Monitored dosage systems are used extensively in social care and are often relied on by care teams to take away some of the risk and responsibility around administering medication. Although widely used, there are lots of myths, mysteries and misunderstandings surrounding this group of compliance aids so it’s great to have this opportunity to set the record straight on a few things and to keep our care teams safe, ethical and legal in their work.
Myth #1: Medication Must Be in a Monitored Dosage System (MDS) to Be Supported Safely
This is incorrect. There is absolutely no legal or ethical reason why medication needs to be in a monitored dosage system. It can just as easily and safely be supported from bottles, boxes and original packs as long as the correct checks are made, the dose instructions followed and good records kept.
Incidentally, these things have to happen for MDS too.
Clarification: Medication can be safely managed using original packaging, provided proper checks and records are maintained. MDS is not legally or ethically required.
Myth #2: All Tablets and Capsules Are Suitable for MDS
This is incorrect. Not all tablets and capsules will remain stable once out of their original packaging and therefore must be dispensed in their original packs.
Clarification: Some medications must remain in their original packaging to ensure stability and effectiveness; not all can be transferred to an MDS.
Myth #3 Friends or Relatives Can Legally Fill an MDS
This is incorrect. All monitored dosage systems must be filled by a pharmacist (or dispensing GP in rural areas). Supporting medication in trays filled by friends or relatives is not legal. If this is happening in your service you should take steps to make changes. Inform relatives or friends that from a certain date (e.g. a month’s time) that you will no longer be able to support the service user if they continue to fill the trays themselves. They should go to the pharmacy and request an assessment under the Disability Discrimination Act in order to have the medication dispensed by the pharmacy into a suitable MDS. If the service user meets the criteria of the Equality Act they will be entitled to this service free of charge from the pharmacy.
Clarification: Only a pharmacist or dispensing GP is legally authorised to fill an MDS. Trays filled by non-professionals are not compliant with legal standards.
Myth #4 All MDS Systems Are Suitable for Social Care Use
This is incorrect. Any MDS system used in both care homes and domiciliary care must be dispensed by the pharmacy into a system that is able to be properly labelled to identify it’s contents on the actual pack containing the medication. The system used should also be tamper-evident and secure.
Any system that does not meet this requirement should not be dispensed into by the pharmacy for use in social care. This includes the little “finger” type systems that have a different “finger” per day that can be taken separately from the pack. These systems have historically been purchased by the service user and filled by the pharmacy which is fine if they are assessed and unsupported, for you though as care staff supporting service users they are not suitable. If you have clients using these systems please ask the pharmacy to provide a system that meets labelling and security requirements.
Clarification: MDS systems must meet specific labelling and security requirements to be used in social care. Not all commercially available systems are appropriate.
Myth #5: Medication Dispensed by the Pharmacy Is No Longer My Responsibility
This is not correct. You have a legal obligation to check that the right patient receives the right medicine by the right route in the right dose at the right times. So, you then need to check the name on the pack is the right service user. You need to check that the contents of the pack match both what was ordered on the prescription and what is on the medication administration record. You need to check that the strength of the medication is what was expected and that the instructions for use are the same. Do the time slots in the pack match the administration times and do you know exactly how this medication is to be taken, used or applied?
Clarification: Care staff have a legal obligation to verify that the correct medication is administered to the right patient, even if dispensed by a pharmacy.
Monitored Dosage System summary
I do hope that this has cleared up many common misperceptions about monitored dosage systems and that as a result you will check your policies and procedures and update where necessary.
The other important issue that needs to be addressed with regards to medication and monitored dosage systems in secondary dispensing particularly in care homes and supported living homes. What is secondary dispensing? Why and how does it happen? How to avoid it and put into practice safe systems that allow you to stay safe and legal.
Momentum People in Stoke-on-Trent is dedicated to supporting care teams with expert training on the safe use of medications. We offer comprehensive training programs tailored to the specific needs of your care home staff, ensuring they are well-equipped to handle medication safely and legally. Our Safe Use of Medications training covers essential topics such as monitored dosage systems, secondary dispensing, and proper medication administration procedures. By partnering with Momentum People, you can be confident that your team is receiving the highest standard of training, helping to maintain the safety and well-being of those in your care. Enquire today to find out more.