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FMD case study - David Broome, Stancliffe Pharmacy, Bramhope
We visited pharmacist David Broome at his pharmacy in the village of Bramhope, North Leeds in February 2019, four days after the Falsified Medicines Directive (FMD) became law, and two weeks after he first activated FMD scanning.
Preparing to go live with FMD
David and his team decided to use the integrated solution that their pharmacy stock control system supplier was offering. For Stancliffe Pharmacy scanning medication pack barcodes was nothing new. In fact, the team has been doing so for the last twelve years. This meant that the introduction of the new FMD 2D barcode didn’t involve any significant changes to their processes or mean any new scanners were needed. The team had been scanning during their dispensing process as a safety check to confirm that the medicine they had picked matched the prescription – their pick error rate is nil and has been for years.
Training staff on FMD
David has been an enthusiastic champion of FMD for some time and has presented at local workshops at the request of the PSNC to spread the word provide support and answer questions about FMD implementation and processes. David used this knowledge, alongside the FMD guides provided by his system supplier, to train the team. Shafia Ahmed who works at the Stancliffe Pharmacy on a pre-registration training placement, told us the team were learning as they went along, using the supplier’s guides for additional reference.
Day to day operation – verification and decommissioning
David chose to implement the verification scan during the dispensing process, rather than at goods-in, as is the case in some community pharmacies. When the team pick a pack that has an FMD barcode on it, they simply scan that instead of the barcode they would have previously scanned. The FMD barcode provides everything their pharmacy stock control system needs, as well as allowing them to verify the pack.
When the item is handed to the patient or representative, they mark as collected and decommission. For deliveries, they decommission the packs early in the morning before they are sent out for delivery mid-morning. Any that deliveries that are unsuccessful are then recommissioned before they go back onto the shelf for delivery the next day. During dispensing, the pharmacy stock control system provides an aggregated bag label which supports FMD decommissioning. For Monitored Dose Systems, they decommission as they make up the packs, and mark any part-used packs so they don’t try to decommission them twice.
Benefits of FMD
The benefits of barcode scanning were the main reason David chose his existing system supplier, and he believes barcode scanning is essential for patient safety. The ability to scan a barcode and check against the EPS prescription to make sure the correct item had been picked was a key consideration when choosing his pharmacy stock control system. FMD brings the additional benefit the reduced likelihood of issuing a falsified, recalled or expired medicine.
David considers there are additional benefits that can be provided as pharmacy stock control system suppliers make more use of the data in the FMD scan. For example, improved functionality to update stock levels which will help when re-ordering, easier drug recalls now that there will be a unique pack link back to individual patients and, perhaps, some intelligence when decommissioning which tells you there’s a pack on your shelf with a shorter expiry date, assuming you’re scanning at goods-in.
David recalls an incident some years ago where a major wholesaler was found to have been unknowingly distributing falsified medicines to community pharmacy. If FMD had been in place, they would have been found and stopped before patient safety was compromised, so David is happy to see FMD scanning being put in place.
Verification involves scanning the 2D barcode to check the product is authentic and originates from a legitimate manufacturer. This scan can take place at any time before medication is given to the patient, and you can verify as many times as you wish.
Decommissioning involves scanning the 2D barcode and changes the pack’s status to indicate it has been supplied to a patient. If you were to try to decommission the same pack a second time, it would report an error.
Possible FMD improvements
A key improvement for David would be if the system told users the scanned item hadn’t been uploaded to the national database so they would know straight away that they didn’t need to do anything with that pack. David would also like to see some updated guidance on error messages detailing what to do in each scenario and who to contact.
Useful learning points for other pharmacies
Review the different FMD systems that are available and find one that will fit in best with the way you want to work.
Take a good look at your existing workflows to see how you can add FMD scanning without causing too much disruption.
Take time to get used to the new ways of working.
Be prepared that volume of FMD compliant packs will probably be low for a while. (The team is slowly seeing more compliant packs and currently estimate around 10% are compliant, mainly fridge items, asthma inhalers and statins).
Sometimes it can be difficult to identify that a pack has FMD safety features, as not all packs have a holographic seal.