Monitored dosage systems

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Monitored dosage systems (MDS) is the jargon used in the UK for certain types of medicine compliance aids such as blister packs prepackaging all a patients medications or dossette boxes. This is not the same as manufacturers blister packaging.

They can have major problems, including titration of a medication, cost and that they may actually not impact compliance (pill count compliance is not the same as pill taken compliance)[1] and introduce their own safety issues[2].

Compliance with health benefit may be improved with MDSs when a self administering patient is on complex medication regimes[3], but also with certain designs of calender packs for individual medicines[4].

They need to be individualised, and this ideally should be done by a pharmacist without a conflict of interest.

Contents

UK Relevance

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Interesting distortions may have developed. The important point is that any organisation claiming that a patient has to have an MDS because we are told we have to do it by our regulators are actually using regulation to justify an organisational policy that is probably convenient for them, so they comply with the relevant regulations.

The Disability Discrimination Act 1995 specifies that businesses that provide a service to the public have an obligation to make reasonable adjustments to their services for people with disabilities. This could include the use of compliance aids such as MDS but only where appropriate. Interestingly if a pharmacist or presumably a doctor felt the supply of the aid was inappropriate by formal assessment, the supplying pharmacist could charge for the service.

  • In the 1990s a major pharmacy chain offered MDSs to nursing and residential care homes. They increased their prescription business. The homes were happy as it transferred issues around training staff in certain medication issues and responsibilities to the pharmacy and made documentation on MAR charts trivial. This made it easy for care homes under the CSCI (Commission for Social Care Inspection) standard 9 guidelines to monitor and audit the administration and control of medicines on behalf of their residents/patients. The pharmacist might even supply the records. A current 2008 advert runs "X will package medicines in the way that meets the needs of your clients or service and allows you to accurately monitor stocks of medicines."
  • In non care home settings professional carers have liability issues with medications that their employer and themselves may feel are best dealt with by MDS solutions. The objective evidence for patient (client) benefit in most home care situations is sparse, but legal liability risk seems to have driven an entire subculture. Indeed it has been reported that at least one local authority determined that any patient who took more than one medication could only be helped with medicine administration by home helps if all medication was supplied in MDSs.

The cost of the ever increasing supply of MDSs along with wastage potential is controversial.

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Advantages

  • Time saving devices
    • Simplify medicines administration process to large groups of people on complicated medication regimes.
  • Tamper-evident
  • Facilities for labelling of medicines in compliance with legislation and good practice
  • Easy visual check on whether medicines have been given

Disadvantages

  • Difficult to adapt to rapidly changing medication regimes
  • Shelf life is reduced : effectively to about 8 weeks
  • Only suitable for certain solid oral dose medication.
    • Thus dublication with traditional delivery means for
      • Liquid medicines
      • Creams
      • Eye drops
      • Inhalers
  • Not suitable for drugs with special storage requirements, eg dispersible, hygroscopic, photosensitive or need fridge storage
  • Not suitable for '‘when required’' medication;
  • Not suitable for drugs which can cause cutaneous hypersensitivity reactions
  • Not suitable for cytotoxics
  • Not suitable for oral anticoagulants

Some common drugs that might best not be removed from manufactures original packaging for these reasons include dispersible aspirin, ranitidine, atenolol, thyroxine and atorvastatin.

References

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