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The nomadCommunity Dosage System

 

WHAT IS nomad CDS?

The Nomad Community Dosage System has evolved from the proven Nomad MDS system. In the UK it is used by over 8,500 nursing homes, care homes and public hospitals. 

THE BENEFITS OF nomad CDS?

FOR THE PHARMACIST:

It adds value to a standard range of services
Increases revenue
Strengthens links between patient and pharmacist
Encourages a closer relationship between the pharmacist, district nursing and general practice.

FOR THE PATIENT:

Reduces/eliminates accidents – 48% of drug related hospital admissions of people over 65 are caused by dosage problems and/or poor compliance.
Organises medication/ reduces errors – they know what drugs to take and when.
Reduces anxiety – it shows clearly the medication that has been taken.
Optimises the benefits of the drugs – they are taken at the right time and in the right combination.
Safe – it is controlled by the pharmacist.
Easy to use – it is a simple system and the cassette is easier to handle than a cupboard of medications.
Specially adapted version for the partially sighted or blind.
Special sliders available for arthritic patients.

FOR THE GP:

Patient compliance is improved. Provides a medication base line against which further treatment can be assessed.
Reduces the level of patient attention required – the system is easier to administer than bottles.
Reduces medication hoarding.
Provides GPs with an additional management option.

FOR THE CAREGIVER:

Simplifies the process of administration of medication.
Easy to check whether medication is being taken, without intrusion.
Removes secondary dispensing, is therefore safer and provides more time for caring.

 

SETTING UP NOMAD CDS IN A PHARMACY

There are three stages to set up nomad CDS in a pharmacy;

Preparation
Implementation
Running the system

PREPARATION

Coordination of four groups of people will ensure nomad CDS runs smoothly.

The Pharmacy:

Training the staff to run nomad CDS and establishing the best administrative system to run it cost effectively.

The GPs in your area

Gaining their co-operation especially with scripts and in selecting the appropriate patients

The Caregiver

If patients have a caregiver who assists with or administers medication they should be briefed on the details of nomad CDS. Such people may well have requested the system in the first place.

The Patients

Choosing patients who will benefit from using nomad CDS.

 

PHARMACY PREPARATION

Before setting up nomad CDS in your pharmacy, it’s important that all pharmacy staff understand the system; how it works, its benefits and how to implement and run the system.

We recommend;

A Ensure that staff are fully trained
B Plan how you are going to implement the system thoroughly before you start, e.g. gaining GP co-operating and deciding which patients may elect to use the service.
C Decide on the exact service you are intending to offer, i.e. whether you will be involved in collection/delivery.
D Set up your administration system before the first patient is recruited.

CONSULTING GPs

It is recommended that GPs in your area should be advised that you are providing this service. There is general acceptance that CDS packs promote medication compliance and few GPs have difficulties with the principles of CDS. GPs assistance in aligning scripts with dispensing is useful.

 

PREPARING PATIENTS

New patients may mean additional revenue, however, it is important that existing patients are not excluded and are also given a reasonable opportunity to be brought onto CDS. 
Begin by inviting patients you know to use nomad CDS. Once the system is running smoothly, then you can seek patients in a number of ways.

Suitable CDS users are patients with regular scripts of, we suggest, two or more items.  The following groups may find benefits in using an CDS pack.:

Elderly people
Confused or prematurely senile people
Former psychiatric hospital patients in the community
People with learning disabilities
Children with learning disabilities attending special schools
Children with medication to be administered during school hours
Blind or partially sighted people
People with epilepsy
People living in hostels or other shelters
People with compliance problems.

How many people should be brought onto CDS initially?

Aim to implement CDS over a period of time to avoid pressure until the pharmacy is in a regular CDS routine.
Once the pharmacy can handle CDS satisfactorily, then the number of nomad users can be expanded as required.

Criteria

In most cases the pharmacist will select the people he feels will benefit most. In some areas institutional or voluntary services may wish to use a CDS pack for some of their service-users and will recommend these people to the pharmacist. Once nomad is well established it is likely that District Nurses, Care Assistants etc will recommend people for nomad CDS.

Acceptance

Services providers will often ask nomad pharmacists for assistance. 
Patients need to understand what CDS is, how it works and how they will benefit. You may decide to leave a brochure with them for them to consider. 

 

THE CAREGIVER

To ensure the maximum co-operation, every opportunity should be taken to inform caregivers about nomad CDS. It is particularly important that the caregiver of each person who applies for Nomad CDS is informed about it.

IMPLEMENTATION

There are three stages to go through before the patient receives his/her nomad cassettes:

GP approval
Synchronise the medication
Set up the medication and administration.

GP APPROVAL

The pharmacist may request approval from the patient’s GP. When requesting approval from the GP you will need to suggest the date when you wish to start their patient on Nomad CDS and inform the GP of the script(s) needed to ensure a smooth transition.

 

SYNCHRONISING MEDICATION

With the approval of the GP you will also have received agreement to the implementation date you suggested. The most convenient date to select is one which is before the patient’s current medication runs out.
Synchronisation is achieved by obtaining prescriptions to allow all medication to start by the CDS start date.
Once the date is agreed, inform the patient or their caregiver of that date and, if it is their responsibility when they need to get the script(s) to the pharmacy

 

SETTING UP THE MEDICATION

This is very straightforward. You need to:

Ensure the script is available, either via the patient or their caregiver, or via collection from the surgery.
Prepare the medication – 4 filled trays which are then each sealed with a perforated seal. The first time the patient is given Nomad CDS, one of these trays will be placed in the cassette which is labeled with their details, plus the medication sheet.
Set up the administration records for the patient.
On the due date, the cassette is collected by the patient or their caregiver or delivered by the pharmacist. It is important to fully explain how to use the system and what will happen at the end of the 28-day cycle in order to obtain the next month’s supply.

 

PHARMACY OPERATIONAL PROCEDURES AND ADMINISTRATION REQUIREMENTS

Before the dispensing of items commences, the pharmacy will need to set up records that will ensure that packs are completed on due dates and their issue recorded. This aids the smooth running of the service in both the domiciliary setting and the community pharmacy.

Nomad for Windows software, assists in the administration and operation of this service.

It is usual to obtain the consent of the patient or the care giver. A sample form is attached.

 

SUMMARY OF SETTING UP NOMAD CDS

PREPARATION

Establish the basis on which you will operate Nomad CDS
Set up the administration system, (Nomad for TonIQ or LOTS)
Train the staff
Approach the GP’s in your area to explain CDS
Select the patients who will benefit from using CDS
Approach them according to your implementation schedule (see next section).

 

IMPLEMENTATION

Approval from the GP and Caregiver.
Synchronise the medication
With GP approval inform the patient and their caregiver of the Nomad start date and any action they need to take, e.g. obtaining scripts
On receipt of the script, prepare the trays and any other medication
On the due date, hand over or deliver the Nomad CDS Pack to the patient or their caregiver. Ensure they know how to use the system.

Check the patient/caregiver knows how to use the system.

 

 

PROBLEM SOLVING

MEDICATION CHANGES

It is important that you are notified as soon as possible in the event of any medication changes. You should encourage the GP and patient to let you know prior to a new script being presented. For example, the GP could telephone you from the patient’s home. The GP should prescribe for the number of days left in the cycle. All trays should be returned to the pharmacist who can then refill the cassette trays with the new medication.

HOLIDAYS

Users should ensure that they have sufficient medication for their holiday periods and liaise with the pharmacist to ensure this.

HOSPITAL STAYS

Users should inform their pharmacist if they go into hospital for any period of time, so that medication is not prepared unnecessarily.

BREAKING/LOSING CASSETTES

Usually the cassettes remain the property of the pharmacist, (unless otherwise agreed with the patient or caregiver.). It is the pharmacist’s responsibility to come to an arrangement with the patient.

USING NOMAD CDS OUTSIDE THE HOME

The user can either choose to take their cassette with them, or can remove the appropriate medication and place in a separate container.

RUNNING OUT OF MEDICATION

The usual procedures apply, with the pharmacist being informed as soon as possible.

CLEANING

Insert Trays are single patient use only and should not be cleaned or recycled in anyway. They must not be 'interchanged' between residents. They should only be used for the resident listed on the 'Insert Tray ID Label.

Cassettes may either be washed by hand or in a dishwasher. Do not overheat.

MONTHLY SUPPLY

If trays are supplied monthly in a Carripac each tray much have the relevant backing sheet attached or enclosed. 'Enclosed' requires that the track and backing sheet are in a sealed bag (supplied by Nomad) Attached may be by means of a glue stick or similar.

 

MEDICATION NOT FOUND IN THE CASSETTE

Medication which should not be included in ANY CDS or MDS packs.

* All soluble or effervescent tablets 
* Hiprex tablets (Dispersible Aspirin may be packed in Nomad cassettes)
* Aluminium Hydroxide tablets 
* Losec (if dispensed monthly)
* Buccastem tablets 
* Magnesium Trisilicate tablets
* Controlled drugs not in tablet form 
* Nolvadex
* De-Nol tablets 
* Pyrogastrone tablets
* Epilim 
* Suscard Buccal tablets
* Gaviscon tablets 
* Temgesic tablets
* Glyceryl Trinitrate tablets

(3) SurgiChem has consulted with pharmaceutical suppliers in the UK and they recommend that these pharmaceuticals are not (unless in their original foil) be placed in ANY MDS packs.
Tablets which are foil packed, may be cut out with their immediate foil around them and placed in the cassette.

 

NOMAD COMMUNITY DOSAGE SYSTEM (CDS)

The following forms may be downloaded or used as templates

GP ADVICE FORM

 

Dear Doctor ………………………..…….,

The following patient has requested that medication be dispensed in a nomadCDS pack and has agreed that I should advise you.

Name ………………………………….………………

Address …………………………………………………..……………………….…

………………………………….…………………………………………..

I am proposing that he/she should start the on  ……………………………
and would appreciate your co-operation with supplying scripts as follows

….…………………………………………………………………………………………………………………………

 ………………………………………………………………………………………………….…………………………

If in your opinion it is inappropriate for the patient to be supplied medication in a CDS pack or if you require more information please advise.

Signed ………………………………………… Date ………………………………………

 

 

 

 

NOMAD COMMUNITY DOSAGE SYSTEM (CDS)
PATIENT’S REGISTRATION FORM

Please complete appropriate sections.

1/ PATIENT OR CLIENT

Surname ………..……………………………………………………… (Mr / Mrs / Miss /Ms.)

Forenames ………………………………………………………………………………………..…………………

Date of Birth ………../………………/…………..

Address ………………………………………………………………………..…………………………………

…………………………………………………………………………………………………………..

Telephone ………………………..

I would like to have all appropriate medication supplied in nomad cassettes.

2/ DOCTOR

Name ……………………………………………………………………………………………

Practice Address ……………………………………………………………………………………………

Telephone ………………………. Other Phones ………………………..…...

 

3/ REFERRED BY

Name ……………………………………………………………………………………………

Contact Address ……………………………………………………………………………………………

Telephone …………………… Position/Relationship … ……………………..…...

ALL information provided is subject to the privacy act and will be treated in the strictest confidence.

Signed ………………………………..……… Date. ………/………………/……….…

 

PHARMACY USE ONLY; …………………………………………………………..………………

……………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………….

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