A Blister Epidemic: Exploring the Increased Promotion of Monitored Dosing Systems for the Elderly
Controlled Dosing Systems (MDS), also known as multi-compartment compliance aids, are medication storage devices with compartments divided into days of the week and times of day. Over the years, different terms have developed to describe them, such as “blisters”, “monthly trays”, “medibox” or “pod boxes”. They come in many forms, including trays of blister packs and rolls of pouches or sachets, and are intended to facilitate the taking of medication by patients and/or the administration of medication by caregivers.
However, it is unclear whether they provide a solution or create problems for healthcare providers and patients.
For example, here is an all-too-familiar scenario with an MDS.
Case Study: Mrs. B
On a Friday afternoon, 83-year-old Ms B is ready to be discharged from the hospital, where she spent several days following acute hospitalization for community-acquired pneumonia, electrolyte imbalance and acute kidney failure .
Mrs. B generally self-administers her medications from a monthly MDS tray in her community pharmacy. Earlier in the week, the ward team spent an afternoon contacting the busy community pharmacy and GP practice to relay the latest changes to Mrs B’s medications to ensure that her existing MDS is updated. Unfortunately, the community pharmacy had already prepared Mrs. B’s monthly MDS tray, which was due to arrive this week, and this will now go to waste as it does not contain her latest additions of short courses of slow K, co-amoxiclav, sando -phos and furosemide. And what about warfarin, which cannot be added to MDS — will Mrs. B remember to take it in addition to the MDS drugs?
On discharge, the hospital pharmacy delivers a first supply of drugs to patients; however, the Hospital Pharmacy Adherence Robot only dispenses medicine in a roll of sachets.
When demonstrating the system to Mrs. B in the ward, it becomes clear that she lacks the dexterity to open these pouches and has difficulty reading the small printed label. At one point, the pills scatter on the floor as she tries to open it.
In Mrs. B’s case, discharge may be delayed and temporary caregivers will be put in place to help manage her medications.
Many drugs cannot be dispensed in an MDS due to their unstable nature; for example, effervescent, dispersible or hygroscopic products, which are the most sensitive to the effects of humidity, the frequency of administration (e.g. treatments for Parkinson’s disease), or their form (e.g. patches, creams topicals and inhalers).
MDS devices are also not suitable for “as needed” medications, such as analgesia, or medications that vary in dose, such as warfarin. However, in these cases, it could be confusing if patients were prescribed their medications in both an MDS and their original packaging.
Wastage is also an issue when there are changes to usual medications, as in the case of Mrs B, who needed a brand new MDS to be dispensed mid-cycle.
Major concerns with MDS devices include the possibility of human error, as well as the risk of drug destabilization through exposure to moisture, light, and contamination from other drugs or bacteria.
Use in nursing homes
In nursing homes, MDS devices should only be used when they meet the individual needs of residents to enable self-administration and compliance. While many healthcare providers believe that the use of an MDS improves the accuracy of medication administration and provides a visual method of checking staff members, there is no clear evidence that MDS reduce medications overall. medication administration errors. In addition, it is estimated that 40% of drugs in EHPADs cannot be delivered in MDSs (eg topical products or unstable drugs); therefore, the use of MDS results in parallel administration systems, which makes the process more complex.
The National Institute for Health and Care Excellence (NICE) guidelines for adults receiving social care in the community state that the use of MDS should only be considered when an assessment by a healthcare professional has been completed and that a specific need has been identified to support medication adherence.
Guidance issued by the Royal Pharmaceutical Society on the best use of multi-compartment compliance aids states: “Use of original packaging of medicines, supported by appropriate pharmaceutical care, should be the preferred intervention for the supply of drugs in the absence of specific need. for multi-compartment support in all settings.
There are many alternatives to MDS to support an individual’s independence by continuing to take their medications in the original packaging. An adherence assessment by a healthcare professional, such as a pharmacist, is essential to determine the best option, alongside a patient-centred medication review to ensure that inappropriate polypharmacy is being addressed and that drugs are optimized.
Membership solutions to consider include reminder boards and larger font labels. Alarms are also an option to remind patients to take their medications, including a talking alarm clock. There are devices to help pull pills out of their packaging and catch them in a container, reducing the risk of dropping pills.
Most importantly, healthcare professionals should always talk to the patient, their family and any carer to find a solution that meets their overall healthcare needs, helping them to remain independent wherever possible.