Boxes or Blisters? What is the best option for Care Homes?

Are Blister packs outdated? Are they still safe to use? What is the guidance?

These are all questions your organisation may have reviewed over the past few years when faced with supplier changes and changes in guidance or the landscape of Medication Management within care homes.

Many of these questions have been raised due to 3 main reasons….

Covid – As well as representing a huge challenge to many pharmacies looking after care homes, in terms of workforce issues, guidance around infection control and just keeping going. This period represented an opportunity for many pharmacies to move away from blister packs. Put simply the preceding 4 years had resulted in cost cutting from government reimbursement in pharmacies, which simply meant that supplying care homes blister packs became less viable for businesses. This resulted in many pharmacies prompting a switch to boxed medications.

Financial Viability - Put simply blister packs cost. They are time intensive to prepare with many drugs having to be hand popped, they have a base cost of the blister and packaging which the pharmacy does not get reimbursed for and they are riskier to prepare as there is a higher chance of dispensing errors when popping out medications and placing them into a new blister. All the above coupled with rising inflationary costs and downturn in government reimbursements, has simply meant that many pharmacies simply cannot afford to supply blister packs.

Guidance document – As the two above factors saw a tide of change, larger companies High Street companies saw this as a great opportunity to exit the blister market totally and to do this, they used a small guidance document to help them convince homes to move away. The guidance ultimately stated that having medications in multiple different forms e.g. blisters and boxes could result in a higher chance of something getting missed or not being given. This has long been the case, and homes have protected against this risk by using effective training, audits, and competency assessments to help prevent missed medications.

However, with this guidance many high street pharmacies decided to advise homes that CQC no longer recommended blister packs. This was simply not the case. CQC have always maintained that whatever medication management systems that the care homes use, they need to be safe and robust, they have never stated a preference for boxes, blisters, compliance packs or pouches, as they are fully aware that each home is different and therefore require systems that are appropriate for them.

Are Blisters still safe?

There has never been a real issue around the safety of blister packs. There is a long-standing history of using blister packs and any system used within the right framework of training, audits and assessments can work for care homes. This is the same for boxed medications with EMARS or Blister packs with paper MARs. Blister packs give visibility of medications, so are safer in the respect that you can clearly see when a resident will run out, however they still rely on a suitably trained team member to identify this.

So what should you use?

This is down to the type of care home, the number of beds and the experience of the team.

From personal experience, I always advise homes over 20 beds to avoid multi-compartmental aids e.g. compliance packs or pouches with multiple medications in them for the same time slot, this is principally because of medication changes become very difficult to handle with these solutions.

Blister packs with racks are easier to manage change within and make the process for dealing with medications very simple. ?Boxed medications with a EMAR provide another sensible solution, where the EMAR gives the care home extra safety netting especially where they are integrated to the pharmacy system.

Overall the key thing is that there is good support from the pharmacy and any third party provider to support training and use of the system, as well as good audits with in the home to ensure great safety netting in case of system failure or misuse.