Josephine Summers is 79 years old and lives alone in a third floor warden-assisted flat. Recently, she has started to show signs of frailty and dementia, including slower mobility, two falls and cognitive impairment

Josephine has a past medical history of hypertension, postural hypotension, anxiety and type 2 diabetes. In spite of these, she visits the local shops daily and regularly attends activity classes. She is out for most of the day, returning home late in the evening.

Her medicines are dispensed in a monitored dosage system (MDS), which she picks up every Thursday morning from your pharmacy. She had been self-administering her medicines until a few weeks ago when she was referred by her GP to the district nursing team due to high Hb1Ac as well as fluctuating hypo- and hyperglycaemia. Her insulin has since been changed from Humulin I bd to Lanctus od and the district nurses have been visiting every morning to support her with the changeover. 

Prior to a domiciliary medicines use review (MUR), the district nurse reports that Josephine has not quite mastered the administration technique with her Lanctus and her blood sugar levels are still fluctuating. The nurse is also concerned that she is not taking her oral medicines as prescribed, although Josephine maintains that she is. As a result, the nurse has insisted that Josephine waits for their morning visit so she can be supervised while taking her medicines. Josephine dislikes this arrangement as she finds it limits her activities and lifestyle. The nurse then puts the evening and night-time medicines out onto a saucer for her to take later. The nurse says that sometimes the medicines are still there the next morning. 

During the domiciliary MUR, Josephine said that she wants to be left alone to manage her medicines and get her blood sugar levels back to normal. Initially, she played down forgetting to take her medicines but later admitted that she stopped taking her water tablets (furosemide) a long time ago because of urine frequency and was not keen on taking the evening and night-time medicines. She said she felt overwhelmed taking so many medicines and was keen to know why and how long she has to take them for.

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