Guiding principles for medication management in the community - July 2006

Guiding Principle 3 - Dose Administration Aids

Further explanation on Guiding Principle 3 - Dose Administration Aids.

Page last updated: 06 September 2006

Dispensed medicines should be retained in the original manufacturers' or other dispensed packaging unless a Dose Administration Aid (DAA) could help to overcome specific problems that a consumer or care worker might face.

A DAA is a device or packaging system for organising doses of medicines according to the time of administration. Different types of DAAs include blister or bubble packs, compartmentalised boxes, and compliance packs such as those provided by automated medication dispensing systems. A DAA is a tool to be used in a coordinated approach to medication management.

There are safety limitations to the use of DAAs. They might be difficult to label with medicine information or cautionary labels unless they have been specifically designed for such labelling and they might not be tamper-evident. DAAs might not be suitable for all consumers and their use should be considered carefully. Some consumers might find it difficult to use a DAA, for example, a person with rheumatoid arthritis or other physical disability. The cost of a DAA might also make it an unsuitable aid for some consumers. It is important that consumers or their carers are supported in making informed decisions about the aid that most suits their needs.

The legislation and service provider policies applying to DAAs will differ between states and territories.

Assessment

Assessments to identify consumers that may potentially benefit from the use of DAAs could be conducted by a health care professional upon the request of the consumer or a carer or another health care professional. Carers, families, care workers, community pharmacists, community nurses, doctors and other health care professionals all share a role in identifying any concerns about a consumer’s ability to manage their medicine.

Consumers who are using DAAs should be monitored in the same way as all other consumers to make sure that they continue to administer medicines safely (refer to Guiding Principle 2 – Self-administration).

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Preparation

DAAs should be packed and fully labelled either by a pharmacist or under the supervision of a pharmacist, in accordance with professional guidelines4. The pharmacist should sign off that the correct medicine(s) have been packed into the DAA, in accordance with professional standards and guidelines5. In some states and territories, a health care professional other than a pharmacist, that is, a registered nurse or Aboriginal Health Worker or Torres Strait Islander Health Worker, might fill a DAA. Nurses and Aboriginal Health Workers and Torres Strait Islander Health Workers should refer to relevant legislation, guidelines and service provider policies for when this may occur.

Only solid oral medicines can be packaged in a DAA.

The following should not be placed in a DAA with other medicines:

  • medicines administered on an ‘as required’ basis
  • solid dose cytotoxic preparations
  • medicines unsuited to this form of storage due to their instability if exposed to heat, light, air or moisture, for example, effervescent, dispersible, buccal and sublingual tablets, and significantly hygroscopic (moisture absorbing) preparations
  • medicines that might be affected when the backing of a DAA is heat-sealed, for example, soft gel caps.

If the pharmacist is not packing the DAA, information about medicines that might be unstable in a packaging system should be sought from a pharmacist, medicine information service or product information before the system is packed.

A consumer might want to have complementary health care products and non-prescription medicines included in the DAA. The pharmacist should check for potential interactions and other considerations and with the consumer’s consent, inform the prescriber.

The DAA should be returned to the pharmacist for repackaging if there are any changes to the consumer’s medicines. It is the responsibility of the prescriber to notify the pharmacist, carer, health care professional and/or care worker of any changes, with informed consent from the consumer and/or carer (refer to Guiding Principle 5 – Medication lists).

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Procedures

The pharmacist should verify a medication order with the prescriber where necessary. Communication protocols should be set up between the prescriber, the pharmacist, carer and care worker or nominated responsible person.

Pharmacists should keep a master copy of each consumer’s medication profile and should only make changes according to written or direct communication from the prescriber. These communications should be recorded and stored according to professional guidelines.

Labelling

The DAA should be clearly labelled with:

  • details of the person packing the medicine(s) in the DAA
  • the name, strength and form of all medicines supplied in the DAA, to enable identification of individual medicines
  • directions for the use of each medicine
  • date of filling
  • date and day of week the medicine is to be administered
  • any specific instructions about the use of the medicine, including cautionary and advisory labels, including KEEP OUT OF REACH OF CHILDREN, and information about alteration of the dosage form where appropriate (refer to Guiding Principle 5 – Medication lists)
  • any other details as required by relevant Australian, state and territory legislation
  • an indication in a prominent position that other medicines are contained in another DAA pack/s and are to be administered (e.g. 1 of 2 DAAs) as applicable.

The print font used should be of a size and type easily readable by the consumer.

Labelling should include both the brand and the active ingredient names, reference to the colour, shape and size of the medicines, as well as manufacturer's marks that have been made on each product.

All or part of a consumer’s medication regimen might be provided in a DAA. Where medicines are ordered for a defined short-course treatment, or in a complicated regimen, or where there are specific requirements regarding timing of administration in relation to meals and other medicines, such medicines should be in their original container or unit dose packs. Prompts should be given on DAA labels that the consumer is taking other medicines.

Role of care workers

A care worker should only physically assist a consumer in using their DAA if the consumer is responsible for their own medication management, and where agreement has been reached between the consumer and service provider in accordance with relevant Australian, state or territory legislation.

The care worker might remove medicines from a DAA or prompt a consumer to remove and take the medicine. Care workers should have competency-based training in accordance with organisational policy and Australian, state or territory legislation. Care workers should monitor medication management by consumers and be guided by their organisations’ medication management policies and procedures if there are any suspected adverse medicine events.

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Provisions for registered nurses

Preparation

All efforts should be made to have a DAA packed by a pharmacist. A registered nurse should only pack or re-pack a DAA if a pharmacist is unable to do so, if a consumer will self-administer medicines, and if the consumer’s health and welfare is at risk if the registered nurse does not do so. This practice should be restricted to ‘special circumstances’ and should comply with relevant Australian, state or territory legislation, as some states restrict the re-filling of DAAs by registered nurses, as well as being in accordance with organisational policy. Before packing a DAA, the nurse should liaise with the doctor and dispensing pharmacist to obtain all relevant information.

A carer or another nurse cannot administer medicines contained in a DAA that has been packed by a registered nurse.

A registered nurse packing a DAA should document this activity in the consumer’s clinical record or notes. Labelling of the DAA by the registered nurse should also be in accordance with organisational policy.

Administration

It is preferred that a registered nurse administer medicine from the container in which the medicine was originally dispensed, however, if a consumer has been supplied with a DAA (which has not been packed by a registered nurse), a registered nurse should only administer these medicines if they have a prescriber’s order and the medicines can be clearly identified from labels that state the name, colour, shape and details of manufacturers’ marks. A registered nurse cannot administer medicines that are not clearly identifiable.

Quality assurance

Safety and quality

The DAA should contain features that will show if the container has been tampered with before the medicine has been administered, depending on the individual requirements of the consumer receiving the medicines. If a care worker is to help a consumer use their DAA and it is evident that the DAA has been tampered with, it should be returned to the pharmacist for repacking.

In the event of a dosage or medicine change where the consumer is self administering medicine from a DAA, the DAA should be returned immediately to the pharmacy or Aboriginal Medical Service for re-packing and re-delivery. The registered nurse, care worker or community care provider should liaise with the consumer about returning the DAA to the pharmacy and arrange alternate supply where necessary.

Quality assurance activities should be implemented to make sure packing processes are audited regularly.

Consumer Medicine Information (CMI)

Even when medicine is supplied in a DAA, CMI should be provided, in accordance with professional guidelines.


4 Pharmaceutical Society of Australia (1999) Dose Administration Aid Guidelines. July 1999. www.psa.org.au

5 Pharmaceutical Society of Australia (2002) Dose Administration Aid Standards. Version 2.