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• White Paper (5)
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• Eczema
• Chemotherapy
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• MDS
• Parallel imports
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Letters to the Editor
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Monitored dosage systems (MDS)
A waste of time and money
From Mr J. A. Schofield, MRPharmS
I refer to the article by Toni Orr (PJ, 7 April, p398) calling for provision
of monitored dosage systems (MDSs) to be a core service.
The history of MDSs is that they were offered free of charge during the
early 1990s by a major pharmacy chain to nursing and residential care
homes in a successful attempt to win prescription business. Independent
pharmacy contractors, including me, fought back by offering the same
service plus 24 hour on-call etc— all, of course, free of charge.
Year after year we went off to local pharmaceutical committee conferences
demanding funding for this service we had all been happy to offer free
of charge but were now finding a bit of a burden. Surprisingly the Department
of Health never saw the reason to pay us when we were offering it free
of charge to patients. If we could not make money from it why did we
offer it?
In an attempt to grow the market, manufacturers started offering domiciliary
versions to “assist” patients with their medicines at home.
Not surprisingly, carers, whether relatives or professionally trained
and employed by social services or privately, were keen to embrace this.
As in care homes the workload reduced and the responsibility was transferred
to the pharmacist.
Once we take a medicine out of its packaging and repack it in new packaging,
the liability for that medicine is transferred from the manufacturer
to us. Toni Orr spells out the scene in great detail: replicating the
dose accurately, checking records, ensuring that changes to medication
are noticed and prescriptions seamlessly reflect changes once a patient
has been in hospital. To this I would add that some larger pharmacy companies
do all their MDS work at a single site. This streamlines work but adds
a further link in the chain which cannot be justified on governance grounds.
Also one changed medicine means that MDS cassettes prepared in advance
must be discarded and new prescriptions for discarded but currently prescribed
medication must be obtained. Wasteful?
And why do we do this? What is the evidence base supporting this “valuable” intervention?
It is that social services and carers put us under pressure to do it.
I am unable to find any good quality evidence anywhere that these devices
are of any value to a slightly confused (or worse) patient. Am I alone
in believing that to be a good enough reason to ask for payment?
Social services either provide staff direct, or contract with professional
companies to provide staff, to look after the housebound. I know that
such staff, as a condition of their job description, must be able to
read. They, therefore, can read labels on medicines and they can also
fill in medicines administration records. They may not wish to and their
employers may be reluctant to take such responsibility for their staff
needing to read. However, social services also have a duty of care to
their patients. When they contract with such companies or individuals
it is essential that carers are taught how to administer medicines. It
is social services’ responsibility to ensure that these patients
are properly looked after. Pressuring pharmacists to provide a service
of doubtful value and fraught with governance issues is not acceptable.
Pharmacy may well have a role in training and accrediting carers but
pharmacy should be distancing itself from an intervention that cannot
be justified and, in particular, one that is as fraught with danger as
taking responsibility for providing MDS.
Tony Schofield
Jarrow, Tyne and Wear
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The
Pharmaceutical Journal