Med management

[RN94]

Anyone have any advice regarding med management? My toughest patients are the ones that are forgetful due to dementia and either don't take their medications at all or miss some days etc.... My boss and one of the NP's I work with recommend getting meds prefilled by the pharmacy, but this does not help the forgetful pt because even if it's filled correctly, the pt doesn't remember to take them or they could forget they took them and take more than one day's worth. Lifeline has a dispensing machine that will alert ppl (i.e.: family member) if the pt didn't take the meds but even that is not foolproof and some families/pt's can't afford it and don't want it. So, I guess my question is, if I've identified the problem and notified the MD and educated the pt/family on options to safely deliver meds, can I leave it up to them and discharge the patient? I just feel with some pt's nothing is going to work. There may be a slight improvement in compliance but I don't know what more to do. I can't go everyday to give the meds myself and if I've notified the MD and educated the family, referred SW, etc... etc.... That's all I can do right? I should discharge right? If I've done all the forementioned things and I continue to go in and find that medication is not being taken or extra meds are in the pillbox, there's not a whole lot more I can do about it. It's my understanding that if I'm just going in and checking a pill box and taking vs, that's not really skilled nursing that insurance will pay for. Is that right? Any advice comments would be appreciated. Thank you.