NHS Dictionary of Medicines & Devices

The NHS Dictionary of Medicines and Devices (dm+d) has been developed as the future standard for medicines and device identification and is a cornerstone of the Electronic Prescription Service. dm+d provides a unique code for each medicine and device along with a textual description of the item and as both pharmacy and prescribing systems have adopted dm+d, it supports interoperability by allowing these diverse clinical systems to ‘talk the same language’.

Data Structure

The dictionary is structured with each product having five components: Virtual Therapeutic Moiety (VTM), Virtual Medicinal Product (VMP), Actual Medicinal Product (AMP), Virtual Medicinal Product Pack (VMPP) and Actual Medicinal Product Pack (AMPP).

A Virtual Therapeutic Moiety (VTM) is an abstract representation of a substance formulated as a medicinal product. An example would be ‘Aspirin’. This component is not routinely used in primary care systems. The Virtual Medicinal Product (VMP) describes the generic title for a product including the form and strength, for example ‘Aspirin 75mg tablets’.

The Virtual Medicinal Product Pack (VMPP) describes the generic title for a generic or proprietary product pack which is known to have been available. The description includes the pack size, for example ‘Aspirin 75mg tablets 28 pack’.

The Actual Medicinal Product (AMP) describes an actual product which is known to have been available linked to the name of a particular supplier, for example ‘Angettes 75 tablets (Bristol-Myers Squibb Pharmaceuticals Ltd)’.

The Actual Medicinal Product Pack (AMPP) describes an actual product which is known to have been available linked to both the name of a particular supplier and information on the pack size of the product, that is, a product that physically exists, for example ‘Angettes 75 tablets (Bristol-Myers Squibb Pharmaceuticals Ltd) 28 tablet 2 x 14 tablets’.

Linked to each component, the dictionary also includes information to support the prescribing and dispensing process, for example linked to the ‘Actual Medicinal Product Pack’ component is information linked to a product’s prescribing status in primary care and a flag to indicate whether the product is considered a special container or calendar pack. This information is populated by the NHSBSA PPD.

Mapping

A prescriber will issue a prescription for a product using either the VMP or AMP code.

System suppliers currently use a variety of drug databases in their systems, in some cases these are maintained in-house, in other cases a supplier may purchase their database from an external company. Where a supplier has not adopted the NHS dm+d as their core database, they must ‘map’ the codes of the individual products on their database with the dm+d to send messages via the Electronic Prescription Service. Electronic messages will contain the dm+d codes and descriptions even where a supplier has adopted a mapped solution.

An issue that may arise is that if an individual GP system supplier has not mapped a particular item held on their drug database with the dm+d code, that GP may not be able to prescribe that item electronically. There is currently no requirement on GP system suppliers to undertake 100% mapping of their drug databases to dm+d.

It is essential that mapping is accurate with system suppliers being responsible for the medico-legal consequences of an incorrect map. If whilst dispensing a prescription via the Service, a pharmacist identifies an incorrect map, for example if the information printed on the token is different from prescribing information shown on screen, the pharmacist should report it to their system supplier immediately. The incident should also be reported to the National Patient Safety Agency (NPSA) using their online reporting form (www.npsa.nhs.uk/eform).

It is estimated that dm+d contains over 99.9% of medicines and appliances prescribed in primary care. Items not included in dm+d include certain extemporaneously dispensed and special formulation products and some products available in combination packs. If a GP wishes to prescribe a medication item which is not listed in the dm+d, an electronic prescription cannot be issued via the EPS and current paper prescription processes should be followed. The dm+d aims to include all new licensed medicines by product launch date.

Changes that pharmacy staff may notice

Depending on what functionality has been available historically in a particular system, pharmacy staff may notice improvements in the accuracy of guidance provided by pharmacy systems, for example information on whether a product can be prescribed on an NHS prescription. Populated by NHS Prescription Services, this information is now available for use in systems through dm+d. Different suppliers are likely to make use of this information in different ways.

Staff may also notice a change in the description of products in their systems with products listed in dm+d described according to the agreed editorial policy. For example, dm+d describes products in the order: product, strength, formulation whereas some existing systems describe products in the order: product, form, strength. As well as noticing subtle changes in the description of products, pharmacy staff may also notice that the location of products on ‘picking lists’ in systems changes depending on how a supplier has implemented dm+d within their system. Also in some systems, the description of a product on-screen may be subtly different from the description used in the picking list, for example where a supplier has chosen to abbreviate information in picking lists.

In some cases, the descriptions defined by dm+d are much longer than the titles used in existing supplier drug databases, this could mean space pressure on tokens being printed. In some cases, it will not be possible to print a product’s full name on a dispensing label because of space restrictions, in this case, the system may automatically abbreviate the name of the product to fit on the label.

PSNC Input into the Dictionary

PSNC has liaised with the DM&D Editorial Board on a number of issues relating to the Dictionary's editorial policy and how particular products are represented in the Dictionary Structure. PSNC is monitoring the implementation of the Dictionary and will continue to raise issues as necessary with Connecting for Health and NHS Prescription Services. PSNC is represented on the dm+d User group.

Related Project: Standard Dosage Syntax

The DM&D is providing a standard description and electronic identifier for all medicines but at present there is no standard structure to represent dosage instructions, for example, "Take two tablets three times a day." Without this standardisation, this information can only be sent and stored electronically using 'free text'/text strings.

Work is ongoing to develop a standard 'dosage syntax' so that this information can be sent in a standard coded format, which will enable diverse clinical systems to manipulate the data transferred, for example calculate a dose or quantity. This will also improve patient safety by standardising the way that dosage instructions are communicated and reducing the potential for misinterpretation.

The dosage syntax model was developed by the NHS Information Authority in conjunction with the international health standards organisation, HL7. Once finalised, the model will be put through an HL7 ballot to become the recognised international standard and made available as open source.

PSNC believes it a priority to finalise and implement the standard dosage syntax.

More Information

DM&D Viewer at Medicines.org.uk

DM&D Viewed on the PPD Website

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