SNOMED, dm+d, GS1 and FMD – how does it all fit together?

In our second Pharmacy insight session, three leading figures in NHS Pharmacy look at national context of GS1 implementation for medicines, the implications for pharmacy data and how it works in Acute Trusts:

• Andrew Davies, National Professional Lead for Hospital Pharmacy, NHS Improvement
• Jo Goulding, Business Lead, Pharmacy Terminology, NHS Digital
• Mary Evans, Chief Pharmacist, Luton & Dunstable University Hospital NHS Foundation Trust

Andrew Davies, National Professional Lead for Hospital Pharmacy at NHS Improvement, opened this session by highlighting how much we often take medicines for granted. Medication safety is a massive issue with between 5% and 8% of hospital admissions being associated with medication related issues. It’s on Jeremy Hunt’s list of top priorities and with good reason - terrorism is the number one risk registered on the UK risk register and anti-microbial resistance is number two. We also know that 50% of patients don’t take their medicines as intended and new data around patients tells us that more than a million patients are taking over eight medicines a day. It might not be such a big surprise then that medicines spend is the biggest cost to the NHS after staff. And that some of the biggest challenges are around treating too many patients when we should instead be stopping patients getting ill.

For all that to happen, we need to tackle the funding and efficiency gap. The Carter Report suggested there could be a £5bn saving from the work that he’d done, and there’s also the Getting It Right First Time programme and the Five Year Forward View. The key for the future is how we join all those pieces up and the Medicines Value Programme is a big part of that too. It all connects intrinsically to the need for data, for intelligence and to join information up and capture it through barcodes.

Data, data, data

For Andrew, the most important piece is around the optimised use of medicines and that comes back to knowing what the outcomes of medicines are. Until you have data, you can’t do any of those things. It’s about being able to look at how we can minimise wastage and manage stock. And all of those things connect directly with GS1.

Medicine optimisation is about being able to help clinicians choose the right medicines for patients. It’s about improving patient outcomes and the key part is data – knowing what the outcomes are and turning that into intelligence about medicines. Hospital pharmacy spends about £700m on pharmacy service and £7.6bn on drugs, so we really need to focus on medicines optimisation to get the larger savings. Working closely with Getting It Right First Time is key, to see how it might influence medicines but also how the right care programme works, as it uses data on a massive scale across the country. It’s also important to consider the Falsified Medicines Directive (FMD) and how we have a pharmacy supply chain from the manufacturer to the wholesaler to the wards.

From a medicines point of view, one of the key drives is around reducing the growth in medicine spend. Medicine spend was growing at 18-18.5% annually but last year, for the first time, it’s gone down to single digits. It’s fallen because of activity to look at the choice of medicines and that drop has resulted in £121m savings in six months, and we can quantify that to a Trust level and to a drug level. Now that we have the data, we can actually start looking at getting better value from the drugs we’re buying and what is being used.

dm+d

Jo Goulding, Business Lead, Pharmacy Terminology at NHS Digital was then introduced to the room to talk through the more technical side of managing medicines and devices, and how all the different standards – dm+d, GS1 and SNOMED CT – link together. dm+d is the NHS dictionary of medicines and devices, owned by the Department of Health and Social Care (DHSC), that gives a unique code and standard description for all medicines and devices used across the NHS for patient care. And SNOMED CT is the clinical terminology of choice for the UK. So all diagnoses, procedures etc. will be in SNOMED CT and that’ll be rolled out very soon.

In a nutshell, dm+d gives you the text description which forms the human readable bit, and the unique code which is the computer readable bit. It is delivered as XML files to build a system around, it doesn’t deliver a system to you. dm+d is the NHS Standard for coding medicines and If you’re going to be coding or communication information about medicines for clinical care in the NHS then you’ve got to use industry standards and for the NHS, that’s dm+d.

dm+d is only concerned with the clinical care of the patient; supply chain is out of scope. However there is a recognition that deliver on requirements for e.g. Closed Loop medicines (prescribing, supply, administration) there needs to be a clear and accurate link (map) between dm+d and GS1 codes.

Pharmacy in Trusts

The last speaker for this session was Mary Evans, Chief Pharmacist at Luton & Dunstable University Hospital NHS Foundation Trust. For Trusts, the task at hand is to put it all into practice. For Mary, it’s all about the traceability and interoperability that standards bring, but it’s also about patient safety. It means being able to document properly into a patient’s notes and be sure that the prescription is checked and traceable from the manufacturer to the patient. It’ll also make life a lot easier in the case of product recall where they’ll be able to be certain over what the patient’s been given, who gave it to them, when they’ve been given it. At the moment, that’s almost impossible.

The drivers to do this are out there. dm+d compliance was needed by 2017, FMD by 2019, GS1 implementation in Trusts by 2020, Carter requirements by 2019 and Luton & Dunstable are a global digital exemplar so for that GS1 is needed by 2020. But there’s a long way to go, most medicines have an EAN 13 barcode but what’s needed is the GS1 data matrix. It’s needed for closed loop medicines administration, so there are checks at each stage. The aim is for a clinician to be able to bring up a prescription on their ePMA using the barcode on the patient, meaning they have all the information they need when prescribing. It would then be sent electronically to the pharmacist for verification, and then to prescription processing, where the robot will use barcodes to pick the products ready to go up to the wards. The nurse will then be able to scan the patient to bring up the medicines, scan the product barcode to check it’s the right one and scan themselves to say they’re administering it.

These checks all along the way are what GS1 standards enable, but what’s needed is a GS1 compliant stock control system, scanners that can scan barcodes on both the wards and in the pharmacy and medicines that have the GS1 data matrix. Luton & Dunstable are on the GS1 journey - we know where we want to get to but we’ve got an awful lot of questions to ask on the way, to get us there.

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