Knowledge summary - Experience with multidose focusing on the Scandinavian countries

Report Abstract

Literature with material from Norway reports that multidose-packed drugs are perceived as a quality improvement, both in terms of increased patient safety and increased efficacy. Multidose appears to make administration of drugs easier and safer by reducing errors in the dispensing process. Most physicians perceived the system as a generally good system, as well as benefits related to patient safety, increased patient compliance, improved overview and reduced risk of malpractice. However, some doctors thought the scheme was more time consuming. They experienced spending a lot of time prescribing and reviewing the drug lists for multidose users. Nurses found that multidose facilitated the rendering, transportation and administration of drugs to patients, they spent less time on medicine orders and received less monotonous tasks. Nurses also found that they had more time for patients. The introduction of the multidose system has also resulted in cleanup of medicine lists and increased quality of information exchange between doctors and home nurses. They found seldom deviations from the drug list in the multidose rolls, and the nurses found that the collaboration with the pharmacy works well.

Studies from other countries show mixed results. Swedish studies found that e-multidose increased the risk of medication errors than for common prescriptions without multidose. Lower quality of the drug lists with multidose was also reported. The interpretation was that this could be due to the fact that the multidose regulation is more automated, resulting in less medical contact and fewer drug reviews. The Swedish multidose scheme is different from the Norwegian, which makes a direct comparison difficult. The main differences are the use of a dosage regimen in Sweden where all the drugs are listed, while in Norway, prescriptions are written on each medication in addition to a drug in use list (LIB), and that all doctors can prescribe multidose. In Norway, the patient has only one responsible physician who can prescribe multidose. The Swedish studies compare e-multidose with common prescriptions without multidose. In Norway, e-multidose replaces paper order cards which, in most cases, are sent from the GP to pharmacy via and fax. Literature review did not find any studies that specifically analyzed medication errors and prescribing quality in e-multidose versus multidose on paper.

In summary, the literature finds both the pros and cons of using multidose. The overview presented in this report may provide a basis for further developing the service and establishing measures to achieve increased patient safety through the introduction of multidose in e-prescription in Norway. Finding that multidose reduces patient safety should be followed up with more research.