A dosette box, also known as monitored dosage system (MDS) is a plastic box designed to organise and aid administration of patient’s medication. Dosette box is composed of small sealable compartments, which hold tablets removed from blister packaging (original pack). Dosette box, therefore, can be useful when a patient takes many drugs at different times of the day. Summary of ‘What is a dossete box’ post:
- design of dosette boxes
- design of pillboxes/pill organisers
- advantages and disadvantages of dosette systems
- criteria for getting a dosette on NHS
- an alternative option MDS
- list of drugs, which should not be placed in dosettes
- a brief review of popular pillboxes available on Amazon.co.uk
What is a dosette box: design
The most common model of a dosette box is composed of 4 rows, each row with 7 pill compartments/slots. Four rows represent daily dosing times, for example:
Seven columns of pill compartments represent days of the week, from Monday to Sunday, giving a total of 28 slots. When a community pharmacy team prepares a dosette box, it is almost always this type of dosette box which is supplied to patients. Each box is single-use. Each dosette box provides supply drugs for seven days.
Each box comes with a card/chart which contains dispensing labels and description of supplied drugs. The information on the label should include:
- Name of the drug
- Directions for use
- Precautions for use
Each card additionally has space for additional information about dispenced drugs, to allow patients to identify medication taken:
- Form of the medicine (e.g. tablet or capsule)
- The shape of the drug (e.g. round, prolonged)
- Colour of the drug
- Any markings present on the drug. This could be a number, a letter etc.
Common brands of a single-use dosette boxes used by community pharmacies include Nomad, Sureme, Medidos and Venalink.
Smaller pill organiser, with less than 28 compartments are usually called pill boxes, rather than dosette boxes. These are usually available to buy rather than used by community pharmacies to supply patient’s medications. These may include:
- Pillbox: 2 by 7 for morning and evening doses (2 rows) for each day of the week (7 columns: Monday-Sunday)
- Pillbox: 1 by 7, suitable for patients who do not take many tablets, usually when medication is taken at the same time of the day or to store tablets when travelling (e.g. holidays)
How dosette box is prepared? (video)
Advantages and disadvantages of dosette boxes
Advantages of dosette boxes:
- Useful for people who take a few drugs at different times of the day providing a simple and convenient way of drug administration
- Patients may have a visual confirmation of whether a dose of the drug(s) was taken at a specific time of the day keeping track of what medicine was taken
- Reduces confusion (when instruction on the use are provided)
- Reusable (when purchased)
- Single-use, sealed boxes are tamper-proof
Disadvantages of dosette boxes:
- Certain medicines cannot be placed in the dosette box, which means patient need to remember to take drugs which are provided outside of the box.
- Stability of some medicines may be affected
- Although drugs have a visual description, it may be difficult for patients to identify medications taken
- Dosette used by community pharmacies are usually plastic and single-use
- Reusable boxes are not tamper-proof
- Take time to prepare
- Increase workload for pharmacy teams which can contribute to drug errors
- Not childproof
How to get a dosette box?
The easiest way of getting a dosette/pill box is to purchase one from the pharmacy or online. In this case, it would be patient’s or patient’s representative responsibility to prepare the box – empty all necessary tablets from the original box to the dosette box. Pillboxes available for customers to buy are usually reusable.
How to get a dosette box (NHS patients)?
Getting medicines supplied by a pharmacy in the form of dosette boxes may not be a straight forward process.
In the first instance, patients may talk about the supply of medication in dosette directly with the pharmacy. Pharmacy decides whether it is necessary to supply the medicines in dosette. Pharmacies have the right to refuse this service unless the patient qualifies under the Equality Act (2010) (known previously as the Disability Discrimination Act 1995). Pharmacy needs to make a ‘reasonable adjustments‘ for patients who fall under the Equality Act, for example, patients who have a disability or have a physical or mental impairment, which impact day to day tasks. The impairment needs to be a long term, lasting more than 12 months.
Alternatively, a GP may ask to supply the medication in dosette boxes; however, the same rule applies when the decision is made.
With several cuts to pharmacy funding in recent years, the supply of medication to patients in dosette boxes became no longer valuable to the business. Depending on patients medicines, the process of preparing a dosette box can be time-consuming. Additionally, pharmacies do not get any extra payments for this service.
Alternative options to dosette boxes?
PillTime is an online pharmacy that sorts patient’s repeat medication into easy to manage pouches. Each pouch is clearly labelled and contains all drugs (removed from its original packaging) which need to be taken at a specific time of the day, for example, morning. Where possible PillTime will also request a patient’s medication when it is due. Patients medicines are delivered free of charge by post.
Can you put any drug in dosette boxes?
Certain drugs should not be placed in dosette boxes. Some drugs need to be kept in their original packaging due to (physiochemical) properties of the formulation. List of drugs which should not be placed in dosette boxes:
- Drugs which are moisture sensitive. These need to be kept in its original packaging. The requirement for the storage of medication in its original packaging is usually included on the box. The advice reads ‘keep medicine in its original container.’ Common formulations in this category include soluble, effervescent and dispersible tablets, for example, aspirin 75mg, prednisolone soluble tablets, Madopar dispersible tablets.
- Hygroscopic drugs (drugs which absorb moisture), for example, sodium valproate, Epilim tablets, ciclosporin (Neoral) capsules, Madopar capsules, prochlorperazine buccal tablets, some nicorandil tablets, Pradaxa (dabigatran).
- Drugs which need to be refrigerated for example Nardil (phenelzine), Fludrocortisone tablets (can be stored for up to 30 days at room temperature up to 25°C)
- Drugs which may cause skin reactions, for example, Creon (pancreatin), chlorpromazine tablets.
- Drugs which need to be protected from the light
- Drugs which are prescribed as ‘when needed‘ or ‘when required‘.
- Drugs with variable dose (for example warfarin)
- Cytotoxic drugs, for example, methotrexate, colchicine, letrozole.
Review of dosette boxes/pillboxes
Patients, careers or a family member who looks after and organise someone’s medication have some excellent choices of buying dosette boxes online or in pharmacy. Amazonc.oo.uk has a wide selection of reusable pillboxes. Three brands available on Amazon.co.uk of reusable pill boxes stand out with the design: Auvon, Eono (by Amazon) and PuTwo pill box. Below is the list of the most popular dosette boxes offered by those companies:
PuTwo Pill Box 7 Days 28 Compartments[amazon box=”B00YTST4LA” image_alt=”What is a dosette box? PuTwo Pill Box is Amazon’s choice for reusable dosette box” link_title=”What is a dosette box? PuTwo Pill Box is Amazon’s choice for reusable dosette box”]One of the most popular pill boxes on Amazon.co.uk, and also Amazon’s Choice (highest rating and well-priced product). This product catches some attention due to colourful design which helps to organise and identify drugs which need to be taken every day. Other features include:
- Total storage space of 28 compartments allowing to organise medicines which need to be taken for up to four times a day
- Deep (spacious) containers
- Removable containers
AUVON iMedassist Weekly Pill Organizer[amazon box=”B07794YMY7″ image_alt=”What is a dosette box? Example 7 day, once a day pillbox available on Amazon.co.uk” link_title=”What is a dosette box? Example 7 day, once a day pillbox available on Amazon.co.uk” description_items=”1″]AUVON iMedassist Weekly Pill Organizer offers storage of medication for up to 7 days. This box is composed of a single row of seven compartments (Monday-Sunday), which means that all daily tablets are placed in a single slot, regardless of the time of dosing. The lids are coloured and marked with days of the week.
AUVON iMedassist Weekly pillbox[amazon box=”B074MC6HJR” image_alt=”AUVON iMedassist Weekly pillbox available on Amazon.co.uk” link_title=”AUVON iMedassist Weekly pillbox” description_items=”2″]
AUVON iMedassist Weekly is the largest Auvon pillbox offering storage of drugs for seven days for users who take medication up to four times a day. Similarly to other pillboxes discussed, Auvon is beautify coloured and offers moisture-proof design. This product is also Amazon’s choice based on the price and recommendations by customers.
Eono by Amazon[amazon box=”B07YYXK99X” image_alt=”Eono dosette box by Amazon” link_title=”Eono dosette box by Amazon” description_items=”3″]
Eono by Amazon offers different pillboxes allowing to organise a seven day supply of medicines including:
- Seven-day pillbox with once-daily dose (7 compartments)
- Seven-day pillbox with twice-daily dose (14 compartments)
- Seven-day pillbox with three times daily dose (21 compartments)
All boxes are well designed, with clear labels and colours to differentiate between different days of the week. Each compartment can be opened with ease by pressing down the button, which ‘pop up’ the lid.
Sagely Smart Weekly Pill Organiser[amazon box=”B01CPQHARW” image_alt=”Sagely Smart Weekly Pill Organiser / dosette” link_title=”Sagely Smart Weekly Pill Organiser / dosette” description_items=”2″]
Sagely Smart Weekly Pill Organiser is a large weekly pill organiser (12.5 inches by 3.8 inches / 31.8 cm by 9.7 cm). Sagely dosette comes as a seven-day box with two compartments for each day: AM and PM doses. Compartments can also be removed from the base, for example, when going away for the weekend.
Sagely comes with a free Android and Apple app which reminds to take medication at the right time.
Monthly Pill Organizer (MEDca)[amazon box=”B07F7GD2JZ” image_alt=”Montly dosette box / drug organiser (MEDca)” link_title=”Montly dosette box / drug organiser (MEDca)” description_items=”2″]MEDca offers a monthly pill organiser with spacious compartments. MEDca allows to organise a month’s worth of supplements/drugs up to 31 days with one extra compartment present also. Each daily compartment can be removed. Drugs can be split into morning and afternoon doses. The choice of two doses (AM and PM) may not be suitable for all patients; nevertheless, this pillbox is one of few which allows to organise a monthly supply of drugs.
What is a dosette box? Conclusion
Dosette boxes can be useful in the management of patients medication. Although regarded as safe, dosette systems may be a source of administration errors, when inadequate training on the use is provided.
Small pillboxes (7-day with AM and PM doses or 14-day AM and PM doses) are useful for patients who take few drugs or patients who need to arrange their medicines for travel purposes. Patient who take medication troughout the day (more than twice a day) should consider getting a 7-day four doses (morning, afternoon, evening and night) pillbox which allow a better organisation of their medicines.
Patients who cannot get their medication dispensed in dosette boxes should consider buying a pillbox. Amazon.co.uk have the best choice of pill organisers on the market.
NHS (2011). Frequently Asked Questions (FAQ) on the use of Multi compartment compliance aids (MCAs) in the community: A resource for community pharmacists and other health and social care professionals involved in medicines management for older people.