Preparation of the administrated dose by repacking in dependent old people’s home (DOPH), still a relevant practice?

Background

In order to secure the medication circuit for long-term patients, our hospital has chosen to deploy a repacking-unpacking automaton. This automaton allows the preparation of the administrated dose (PAD) in individual pack facilitating the caregivers’ work.

Aim

All medication are not eligible for repacking (Recommendations from the automaton users’ club), we would like to evaluate if this method is still relevant.

Material and method

Currently, the PAD automaton provides the dispensation of 272 patients. On a typical week, we analyzed the total number of individual pack produced and taken medication not supported by the automaton. Medications administrated by the nurses (injectable, aerosol) are not included in this study.

Results

16187 sachets are produced for 22 437 taken medications. 6250 taken medications are not supported by the automaton (TMNSBA) or 28% .Among the TMNSBA, there are: immunosuppressant and cytotoxic’ agents (n=74; 1.8% of TMNSBA), beta-lactams (n=121, 1.9% of TMNSBA); sachets and patchs (n=1879; 29,7% of TMNSBA); orodispersible tablets and oral solutions (n=1712; 27% of TMNSBA ); paracetamol capsule (n=2464; 39% of TMNSBA).

Discussion - conclusion

28% of the total taken medications are not supported by the automaton, which does not facilitate the administration of medication by the caregivers. 60% of TMNSBA are attributing to an incompatibility between medicinal specialties and the automaton. 40% concern the paracetamol which gives rise to logistical problems. The use of this automaton is questionable. The transition to an automaton allowing the over-packaging or a nurse preparing medication organizers are both potentially efficient to solve these problems.