Prescribing

Urinary tract infections

Guidance on managing UTIs has changed. In particular the recommendations place much less reliance on urine dipstick results.
There is a link to the latest management guidelines in the
Guidelines section.
Antimicrobial prescribing guidelines were also updated last year and can be found in the same section.

EpiPen shortage

I have published a memo about the current EpiPen shortage.
It recommends that doctors consider carrying ampoules of Adrenaline rather than EpiPens.
It can be found in the
Memos section

Sinusitis treatment

NICE have published new guidelines on the management of acute sinusitis.
They can be found in the
Guidelines section.

EXTRA Care prescriptions at Blaydon

There has been a change in the arrangements to access the emergency prescription pad, details can be seen in the Memos section

Fentanyl

With recent publicity about frug deaths related to Fentanyl, I have added an information sheet produced by Greater Manchester Police. It can be found in the Guidelines section.

Managing diabetic patients during Ramadan

The CCG has just published helpful guidance on helping diabetic patients during Ramadan.
It can be found in the
Memos section

Heroin contaminated with Fentanyl

We have received a warning from Public Health England about this contamination which has lead to deaths amongst drug users.
The warning can be found in the
Memos section.

NHS Urgent Medicines Suppy Advanced Service

This service is an expansion of the pilot we had in the NE last year. The service was commissioned in late November and is on national roll out with NE area having gone live during December 2016.

If a patient has run out of medicines then 111 can signpost them to a pharmacy that has signed up via logging the patient on PharmaOutcomes.
Roughly 600 NE pharmacies signed up to date (out of about 750).
PharmaOutcomes captures - Name, DOB, Postcode but no details re the medicine needed.

The patient then goes to that pharmacy and pharmacist makes a clinical judgement regarding supply within the existing legal framework for emergency supplies - main thing they cannot give is controlled drugs.
If pharmacist supplies they log this on PharmaOutcomes and payment of medicines covered by NHS.
Patient's GP is informed of the supply by NHS mail or physical paperwork going to the practice from the pharmacy.

If they cannot supply, in the OOH period, then patient will be referred back to 111 as they will need to be seen by a GP - this should be a small minority of patients.
If it is in-hours then the pharmacies have been encouraged to do what they can to appropriately sign-post the patients and try to resolve the situation.


GatDOC should see reduced numbers of patients presenting needing a script for medicines they have run out of.
For any patients that do present feedback of what was needed would be useful so that we can let LPC know if anything inappropriate occurs which should have been managed by pharmacy via this service (NUMSAS).

GatDOC cannot log onto PharmaOutcomes and everything should be managed by 111 without any GP OOH involvement.

Advice re Mefloquine

Mefloquine, an anti-malarial, was prescribed to military personnel who were operating or training in Sub-Saharan Africa (not in Iraq or Afghanistan, with few exceptions) over the past 20 years. This NHS England document provides information on what steps should be taken by practices if a patient presents with symptoms relating to the side-effects of Mefloquine.
The document can be found in the Memos section

Pharmacy Opening Times

I have added a note with opening times for the local pharmacies over the Bank Holiday weekend to the Memos section

Prescribing During Passover

This year Passover does not coincide with Easter, it is 4 weeks later.
During Passover the rules about what members of the orthodox community can take are stricter.
I have added general guidance to the Medication section of the handbook

Management of Over-coagulation

We have a new guideline for managing this.
It may be helpful when receiving a call from the labs advising the duty doctor that someone INR result has been recorded as greater than 8.
It can be found in the Guidelines section

Prescribing in Adastra

I hope everyone is getting on okay with the new version of Adastra.
The prescribing screen is slightly different so I have added a quick reference guide to the
Guidelines section.

Letter re Hyoscine

Public Health England has recently published a letter warning about the possible misuse of Hyoscine Butylbromide. Although it is primarily aimed at prison doctors, I am advised that the misuse of Gabapentin started in the community. It can be found in the Memos section

Prescribing

We had our review meeting yesterday.

One of the issues which came up was a relatively high rate of prescribing by brand name, which is expensive. Unlike EMIS, the Adastra system does not automatically do a generic substitution. Please be careful when searching for a medication to do so by generic name rather than brand name unless you specifically need to prescribe that medication by brand.

Please also be careful about quantities of Tramadol, Gabapentin & Pregabalin. The EMIS link is now working and if you click the primary care record tab in Adastra, you can (with the patient's permission) see the GP record; this may help with prescribing of these medications.

We would be grateful if you could keep these matters in mind.

Medicines Issues

Our pharmacist has been reviewing our prescribing and there are a couple of issues which she has noticed. I would be grateful if doctors could read the memo below and ensure they follow the advice.

When writing a purple FP10rec form for a supply made from either the GatDoc cupboard or any of the home visit boxes please try to make sure the drug name, form, strength and quantity is stated. 
It is not necessary to include the batch and expiry date information (for items administered to patients directly e.g. injection, nebule, STAT doses the batch and expiry should be recorded on the Adastra record for audit trail purposes)

If supplying prednisolone, please clearly state "soluble" if it is the soluble that is being supplied. 
NB standard 5mg tablets are in packs of 28, soluble are in packs of 30 and for both clinical audit purposes and due to the large price differential we need to know which has been supplied.

Prescribing during Passover

You may be aware that Passover is coming up for the Jewish community (it is usually around the same time as Easter). During this time the rules around what can be consumed, including medicines, become stricter. I have added a guide to prescribing at this time to the guidelines section of the handbook.

Medicine Stock Changes

We have changed our supplier of medications as it was getting increasingly difficult to obtain the medicines we require in appropriate pack sizes. This has resulted in some changes to stock items. The changes and rationale are appended:

Clarithromycin is new - we should be stocking this in line with local guidelines
Otomize is to replace Locorton Vioform
Prochlorperazine (Buccastem M) is a smaller pack of prochlorperazine allowing the GPs to give a pack with full instructions - please can you advise the GPs to put this on the purple rec forms as "Buccastem M" not the generic drug name
Prednisolone - we are going to start stocking non-soluble tablets as the price difference for the NHS is getting too big for us to keep using the soluble for all.
Topal is to replace Gaviscon

New GMC Prescribing Guidance

The GMC has recently published guidance on good practice in prescribing. It has sections which cover what a doctor should do when the full notes are not available and these are relevant to OOH doctors. The board would encourage all doctors to read the guidance which is in the Guidelines section of the handbook/
On a more positive note, we are hopeful that the Adastra-EMIS link will be restored in the near future.

Prescribing

We had our regular quarterly review meeting with the PCSA recently.
We covered many issues as usual, but some concern was expressed about some of our prescribing.
I have put a memo about prescribing in the Memos section today which covers the issues

Whooping Cough

There has been an increase in the incidence of whooping cough recently. The Health Protection Agency has brought out new guidelines on diagnosis and management, they can be found in the Guidelines section.

New information on opioids and memo

I would like to bring your attention to the new guidelines on prescribing opioids, particularly in palliative care. These can be found in the medication section of the site.
We have just published a memo to all duty doctors covering some issues which we would like all duty doctors to be aware of. It can me found in the memos section.

Strong Opioid Prescribing

New PCT guidelines on use of strong opioids added to Medication page.