The use of multicompartment compliance aids (MCAs) in the community is “excessive” and an “ingrained area of practice” that needs to be challenged, guidance from NHS Wales is expected to warn.
The recommendation is part of a set of national guiding principles, which have yet to be given a publication date, developed by NHS Wales and the All Wales Heads of Adult Services Group to help define different levels of medicines support in the domiciliary care sector and promote standardisation in medicines policies across Wales.
Health boards and local authorities in Wales will be expected to acknowledge the principles, which were developed in line with the National Institute for Health and Care Excellence (NICE) guideline 67, and commit to reviewing their local medicines policies to ensure they reflect them.
The national principles for medicine support have been endorsed by the Royal Pharmaceutical Society and are currently awaiting final endorsement from NICE before they are officially launched in Wales.
NICE says that an MCA should be considered “only when an assessment by a healthcare professional (for example, a pharmacist) has been carried out, in line with the Equality Act 2010, and a specific need has been identified to support medicines adherence”.
Emyr Jones, national lead for community healthcare in Wales, who helped draw up the principles, said: “There is no legal reason why care workers cannot support patients with medication from original packs, recording the supply via the medication administration record.”
He added that there were examples of providers’ insurance being reduced if care workers are administering from an MCA, which he said showed “a worrying lack of understanding of the role of MCAs, which is not backed by any evidence … supporting the misconception that they are … a panacea for all problems or difficulties with medicines use”.
Jones reiterated that a full assessment should be carried out before a patient is started on an MCA to establish their exact support needs and ensure there is no risk of harm.
“If a patient is non-adherent and, all of a sudden, they’re taking all of their medicines [in their MCA], there is the potential for harm straight away [because of the] huge increase in dose,” he said.
One solution, which is high on NHS Wales’s agenda, is the move towards using the electronic medicines administration record to help promote the use of original packs by way of barcode technology, said Jones.
An investigation carried out by The Pharmaceutical Journal
in February 2019 found that in the first half of 2018, 507 patient safety incidents involving the terms ‘monitored dosage’ or ‘dosette box’ were reported to England’s National Reporting and Learning System.