What is the dictionary of medicines and devices?

This topic is an excerpt from an NHS training overview. It provides a useful explanation of the identification codes that play a fundamental part in matching the item prescribed against the item dispensed.

 

There are currently a variety of medicines and devices descriptions used in prescribing and dispensing systems. Each has its own particular conventions and features.  Until now there has been no common way of describing and coding medicines and devices in clinical systems.

The NHS Dictionary of Medicines and Devices (DM+D) has been developed for use throughout the NHS to address this lack of standardisation. The dictionary contains textual descriptions (terms) with associated coded identifiers (codes) for a full range of medicines and devices.

The following are examples of DM+D terms with their codes:

Suitable for prescribing:

Code*	Term
69711000001105	Neoclarityn 5mg tablets (Schering-Plough Ltd)
319099005	Isosorbide mononitrate 60mg modified-release capsules
317895005	Digoxin 62.5microgram tablets
756111000001109	Lipitor 80mg tablets (Pfizer Ltd)

Suitable for dispensing:

Code*	Term
2163211000001108	Neoclarityn 5mg tablets (Schering-Plough Ltd) 30 tablet 3 x 10 tablets
1840811000001100	Monomax SR 60 capsules (Trinity-Chiesi Pharmaceuticals Ltd) 28 capsule 2 x 14 capsules
1361811000001100	Digoxin 62.5microgram tablets (Kent Pharmaceuticals Ltd) 28 tablet 2 x 14 tablets
1879911000001103	Lipitor 80mg tablets (Pfizer Ltd) 28 tablet 4 x 7 tablet

*Prescribing/dispensing systems do not need to display the code on screen.

DM+D and EPS Release 2

Suppliers of Release 2 systems, such as Cegedim Rx, are incorporating DM+D into our systems as it is essential that both prescribing and dispensing systems use the same dictionary.  Where the prescribing system can use the DM+D code for a particular item, the prescription can be sent via the EPS. Any items that are expressed using other terminologies will be processed using a paper FP10 prescription.

What differences will prescribers and dispensers notice with the introduction of DM+D in Release 2?

Prescribers and dispensers are familiar with the descriptions that are currently provided by their system suppliers. The following are examples of commonly occurring differences between the DM+D and these proprietary terminologies.

Word order

Throughout the whole of DM+D, the convention of Name, Strength and Form has been adopted in line with the Guideline on Summary of Product Characteristics, Council Directive 2001/83/EEC and the Medicines and Healthcare products Regulatory Agency document entitled: ‘Best Practice Guidance on the Labelling and Packaging of Medicines’.

Not all proprietary terminologies follow these guidelines at present and examples of adopting the directive are shown below:

Proprietary	DM+D
Phenoxymethylpenicillin tablets 250 mg	Phenoxymethylpenicillin 250mg tablets
Simvastatin tablets 10mg	Simvastatin 10mg tablets

Word conventions

In some cases DM+D may use different words to those found in proprietary dictionaries currently used in prescribing and dispensing systems.

Examples of these differences could include:

Proprietary Word	DM+D word	Example of DM+D term
enteric coated or e/c	gastro resistant	Aspirin 75mg gastro-resistant tablets
actuation or puff or inhalation	dose	Salbutamol 100micrograms/dose inhaler
M/R	modified-release	Aminophylline hydrate 225mg modified-release tablet
30mg+500mg	30mg/500mg	Co-codamol 30mg/500mg effervescent tablets

Quantities and units of measure

In the case of inhalers, DM+D expresses the number of doses contained within each inhaler. This feature is particularly useful when manufacturers provide inhalers for the same product that contain different numbers of doses. (See Ciclesonide examples below where both 60-dose and 120-dose inhalers are available).

Proprietary	DM+D
Salbutamol cfc inhaler 100 micrograms/puff   ...          2 inhaler	Salbutamol 100micrograms/dose inhaler CFC free 400 dose
Ciclesonide 160micrograms/dose inhaler CFC free 1 inhaler	Ciclesonide 160micrograms/dose inhaler CFC free 60 dose
Ciclesonide 160micrograms/dose inhaler CFC free 1 inhaler	Ciclesonide 160micrograms/dose inhaler CFC free 120 dose

What happens in the last Ciclesonide example if either the prescriber or the patient/carer required 2 X 60 dose inhalers to be supplied rather than just 1 X 120 dose inhaler?

In cases where more than one inhaler is required, e.g. one is for home use and one to be left at work or school, the prescriber can specify this using the additional instruction portion of the electronic message.

If however, a pharmacy received a prescription that did not contain additional instruction to that effect, the pharmacist can use the pack endorsement to notify the NHS Business Service Authority Prescription Pricing Division that two 60 dose inhalers had been supplied on that occasion rather than one 120 dose inhaler. The pharmacy would then be reimbursed accordingly in line with the Drug Tariff.

Length of terms

Some DM+D terms are longer than their proprietary counterparts, as a result some terms may wrap over onto more than one line when they are displayed on screens.

Examples:

Proprietary	DM+D
Cardicor Tab 2.5mg	Cardicor 2.5mg tablets (Merck Pharmaceuticals)
Influenza_Vac Inact 0.5ml Pfs	Influenza vaccine (split virion, inactivated) suspension for injection 0.5ml pre-filled syringes

Other system functionality - decision support and alerts

Many clinical systems provide additional functionality to support prescribing and dispensing, such as decision support and associated alerts, which may check for contra-indications, drug interactions and allergies. Very often these will involve looking up information in the patient’s past medical history and referencing decision support knowledge bases. As the vast majority of information contained within these systems pre-dates the introduction of DM+D, the data will be stored using proprietary terminologies and not DM+D.

To ensure that these important functions can continue to work efficiently and effectively when DM+D is incorporated into systems, many suppliers provide mappings (or links) from DM+D to the existing proprietary terminology.

For further information about DM+D, please see: http://www.dmd.nhs.uk

 

Acronyms

AMP - Actual Medicinal Product

AMPP - Actual Medicinal Product Pack

VMP - Virtual Medicinal Product

VMPP - Virtual Medicinal Product Pack

 

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Updated 5th July 2013