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Walsall Joint Medicines Management Committee
Prescribing Update Newsletter November/December 2018
If you have any comments or suggestions about this or future editions please contact: [email protected]
MHRA Drug Safety Update Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use Systemic and inhaled fluoroquinolones: small increased risk of aortic an-eurysm and dissection; advice for prescribing in high-risk patients Sildenafil (Revatio and Viagra): reports of persistent pulmonary hyperten-sion of the newborn (PPHN) following in-utero exposure in a clinical trial on intrauterine growth restriction Support Yellow Card: improve the safety of medicines in pregnancy and breastfeeding, and in babies and children Lidocaine products for children's teething relief are being changed from GSL to P medicines—this means they can only be sold under the supervi-sion of a pharmacist. Non-pharmacological treatments are first line: e.g. teething rings and massaging of gums. Valproate medicines—are you acting in compliance with the pregnancy prevention measures? Reports suggest that compliance with the new measures is currently patchy, see new guidance from RCPsych Emollients: new information available about the risk of severe and fatal burns with paraffin containing and paraffin-free emollients Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in pa-tients with diabetes Hydrocortisone muco-adhesive buccal tablets: should not be used off-label for adrenal insufficiency in children due to serious risks of what?
Nutilis Pre-Thickened range undergoing label change
We are aware of some issues when using the GP prescribing systems and the prescribing of Nutilis Pre-thickened supplements. These products are undergoing a label change due to the International Dysphagia Diet Stand-ardisation Initiative (IDDSI) framework. Some GP systems may not update immediately so special attention should be taken when prescribing these products e.g. If Nutilis complete stage 1 can’t be found instead search for Nutilis complete drink level 3. When recommending these products please consider using both names for the product to aid prescribing.
Current descriptor New IDDSI label
Nutilis Complete Stage 1 Nutilis Complete Level 3
Nutilis Complete Stage 2 Nutilis Complete Crème Level 3
Nutilis Fruit Stage 3 Nutilis Fruit Level 4
LOCAL ALERT FOR PRESCRIBERS: Potassium Prescribing (Sando-K)
Prescribers please ensure NUMBER OF DAYS OF TREATMENT is specified on prescriptions.
As Sando-K has a specific container, community pharmacies may issue a full container (which contains 20 tablets). This could result in patients
taking treatment longer than intended.
Controlled Drug Incident Reporting— report this through the website: www.cdreporting.co.uk
(select West Midlands region to register) Controlled Drug Accountable Officer: Chris Weiner
Medication Error Reporting — https://report.nrls.nhs.uk/GP_eForm (including near misses)
If you have any comments or suggestions about this or future editions please contact: [email protected]
Learning from incident across the healthcare system
A patients cardiologist sent a letter in 2015 asking the GP to stop medication (amiodarone). Patient continued to
take the medication and was admitted via A & E on 12/02/18 and subsequently to a ward on 13/02/18 with AKI
following diarrhoea. Patient was known to have severe Left Ventricular Systolic Dysfunction (LVSD) and mild coro-
nary artery disease. The patient was taking Amiodarone, Eplerenone, Dabigatran and Bisoprolol.
As the patient was on Amiodarone the thyroid function tests (TFT’s) were done along with routine bloods on
13/02/18. All blood tests were reviewed, except the TFTs, on the day of discharge (13/02/18). The patient was re-
admitted on 02/03/18 (discharged 06/03/18) with symptoms of thyrotoxicosis, therefore there was a delay in initi-
ating the anti- thyroid treatment from 13/2/18 to 2/3/18. The patient went on to have a further admission to hos-
pital when he was treated on critical care and subsequently died on 28/3/18.
Issues:
Large number of letters sent from hospital (paper and electronic, with duplications).
Oversight and insufficient documentation can occur in such situations.
Letter could have been clearer and in the format agreed with GP Leads, specifying under sub headings of
‘GPs role’ and ‘what the patient has been told’ (not uniformly practiced by all clinicians in the hospital).
Patient could have been adequately counselled or important medication changes given in writing.
How can this error be avoided in the future?
Letters to be read by a trained member of staff, if any action is needed by a clinical member of staff it is directed to
the most appropriate person. The letters should also be actioned in a timely manner and a system put in place to
check they have been actioned.
OTHER INFORMATION
RMOC has issued guidance on homely remedies in Care Homes
New supply issues: Bricanyl Turbohaler, Bactroban nasal ointment , Adalat products, Madopar
Discontinuations: Cilest (July 2019), Desitin, Almogran (6 tablet pack), Noristerat injection, Pro-Viron, Hypurin Bo-
vine Insulin, Duavive, Adalat (Nifedipine) products
