The Saga of the Cheese Toastie: Medicines, Heat and Why It’s Always Worth Asking

A children’s service emailed TeeJay with what looked like a simple question: how do we dispose of a cheese toastie that has medication in it? It wasn’t simple. The medication was methylphenidate, a Schedule 2 controlled drug. It had been put into a hot toastie, covertly, on a consultant’s advice, and there was no sign a pharmacist had been involved in the decision. The staff had followed the advice they were given. But they did have the confidence to ask what to do with the leftovers, and that one question turned into a safeguarding conversation. TeeJay and Hollie use the story to talk about why medicines and heat don’t mix, what actually happens to a medicine that gets too hot, and why a medicine cupboard that reads 29 degrees at 7am can be a very different story by the afternoon. They also look at covert medication in children’s services, where capacity isn’t about age and children still have the right to refuse, and why the pharmacist belongs in the multidisciplinary team. In this episode: Medicines in food: as little food as possible, kept cool, and checked with a pharmacist first Why heat can destroy a medicine or turn it into something different Heatwaves, medicine cupboards, and medicines left in glove boxes or rucksacks Recording and disposing of a controlled drug that wasn’t taken Covert medication and children: capacity, the right to refuse, and who should be involved in the decision Why consultants are experts in diagnosis and treatment options, and pharmacists are the experts in medicines How to challenge something that doesn’t seem right without rubbing anyone up the wrong way A second query from the team’s inbox: an end of life medication shortage, and why using another resident’s medicine wasn’t an option Timestamps: 00:00 Welcome 01:06 The saga of the cheese toastie 04:30 Who said to put it in hot food? 07:12 Raising it as a safeguarding concern 09:18 Why medicines and heat don’t mix 12:43 What happens to a medicine when it’s heated 14:04 Heatwaves and medicine cupboards 16:41 Controlled drug records and disposal 17:56 Ask, challenge, and check it out 20:24 The end of life medication shortage query 23:32 Covert medication and children 27:26 Final thoughts If you’ve trained with us and something doesn’t feel right, always fee free to ask! No question is a silly question, and the team would always rather hear it than not, no matter what it is. If you enjoyed this episode, follow or subscribe wherever you listen to Momentum Matters.