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Letters to the Editor
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Monitored dosage systems (MDS)
MDS is not usually the best way
From Miss S.J. Thompson, MRPharmS
I would like to comment on the article
by Toni Orr (PJ, 7 April, p398).
First, monitored dosage systems are a core service in England. The contract
states: “Under the Disability Discrimination Act 1995, pharmacies
as service providers have a duty to make reasonable adjustments to
enable someone with a disability to utilise the service. Reasonable
adjustment may include the provision of an auxiliary or compliance
aid to enable a person, who is disabled, to take their medicines. In
determining what is reasonable, consideration needs to be given to
the individual circumstances of the patient and the pharmacy, and a
judgement made by the service provider, the pharmacy.” The “reasonable
adjustments” are funded under the contract.
Second, although Mrs Orr alludes to how labour intensive the filling
of such compliance aids is, she neglects to mention what a high-risk
process it is. Any community pharmacist who has checked an MDS containing
19 different “little white pills” will be fully aware of
the errors just waiting to happen. Then there is the risk to the patient.
Patients often do not have the dexterity to open the small openings and
often use sharp objects to achieve this. They do not know which tablets
are which, so if a medicine is stopped they do not know which one it
is and are less likely to spot errors.
Finally, social services carers can administer or prompt medication from
original containers. The Commission for Social Care Inspection supports
this. In Leeds, there have been incidents where medicines that cannot
go in an MDS blister (eg, soluble tablets or prn medication) have not
been administered and patients have suffered because of this.
I acknowledge that patients need help in taking their medicines in a
domiciliary setting but I think that MDS is not usually the best way
to provide this. Community pharmacists would be well placed to provide
training and or information to groups or individuals providing care to
such patients.
Sarah Thompson
Medicines management and prescribing manager
Leeds Primary Care Trust (NW Area)
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Toni Orr was writing from Scotland, where, The Journal understands,
MDS provision is not currently a core service under the community
pharmacy contract.
— EDITOR
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Main thrust for providing MDSs in the community comes from carers
From Mr D. V. Nandha, MRPharmS
Toni Orr makes a strong case for the provision
of monitored dosage systems to be a core service (PJ, 7 April, p398)). Tony Schofield counters this
viewpoint (PJ, 21 April, p458), with some equally pertinent points and
spells out the perils of choosing to go down this route, a view I am compelled
to concur with.
It is clear that the main thrust for providing MDSs in the community comes
from carers, who seek to off-load their own responsibilities onto pharmacists,
often for their own convenience, rather than for the benefit of the patient.
Under the Disability Discrimination Act, pharmacists are required to make “reasonable
adjustments” to help patients who have a genuine disability. Unfortunately,
too many carers, and some nurses, view MDSs as a panacea for all the patient’s
problems without regard for a proper assessment, which could identify a
range of simple solutions.
To provide a well managed MDS service for patients is, of course, a time-intensive
operation, requiring robust procedures in the pharmacy, in terms of accuracy
at time of filling, regard for tamper-evidence, consideration for the production
of accurate medication charts with descriptors highlighting the form, colour
and code of the relevant medication and the provision for patient information
leaflets, as well as the maintaining of a pharmacy system that records
batch numbers and expiry dates of the preparations used.
These components are the bare minimum, for clinical governance purposes,
for safeguarding pharmacists and patients alike. However, MDSs place huge
and often unrealistic demands on pharmacists in their attempt to enable
an “adjustment” to be made, for which there is either little
or no evidence, or which pharmacists frequently make because they feel
obliged to.
While MDSs may be considered a solution to aid compliance in patients who
are confused, they have been known, paradoxically, to add to confusion
since many common pharmaceutical preparations which are unstable or unsuitable
cannot be placed into such a system and have to be dispensed separately.
Therefore, the patient for whom such a system may have been deemed appropriate
still has to juggle between medicines in original containers and an MDS,
which must be, at the least, self-defeating for the patient.
It seems absurd that family members who are able to take on the role of
carers can support their loved ones at home by administering medicines
direct from original containers, whereas carers, trained or otherwise,
cannot or refuse to do so. Administering medicines from original containers
remains the safest option, so when developing core services, it may be
more expedient to press for the administration of medicines by carers as
a core requirement of their job.
Dipak V. Nandha
London |
The
Pharmaceutical Journal