A stability database put together by UKMi could help relieve some of the stress associated with dispensing medicines in compliance aids, reports Asha Fowells

After a busy morning dispensing walk-in prescriptions, it is time to turn to the stack of prescriptions that need dispensing into multicompartment compliance aids (MCAs). But which medicines are OK to go in and which items should be left out?

Warfarin is a ‘given’ for being kept separate due to the flexible dosing schedule the vast majority of patients need to follow. Ditto catheters and dressings, because they physically don’t fit. But what about bendroflumethiazide? Enalapril? And there’s something about aspirin…

This is a scenario familiar to most community pharmacists who have been involved in repackaging medicines into MCAs. Over the years, many have turned to their local medicines information (MI) department for clarification, which has led to the production of a database of stability guidance by UK Medicines Information (see panel).

The project was co-ordinated by Trevor Beswick, director of South West Medicines Information and Training Centre and UKMi vice-chair. “The database uses a traffic light system to indicate whether a medicine can be repackaged without any issues, if it is a complete no-no, or is something in between.”

Anyone expecting a definitive ‘yes or no’ may be disappointed, he says. “Pharmacists need to use their professional judgement when repackaging medicines into compliance aids, which the site states very clearly.”

The catalogue has been populated with more than 1,000 products, most of which are branded due to the huge number of generics on the market. If a user looks for an item that is not included – and is not covered by the disclaimer on the cover page of the database – there is a feedback function.

Word of mouth

The database has been in use for a year or so now, with access initially restricted to a small group of MI pharmacists and then widened out to the UKMi network. Gradually, word of mouth has led to more people requesting access – mostly hospital dispensary managers, but also a few pharmacists who work in community or primary care and are heavily involved in this area of practice – which has led to a few tweaks being made to improve the user experience.

Araf Iqbal, a medicines optimisation pharmacist within Bristol CCG, was part of this wider group of testers thanks to his second job at a local community pharmacy. MCAs comprise “a reasonable part of the business” at the branch he works in as a pharmacist, he says, making him an ideal tester from a community pharmacy point of view. Araf describes the database as “exceptionally easy to use and very, very quick compared to the huge amount of time you can spend running around to find out about each drug in turn”.

“It is really well thought out, in that you can enter all of a patient’s drugs and see them all together. You can then print this out and attach it to the patient’s medication record or file, so you have it to refer to in the future.” Araf adds that the usefulness of the database should not be restricted to pharmacists and their support teams.

“It would be really handy for GPs to use. They could punch in the drugs they want to put a patient on and check they are suitable for being dispensed in a compliance aid, rather than the prescription going backwards and forwards between them and the pharmacist as can happen at the moment.”

The database uses a traffic light systemto indicate whether a medicine can be repackaged without any issues

Open access

The good news is that the database has proved sufficiently reliable and robust for UKMi to make it open access from October 1 at www.ukmi.nhs.uk/ applications/mca. However Trevor Beswick cautions against being lulled into thinking that a compliance aid should be an automatic choice for a patient just because the medicines they are taking are catalogued.

“The fact that UKMi has produced this database is not a judgement on whether compliance aids should or should not be used. It is important that patients are assessed – as the Royal Pharmaceutical Society laid out in the guidance that it published around a year ago – and where a MCA seems to be the most appropriate option for a particular patient, the database will assist those involved in filling it.”