After introducing Australia’s first blister pack medication management systems 30 years ago, pharmacist and inventor, Gerard Stevens, tells David Hutchins how high technology is improving safety.
The best medicines in the world are worthless and potentially dangerous if not taken as prescribed, by the person to whom they have been prescribed, and within the prescribed course, says pharmacist and inventor, Gerard Stevens.
Stevens says that while medication has the power to do good, it also had the potential to do harm if not taken correctly or if its taken by the wrong person. He says he has been developing Webstercare packs for better, more efficient medication management for more than 30 years.
His Controlled Dosage System, he says, “was the first unit dose blister packs in Australia way back in the mid-1980s, and was absolutely the first multi-dose blister pack anywhere in the world”. Stevens refined the offering, designed as a safer productivity device for dispensing nurses, and relaunched it as the Webstersystem.
“We offered the first series of Webster-paks about 30 years ago. I was working as a pharmacist, supplying prescription drugs to aged care residences. Increasingly, these facilities were wanting to negotiate better margins. I noticed how time consuming and error prone dispensing pill bottles were for nurses and realised there had to be a better way.
“So I developed our first range of blister packs and quickly saw nurses saving 40 per cent of their time with dispensing medicines more efficiently and reliably,” he says. Since then he has continued to refine the system, which relies on greater use of information technology and robotics and his original process is obsolete.
“Our older systems have almost entirely been replaced now with our Unit Dose 7 (UD7) system. UD7 is a unique Australian innovation, where a (blister pack) card contains a week’s medication.
“Each column has just one type of drug, and the four columns mean you can have four different drugs in the one card for each dosage time. Each row can offer a series of four medications for all the dosage times over a week. It is unique to Australia and is not used anywhere else in the world,” Stevens says.
He says despite the influx of stronger technology, the core challenges of medication management remain and that is ensuring patients get the right medication at the right time, and that pharmacists and dispensing clinicians are fully cognisant of all the medications on a patient’s schedule.
“Doctors make clinical decisions based on unrealistic assumptions that medication is taken as prescribed with 100 per cent compliance and full disclosure about other medications the patient may be taking and which may cause contra-indications. However, patients are likely to be compliant less than 65 per cent of the time (Ref 1),” he says.
“Doctors' prescriptions and treatments are often frustrated because that key assumption is often wrong. Like much of the industry, we are now harnessing information technology with our electronic medication recording system, which enables tablet PCs and touch screens to record doses.”
Stevens says his systems are constantly being refined with much thought driving innovative ideas to help ensure patients take the right medication at the right time.
“We are developing a range of systems and enhancements to assist better medication management. Without revealing commercial information we are constantly looking at ways to reduce medication errors, such as incorporating visual reminders on our packaging, or equipping them with magnets so they may sit prominently on a patient’s fridge.
“This is particularly important for elderly people, particularly those who may be suffering dementia and need to be reminded to take their medication. Also, any mechanisms that assist effective medication management is significant for carers,” he says, adding that the need for such assistance is world-wide with his product generating sales in Hong Kong, New Zealand, Malaysia and throughout Australia.
With an inventor’s enthusiasm and a pharmacist’s meticulousness, Stevens maintains effective medication management is as much about understanding patients as it is about pharmaceutical acumen.
“I recall a case in which an elderly gentleman, of Italian origin, was failing to take his medication. He was quite resistant, suffering mild dementia and while he had lived in Australia for many years, increasingly he was communicating in his native Sicilian dialect.
“This was causing him significant problems and considerable anxiety for this wife. We were able to introduce an Italian pack with translated dosage times plainly labelled in the language in which he was now comfortable. We suddenly got full compliance.
“Our systems are now used by 60 per cent of Australian pharmacists – it is the most widely used management system in Australia and they have been proven to improve compliance to over 95 per cent,” he says.
“Our Webster-paks list Monday to Sunday down the pack and across the pack Breakfast, Lunch, Dinner and Bedtime is listed, and the corresponding compartments are filled by the pharmacist with exact medications, such as quarter, or half tablets, up to 1-4 tablets as prescribed.
“ All a person has to do is pop the compartment and they know they’re taking the right medications at the right time. The top of the pack can have a personal photo and a list of all the person’s medications and dosages.
“This vital identifying information helps ensure the right person is taking the right medication, and can, if there is an unfortunate incident, assist any remedial action.
“Our multilingual Webster-paks offers this in 20 languages, with English and the second language written side by side. They are available in Arabic, Chinese, Croatian, Dutch, German, Greek, Indonesian, Italian, Korean, Macedonian, Maltese, Polish, Russian, Spanish, Serbian, Tagalog, Tamil, Turkish, Ukrainian and Vietnamese – and with more languages being introduced in the future. A modified version caters for patients with poor eyesight,” Stevens says.
Constant refinements to the system has, Stevens says, meant incorporating even more advanced technology, such as automation and robotics for larger volumes of prescribing work into the current version.
He says his latest offering, the MedsPRO Virtual Pill Count (VPC), reduces packing time and amount of required working space for pharmacists.
“Its a ‘mini’ dispensary with the most common medications directly in front of the packing technician. The all in one touch screen computer guides the technician through the packing, dispensing and script management process – and the barcode verification supports packing accuracy.
“We developed the MedsPro VPC so pharmacies can significantly increase their output. Pharmacists and technicians have told us interruptions, when stock is unavailable, or a script is needed, causes delays.
“MedsPro VPC minimises the disruptions these complication add to the packing process,” Stevens says.
Luca Boffo, who runs Luca’s Chemist at Copa in NSW, says the system’s space saving is its best asset.
“For us, it is saving a lot of space – we went from servicing 500 beds to 700 beds using the same space – this would not have been possible without the MedsPro system,” Luca says.
Sarah McInerney of the Priceline Pharmacy in Kiama, NSW says MedsPro helps “create an efficient workflow”.
“MedsPro delivers an advantage by reducing the physical demands of packing as well as making the environment more user friendly. By creating the right environment, allowing easy access to packing medications, having efficient processes and improve accuracy the system has almost halved our packing time.
“Another advantage was how easy the system is to train new staff, which allows more staff to be multi-skilled and reduces downtime when staff are away,” McInerny says.
Ref 1: VA Research Today, PP54-57 Valenstein et al. Using a Pharmacy-based intervention to improve Antipsychotic Adherence among patients with serious mental illness. Schizophrenia Bulleting 2009; pp8-9.
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