Why we should think carefully before using Multicompartment Compliance Aids (MCAs)
I have come across a couple of interesting articles in The Pharmaceutical Journal and The Pharmacist about the work of Debi Bhattacharya's team at University of East Anglia that I thought I'd share with you all. The news that this research team have been developing new guidance for the use of Multicompartment Compliance Aids (MCAs - also commonly referred to as Monitored Dosage Systems, and coming in forms such as blister packs and dossette boxes) is extremely welcome.
The need for the development of this guidance is supported by the research published in The Pharmaceutical Journal by the Royal Pharmaceutical Society (RPS), which found that over 500 patient safety incidents related to these aids were reported in the first half of 2018 - and, given that many incidents go unreported, it is likely that the true figure is much higher.
For those keen to find out more about other research that has been conducted, Lelly Oboh, Consultant Pharmacist for the Care of Older People in Lambeth NHS Trust has written a great FAQ document on MCAs. This includes a summary of the research evidence into MCA use, for example the CHUMS study, which found the use of MCAs to be associated with a greater risk of dispensing errors.
It is therefore perhaps no surprise that the widespread use of MCAs is going out of favour. In RPS Scotland's Improving Pharmaceutical Care in Care Homes report, 2012, they boldly stated "the cultural reliance on medicines supplied in monitored dosage systems (MDS) within care homes and care at home services should be challenged." More recently, in January of this year, Boots announced they would no longer be supplying MCAs to care homes, in accordance to NICE and RPS guidance. Lloyds Pharmacy are also phasing out the use of MCAs.
The CQC state that MCAs "should not be the first choice intervention to help people manage their medicines", while the RPS state "The use of original packs of medicines with appropriate support is the preferred option of supplying medicines to patients in the absence of a specific need requiring an MCA as an adherence intervention.", and provides some assessment criteria to consider. Both the CQC and the RPS highlight that, when removed from its original packaging, a medicine will often considered unlicensed - this means that there is increased risk of liability if an individual comes to harm from their medicines.
Despite this, in a case study provided on the NICE website, Taunton & Somerset NHS Foundation Trust managed to reduce the dispensing of MCAs on discharge from acute hospital by 80% through conducting assessments and only issuing these to address specific issues around medicines administration. This suggests that such assessments are not always being conducted and/or decisions to use MCAs reviewed, resulting in inappropriate use.
So, the takeaway message?
Although MCAs may be beneficial for a select group of individuals to assist them in self-administering their medicines, any widespread, blanket-policy use in adult social care should be scrutinised. Before initiating an MCA, make sure an assessment is conducted, a specific issue around medicines administration is identified which the MCA will address, and other options to support original pack administration have been explored. People involved in the supply or administration of medicines in MCAs should also be aware that, through re-packaging, the medicine may become unlicensed.