From Dr M. Ahmed, MRPharmS
SIR,-Monitored dosage systems (MDSs) in the form of trays containing loose tablets and capsules are used in nursing homes and other similar institutions on a weekly and sometimes on a monthly basis. The stability of many products, for example, effervescent tablets and alfacalcidol capsules, could well be compromised in these MDSs. There is also potential for errors, judging by recent Statutory Committee proceedings.
Undoubtedly, these systems were of value when they were introduced about 20 to 25 years ago in the days when the pharmaceutical industry distributed products in bulk containers. With the advent of patient packs and the packaging of products into blister packs by the pharmaceutical industry, the use of MDSs should be reviewed in nursing homes and alike.
It is worth noting that some products, such as antibiotics for short-term treatment and liquid medicines, are dispensed to nursing homes as normal without the use of MDSs. Therefore, ceasing the use of MDSs should not cause any significant problems and may even be in the interest of patients and help reduce medicines wastage, saving money for the National Health Service.
It may be argued that these systems are convenient, but we should not be giving preference to the convenience of the nursing home staff but to the effective and safe administration of medicines to the patients in nursing homes.
If any pharmacist is making money by supplying medicines in MDSs, I apologise to them. I believe the time has now arrived for us to design a better way of managing and administering medicines to nursing home residents. Medicines in patient packs once dispensed by local pharmacists could be stored in individual patient dedicated cabinets without compromising the stability of the medicinal products. The monthly supplies to nursing homes could be replaced in the usual way by local pharmacies with which the nursing homes are registered and the dispensed medicines stored in dedicated cabinets located in the rooms of nursing home residents during use.
I urge all parties concerned, including the authorities responsible for nursing homes, the Royal Pharmaceutical Society, the nursing homes themselves and pharmacists, to review the system to improve the health and care of nursing home residents.
M. Ahmed
Isleworth, Middlesex