Helping patients take their medicines safely
Medicines Compliance Aids (MCA’s) have many different names (MDS, MCCA, etc.) and brands (e.g. dosette boxes), but are generally reusable plastic containers for storing medicines, divided into days and/or times of day, to act as an aid for patients taking multiple medicines. MCA’s can be supplied and filled by the patient/carer in accordance with the patients’ prescriptions. MCA’s can also be dispensed prefilled by the pharmacy.
Contractually the decision to issue a prefilled MCA should rest with a pharmacist and be based on an assessment made in accordance with the Equality Act (2010), which determines that an MCA is a ‘reasonable adjustment’ to enable the patient to use their medicines effectively. The current culture around MCA use is far from this ideal, with MCA’s being issued without assessment in many situations.
There is currently a lack of regulation around the use of MCAs, however both NICE and the Royal Pharmaceutical Society (RPS) agree that there is not sufficient evidence that MCA’s improve medication adherence for their widespread use to be recommended. Studies have shown there are a number of risks associated with their regular use, including pharmacist error and reduced stability of some medicines once removed from their original packaging.
In 2016 researchers reported three pharmacist errors in MCA preparation that resulted in fatality, and National Reporting and Learning System (NRLS) data from the first half of 2018 showed 507 patient safety incidents involving MCA-related terms. MCAs are also very labour intensive for pharmacists, who do not receive funding for preparing them as part of their contract. MCAs can produce unnecessary waste if changes are made to prescriptions. Based on these concerns both NICE and the RPS advise that an MCA should only be considered following appropriate assessment, and that original packaging is preferred in the absence of a specific need for an MCA.
What’s happening locally?
Local stakeholders, particularly within the Local Pharmaceutical Committees (LPC’s), are aware of the issues surrounding MCAs and keen to implement interventions to reduce their use as part of a wider agenda to address problematic polypharmacy. This is an opportunity to improve the safety of patients within the West of England in relation to safe use of medicines, with the project having other benefits including freeing up pharmacists time for patient consultation, and improved patient understanding of their medicines and conditions.
The project has two main priorities:
- Standardising assessment for MCA eligibility across the West of England, by introducing an assessment form that can be used by pharmacists in all care settings.
- Educating healthcare professionals, carers, patients and public about the benefits and risks of MCAs, and increase awareness of other reasonable adjustments available to support patients to use their medicines safely and effectively.
- Specialist Pharmacy Service (SPS) Summary of Guidance and Evidence for Use of Multi-Compartment Compliance Aids (MCCAs)
- North East & North Cumbria AHSN Medicines Adherence Support Project
- BNSSG CCG Managing Compliance Aids in Primary Care Advice for GP Practices
- NICE Quality and Productivity Case Study: Ensuring appropriate use of monitored dosage systems: reducing unnecessary pharmacy workload
Want to know more?
Please contact us to discuss this project and how you can get involved.