Dispensers placing tablets into monitored dose systems often suffer sore thumbs as a result of pushing tablets out of their packs. This may sound trivial, but for anyone having to do this on a regular basis, it can result in repetitive strain injury.
While a few medicines are supplied in open bottles, often in quantities of 100-500 tablets or capsules, the majority of medicines come in monthly packets.
It is usually more cost-effective to use these packs, partially due to proportionately higher reimbursement from the drugs tariff, but also to prevent duplication of medicine stocks.
This creates the problem of manually removing the medicines from their packets; however, several companies have developed devices to help with this process. These are mainly designed to aid medicine administration, but some dispensaries and pharmacies use them to reduce the bulkiness of returned stock prior to disposal and prevent re-use.
The simplest devices (beyond literally pushing out medicines by hand) are aids designed primarily for patient use, sold by medicine compliance aid suppliers to help patients with arthritis or other disabilities to remove individual tablets from packets. Commonly-used devices include the 'Poppet', produced by Dudley Hunt.
Their benefits are that they are cheap, often costing less than £5 each, and simple to use, resembling a hole punch, pushing out tablets and collecting them in integrated small containers.
However, care is required to prevent damage to the contents of the pack: tablets tend to be more fragile than capsules.
These cheaper aids can be helpful for a few packs of medicines but are too slow to use for large quantities. They are not intended for commercial use and so come with no guarantees; when they break you simply replace them.
Fortunately, several suppliers have recognised the difficulties dispensers face in loading monitored dose systems and have developed machines to ease this process. These deblistering machines push out the medicines from their packets with little or no manual effort.
The most widely-used device in dispensing practices is the 'Poppitts' machine, an electric device that uses a small 'rod' to push out and collect tablets from packets that are fed into its jaws.
This is small, cost-effective at around £300, easy to use and comes with a one-year guarantee, requiring little or no maintenance. It appears to be widely praised by users, with few detractors, though faster machines are available if you are prepared to spend a little more.
Understandably, the degree of automation increases with price, with lower cost models using hand-operated rollers, while more expensive devices use mains-operated motors.
Recent innovations include MTS Medication Technologies's DB500 manual machine. This is a manual, desktop unit. You feed packs of pills into the top, lining up the grid to fit the pack size and turn the handle. The machine then processes the pack, dropping the spent pills into the tray below for collection.
The fact that it is able to deblister all the tablets from a medicine sachet in one operation greatly increases efficiency, however, such speed comes at a price of around £2,000.
The jaws of the machine's roller need to be altered for different sized packs but it is a quick and simple procedure. Little maintenance is required beyond occasional cleaning of the rollers and jaws and training in its use takes 10-15 minutes.
Other large deblistering machines that have received positive feedback include models produced by Sepha, offering vary degrees of automation. The machines are reliable and breakdowns are rare.
At the top end of the scale, Sepha's Press-Out Universal can deblister 50 tablets per minute and claims to be gentle enough not to crush soluble or dispersible preparations. However its size and cost would preclude it from most dispensaries.
Similarly, the Unidose machine supplied by Mach4 is not only able to deblister medications but also packs them direct into clear labelled monitored dose sachets. However, with a price tag of around £40,000, it is unlikely to be suitable for the majority of dispensaries or community pharmacies.
The prices of deblistering devices vary, especially when dispensaries are purchasing more than one machine, or buying them through a buying group. It is worth shopping around.
Opting for a mid-price model may prove a worthwhile investment improving the morale and efficiency of the dispensing team, preventing sore hands and repetitive strain injury and gaining the practice's dispensing lead a thumbs up into the bargain.
- Dr Phipps is a dispensing GP in Lincolnshire
Manufacturers of deblistering devices include: