The monitored dosage system (MDS) or sometimes known as multi-compartment compliance aids versus original pack dispensing what do you think or more importantly what do your patients think.
I tend to side with original packs for several reasons the first and foremost being patient safety. When MDS first was used widely in the 1980w we were still using many stock pots to dispense from and tablets were loose thus in a way the MDS was the equivalent of the calendar blister pack/ patient pack which was introduced in 1991.
But deblisterig and re-packing introduces risk into the system, both human error and exposure of the medicines to light, moisture, contamination from other medication and bacteria from assistants hands. It comes as no surprise to me to read the Pharmaceutical Journal today to find that in March 2014 that the National Institute for Health and Care Excellence (NICE )carried out a study of MDS versus original pack dispensing and found that the advantages for original pack dispensing far outweighs the advantaged for MDS. NICE could find no disadvantages in using original packs. Their findings reflect the Royal Pharmaceutical Societies guidance on better use of MDS.
Monitored dosage systems (MDS) may result in the robotic administration of medication, there is much evidence to suggest that care homes should adopt a more patient centred approach. If a patient is a late riser they may always miss the first drug round in the morning and thus go without medication.
There still is a place for MDS in the community when patients may have early stages of dementia and the blister pack act as an aide memoir for them and also a monitoring tool for relatives, carers and pharmacy staff if they make up the MDS for the patients.
If we move away from the MDS then the old fashioned system of a more supportive role provided by the local pharmacy and original pack dispensing would be my favoured choice.
Before a home decided to make the switch, they should carry out a robust risk assessment of what they do now and what they are proposing and ensure that they engage with their local pharmacy who supplies their medication. It may be worth reviewing all the patients and assessing them one by one and decide which system would work best for each one of them.
Do not forget that your trolleys may not be the most ideal if you switch and some patients do not like change and thus may not want to change.
The Quality System in the home would have to be amended to allow for the new procedures and the Medicines Policy will have to be updated to facilitate the change. Staff would have to be trained in the new ways of working and read the new SOPs.