Members of our Clinical Team reflect on regulatory insight and outline the principles that support safe, person-centred decisions about monitored dosage systems (MDS).
Understanding MDS
Monitored dosage systems such as blister packs, Dosette®, Nomad®, Venalink® and Medidose®, are used to help people organise their medicines. However, they don’t always improve adherence or safety for everyone.
Preparing and supplying medicines in an MDS requires extra time, resources and professional judgement, and can introduce risks. These include people being able to use them correctly, stability issues and delays in supplying the correct medicines in a timely way when regimens change.
Decisions about whether to provide MDS, and charging for them, must be consistent, evidence based and centred on the person’s needs. Consider whether changes could worsen health inequalities, especially for older people, those with disabilities or complex social needs.
Person-centred assessment
Decisions to start, continue or stop MDS must follow an individual assessment which is reviewed regularly in case of any changes, and considers a person’s:
- clinical conditions
- cognitive and physical abilities
- medicines regimen
- support network
- preferences
A multidisciplinary approach will support safer, more coordinated decisions.
The Equality Act 2010 and reasonable adjustments
Under the Equality Act 2010, pharmacies must make reasonable adjustments so that people with protected characteristics are not placed at a substantial disadvantage when accessing services.
Reasonable adjustments may include:
- easy open containers
- providing labels in larger font or braille, or using color-coded systems for different doses
- reminder or dosing charts
- MAR (medication administration record) charts
- additional medicines support or counselling
- providing pictures or descriptions of medicines
In some cases, providing an MDS may be a reasonable adjustment. Pharmacies can consider their resources and capacity, but any decision to charge must not undermine their legal duty. Decisions must be proportionate, clearly justified and supported by a transparent rationale.
Guidance and regulatory expectations
NICE guidance states that evidence for adherence interventions is mixed and that MDS should only be considered where a specific need is identified. Royal Pharmaceutical Society guidance reinforces the importance of reviewing suitability over time. All decisions must align with the standards for pharmacy professionals and standards for registered pharmacies, ensuring safe and person-centred care.