The Practice Guidelines for Multidose Drug Dispensing Need Revision-An Investigation of Prescription Problems and Interventions.

Multidose drug dispensing (MDD) is an adherence aid used by one-third of patients receiving home care services in Norway. The system can increase patient safety by reducing dispensing errors and increase adherence, however it has also been criticised for unclear routines and distribution of responsibilities. We investigated prescription problems which pharmacists have detected, and the responsibilities they adopt regarding MDD. For two consecutive weeks, 11 pharmacies used a self-completion form to register prescription problems identified with MDD. Of the 4121 MDD prescriptions, problems were identified on 424 (11%). The most common issues were expired prescriptions (29%), drug shortages (19%), missing prescriber signatures (10%) and unclear/missing medication names or strengths (10%). Compared to ordinary prescriptions, the pharmacist took on additional responsibility for renewing MDD prescriptions. However, because these patients received their medications via the home care service, there was limited patient counselling during dispensing. To increase the efficiency and patient safety of the MDD system, the roles and responsibilities of the pharmacist, GP, and home care nurses in the MDD system should be clearly defined. This seems most urgent for the renewal of prescriptions and patient counselling, where the responsibilities and work practice seem to differ from ordinary prescriptions.