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FMD case study - Aintree University Hospital
Alex Jennings is Deputy Chief Pharmacist at Aintree University Hospital NHS Foundation Trust in Liverpool. He has developed standalone software for the Falsified Medicines Directive (FMD) in his spare time and currently more than 40 hospitals and five community pharmacy chains are using it. We visited him in February 2019.
The impact of FMD on Aintree
The impact was significant as Aintree receives on average 55,000 medicine packs through goods-in each month. The majority of these are prescription-only medicines which, once
they are all in FMD-compliant packaging, will need scanning for verification and decommissioning. To give you an idea of volumes, some deliveries contain as many as 1,200 packs of the same item, and each individual pack will need to be scanned.
Developing FMD software
The trust obtained quotations from the trust’s pharmacy stock control system and dispensing robot supplier and realised they didn’t have the budget to upgrade. As Alex has a
background in coding, he did some research and felt he could produce a solution that would work for him and his team. The software was installed on existing PCs, and was configured to work with scanners the team already had available.
A variety of scanners can be used, ranging from relatively cheap handheld options up to more expensive supermarket-style flatbed scanners which would speed up the scanning. Alex and his team will review their scanners once the volume of FMD compliant packs increases. Alex has subsequently offered his software to others on a no fee but no technical support basis (as his full-time pharmacist role keeps him busy enough).
FMD go live
Aintree was the first trust to go live with FMD in November 2018, and the first UK location to decommission a pack. Rather than trying to implement FMD scanning at all the pharmacy supply stations, Alex realised scanning at goods-in meant they could use the existing three to four people who work on stock receipts. They only needed to purchase a handful of scanners, rather than trying to deploy equipment and training across the department.
Alex considered decommissioning at ward level but decided this was not practical with the requirement for equipment and need to provide training to around 3,000 personnel across the site. Instead, they perform the verification and decommissioning scans at goods-in (FMD regulations allow hospitals to decommission on receipt of medication). Alex added that his software he’s developed can verify and decommission separately at any part of the process and is therefore suitable for hospital, community pharmacy or primary care locations.
By the end of March 2019, Aintree had decommissioned 2,500 medicines, and Alex estimates 1% of incoming packs are FMD compliant, which means they have a 2D barcode, tamper proof packaging, and have been uploaded to the National Medicines Verification System (NMVS) database).
Alex’s robot loads medicines from a large hopper, and scans each pack as it is loaded. He’d like to use the robot to perform FMD scanning but it can only be configured to scan existing barcodes or FMD barcodes, not both. Once a high proportion of packs are in FMD compliant packaging with the 2D barcode on he will switch it to perform the FMD scanning.
Benefits of FMD
Alex has confidence in his existing medicine supply chain but can see there’s a need for a system that deters criminals from attempting to insert falsified medicines into the legitimate supply chain, so that patient safety is not compromised. He’s looking forward to FMD compliant packaging becoming the norm so he doesn’t need to run separate systems to manage FMD packs, although recognises it could be some time before all non-compliant packs have worked their way through the system.
Alex’s FMD software captures and stores batch numbers and expiry dates for newly delivered medicines so, as the percentage of FMD compliant packs increases, he can reduce the time consuming paper-based recording they currently use.
Alex has noticed a range of different packs that are available and it can be confusing identifying whether to scan. He’s seeing:
- old style barcode and not tamperproof pack
- old style barcode with tamperproof pack
- FMD 2D barcode but not tamperproof pack and not uploaded to NMVS
- FMD 2D barcode with tamperproof pack and uploaded to NMVS
- FMD 2D barcode printed white on a black background
- non-FMD 2D barcode (often contains links to manufacturer’s website for patient use)