Medicines pre-packed into individual boxes are being requested with increasing frequency by nursing homes, patients and social services since they can aid compliance and reduce medication errors.
Dispensing doctors therefore need to ascertain which is the most appropriate choice of system for their patients.
The increased use of monitored dose packs has been triggered by patient demand and by dispensing practices' fears that they will lose patients if they do not comply.
However, these systems also increase profitability. Switching patients to weekly prescriptions boosts the number of dispensing fees significantly: a recent estimate is a rise of more than £5,000 per annum for supplying a 30-bed nursing home.
The reusable dosette boxes, made of plastic with clear lids, were the first to be adopted but are not popular nowadays. They may be used for elderly patients, by their relatives and friends, but there are problems with cleaning and breakages.
At a cost of £5-£10 each for robust models, there is a high up-front cost especially as at least two of these cassettes will be needed for every patient, one for delivery and one for collection. In addition there is also the cost of cleaning the packs.
To reduce cost and further aid delivery, many practices use disposable boxes, the best known being the Nomad system from supplier Surgichem. These are trays of individual boxes labelled with the days of the week and set times of administration; typically, morning, noon, evening and night.
First produced in 1989, they are cheap and simple to use: tablets are placed in the trays as appropriate and a plastic film is pulled across to seal these in place, known as a 'cool seal system'.
The trays are labelled with details of the medicine they contain, and the patient for whom it has been prescribed.
Currently, there are plans for 'DispenseIT', the software system used by many dispensing practices, to be upgraded to enable these labels to be printed directly, along with a medication administration record sheet.
The units cost less than 50p each for the simplest version with further possible reductions through buying groups.
However, their drawback is that they are relatively inflexible; the trays can often only hold a few tablets and it may be a problem if a patient is away from their home for a few hours or overnight as the trays cannot be separated.
Large tray sizes are available for the Nomad system, but other more flexible systems are also manufactured. These include disposable trays such as the PlusPak produced by MTS which have perforations which allow patients to separate individual doses, days or even a weekend's supply of tablets.
|Benefits of Monitored Dose Systems|
Some of the disposable trays use a heat-based system to apply a foil backing to seal the tray. These tend to be used where practices have a high number of patients on the monitored dose system as there is a higher initial set-up cost.
The heat seal system requires investment in extra equipment to heat the foil backing costing up to several thousand pounds. The trays in this system are considered quicker to use, particularly where there is a high demand, and are consequently mainly adopted by pharmacies with contracts for several nursing and residential homes.
Until recently, only tablets and capsules could be placed in these trays, but a recent innovation by manufacturer Protomed now allows individual liquid doses to be dispensed in this way.
The trays for its Biodose system are more expensive, but could prove popular with nursing homes as they further reduce the potential for errors in administering liquid medicines.
The trays come with the patient's name, address, medicine and the time and date of administration printed on the plastic covering of each box.
The trays even have a picture of the patient on the side of the tray to further reduce the possibility of error in patient administration.
Automated forms of monitored dosing also exist, though these tend to be and outside the scope of most dispensing practices.
Supplier ARX is introducing an additional module to its robotic dispensing system and HD Medi and Robotic Technology have standalone systems.
These systems store tablets in tubs and place them into sachets at the rate of approximately one per second.
The sachets are rather like small packets of sweets and have the patient's name, date-of-birth, address and medication printed on them, along with the time of administration.
Some give the option of printing the patient's photograph on the individual sachet to further reduce the chances of medicines being administered incorrectly, in a nursing home environment.
A dispensing practice's choice of monitored dose system will depend on a number of factors, some general, some specific to the individual practice.
While cost and storage space are relevant, ease of use is the most important issue to consider since the most significant cost factor, related to the filling of monitored dose packs, will be staff time.
- Dr Jeremy Phipps is a dispensing GP in Lincolnshire
Suppliers of monitored dose systems include:
- Surgichem www.surgichem.com
- MTS www.mts-mt.co.uk
- Protomed www.protomed.co.uk
- HD Medi www.hdmedi.eu
- Robotic Technology www.rts-group.com/
- ARX www.arx-ltd.co.uk/