Time for another update. Have a stiff drink ready for when you get to the end of this missive.

The lack of correspondence in the PJ etc about EPS (Electronic Prescription Service) is very worrying. We as a profession seem to be hypnotised by the perceived benefits and not using our analytical skills to see if the new emporer is actually wearing clothes. The hard lessons of dispensing accurately and to the prescribers intentions do not seem to be reaching the ears of those who make the decisions. Probably because most of the dodgy prescriptions have been sorted out before they get back to the NHS. Here are some things that we should be asking.

1. Perpetuated prescription errors. We all know these. They are the prescriptions that we get month after month with a minor problem on them that we correct from our PMR. The script is sent back to the surgery for alteration and then we submit the script. The surgery system never seems to be updated with the correct information, so next month the same problem arrives again. In the EPS I model we can reject the e-script and dispense from the paper, and carry on the old way. In EPSII when there is no paper prescription we will have to reject the prescription and send the patient back to the surgery. I guess the powers that be are hoping that there will be some cleaning up of the data on surgery computers as each EPS script fails.

2. DM+D. No Clinical Content.
There are two points about the DM+D. First it is not meant to contain any clinical information. As a consequence of this in some areas the 12 and 24 hour release m/r preparations are on the same Generic. So here's the scenario, the GP orders the brand on his system with the correct dose. His system uses the correct DM+D link to turn the brand name into a generic name. The pharmacy downloads the script which the pharmacy computer because there are no true generic products links back to a choice of brand. Because the brands are on the same link, a choice of 12 or 24 hour release is presented. You then have to work out which one to give from the dose - easy enough, but what happens if it is One as directed? But we have to ask the question - why are the 12 and 24 hour release on the same generic link in the first place?

3. DM+D and redundant information.
The product descriptions in the DM+D do not have a maximum length. There are short descriptions for products but even these are 60 characters. They are fine for a prescribing system, but pharmacy systems have have max name length of 40 - 45 chars for a product name so that it fits on a label. That's one point. The second point is the amount of unnecessary information. Information is present that makes you draw the conclusion that it is there to distinguish a product from another one. However, other products may not exist!. Because this information is there you have to check the very fine details of the product that you would have dispensed when there may be no need to. For example, lets pretend that there is no such thing as a CFC free Breath actuated inhaler for a moment. Supposing then, that a Salbutamol Inhaler was launched, it could be called, on the DM+D... Salbutamol non-CFCFree Manually Actuated Metered Dose Inhaler 100micgrogram/Actuation. Pack size 200 dose. There is much redundancy in this description is clearly not necessary because there is no other product to confuse it with. The additional information is only needed when cfc-free etc inhalers are launched. Have a look at some of the names used on hosiery and appliances, the DM+D is on the internet for all to enjoy. (See link below)

3. DM+D and Verapress, for example.
Watch out for branded generics that can be sold under different liveries. The DM+D puts them on as different codes so that if they are ordered under one livery another livery cannot be used. Ideal if you have one livery in stock but the EPS prescription has ordered the other livery. You look like a right jobsworth.

All the above, and more have been raised with CfH and the DM+D team in Newcastle.
Is one NHS organisation creating problems to keep another NHS organisation, such as the NPSA active?

DM+D http://www.dmd.nhs.uk/about
NPSA http://www.npsa.nhs.uk/