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Using multi-compartment compliance aids (MCAs) in home care services

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Reasonable adjustments

GPs and other healthcare professionals must make reasonable adjustments to help people take their medicines. The Equality Act 2010 requires such adjustments and MCAs may form part of these.

You might use a range of different MCAs in adult social care settings. These could include, NOMAD® trays or pharmacy-sealed blister packs. 

MCAs can be a convenient way for people to take their medicines. MCAs do not always simplify how people take their medicines.

The Royal Pharmaceutical Society and NICE have both suggested that MCAs should not be the first-choice intervention to help people manage their medicines.

Royal Pharmaceutical Society (RPS) report on MCAs

The RPS report did not find enough evidence that MCAs help patients to take their medicines. The report found no evidence that they improve patient outcomes. Evidence does not support using MCAs as a panacea in health or social care policy.

NICE guidance

NICE guidance (NG67) states:

“Consider using a monitored dosage system only when an assessment by a health professional (for example, a pharmacist) has been carried out, in line with the Equality Act 2010, and a specific need has been identified to support medicines adherence. Take account of the person's needs and preferences and involve the person and/or their family members or carers and the social care provider in decision-making.”

Other options

There are other ways to promote people’s independence. Other reasonable adjustments to support the person to use original packs of medicines may include:

  • reminder charts
  • winged bottle caps
  • large print labels
  • alarms (such as notifications on mobile phones)
  • tablet splitters and “poppa” devices

Considerations

Providers need to consider how people and home care staff manage different systems of medicines administration. Home care staff should record this support in care plans. For example, people could have original packs of medicines as well as those in their MCA. Soluble painkillers are a good example.

When removed from the original packaging, medicines can become unstable. Using medicines in this way could be unlicensed. This is when you use a medicine outside its usual product licence or marketing authorisation.

Home care staff must be able to identify the individual medicines before they administer them. The dispensing pharmacist should include a list of all medicines supplied, including a description.  It can be hard to identify a specific tablet from a MCA compartment that contains many different medicines. This might be necessary if the person no longer wants or needs to take an individual medicine. It might be necessary to get a new MCA and MAR chart, if the change is long term. 

Some MCA devices are not child resistant, tamper proof or tamper resistant.

Only trained and competent home care staff should support people to take their medicines. Providers need to make sure their policy explains how they manage when changes are made to people’s medicines. For example, when adding new medicines or changing doses. This could include liaising with the community pharmacy. 

Policies should also describe what actions to take if a person refuses to take one or more of their medicines.

MCAs can increase medicines waste. Home care workers need to dispose of any unwanted medicines. This includes those left at the end of the pack and medicines removed from their original packaging.

Medicines administration records (MARs)

Home care workers should record each time they provide medicine support. The record should include who administered the medicine and whether a medicine was taken or declined.

Medicines support is any support that enables a person to manage their medicines. In practical terms, this covers:

  • prompting or reminding people to take their medicines
  • helping people remove medicines from packaging
  • administering some or all of a person’s medicines

There is no need to keep records when the person is managing their medicines themselves.

NICE recommends that printed MARs should be used where possible. These should include:

  • the name of the person
  • the name, formulation and strength of the medicine(s)
  • how often or the time the medicine should be taken
  • how the medicine is taken or used (route of administration)
  • the name of the person’s GP practice
  • any stop or review date(s)
  • any additional information, such as specific instructions for giving a medicine and any known drug allergies - examples might include medicines to be taken with food (such as ibuprofen) or without food (such as some antibiotics)

Home care workers must record the medicine support given to a person. This must be for each individual medicine on every occasion in line with Regulation 17. The record can look different to a standard MAR. However, it should be a clear record of all support provided, and for which medicines.

The home care worker could record that they gave medicines from an MCA, by recording words such as “MCA given” or “blister pack given” on the MAR. To do this there must be an accurate list of the individual medicines contained in the MCA.  Home care workers should date this list and keep it as a record with the MAR. This means that it is possible to identify which medicines have been taken in the past.

Providers must ensure that home care workers follow the principles of the ‘6Rs of safe medicines administration’ when supporting people with medicines from a MCA or ‘blister pack’.

Care workers should only make handwritten changes to a MAR chart if they are competent to do so. If a medicine changes mid-cycle the MAR should have a new entry. The update should make it clear what changes have occurred and who authorised it. How to complete handwritten records and changes should in the medicines policy.

Last updated:
28 August 2019

 


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