More on dosettes
As I mentioned earlier this week, we have recently done a lot of work to really tighten up on our dosette box service. This work largely arose for three reasons:
• We didn’t have a formal written SOP for this service.
• The service, like so may others, had begun with a handful of patients and was now managing in excess of 100 and so needed more formal procedures in place to ensure that it continued to run safely and effectively.
• Because of the patient numbers involved one of the GP practices was not proactively telling the pharmacy about medication changes and so extra safeguards were needed.
So I started by talking to all the pharmacy staff involved in the service to check my understanding of the service (e.g. how were new patients initiated on the service and counselled by the pharmacy staff on the use of the weekly service; how did the pharmacy request weekly scripts; how were the dosette boxes assembled; how were changes in medication communicated to us, made by us, and communicated to the patient/carer).
And then I wrote a draft SOP which also acted to tighten up on a number of the pharmacy procedures, particularly:
• If a stock bottle was needed from an unchecked dosette box then a senior member of the dispensary team would verify and initial that the correct stock bottle had been removed.
• Keeping a formal written log of all changes to patients’ medication on the occasions where there wasn’t a script to back this up (e.g. GP surgery informing us of a medication which needed stopping).
• Using more experienced staff to run through the weekly scripts and pick up any medication changes that the surgery had not proactively told us about.
• Ensuring that patients using the service were aware of their responsibility for the dosette box and the cost of replacing any lost boxes (see Boxing shorts).
Once we had produced the draft SOP we shared it with the GP practices in order to get their input and let them see what service involved. This proved to be really helpful because the GP practices were becoming concerned about issuing weekly scripts and proactively letting us know about any medication changes.
However, once they had read the procedure they realised the work involved on a weekly basis by the pharmacy. In addition, they also agreed to slightly alter their procedure for issuing us with timely weekly scripts.
This now means that our procedure has been tightened up even further and that before an assembled dosette box is given to a patient, the second check that is performed by the pharmacist involves a double-check against the latest weekly script (hence picking up any recent medication changes straight away).
The service is still a very involved and time-consuming one but everyone is now much happier that we have a formal written procedure in place that has tightened up on a number of areas where errors could have occurred.
• We didn’t have a formal written SOP for this service.
• The service, like so may others, had begun with a handful of patients and was now managing in excess of 100 and so needed more formal procedures in place to ensure that it continued to run safely and effectively.
• Because of the patient numbers involved one of the GP practices was not proactively telling the pharmacy about medication changes and so extra safeguards were needed.
So I started by talking to all the pharmacy staff involved in the service to check my understanding of the service (e.g. how were new patients initiated on the service and counselled by the pharmacy staff on the use of the weekly service; how did the pharmacy request weekly scripts; how were the dosette boxes assembled; how were changes in medication communicated to us, made by us, and communicated to the patient/carer).
And then I wrote a draft SOP which also acted to tighten up on a number of the pharmacy procedures, particularly:
• If a stock bottle was needed from an unchecked dosette box then a senior member of the dispensary team would verify and initial that the correct stock bottle had been removed.
• Keeping a formal written log of all changes to patients’ medication on the occasions where there wasn’t a script to back this up (e.g. GP surgery informing us of a medication which needed stopping).
• Using more experienced staff to run through the weekly scripts and pick up any medication changes that the surgery had not proactively told us about.
• Ensuring that patients using the service were aware of their responsibility for the dosette box and the cost of replacing any lost boxes (see Boxing shorts).
Once we had produced the draft SOP we shared it with the GP practices in order to get their input and let them see what service involved. This proved to be really helpful because the GP practices were becoming concerned about issuing weekly scripts and proactively letting us know about any medication changes.
However, once they had read the procedure they realised the work involved on a weekly basis by the pharmacy. In addition, they also agreed to slightly alter their procedure for issuing us with timely weekly scripts.
This now means that our procedure has been tightened up even further and that before an assembled dosette box is given to a patient, the second check that is performed by the pharmacist involves a double-check against the latest weekly script (hence picking up any recent medication changes straight away).
The service is still a very involved and time-consuming one but everyone is now much happier that we have a formal written procedure in place that has tightened up on a number of areas where errors could have occurred.
posted by Dee Spencer at 9:54 am
3 Comments:
Hi Dee
Interested to read your comments on the thorny subject of MDS. We only have nine patients receiving them and that's bad enough so I don't know how you manage.
We have also had the problem of surgery staff not telling us about medication changes. A very productive meeting with two of the GPs and the practice manager seems to have resolved this.
A problem in my area is the issue of social service carers who aren't allowed to administer medication unless it is in MDS (I understand this policy varies between areas). As a result of this, we are now in the ridiculous situation of having to provide a weekly MDS for a lady taking ONE tablet in the morning.
What is your policy on items which are not suitable for inclusion in MDS? How strict are you about this? We have two patients on several items which can't be put in and I question the usefulness of MDS in these circumstances (fortunately they don't need carers to administer their medication or we'd be really stuck). Sorry to ramble on so much but this is a subject that causes me considerable problems.
Hi - well it's good to know that we all have the same problems! At the moment it isn't the pharmacy that is agreeing which patients are suitable for the MDS service, but the GP practice.
I've also inherited patients using the service who take two tablets a day or where there are so many prn or unsuitable medicines for MDS that a dosette hardly seems worthwhile. I do plan to find a suitable screening tool to use in order to get the pharmacy more involved at the beginning but I haven't yet had time. Don't know whether there is anyone else out there who can help?
In terms of social services, the national guidance from the CSCI at http://www.csci.org.uk/Docs/medicines_dom_care.doc doesn't stipulate the use of MDS so I would ask your LPC to intervene here.
In the case of one or two tablets a day, does medication really have to be in the MDS trays (like the ones you get from surgichem)? Can they not be issued into a little box (like the Fortuna weekly dossette box - the long rectangle ones)?
Two labels (for the persons name and the medication) can be stuck on the back. No use of backing sheets or MAR charts.
Sachin
Sachin
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