How safe are dementia patients in hospital?

Data produced by the National Institute for Health and Care Excellence indicates that one in four hospital beds are occupied by people with dementia. This places a serious demand on already stretched staff, which in turn raises concerns about safeguarding, particularly around medication controls. My own experience of caring for my wife, who has dementia, is that hospital staff are often ill-equipped to manage the medication needs of dementia patients, who in turn are unable to help oversee their own care. Much is left to relatives, who cannot always be present.

Many dementia sufferers are not fully aware of the details of their medication, especially the required dosage. This is also the case for other patients who may become confused in hospital, perhaps due to illness or a reaction to other medication. Medication rounds usually occur outside visiting hours, meaning carers and family members are unable to monitor visually what takes place. And patient confidentiality means that records are mostly stored in a way that cannot be later checked by visitors. This confusion, combined with human error when administering these drugs, is putting people at risk of harm.

Is it an issue of staffing levels?

In hospital, controlled and intravenous (IV) drugs are checked by two nurses before being administered to the patient. When a patient cannot confirm their identity, such as with some dementia patients, this may be done via a hospital-issued patient wristband containing the relevant details. However, the four drugs available in the UK to manage dementia symptoms – donepezil, galantamine, rivastigmine and memantine (which may be prescribed under manufacturers’ brand names) – are not controlled drugs. This means that in many hospitals, administering these oral medications is often done by just one nurse.

But an overdose of any of these dementia medications can cause serious illness, and in some instances can be fatal.

There are more than 200 NHS trusts and foundation trusts in England. In May 2025, I submitted a Freedom of Information Act request to 98 of these trusts. I asked how many nursing staff are required to be involved in administering controlled and IV drugs on geriatric wards, how many are required for oral medication on geriatric wards, and how many near-miss episodes they had recorded in this year to date, and in the previous three years. [see table of results below].

Only 60 of the trusts replied, none of which has a policy to have two nurses routinely administer oral medication on geriatric wards. If these figures were also typical for the remaining trusts which did not respond, then it would appear that oral medications are being given to dementia patients with no safeguards in place to take account of the fact that dementia patients are often not capable of acknowledging the quantities of and type of medication they should be receiving.

I have been urging my local trust – South Tees Hospitals NHS Foundation Trust – to introduce the protocol of a second person checking the medication and quantity, but this has been rejected, primarily due to staffing limitations.

Margaret’s story

My wife Margaret was diagnosed with Alzheimer’s in early 2018. She was prescribed oral medication – liquid galantamine at a dosage of 1ml in a little water.

On 28 December 2022, Margaret collapsed while walking through the kitchen. She was admitted to James Cook University Hospital, Middlesbrough, with various injuries that included a fractured wrist.

I insisted on staying with Margaret 24/7 while she was in hospital. After 16 days in ward 10, the nurse in charge informed me that it was hospital protocol to hand in Margaret’s dementia medication. This meant responsibility for administering this drug was transferred from me to the hospital, even though it did not routinely stock the drug at that time.

On the next medication round the nurse came in with 10ml of galantamine in a syringe. I challenged them, because the prescribed quantity was 1ml to be taken orally in a little water. The following morning a different nurse brought in 4ml of galantamine. On both occasions I was present and prevented the administration of the galantamine.

In some trusts, patient medications are now routinely documented on a tablet device. One reason for this is to reduce the potential for human error. The doctor did say he would make sure the nursing staff understood the dosage and even went so far as to show me the screen with Margaret’s medication, which clearly said “1ml in a little water”. Margaret was fully dependent on other people being aware of or reporting on the administration of her medication.

Following Margaret’s discharge from hospital, I contacted the manufacturer, who submitted a formal statement that 10ml would have killed Margaret, and 4ml would have been critical but could probably have been managed because we were already in hospital.

Health

Alzheimer’s and dementia: no memory, no rights

by Derek Brown

5 July 2021 - Updated on 11 October 2024

Human errors keep on being repeated

I submitted a complaint to the hospital, and in their initial report they stated that it had been “human error”. I followed this up with a complaint to the trust and then the Parliamentary and Health Service Ombudsman (PHSO). The hospital confirmed in writing that they had taken steps to prevent it happening again.

Two years later, in November 2024, Margaret collapsed and fractured her right femur. She was admitted to the same hospital and required surgery, so once again I stayed with her 24/7. A few days after the surgery, a nurse brought in 4ml of liquid galantamine. I again stopped her and pointed out that the correct dose was 1ml. She said she had been nursing for nine years but had not come across galantamine before.

Training for hospital staff caring for patients with dementia

The final PHSO report outlines additional training that has been introduced regarding safety around liquid medication, and face-to-face dementia training on wards across the trust, together with amendments to allow carers to administer medication that the patient was already taking before being admitted.

Independent of this review, I had previously contacted the group chief executive of the hospital trust and suggested I would like to assist in a dementia training video. I was able to tell Margaret’s story, unedited and in my own words to create a dementia case study for the trust. This video is now part of the staff training schedule.

In addition to raising concerns about the monitoring of medication during Margaret’s last stay in hospital, I also highlighted the lack of assistance she was given in being mobile while in hospital. Unfortunately, this lack of assistance, combined with her dementia symptoms and lack of cognition, meant she spent four weeks confined to bed, and lost her ability to walk. Margaret is now fully bed- and wheelchair-bound.

Both the medication and the rehabilitation issues highlight a desperate need for the increased dementia training of all hospital nursing staff, together with the need for specialist dementia nurses or Admiral Nurses within every hospital trust.

A spokesperson for South Tees Hospitals NHS Foundation Trust said: “We are committed to learning from patient and carer feedback and welcomed the opportunity to work closely with Derek to share his and Margaret’s story which is now embedded in our teaching.”

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