Dose Administration Aids: the good, the bad and what they don’t tell you


Dose Administration Aids

Dose Administration Aids seem to be universally accepted… but let’s not forget their shortcomings, writes Keryn Coghill

Dose administration aids: we hear lots about these little devices and how useful they are in assisting in the ‘safe’ and ‘efficient’ delivery of medications; how they are the saviour of aged care facilities and the elderly managing their multiple medications at home.

So what do they look like these days—now that the little red and white plastic boxes have long gone (or should have)?

 

First Generation

  1. The manual (hand) packed foil-sealed seven-day pack divided into breakfast, lunch, dinner and bed, into which multiple medications can be placed per designated time slot (for example, seven medications in the breakfast blister). These are mostly covered in a plastic sleeve which is reused and designed not only for pack strength but for delivery rack and storage in aged care facilities.
  2. Manual packed foil-sealed seven-day packs as per point 1, which have the ability to remove individual doses because of perforated cold seal technology.
  3. The manual packed foil-sealed seven-day packs divided into unit (single) doses… so, one pack for breakfast with one medication per blister per pack for lunch, and so on.
  4. Robotically (machine) packed varieties of the above electronically programmed based on dispensed packing history.

 

Second Generation

  1. The ‘sausage machine’ DAAs which pack medications in sequential sachets or packets all joined and perforated to remove individual doses. These can be multi or unit dose packets and are packed by a machine electronically programmed based on the dispense packing history and for each individual person.

 

Third Generation

…stay tuned !

 

DAA providers will tell you:

  • Their product is error proof.
  • Their product is easy to use and accepted by the majority of users—perhaps because users don’t know all the facts!
  • That medication changes are simpler and safer with their product. Hmmm.
  • Their DAA is safer than the alternative—original packs.
  • That their DAA increases efficiency by reducing medication administration times in aged care facilities—maybe, but how inefficient is the repacking from the original containers in the pharmacy by the poor pharmacist, who mostly doesn’t even charge or value this service?
  • Machines don’t make mistakes. Well, no, they do! And even more, so do the humans programming the packing instructions into the machines. No step of the process is error-proof.

This only scratches the surface of the issues surrounding DAAs. No system is perfect.

 

A few further points to contemplate in the world of DAAs…

  1. Who takes legal responsibility for what is in the pack… or what is documented on the pack at the point of administration?
  2. Contamination from packers can be a problem.
  3. Contamination from machines can also be a problem: for example, diabetic medications coming down the same shutes as other medications. And then, what about allergies?
  4. How efficient is a DAA when it takes 12 minutes to pack in the pharmacy to save five minutes at point of administration? And importantly, who pays for that time?
  5. What about the time taken for the transmission of data to reach TGA facilities who pack outside a pharmacy to equate to a new and replaced pack at facility level—another huge area for packs which often don’t reflect current GP orders.

 

Don’t get me wrong. I believe there is a place for these DAAs in both aged and community care.

And they have had an overall positive effect in the industry. Unfortunately, in many ways they don’t live up to the claims made by the DAA providers.

Can DAAs can they be rated in safety, efficiency, acceptance and accountability? Yes, they can.

But are there other options?

Again… stay tuned!

Keryn Coghill is the managing director of Mederev. She has 35 years’ experience as a pharmacist in hospital and community pharmacy, as well as aged care and correctional medication management.

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2 Comments

  1. KH
    28/10/2015

    Sure, if you ask the DAA providers about their product, they’ll be blindly championing the benefits convenience/safety, but no one in the real world is going to pretend those claims are the end of the discussion about medication management. Your title suggests there’s supposed to be balance in this article, but seems like a stream-of-thought blog draft so we can ‘tune in next time’.

    • J
      29/10/2015

      Agreed. Having worked with DAAs for my entire career I’m well aware of both positive and negative attributes of them. I have seen DAAs improve patient compliance and confidence in managing their own medications. I also work with nursing homes who rely tremendously on the DAA service we provide. Yes, there are limitations and difficulties but on the whole I believe the positives outweigh the negatives. I was hoping to read an in-depth, intelligent and balanced discussion here but instead was left wondering why they couldn’t be bothered finishing the article…

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