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. MCAs are sometimes referred to as monitored dosage systems (MDS). There are a variety of types of devices available. These would be supplied by a pharmacy or dispensing doctor.

Medicines review

MCAs do not always simplify how people take their 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 Pharmaceutical Society (RPS) and 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 in the absence of a specific need for an MCA in all settings.

The RPS website states:

‘The RPS believes that supporting the best use of medicines involves identifying problems with medicines-use, medication review and consideration of patient characteristics to find the best solution. People can experience a range of barriers to taking their medicines, and multi-compartment compliance aids are often viewed as a solution. However, the limited evidence base suggests a lack of patient benefit outcomes and sometimes they can cause harm. A multi-compartment compliance aid (MCA) is one tool amongst many to help with medicines use but other interventions also exist, which as part of a patient-centred and quality approach, must also be considered. Patients who can safely self-administer their medicines should be encouraged to do so, and where they are unable to do so, there must be appropriate training for carers so that they are able to administer medicines from original packaging’.

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. There were also 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.

Considerations

Providers need to make sure their 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
• what happens when changes are made to people’s medicines? For example, new medicines or changed 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
• about regular review and risk assessment of individual need to make sure medicines are supplied appropriately packaged.

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. 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.

Some MCA devices are not child resistant or tamper evident.

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

MCAs can increase medicines waste. Care staff should dispose of any unwanted medicines safely. This includes those left at the end of the pack and medicines removed from their original packaging.

Medicines should not be repackaged within a MCA in their original strip or blister packaging. There have been reports of people swallowing the medicine and its packaging resulting in severe harm and death.