This is an issue that I came across recently whilst delivering training in medicines management to a domiciliary care. I was surprised to hear how much it still happens out there and feel that it’s an area that needs to be highlighted and discussed – put out in the open if you like.
What is secondary dispensing?
Let me give you an example.
You have service users who visit a day centre and will be there for there lunchtime medication. The medication is dispensed by the pharmacy into a monitored dosage system which you feel is a bit big for the service user to take to the daycare centre with him or her so you take out the lunchtime doses and put them into an envelope with their name on it for him/her to take with them.
You have a service user who goes home occasionally for the weekend. You don’t want to send the whole cassette with their medication in with them, perhaps you’re not sure it will be returned when they come back, so you put the weekend medication in to another container with their name on it and brief instructions as to when they should be taken.
What’s wrong with that you might say?
The issue is that you are not qualified to dispense medication. You are giving out medicines that are not labelled properly or legally and the medication is not identifiable in any way. It also does not give the service user proper dose instructions or warning instructions or safe storage instructions. By giving someone medication in this way you are taking responsibility for it, if something goes wrong you are liable because you acted outside of the law.
So that’s all very well you say – but what is the solution? How do you ensure that the service user gets the medication at the day centre or during home visits?
There are two possible solutions. The first is to send the service user with the medication in the original pack, be that the boxes and bottles dispensed by the pharmacy or the monitored dosage box (e.g. nomad tray, blister pack, dosette).
If your policies do not allow this to happen at present, then in order to operate within the law perhaps it is time to review those policies.
The second option is to speak with the GP practice and the pharmacy to arrange to have the doses needed for outside your care dispensed in to separate containers that the service user can take with them. The medication must be dispensed by either a pharmacy or a dispensing doctor though, not by your staff.
But we’ve been doing this for years you cry! Yes…I know but it doesn’t make it right.
But our inspectors have never said anything about it you tell me……yes….. but perhaps as knowledgeable as they are they are in legislation and guidelines they are not experts in medicines and do not know that what you’re doing is not legal. When something goes wrong ignorance will not be a defence so better to put things right as soon as possible rather than hoe it will be ok and continue to break the law.
For further information or any questions about this or any other medication issues please contact firstname.lastname@example.org