“We visited St. Hans hospital in Roskilde, the section for multiple diagnoses.”

– Section for dual diagnoses: Means that you are hospitalized with both a mental diagnosis, e.g. depression, anxiety or have an antisocial personality disorder, and at the same time having an addiction to e.g. drugs, alcohol, pills etc

This month we have chosen psychiatry as our focus. The employees at section M at Sct. Hans hospital in Roskilde handles medicine every day and pill boxes are an important tool of their work, and therefore we are curious as to which values ​​are important to them and how a pill box can make their work a little easier.

We had a chat with Pernille, who works on the M section. We talked about topics such as daily care, the distribution of daily medication and which challenges are experienced in this context.

Would you like to tell us briefly about yourself, your professional background and which tasks you perform?

I am a trained nurse. I have been employed for 9 years working the evening shifts and have now become a ward nurse and now I am only here during the day. My tasks are everything from looking after patients and preparing medication and holding meetings with pillbox ladies 😉 I coordinate (the patients’, red.) doctor visits and organize what needs to happen when we have meetings with the doctors in the morning. I also have a lot of administrative work, tasks that have nothing to do with the patients. At the moment, we, or I, spend a lot of time ordering dose-packed medication for the patients, so it comes in rolls like this. And there are a lot of challenges associated with that, so there is a constant back and forth between the pharmacy and us concerning corrections and misunderstandings and so on. Sometimes patients receive dose-packed medicine, only to sod off and leave the hospital the next minute, so we are left with a brand-new dose roll. So yes, tasks like that, there are a lot of them, you could say, the medicine is for the patients, of course, but much of what I do is not directly interactions with the patients. At least not as much as I was used to.

I also work as a substitute when the head nurse isn’t here. I go to meetings about shift planning in the new planning system we are converting to; cover shifts when people call in sick; talk to colleagues who want to exchange shifts, etc.

So, in terms of nursing the tasks have become less nursing and much more administrative work.

I just want to go back to what you said with these dose rolls. So they are actually a challenge?

Yes, but it’s not the rollers themselves that present a challenge. It’s the doctors who suddenly change the patient’s dose. These rolls contain 14 days’ worth of medication for the patients and that’s, well, what can you say: Brilliant. Then they get the medication, and they have to administer it, those who can. The challenge is that suddenly in the middle of a roll of 14 days, and actually it happened yesterday, one of our doctors changes the patient’s medication. So the whole roll must be cut up and one pill taken out and another pill put in. It’s a waste of time.

How do you close the bags then?

With tape, or alternatively make the doctor wait with the new prescription until the roll is finished on (e.g., red.) Wednesday next week. Then the patient doesn’t get the medicine he needs, but it usually doesn’t matter if he doesn’t get the medication removed until the week after. It is not something that is, shall we say, dangerous or harmful in any way. He just has to get the new dose, and it just happens a week later.

What is problematic about the dose rolls is the workflow for signing it off inside the health platform. Now we’ve gotten better at it, but at the beginning it took about an hour and a half to sign off on 2 patients. I didn’t do anything else. Now we have become more confident about it. It is still not optimal, because we need to get instructions on how to do it correctly, but there are lawyers who make sure that it is done properly so that we don’t get our “hair in the mailbox”*.

*”Hair in the postbox” is a Danish colloquialism, meaning, to end up in a tricky situation.

Do all patients receive prepacked medication?

No. Right now it’s a trial period. We have 18 patients (in total, red.), and right now it is 8 patients and it is the 8 patients that we estimate are the most stable on medication, so they require the fewest changes in their dosages.

It also needs be patients who are able to administer it themselves. The whole concept of being here is to learn to take care of yourself and learn to take responsibility for taking your own medication.

Those patients who are not considered to be stable enough, as far as medication is concerned, to receive dose rolls are given medication in this disposable box. Do you know why this one was chosen?

No. But I think it’s about money. Where we order our medicine boxes from, there is a limited selection, so we order what is available. Sometimes the boxes start with morning and sometimes with noon. And then we must order the ones we can get. It’s not ideal when the box starts with noon, because there’s a greater risk of mistakenly taking the noon meds in the morning, since logically you think that the first compartment is for the morning.

Ok, so apart from the fact that this box starts with noon, which is not ideal, are you otherwise happy with them?

Yes, mmh, yes, ehh yes. We only tried 2 different kinds. These ones, and then another one where the box is much larger and where the plastic is much softer and therefore bends easier, and that is just f****** annoying. The idea was that we should keep the blue boxes here at the hospital and the white ones were intended for the patients to take with them when they go home on leave. But it was a mess when we had to dose in the white boxes, because the lids were difficult to put on when the plastic was so flexible and then the lid would give way and there would be pills all over the place. That is not ideal. The white boxes were also much larger and just not very practical to carry around in their bags when they were going home on leave. Sometimes we would like the boxes to be smaller and more practical to carry around, but we have some patients who receive enough medicine to fill up an entire compartment. But we have never experienced that there has been more medicine in the boxes than they could contain.

How many pills do your patients take on average per day?

Well, it ranges from one pill in a compartment to it being full. It varies a lot.

Do you know Kibodan’s pill boxes?

Yes, and we’ve had them before. Both Medidos and Medimax. The problem was that when our patients took them home on leave, the boxes usually never came back to the hospital again and it became an expensive affair. The blue boxes we use now, they always come back.

Do you think it could be a solution to use the Kibodan boxes as a tool here in the department and for patients to take the slightly cheaper boxes home on leave?

Um, yes. I don’t see why not. But again, it’s about money.

On average, how long do you have these blue disposable boxes?

It varies, depending on how long the patients are hospitalized. Their hospitalization averages at 3 months. A box follows a patient thus when the patient is discharged, the boxes are destroyed. Sometimes we have use new sets for the same patient, as the boxes can be quite disgusting after a stay at home.

What are the most important values ​​when you prepare medication?

That it’s easy to aim at each compartment; that you don’t drop the pills or miss the compartment. And the blue boxes give us that possibility, because we can move the lid depending on which compartment is to be dosed in. Currently we are only allowed to prepare for the next dose, we CANNOT dose for a whole day. It is the legislation on patient safety that dictates this.

When incorrect dosage happens, do you think that it is due to the design of the product or are there external factors at play?

In our case, it’s that the box starts with noon. Mistakes can occur both on the part of the staff, but also on the part of the patient themselves when they are on leave.

Would you consider our Medinizer Day Box as an alternative to your current boxes?

Yes, I could, easily. It looks good. And the best thing is that it starts in the morning.

It is probably more expensive, but they also last longer and can be washed. Perhaps we could also consider the Mininizer but I’m  concered that it will be too small for most patients. And we don’t want to have several different sizes. But the Mediziner could certainly be interesting and we will strongly consider that.

If you or someone you know needs help you can call the Samaritans on 988, It’s free and confidential.

If you want to know more about how get help for yourself or someone you know you can find more information at mind.org.uk