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DLM400 and the introduction of dm+d in Vision
INPS began distribution of DLM400 and its integrated dm+d drug information system (Gemscript)
in June 2012, after extensive piloting across the UK and it is now installed at over 1600 practices. As
a result of feedback from the piloting a large number of improvements were included in the release
There are a number of issues that have arisen in recent weeks which are unrelated to DLM400 and
should not be confused with the DLM400 upgrade:
1. DLM 380 introduced a change to the enforcement of brand substitution for generic
preparations which the dm+d consider inappropriate to prescribe generically. This functionality is unchanged in DLM400, but may apply to more preparations which are so considered by dm+d
2. A problem with a small group of hosted practices starting during the first week of July and
which caused difficultly in adding allergy records and a lack of display of prescribing decision support prompts, has also been resolved
Since the distribution of DLM400 began, a number of new issues have been reported both to INPS
and to NVUG and we have worked together to resolve them. These will be distributed either by
changes to the Vision code released as a DLM, or Drug Dictionary updates.
Changes incorporated in the June 2012
Drug Dictionary. This dictionary is released and available to
1. The display order of MST Continus tablets is changed to ensure that the lowest strength
preparations appear before the highest strength preparations
2. Not all drugs have suggested default dosage and quantity information and we are working
hard to increase this information. This has improved in this dictionary and will continue to improve with each subsequent drug dictionary.
Changes incorporated in the July 2012
Drug Dictionary. This dictionary is in Testing at present and
will be released next week.
1. An issue regarding the failure of the Generic version of Naseptin nasal cream (Neomycin
0.5% / Chlorhexidine hydrochloride 0.1% cream) to provoke an allergy warning for patients with Nut Allergy has been addressed
2. The problem with existing allergy records for Sibutramine has been addressed and they will
3. Problems for Nurse Prescribers as opposed to Nurse Independent Prescribers, in Scotland has
4. Label warnings have been improved and will continue to improve with each subsequent drug
Changes incorporated in the August 2012
Drug Dictionary. This dictionary will be distributed in
1. The inappropriate flagging of Janumet and its generic Metformin 1g / Sitagliptin 50mg as
2. A missing default dosage for Methotrexate 2.5mg tabs (six tablets weekly) has been added
In Practice Systems Ltd
Changes brought forward into DLM410.
This upgrade will available in August.
1. The display of Parallel imports in the list of branded products will be suppressed, as they are
not prescribable, and confuse the prescribers about which version of a branded product to prescribe. They will still be available to record in patient notes if required, but under the All Generics checkbox.
2. An issue with allergy warnings being displayed when the prescribed drug was not related to
the allergy recorded for the patient has been addressed
3. An issue with age-related warnings for children has been addressed
Recent enhancements to be scheduled for release as soon as possible:
1. The display of alternate brands for a non-prescribable generic (Use Brand flag) will be
improved to show cost comparative information
2. Too many drugs recorded in Allergy records provoke an “unknown drug” message and state
that the allergy cannot be checked. This will be improved by reducing the number of drugs with this assignment.
3. The same enhancement will reduce the number of items which provoke a message saying that
„cannot check against other drugs for drug doubling.‟
4. The ability to add allergies for inactive drugs (prescribed in the past but no longer available)
but still present in dm+d, will be enabled.
5. Some items are marked by dm+d as “Hospital only”. These are not currently permitted to be
printed on FP10, but we recognise that there are circumstances where local arrangements have been made between hospitals / PCTs / and local GPs and the responsibility for these items devolved to the GPs. Our implementation currently prevents these items being prescribed, though they can be recorded in the patient record (and should be in order to continue their contribution to prescribing decision support). We are seeking clarification from dm+d on the exact use of this flag.
Some practices had previously implemented EPS2 in England and had converted their repeat master authorisations to dm+d compatible names as part of that process. Feedback from these practices suggested that DLM400 was a minimal change and so INPS believes that much of the criticism being levelled at the release comes from the change to dm+d. This is the new NHS National Standard Drug Dictionary and as such does impose a change on practices, a change that can only be of benefit to the NHS in the longer term and is to be supported for reasons of clinical safety, standardisation and interoperability between NHS systems in the care of patients. INPS does acknowledge that the release did require significant effort from practices. INPS will continue to work with dm+d and our users to ensure a safe and successful transition to an integrated dm+d solution. INPS is committed to making Gemscript the most complete and up-to-date drug information system available to clinicians. INPS has published on oura number of answers to frequently asked questions and we do encourage all users to read them.
In Practice Systems Ltd
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DMH POLICY Antipsychotic Medications Policy #: 83-50 (Rogers Decision) Date Issued: December 16, 1983 Effective Date: December 16, 1983 Approval by Commissioner Signed by: Date: December 16, 1983 James J. Callahan, Jr., Ph.D., CommissionerRogers – Implications for Administration of Antipsychotic MedicationOn November, 29, 1983, the Massachusetts Supreme Judicial Court is