Considering Monitored Dosage Systems? By Caroline Pond

A Monitored Dosage System (MDS) is a medication storage device designed to simplify the administration of solid dose medication

A MDS can potentially help patients compliance if access to the medication is the problem. May help patients with compliance if the lack of compliance is due to sight impairment or forgetfulness There is no evidence based research to suggest that MDS improve patient concordance.

The RPS, PSNC and BMA all recommend that the use of original packs of medicines with appropriate support should be the preferred option of supplying medicines.

A MDS should not be supplied to aid carers A MDS should not be supplied to aid carers. Intended to aid independent administration of patients own medication Patients must satisfy the eligibility criteria for the supply of a MDS under the Equality Act 2010 for a pharmacy to initiate supply and be remunerated. May be clinically appropriate for a patient to receive a seven day supply of their medications in some instances

What alternative strategies might we employ when considering a patient for an MDS?

Medication review to reduce inappropriate polypharmacy and simplifying regimen Patient counselling to improve understanding of medicines-use Training of social care assistants The use of reminder charts (as a memory aid) The use of medicines administration record (MAR) charts Large print labels Reminder alarms IT solutions and new technology such as phone apps

7 Day Prescribing Only appropriate if the prescriber feels it is appropriate because the treatment is changing and needs regular review/changes and/or the patient is at risk if more that 7 days medications are supplied

7 day scripts should not be requested or supplied as a means of increasing pharmacy/dispensary remuneration. However, if the prescriber really feels the patient would benefit from weekly medications in a MDS then a 7 day script is appropriate

Not all medication formulations are suitable for an MDS. These include: hygroscopic products such as dispersible or soluble tablets, drugs which cause skin reactions such as chlorpromazine, drugs with cytotoxic potential, drugs which require refrigeration unstable forms of drugs oral liquids, eye-, ear- and nasal-drops, external formulations, “PRN” medication Consequently, the MDS does not provide a complete solution for a patient’s medication problem.

www.sps.nhs.uk Medication stability data for MDS

Dispensing practices must consider the liability issues of MDS: drug licence holders are not obliged to produce stability data for the use of their drug in a compliance aid, and without this, drugs are not licensed for use in this situation. Therefore, the decision to fill an MDS is effectively dispensing the medicines ‘off-licence', placing the resulting liability on the prescriber for that action. As with other unlicensed medicines, off-licence prescribing should only be done in agreement with the patient/carer or when a ‘best interests’ decision has been taken.

MDS should not be used when patients’ use of medicines is supported by a paid care worker.

The Dispensing process – ‘Must haves’ Dedicated area for assembly, reduce interruptions and error A standard operating procedure (SOP) for dispensing Formalised process to deal with changes of medicine regimens (re-use?) Instructions for ‘PRN’ dosing Assessment risk/benefit and stability and suitability of medicines for MDS, including Controlled Drugs

The Dispensing process – Labelling on the MDS: Name Practice address Drug name (strength, form) Drug appearance (to identify medicines) Dosage directions Date of dispensing

The Dispensing process – Other considerations: Provision of patient information leaflets (PILs). PILs have been a legal requirement in the UK since 1999 for all medicines and should be issued with each prescription MDS dispensing records – patient check list Training of dispensing staff to check complex MDS assembly Storage of assembled MDS Monitoring of patient compliance, collection of unused medicines

Choosing the Right MDS Does it accommodate all the doses needed throughout the day? Is it easy for the patient to use? Are the dosage instructions, time and patient details clearly visible? Are the medicines clearly identified on the tray? Is the system tamper-evident? Does it accommodate all tablets and capsules

Record Keeping A record should be kept of: The name of the patient Who has initiated the MDS The clinical justification/assessment made for the supply. The stability data check When the PILs were last supplied The number of weeks’ supply prescribed Start date for the MDS issued

Other considerations. Process to deal with changes in medication. Removal of unwanted medications? PRN medications

What if the patient has a CD on their prescription ?

Q: The GP has written four seven-day prescriptions, to be dispensed in a MDS. Can the dispensary assemble all four weekly MDS in one batch and hand out all at once? Q:What if the MDS were batch assembled, but handed out weekly?

Thank you for listening. Any Questions?