Multi-compartment compliance aids (MCAs) in adult social care

The best system for supplying medicines is one that meets the person’s health and care needs. Interventions should aim to maintain the person's independence wherever possible.

A multi-compartment compliance aid (MCA) is a general term for a device designed to contain individual doses of medicines in separate compartments or blisters. 

They are also known by names such as monitored dosage systems (MDS), blister packs or dosette trays. Different types of devices are available, which a pharmacy or dispensing doctor would supply.

Medicines review

MCAs do not always simplify how people take their medicines and they may not be suitable for everyone or for all medicines.

When people need additional medicines support to continue to be independent, it may be necessary to have a medication review to simplify their medicines regimen.

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.

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, braille and talking labels
• alarms (such as notifications on mobile phones)
• tablet splitters.

Evidence

The Royal College of Pharmacy and the National Institute for Health and Care Excellence (NICE) have both said that MCAs should not be the first-choice intervention to help people manage their medicines. They recommend that the use of original packs of medicines should be the preferred choice for the supply of medicines if there is no specific need for an MCA in all settings.

Guidance from the Royal College of Pharmacy emphasises the importance of choosing the most person-centred option to help people maintain healthy independent living, and not to regard MCAs as a universal solution.

It also recommends that people’s needs should be reviewed regularly to ascertain whether MCAs are still the best option. This can be through a holistic individual assessment to determine the most appropriate support, which involves the person and their carer in discussions and choosing what is most suitable for them.

The Care Home Use of Medicines Study (CHUMS) reported that use of MCAs did not reduce the likelihood of medicines administration errors. This study highlighted that errors associated with MCAs included labelling and filling issues, as well as errors when identifying white tablets.

NICE guideline (SC1) states:

Care home providers should determine the best system for supplying medicines for each resident based on the resident's health and care needs and the aim of maintaining the resident's independence wherever possible.

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.

More research is needed into the use of and outcomes from MCAs.

What you should consider

Medicines policy

You need to make sure your medicines policy explains:

• how people and care staff manage different systems of administration. For example, people could have original packs of medicine as well as those in their MCA, such as soluble painkillers or liquid medicines
• how you manage changes to people’s medicines, such as new medicines or updated doses
• what actions to take if a person does not take one or more of their medicines
• when and how to contact the supplying pharmacy or prescriber for support
• the need for each person’s medicines to be regularly reviewed and risk assessed to ensure they are supplied in appropriate and safe packaging
• what to do if a person’s medicines change mid-cycle
• how to manage medicines that have specific administration requirements
• how to store MCAs containing controlled drugs in care homes.

Care staff

Only trained and competent care staff should support people to take their medicines. This includes administration from MCAs and original packs.

Care staff must be able to identify the individual medicines before they administer them. 

Your supplier or pharmacy

The medicines supplier (often a pharmacy) 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. 

NICE guidance NG67 states that care workers should give medicines directly from the container they are supplied in.

Storing MCAs and medicines

You must store MCA devices safely, as some are not child resistant or tamper evident.

Some medicines become unstable when removed from their original packaging and can therefore be unsafe to use. Medicines supplied in this way could be unlicensed, which is when you use a medicine outside its usual product licence or marketing authorisation.

MCAs can increase medicines waste. You must dispose of medicines that are no longer required safely. This includes those left at the end of the pack and medicines removed from their original packaging.

Medicines should not be re-packaged or dispensed in their original strip or blister packaging into an MCA. Reports show cases where people have swallowed both the medicine and its packaging, resulting in severe harm and death.