The Dictionary of Medicines and Devices (dmþd)

The Dictionary of Medicines and Devices (dmþd)

One of the barriers to the seamless electronic transfer of information has been the lack of a common drug dictionary. The use of such a dictionary is a key requirement to support the delivery of systems that aim to facilitate reduction in clinical risk, for example, e-prescribing. Its use will facilitate the use of standard descriptions for all medicines, as well as the use of a common coding system and structure. The lack of use of such a dictionary was further highlighted in 2009 as the main barrier for the development of the pharmacy supply chain and key for addressing problems with pharmacy computer systems in hospitals. Driving existing systems towards the use of dmþd (see below) has remained problematic.

The Department of Health and the National Health Service Information Authority started working to produce a common drug dictionary for second-ary care via the UK Standard Clinical Products Reference Source Project, which worked to produce three component parts – (1) the primary care drug dictionary; (2) the secondary care drug dictionary; and (3) the medical devices dictionary. This project is now better known as dmþd and has developed to become a partnership between the Business Services Authority (BSA) and NHS Connecting for Health (NHS CFH), amalgamating the three compo-nents outlined above.

The BSA and NHS CFH have produced a drug dictionary which contains all items prescribed more than three times a year in primary care as well as an extended range of products to meet secondary care needs. Information on the content can be accessed via a browser available on the internet, from which users can register to receive regular downloads of the content. The medicines content is largely complete, and additional items are added as they are marketed or become known.

The dictionary is not simply a list of medicines that are utilised within the NHS; it also contains a number of other items of information which include, but are not limited to, controlled drug status, product availability and flags identifying whether brand prescribing is required.

The dictionary has continued to develop since its initial release to meet secondary care prescribing requirements. It has now been incorporated into Snomed CT, the key clinical data standard that is being rolled out across the NHS.

Details about the editorial policy, the structure and content of dmþd and implementation guidance for primary and secondary care can be found on the dmþd website. It is hoped that future work will extend the content to link with the Profile database of NHS-manufactured specials and to incorporate medical devices. This latter project is complex and is likely to take some time to deliver fully.

We can see that one of the key building blocks required to support the development of IT systems is now largely in place and has started to proceed through the information standards route. It was accepted at the requirement stage as a fundamental standard in March 2009 and looks set to become the NHS standard for describing and coding medicines by around 2015 in primary care. Secondary care will miss this first standard requirement and will likely take a little longer to move through the process. This will require that NHS trusts use the standard within their systems, thus helping to drive its use forward. Incorporation into pharmacy stock control systems, e-prescribing systems and any other systems used to support NHS medicines management is going to be key to supporting integrated patient care moving forward.