Welcome to the 14th edition of Tablets, a prescribing newsletter produced monthly by the Medicines Management team of Midlands and Lancashire CSU.
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NICE Guidance March 2018
The following guidelines have been published by the National Institute for Clinical Excellence in March 2018:
The Attention deficit hyperactivity disorder guideline has been published and replaces the 2008 guidance. The guideline aims to improve the recognition, diagnosis, support and management of attention deficit hyperactivity disorder (ADHD) in children, young people and adults.
The Heavy menstrual bleeding guideline has been published and replaces the 2007 guidance. The guideline covers the assessment and management of heavy menstrual bleeds (menorrhagia). The guidelines aim to help healthcare professionals investigate the cause of heavy periods that can affect a woman’s quality of life and to offer the right treatments.
It is vital clinicians are aware of these changes and implement any required changes to their practice.
CKS Updates March 2018
During the month of March 2018, the following Clinical Knowledge Summaries were updated:
The most significant change is to the topic on Gout which has been updated in line with national guidance. The alopecia areata and leg cramps topic have both been expanded.
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Homely Remedies
The CSU in conjunction with the Wirral CCG have published the Homely Remedies Guide which Care Homes may wish to use from the 1st April 2018.
A homely remedy is a medicinal preparation used to treat minor ailments e.g. indigestion, coughs, mild-moderate pain, constipation etc. It is purchased from supermarkets and other stores (GSL) or obtained from the Pharmacy (P) and does not require a prescription. The Care Quality Commission agrees that a small range of products may be kept as stock in a care home for residents for the treatment of minor ailments.
Homely remedy products are kept in the home to allow access to products that would commonly be available in any household and allow treatment of minor conditions in a safe and timely manner. Use must however be discussed with the resident and/or family member and their GP and only the named preparations listed in the guidance may be obtained and administered without a prescription. Information on medications that can be used are included in the guide but Pharmacists can also provide advice on the best treatment and give guidance on their use as well.
A training event which will include a session on Homely remedies is yet to be finalised. Date and venue to be confirmed.
Wirral Community Trust Clostridium difficile update for February 2018
There were four reported cases of community attributed clostridium difficile infection (CDI) in February 2018.
The key learning points from these reviews were:
* Always document rationale for choice of antibiotics
* Prescribe treatment for CDI in line with antimicrobial guidelines
Areas of good practice identified from these reviews were as follows:
* Prompt stool sample collection and prescribing of treatment for CDI
* Recognition of CDI as a cause for diarrhoea
Wirral CCG Datix Newsletter
The Wirral CCG DATIX Newsletter will be distributed to GP Practices on a quarterly basis. It is a way of communicating and updating practices on the following:
* Any changes that are being made to the Datix System
* Any trends that are appearing from incident reporting.
* Lessons Learnt that may be useful in GP Practices.
Guidance about Methotrexate 10mg Tablets – for all practice managers and prescribers
As you are all aware it is Wirral Policy not to prescribe 10mg Methotrexate Tablets, this has been the case since 2006 when the first MHRA Alert was actioned. Since this time we have always had a handful of patients still prescribed 10mg tablets, usually at the request of a consultant, for severe compliance issues.
The Pan Mersey APC Formulary does not make exception for any patients, this incudes children at Alder Hey.
An updated safety statement from Pan Mersey is expected soon and this will be circulated via this bulletin.
This issue was discussed at the Wirral CCG Medicines Management Committee and it was decided that we should be moving towards Pan Mersey APC guidance as soon as possible. The committee asked that the Medicines Management team identify any patients currently prescribed 10mg tablets and take the following action :-
- Discuss with GP to see if patient is now able to be switched to an equivalent dose using 2.5mg tablets. The patient and pharmacy must always be contacted before the change is made to ensure that both are aware and understand the change.
- EMIS Web restricts prescribing of Methotrexate to GPs therefore any changes must be made by the GP and not the medicines management team.
The team are currently highlighting any 10mg prescribing but going forward the practice need to review this and follow ScriptSwitch prompts.
For any particular requests from consultants or any queries both WUTH and Alder Hey have agreed to liaise with consultants directly.
Community pharmacies will also be asked not to stock methotrexate 10mg tablets as per the Wirral policy.
Any queries please email abigailcowan@nhs.net in the MLCSU Medicines Management Team.
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Please click here for more information on all of the below safety updates.
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