A friend recently sent me a link to a crowdfunding campaign to build an automated pill dispenser for the home.  He, quite understandably, thought a gadget like this is something Kraydel wouldPill Dispenser like to add to its offering. The truth is, that like most people working in this area, the idea of automated pill dispensers terrifies me. A year ago I knew very little about the rules and laws relating to medication, but I’ve had a crash course in the subject and it’s perilous. Note that I’m not referring to dosette boxes (such as the one in the image above) – I’m taking about small scale versions of the systems found in Pharmacies which dispense from hoppers that you refill.

Disclaimer – The following is my opinion and not legal guidance. I’m an engineer after all.

My current understanding of the law in the UK (likely most countries) is that, broadly speaking, only a qualified Doctor can prescribe, and only a qualifed Doctor, Pharmacist or Nurse can dispense. That might sound simple, but the definitions of those terms are tricky.

Let me give you an example: it’s ok for a domiciliary worker to assist one of their clients in opening their bottle of pills, or popping the blister on a blister pack etc, but they must NOT TOUCH the medication. If they handle the medication to give it to the client they’ve moved beyond “assistance” and into dispensing – and they are not qualified, and hence not insured, to do that. Anything that goes wrong as a result of an error, or an adverse reaction, is going to land them in court.

Similarly, a Doctor, Pharmacist or Nurse can tell you that you should take the blue pill, but anyone else should only tell you “it’s time for your medication” and leave it to the person themselves to determine what they are supposed to take.

As a result of this learning, we’ve had to think long and hard about the Medication Reminders feature in Kraydel. They’ve evolved and there are now two ways in which the system can be used:

Generic Reminders
You can create a general purpose reminder which consist of a time, a sound to be played, a pre-recorded message to be played, and a text message to be displayed. You can also indicate whether it’s a “critical” reminder or not.  If it’s critical you’ll get alerted if it’s not acknowledged within the defined period.

So for medication this reminder could be something like “Ring Ring,  Hi Mrs Moorhead, it’s time for your medication”.  Based on numerous conversations with care professionals, this is the level of assistance that they feel is safe for a care provider to offer. Many of their clients receive their medication in the form of blister packs or pill packs,  so in practice this is all that’s needed – the package of medication (which was created by a Pharmacist) should take care of the rest.

Detailed Medication Reminders
If the system is being set up by a family member then there is the option to do more.  The restrictions on dispensing don’t really apply in this situation: I’m entitled to help my mother take her pills, and that includes handling them, and telling her that she’s supposed to take the red pill and two white ones. Indeed if family members weren’t willing and able to do this, we would be having even bigger problems with elder-care.

The Kraydel system allows a user to create a medicine cabinet, and populate it with details of the medications their mother or father is taking, and that includes taking a photograph of the pills, giving them friendly names, specifying the dosages and timing, capturing notes on incompatibilities etc. This cabinet does not by itself create medication reminders, but it may still be a useful record of the medication plan if there are many medicines involved and other family members also need to know the plan. Now having created a medicine cabinet you can drag medication from it onto a timeline to create medication reminders – and in this case the system will populate the reminder automatically with the details of the medications, which can then be edited if desired. The system will check that the reminder schedule is consistent with the prescription e.g. if a med is to be taken 4 times a day and at no less than 5 hour intervals, it will flag that the proposed schedule breaks this rule, or if a medication is to be taken at night and the reminder has been set for the morning, it will raise a query.  Once saved the schedule will be emailed to the carer for review, and every night the carer will receive an email informing them of the schedule and whether or not the reminders were acknowledged as required (as well as receiving alerts for missed medication during the day if the reminders were marked as “critical”)

We have an open mind as to whether this functionality will be popular or not, which is why we have extensive trials lined up – we’ve already learned several times that what we think is useful and cool may well be inappropriate in the real world.

To return to the subject of automated pill dispensers – I don’t wish to detract from the good intentions and engineering chops of people trying to create such devices, but we live in a litigious world, the consequences of a dispensing device failing to dispense, or over-dispensing, outweigh the benefit to any professional care provider, so in my view the only viable market is home users. And even there, I believe it’s only a matter of time before the first big court case kills the technology.