an allowance of 10p per box to cover the time and costs involved in ‘cutting packs’ in order to make good a full box.

So there you go. Not only are pharmacists now ‘saving the NHS millions’ but they are also profiting from this process.

But is this a good thing? NO! It is extremely dangerous.

Boots never informed me that I was to have box made up of split packs. When I opened it I assumed the worst. I assumed it had either been tampered with or the stock was old. They did not even bother to put in an instruction / safety leaflet, but which was in one of the other boxes. Now what if I only required one box and that did not have the instructions / safety leaflet? Here are a few more concerns.

1. The pack should have contained 2 x 14 tablet blister packs. These packs are sealed and written on the foil is the name and dosage of the tablets. When the packs are split this information is lost. I received half a pack (which did mention the name and dosage) and four other pieces which did not (they only had on them ‘Tue’, ‘Thu’ etc.) Even though the tablets looked the same there is no way of knowing that they were the right tablets or if they were in date.

2. It creates an opportunity for error. If a pharmacist is mixing split packs and the pieces did not have the name printed on it there could be mixing of different tablets.

3. The blister pack allows you to clearly see if you had taken your tablet that day. But this pack was not complete. I had five Tuesdays but only three Wednesday.

After having a kidney transplant I had over a months supply of unopened boxes of peritoneal dialysis fluids at home, kept in clean dry conditions in my my house. I guess this must have cost the NHS thousands of pounds. The hospital says that the fluids will have to be disposed of because the prescription reuse rules does not allow them to use the fluids for other patients. All the fluids are in date. If it was deemed safe for me to use the fluids why is it not safe for other patients to use the fluids?