Monitoring system for drug delivery suitable for elderly people who have been using medicines for long periods in social care facility and at home environment
INTRODUCTION
With the increasing population, the demand for health and social care and the provision of high-quality care for older adults in Slovakia is also growing. These services should meet the needs of individuals who may have a range of acute and chronic conditions. The ability of hospital services to meet these demands is limited, and therefore social services facilities provide accommodation and health services to meet this unmet need. Concerns have been raised in the lay press regarding drug management in social services facilities, and the literature has shown that this process is not optimal. The aim was therefore to review drug management in social services facilities, focusing on areas of extensive drug prescription, administration and disposal of drugs.
Prescribing practices should be carefully considered to reduce drug burden, and efforts should be made to incorporate a multidisciplinary approach to care. For better and more efficient drug management, the Drug Monitoring System (MSDL) is available. MSDL is a storage device for solid medicines aimed at simplifying drug administration to patients/clients. MSDL offers new possibilities for packaging medicines for various social services facilities, for patients in the home environment or in other health facilities such as hospitals. MSDL is packaged by leading or qualified nurses directly in the facility or in the home environment, in a simple manner. This system allows patients/clients to easily take medicines in daily doses as prescribed by the treating physician. It is reported that MSDL has a number of benefits, including increased treatment compliance by clients and minimization of errors related to drug dosage.
In our country, not only financial demands have increased, but recruitment of employees in the social services sector remains challenging. There is a significant shortage of nurses, caregivers, and nurses who could contribute to better provision of social services linked to health services in social services facilities. Studies suggest that nurses prefer working in primary or secondary healthcare rather than in the social services sector. This is partly due to improved access to resources and a multidisciplinary environment in such settings, which are lacking in the social services sector. Another pressure on this industry is increased regulatory oversight (care standards, ÚDZS) due to several significant incidents in client care facilities. This oversight is understandable, as clients of social services facilities are often the most vulnerable individuals in society. However, it is worthwhile. Together, these pressures on society can represent effective and quality care. One of the main nursing tasks in social services facilities is also the administration of medicines prescribed by the treating physician to individual clients. Usually, in social services facilities, clients are not able to manage their own medicines, and therefore staff are involved in managing, administering, and providing medicines.
Clients in social services facilities are particularly susceptible to drug-related harm, which may occur because they have little information about various drug allergies, drug prescribing, and inappropriate drug practices in facilities. Consequently, I focus on drug management in a sample of social services facilities, focusing on prescribing, administration and waste of drugs.
Defining the knowledge base
Ageing is a gradual progressive process characterized by physiological changes and an observable decline in bodily functions along with increased susceptibility to adverse drug effects (Mangoni and Jackson 2003). In addition to physiological decline, there are also age-related neurological deficits that can result in visual, motor, and cognitive impairments. These can reduce quality of life and indeed hinder the individual's ability to take their medicines safely. These changes affect the absorption, metabolism, distribution, and elimination of drugs, which can be unpredictable and subject to significant variability between clients, but can ultimately lead to adverse drug reactions (Stegemann et al. 2010). Consequently, prescribing for this population should be carefully considered.
Complex health conditions, long-term illnesses, multiple chronic diseases, and geriatric syndromes affecting some older adults often require multiple drug therapy as a primary intervention either for treatment, prevention, control, or to improve the quality of life of clients. Given the changes in pharmacokinetics (drug intake to excretion) and pharmacodynamics (drug effect on the body) associated with the age of this population, this leads to appropriate use of drugs.
It is assumed that this dramatic shift in the population will place further pressure on health services in primary and secondary care. The older adult population is, at least partially, prone to multiple chronic diseases and is susceptible to polypharmacy – taking more than 5 drugs a day, which results in adverse drug reactions.
If drugs are administered to social services clients, their administration must be documented in Drug Records. Drug Records represent the main documentary record of drug administration to clients. Each client should have a separate Drug Record, which provides details about the client including their name, date of birth, and allergy status, the name and address of the treating physician, etc. It should also contain a list of all drugs to be administered to the client and prescribed by the physician, with attached dosing instructions, any special instructions or safety precautions associated with the drugs, and a separate section for recording information and comments. There is no uniformly defined form for the Drug Record, but the content will be roughly similar, providing effective information about the client and subsequent recording of drug administration in the Drug Record.
Drug waste can occur at any stage of the drug management process from prescription issuance to drugs in the patient's hands. It is evident that all patients and healthcare professionals (physicians, pharmacists, healthcare staff) contribute to drug waste generation. It is also clear that some causes of drug waste can be prevented (e.g., preventing excessive drug stockpiling, promoting drug management compliance through education and client counseling), while others cannot be prevented (e.g., patient/client death), with estimates suggesting that the ratio of preventable to non-preventable waste is approximately 50:50 (York Health Economics Consort and The School of Pharmacy 2010).
Background
Prescribing is more complex in social services facilities where there are multiple healthcare sources involved with a number of prescribers, such as general and specialist physicians, who often do not consult directly with the client but rather receive information regarding the client through a nurse or caregiver (Bergman et al. 2007).
Estimates suggest that approximately 80% of all drugs in social services facilities could be packaged in MSDL systems.
Drug Monitoring System (MSDL)
MSDL is a drug dispenser and at the same time a storage device for solid and hard medicines aimed at simplifying drug administration to patients/clients. MSDL is recommended for all medicines including as-needed drugs, drugs with potential cytotoxicity, drugs with variable dosing, and hygroscopic or light-sensitive drugs. However, MSDL could be the most common system used in social services facilities or home care for drug management.
Generally, the system is only suitable for oral solid medicines, although there are specialized systems (e.g., Jodóza) that allow liquid dosage forms.
MSDL - Drug Monitoring System is a drug management tool that organizes drugs for the patient's oral dose by day of the week and by time of day when they are to be taken. MSDL, also known as blister drug packaging, is ideal for patients taking more than 5 drugs (Polypharmacy) throughout the day.
MSDL drug dispenser – drug card, prepared by a nurse, are primarily used in the community because care is provided at home but also used in social services facilities to help healthcare providers correctly administer drugs to patients and clients in their care.
Using the MSDL drug dispenser provides clients and patients, their families, pharmacists, and the wider healthcare system with a range of benefits.
Clients, patients and families
MSDL - drug dispenser helps the client and patient adhere to timely administration of multiple drugs throughout the day.
MSDL - drug dispenser prepared by a nurse eliminate the need for patients and clients to manage their own drugs. It significantly minimizes the risk of missed or extra doses of drugs. Clients and patients can better understand their drugs, improving treatment outcomes.
Pharmacists and nurses
Drug dispenser – Patient drug card with (MSDL) are prepared each week to include only current drugs. With regular refills, the pharmacist and nurse can closely monitor drug use by their clients and patients.
Conclusion
The Drug Monitoring System provides clients and patients with better care and individualized services that can influence the well-being and quality of life of patients and clients. The use of MSDL blister packaging can reduce unnecessary hospital admission due to continuous non-adherence to drug use – either taking too little or too much, or incorrect timing of doses. It also contributes to reducing drug waste because drugs are administered on time, leading to less drug waste and reduced stock accumulation.
Author: PhDr. Bc. Marcel Tóth The author of the expert article is a doctoral student at the University of Health and Social Work St. Elizabeth in Bratislava.
References Hilmer, S. N. et al. 2007. Drug burden index to define functional drug burden in older people. Archives of Internal Medicine 167 (8), pp. 781 - 787.
Medeiros-Souza, P. et al. 2007. Diagnosis and control of polypharmacy in the elderly. Revista de saude publica 41 (6), pp. 1049–53.
Patterson, S. M. et al. 2014. Interventions to improve appropriate polypharmacy in older people. Cochrane Database Syst Rev, 10 (10).