SH CP 170 Procedure on Filling and Checking a Compliance Aid (not for use at Lymington Hospital or Fordingbridge Hospital) Version 3 Summary: Filing and checking a Compliance Aid Procedure Keywords (minimum of 5): (To assist policy search engine) Target Audience: Compliance aid, medication compliance, filling a compliance aid box, Medidose box, Dosette box, NOMAD All staff who fill and check compliance aids Next Review Date: May 2021 Approved & Ratified by: Medicines Management Committee Date of meeting: 16 Date issued: Author: Sponsor: Rajan Sharma, Medicines Management Technician Kate Small, Medicines Management Technician Raj Parekh, Chief Pharmacist 1
Version Control Change Record Date Author Version Page Reason for Change June 2014 Rajan Sharma 1 New Southern Health format March Rajan Sharma 2 Sponsor name amended 2016 Additional note at end of 3.3 April 2018 Gareth Fenn Kate Small New Section 6.0 Return and Disposal of Devices 3 Amended 1.3 from pharmacist to trained member of pharmacy staff Removed Venlafaxine tablets/capsules from section 2.1 Removed carer or relative from section 3 Amended section 3.5 and 3.6 Removed sample of compliance aid table Amended section 6.3 Alex Weston 3 Section 6.1: amended to refer to all staff, as opposed to just pharmacy Terminology changed throughout to refer to compliance aid Reviewers/contributors Name Position Version Reviewed & Date Rajan Sharma Medicines Management Technician Version 1 reviewed in June 2014 Rebecca Henry Senior Clinical Pharmacist Version 1 reviewed in June 2014 Stephen Bleakley Deputy Chief Pharmacist Version 1 reviewed in June 2014 Gareth Fenn Lead Medicines Management Technician Version 3 reviewed April 2018 Kate Small Medicines Management Technician Version 3 reviewed April 2018 2
CONTENTS 1. Introduction 4 2. Process 5 3. Procedure for Filling and Checking a Compliance Aid 5 4. Reference Files 7 5. Storage of Compliance Aids 7 6. Return and Disposal of Devices 7 Page 3
Procedure on Filling and Checking a Compliance Aid 1. Introduction 1.1 Health professionals can employ a combination of strategies to promote patient adherence to prescribed medication. There should be a full multi-disciplinary assessment of the patients and/or carers abilities and also a risk assessment of the possible outcomes of non compliance. Contact must be made with the primary care team to ensure a joined up approach. Approaches to improve compliance should be kept as simple as possible. Rationalising medication administration to once or twice a day when a carer could supervise may be all that is needed. When all other approaches fail, a medication compliance device may help. 1.2 Patients assessed as requiring a compliance aid can be provided with this service by community pharmacies as part of the community pharmacist contract. The position as from April 2005 is that this service is provided free of charge to the patient when they provide their standard prescription for dispensing. They would continue to pay any standard prescription fees. Due to demand for this service, many pharmacies are establishing waiting lists. 1.3 A Compliance Aid is a box which is divided into the days of the week and meal times i.e. breakfast, lunch, dinner, bedtime which may be loaded by a carer, e.g. relative (ie. not a carer in a formal care arrangement) or a professional. However, there are a number of issues which make the loading of compliance devices problematic. These include: Use of a compliance aid may make medicines more available to vulnerable patients or others visiting or residing in the clients home e.g. children, therefore increasing risk of overdose or accidental poisoning There is a risk of errors occurring during the transfer of medicines into the device from their original packaging There is insufficient data on the stability of medicinal products when stored in compliance devices Accountability may be blurred when the device is loaded by a member of the community team, yet medicines administration is supported by a member of another service (for example, a personal carer) There is an absence of research demonstrating the effectiveness of compliance devices in improving adherence among older people living in the community Medicines other than tablets and capsules are still in the original containers and are often forgotten or incorrectly taken. It is difficult to differentiate between medicines which must be swallowed or taken before or after food from the others. Yet these special directions may be essential for the medicines to be effective or to avoid a serious side effect. Once filled the compliance aid is not easily altered, this may delay dose changes or medication changes until the next filling of the compliance aid. 4
Wherever possible a trained member of pharmacy staff should fill the compliance aid. Where it has proved difficult to establish a service with a pharmacy and in the interests of patient care, health professionals and qualified MHPs can support the patient in filling and using a compliance aid as part of their role to support and instruct patients regarding their medication, providing these medicines have been dispensed for an individual and the medicines are in the supplying pharmacies original containers. 1.4 A Compliance Aid is used for patients with the following objectives: To assist patients to be compliant with medication To help patients understand the importance of taking their medicines as agreed To enable patients to become as self-caring as possible. 2. Process Health Professionals and qualified MHPs taking on this role must liaise with the rest of the primary care team. 2.1 Not all drugs are stable once removed from their original packaging and should not be put into a compliance aid, for example effervescent tablets or those requiring desiccants,) etc. Advice on stability can be obtained through the Regional Medicines Information Centre 02381 206908/9, or your local trust pharmacist, or your local community pharmacist. 2.2 Courses of antibiotics are often not included in compliance aids especially if shorter than 7 days duration as this may lead to confusion on the part of the patient. 2.3 Drugs that are to be taken on a when required basis cannot be put into a compliance aid. 3. Procedure for filling and checking a compliance aid A healthcare professional can assist a patient in filling the aid adhering to the following guidance. 3.1 Filling a compliance aid is a time consuming operation and great care and accuracy is needed to avoid errors. A quiet area should be used when filling the compliance aid and the operation should be completed without interruption. 3.2 Read the additional labels on the original containers before filling an aid. Some drugs are to be taken before food, after food, swallowed whole, with water etc. After reading the additional labels a judgement should be made as to whether the drug can be included in the aid and if there are additional instructions how these are to be communicated to the patient. 3.3 Check the compliance aid is clean and dry before use. Compliance Aids that can be re-filled should be periodically washed in hot soapy water and left to dry completely before being used. 5
FILLING OF AID 3.4 Check that the drugs to be put in the aid are stable once removed from their packaging. If the drug is not stable, do not include in the compliance aid and discuss with prescriber. 3.5 Fill in the patient s information card (see example below) with the relevant information. These cards require drug name, a description of each tablet/capsule i.e. colour/shape, doses and frequency. Others require a strength and dose for each time of day. 3.6 Check the expiry dates on all the containers from which tablets/capsules are to be taken to fill the aid. (If the container is one from a chemist then it can be used for up to six weeks from the date of dispensing as long as it is still within its expiry date). 3.7 Dispense each drug into all its relevant day/time boxes before moving onto the next drug. 3.8 Check the name of the drug, strength, dose and directions to be taken on the patient s original container. Fill the relevant day/time box with the appropriate number of tablets. 3.9 Keep the original container by the compliance aid for checking and also any patient information leaflets. CHECKING (ideally this process should be carried out by a second person) 3.10 Check the expiry dates of the original container 3.11 Check that the patient information card has been completed correctly. 3.12 Check one drug at a time. 3.13 Check the patient s name, drug, strength, dose and frequency and that the appropriate day/time box has been filled with the correct number and type of tablets/capsules. If there are tablets/capsules left in the original containers check that their description matches these in the compliance aid. Check all additional directions. SAMPLE OF PATIENT INFORMATION CARD Doctor: Name of service user: Address: Telephone: Telephone: Date: Medicine Breakfast Lunch Dinner Bedtime LEVOTHYROXINE 50 mcg ONE LANSOPRAZOLE 30 mg ONE AMILORIDE 5 mg ONE FUROSEMIDE 40 mg ONE Instructions: Check that there is a box for every day of the week and use the correct box. Follow instructions on original labels. Manufacturer is not responsible for user mistakes. Keep out of reach of children. 6
4. Reference Files 4.1 Clinical areas should liaise with Pharmacy to establish reference files for the drugs used within their clinical areas. 5. Storage of compliance aids 5.1 A Compliance Aid should be stored in a safe manner to avoid accidental overdose and to ensure the stability of the medicines. If following a risk assessment it is deemed necessary to store the medicines in such a way as to ensure the patient does not have unsupervised access to their medicines, this should be recorded and shared with other care providers as deemed necessary. 6. Return and Disposal of Devices 6.1 It is the responsibility of all staff to ensure devices are disposed of in a safe and timely manner. 6.2 Compliance aids filled by patients or carers should be emptied with consent of the patient and new supplies of medicines issued. 6.3 Disposable devices that cannot be returned with the patient must be disposed of in the following manner. All medication must be removed and destroyed. All patient identifiers must be removed from the device or obliterated. The device should then be discarded with empty medication blisters and bottles in a blue bin as per trust waste policy. 7