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NoECSU Prescribing Newsletter
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Locality Medicines Optimisation updates

Please click on the links below to access the Medicines Optimisation update for your area:

Patient Group Directions - an update

Before April 1st last year PCTs, sometimes in collaboration with local Foundation Trusts, developed and approved any PGDs required by GP practice staff. Now responsibility for PGDs rests with varying organisations. These include NHS England, local authorities and CCGs.

NICE good practice guidance clearly states that the commissioner of the service should approve any PGDs for that service. This has led to a great deal of confusion and so many PGDs that were in use have now expired.

Public Health England local areas teams, CNTW and DDT, have reviewed PGDs and developed new ones for all the ones needed for the national immunisation programmes such as the childhood imms and influenza programmes. These are now available here.

Read more >
Drug Safety Updates

Adrenaline auto-injector advice for patients: after every use, an ambulance should be called even if symptoms are improving, the individual should lie down with legs raised and, if at all possible, should not be left alone.

Combination use of medicines from different classes of renin-angiotensin system blocking agents: risk of hyperkalaemia, hypotension, and impaired renal function—new warnings

Ivabradine: emerging clinical trial evidence of increased cardiovascular risk—carefully monitor for bradycardia

Transdermal fentanyl (“patches”): reminder of the potential risk of life-threatening harm from accidental exposure

Read more >
BNF updates

BNF for Children

A new edition of the BNF for children has been published (2014/15). It is important that the most up to date version is always used and that older versions are discarded.

There are many alternatives to the paper copy. It is available to NHS staff online (after registration) here or via a number of mobile apps. These have the benefit of being updated every month.

Medicines Q&As

 

UK Medicines Information (UKMi) produce a number of Q&A documents providing quality controlled answers to common or unusual enquiries made to medicines information services.   Here are some of the latest Q&As prescribers may find useful:

What are the equivalent doses of oral benzodiazepines?  Offers advice on the factors to consider when switching from one benzodiazepine to another and includes a table of approximate equivalent doses of oral benzodiazepines licensed in the UK.

What are the equivalent doses of oral morphine to other oral opioids when used as analgesics in adult palliative care?  A summary of information from a variety of sources concerning equivalent doses of oral opioids in adult palliative care.  It discusses how these widely used figures are only approximate and that patient specific factors should be taken into account.

What should be considered when prescribing medicines for patients who have undergone bariatric surgery?  Discusses the many aspects to consider when it comes to medicines and bariatric surgery, including the type of surgery, drug considerations, and patient choice.

All current UKMi Q&As can be found by searching the NICE Evidence Search website for “UKMi Q&A”.

NTAG Decision Summary

NTAG decision summaries are available on the NTAG website.  The following were considered at the meeting on 3rd June 2014:

AccuCheck Mobile

A CAS alert was issued in June highlighting that problems with the way in which the AccuChek Mobile blood glucose meter is used can result in false readings. The device does not use test strips, so the testing procedure may be different than patients are used to. Failure to follow proper procedure (including washing and drying hands thoroughly, obtaining a proper blood drop and avoiding pressing against the test field) may result in false high readings. 

The manufacturers, Roche, have issued a letter and instructions for use to ensure that accurate readings are obtained. Further information is available on the MHRA website here.

Important safety alert: blood glucose testing strips

As a result of a recent incident which involved a patient using an incompatible strip in a glucose testing meter, and resulted in a hospital admission, please note the following information:

It is important that patients are ONLY supplied with blood glucose test strips specifically designed for use with their particular meter.

Strips are not interchangeable between different meters and use of an incompatible strip can lead to inaccurate readings and potential patient harm.

Read more >
COPD: further evidence on the risk of pneumonia with inhaled fluticasone or budesonide

A large Cochrane systematic review of 43 randomised controlled trials provides further evidence that taking fluticasone or budesonide alone or in combination with a long-acting beta-agonist (LABA) increases the risk of non-fatal serious pneumonia events (requiring hospital admission) in people with chronic obstructive pulmonary disease (COPD). No increase in total mortality was found.

Click here for more information.

Updates to Public Health Englandís Immunisation webpage

The immunisation section on the PHE website has been updated to include: vaccine incident guidance, a guide for patients with incomplete or uncertain histories and guidance about porcine gelatine content in Fluenz vaccine.

Click here for more information.

Guidance for Healthcare Professionals on Drug Driving

A new offence of driving with certain specified controlled drugs in excess of specified levels in body is expected to come into force on 2 March 2015. The Department of Transport guidance provides a clear explanation of new legislation including the statutory “medical defence” available to patients.

Read more >
High dose ibuprofen

The EMA have started a review of the cardiovascular safety of high-dose ibuprofen (2,400 mg daily). The review follows the publication of an analysis which suggested the risks of this dose may be similar to those associated with the COX-2 inhibitors.  It should be noted that the review does not impact on ibuprofen as used by the overwhelming majority of patients, and that people should continue to take their medicines as usual while the review is conducted.

Click here to read more.

NoESCU
NHS North of England Commissioning Support (NECS)
www.necsu.nhs.uk
necsu.medicinesnewsletter@nhs.net
Tel: 0191 374 4121
2012 All Rights Reserved

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