Health care professionals’ perspectives on automated multi-dose drug dispensing

Main Article Content

Carola Bardage
Anders Ekedahl
Lena Ring

Keywords

Drug Packaging, Medication Systems, Medication Adherence, Medication Errors, Attitude of Health Personnel, Sweden

Abstract

Background: During the 1980s, manual repackaging of multi-dose medications from pharmacies in Sweden was successively substituted with automated multi-dose drug dispensing (MDD). There are few studies evaluating the consequences of automated MDD with regard to patient safety, and those that investigate this issue are not very extensive.

Objectives: To investigate Swedish health care professionals’ perceived experience of automated MDD and its effects on patient adherence and patient safety.

Methods: Three questionnaire forms, one for physicians, nurses, and assistant nurses/nursing assistants, were developed based on reviews of the literature and pilot testing of the questions in the intended target groups. The target groups were health professionals prescribing or administrating MDD to patients. A sample (every sixth municipality) was drawn from the sampling frame of Swedish municipalities, resulting in 40 municipalities, about 14% of all municipalities in Sweden. Email addresses of general practitioners were obtained from county councils, while the municipalities assisted in getting contact details for nurses, assistant nurses and nursing assistants. A total of 915 questionnaires were distributed electronically to physicians, 515 to nurses, and 4,118 to assistant nurses/nursing assistants. The data were collected in September and October 2012.

Results: The response rate among physicians, nurses and assistant nurses/nursing assistants was 31%, 43% and 23%, respectively. The professionals reported that automated MDD reduces duplication of medication, contributes to correct dosages, helps patients take their medication at the right time, and reduces confusion among patients. Fifteen per cent of the physicians and about one-third of the nurses and assistant nurses/nursing assistants reported that generic substitution makes it more difficult for the patient to identify the various medicines available in the sachets. The physicians did, however, note that prescribing medicine to patients with automated MDD is complicated and can be a risk for patient safety. Both physicians and nurses requested more information on and training in automated MDD. They also asked for more medication reviews.

Conclusions: The professionals generally had a positive attitude to automated MDD with regard to improved medication adherence, but said they believed that the electronic prescribing system posed a safety risk for patients.

Abstract 2311 | PDF Downloads 1074

References

1. Information available at http://www.ehalsomyndigheten.se/ehalsotjanster/e-recepttjanster/vara_register/nationellt_dos-register (accessed 26.09.14).

2. Bakken T, Straand J. [Improved medicine lists with multi-dose packaging?]. Tidsskr Nor Laegeforen. 2003;123(24):3595-3597.

3. Bergman A, Olsson J, Carlsten A, Waern M, Fastbom J. Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care. 2007;25(1):9-14.

4. Danish Medicines Agency. Dose dispensing. Fact sheet from the Danish Medicines Agency; 3 October 2006. Available at: http://www.dkma.dk/db/filarkiv/6080/Dose%20dispensing.pdf (accessed 26.09.14).

5. Åkerlund M, Vissgården A. ApoDos - Apotekets dosexpedierade läkemedel [ApoDos _ The National Corporation of Swedish Pharmacies’ multi-dose dispensed medicines]. Läkemedelsboken 2007/2008 Apoteket AB [National Corporation of Swedish Pharmacies]; 2007.

6. Gerber A, Kohaupt I, Lauterbach KW, Buescher G, Stock S, Markus Lungen M. Quantification and Classification of Errors Associated with Hand-Repackaging of Medications in Long-Term Care Facilities in Germany. Am J Geriatr Pharmacother. 2008;6(4):212-219. doi: 10.1016/j.amjopharm.2008.10.005

7. Berdot S, Gillaizeau F, Caruba T, Prognon P, Durieux P, Sabatier B. Drug Administration Errors in Hospital Inpatients: A Systematic Review. PLoS One. 2013;8(6):e68856. doi: 10.1371/journal.pone.0068856

8. Gilmartin JFM, Hussainy SY, Marriott JL. Medicines in Australian nursing homes: a cross-sectional observational study of the accuracy and suitability of re-packing medicines into pharmacy supplied dose administration aids. Res Social Adm Pharm. 2013;9(6):876-883. doi: 10.1016/j.sapharm.2013.01.002

9. Carruthers A, Naughton K, Mallarkey G. Accuracy of packaging of dose administration aids in regional aged care facilities in the Hunter area of New South Wales. Med J Aust. 2008;188(5):280-282.

10. Gerber A, Kohaupt I, Lauterbach KW, Buescher G, Stock S, Lungen M. Quantification and classification of errors associated with hand-repackaging of medications in long-term care facilities in Germany. Am J Geriatr Pharmacother. 2008;6(4):212-219. doi: 10.1016/j.amjopharm.2008.10.005

11. Hussainy SY, Marriott JL, van Koeverden PM, Gilmartin JFM. How accurate are manually prepared dose administration aids in residential aged care facilities? A pilot investigation. Aust Pharmacist. 2012;31(4):320-325.

12. Roberts MS, Lentile C, Geoffrey L, Stokes J, Doran C, Hendry M, et al. Effectiveness and cost effectiveness of dose administration aids (DAAs) final report [online]. Quality Medication Care Pty Ltd, University of Queensland, Princess Alexandra Hospital, Australian Government Department of Health and Ageing, Pharmacy Guild of Australia; 2004. Available from: http://beta.guild.org.au/uploaded files/Research_and_Development_Grants_Program/Projects/2002-519_fr.pdf (accessed May 2013).

13. Johnell K, Fastbom J. Multi-dose drug dispensing and inappropriate drug use: A nationwide register-based study of over 700,000 elderly. Scand J Prim Health Care. 2008;26(2):86-91. doi: 10.1080/02813430802022196

14. Sjöberg C, Edward C, Fastbom J, Johnell K, Landahl S, Narbo K, Wallerstedt SM. Association between Multi-Dose Drug Dispensing and Quality of Drug Treatment – A Register-Based Study. PLoS One. 2011;6(10):e26574. doi: 10.1371/journal.pone.0026574

15. SBU – [Swedish Council on Health Technology Assessment]. Äldres läkemedelsanvändning - hur kan den förbättras? En systematisk litteraturöversikt. [How can drug consumption among the elderly be improved? A systematic review]. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2009. SBU-Rapport nr 193 • ISBN 978-91-85413–27-0

16. Sinnemäki J, Sihvo S, Isojärvi J, Blom M, Mäntylä A. Automated dose dispensing service for primary healthcare patients: a systematic review Syst Rev. 2013;2:1. doi: 10.1186/2046-4053-2-1

17. Fladstad Heier K, Olsen Krohn V, Rognstad S, Straand J, Toverud EL. [Healthcare providers’ experience with multi-dose packaged medicines] Tidsskr Nor Laegeforen 2007;127(18):2382-2835.

18. Wekre LJ, Melby L, Grimsmo A. Early experiences with the multidose drug dispensing system – A matter of trust? Scand J Prim Health Care. 2011;29(1):45-50. doi: 10.3109/02813432.2011.554002

19. Kwint HF, Stolk G, Faber A, Gussekloo J, Bouvy ML. Medication adherence and knowledge of older patients with and without multidose drug dispensing. Age Ageing. 2013;42(5):620-626. doi: 10.1093/ageing/aft083

20. Lipowski EE, Campbell DE, Brushwood DB, Wilson D. Time savings associated with dispensing unit-of-use packages. J Am Pharm Assoc (Wash). 2002;42(4):577-581.

21. Quicksearch. Enkätverktyg, undersökning och uppföljning. Available at: http://www1.quicksearch.se/ (accessed 26.09.14).

22. Heier KF, Olsen VK, Rognstad S, Straand J, Toverud EL. Healthcare providers' experience with multi-dose packaged medicines. [Article in Norwegian]. Tidsskr Nor Laegeforen. 2007;127(18):2382-2385.

23. Wekre LJ, Bakken K, Garasen H, Grimsmo A. GPs’ prescription routines and cooperation with other healthcare personnel before and after implementation of multidose drug dispensing. Scand J Public Health. 2012;40(6):523-530. doi: 10.1177/1403494812455468

24. Friberg A. Verksamhetsanalys – öppenvårdsdos i Västra Götalands Regionen (VGR). Rapport Göteborg , 2011. [County Council report on multi-dose in primary care] Available at: http://epi.vgregion.se/upload/L%c3%a4kemedel/Dosexpedition/Verksamhetsanalys,%20%c3%b6ppenv%c3%a5rdsdos%20i%20VGR,%20slutversion%202012-02-02.pdf (accessed 26.09.14).