Prescribing Advice for GPs

Guidance on Patient Specific Directions

April 22, 2013 at 4:41 pm | In Prescribing Extra - Other |  Print | No Comments

The Medicines and Healthcare products Regulatory Agency has published guidance on patient specific directions (PSDs) in response to a number of enquiries about the use of PSDs in healthcare settings.

The guidance answers some frequently asked questions and includes a definition of a PSD. It also clarifies what information is needed on a PSD, how long they remain valid and the responsibilities and accountabilities of the prescriber who writes the PSD.

Action: Clinicians who make use of PSDs should be aware of this guidance and ensure that use of PSDs is in accordance with this guidance.

BNF 65

April 15, 2013 at 4:09 pm | In Prescribing Extra - Other |  Print | No Comments

The 65th Edition of the British National Formulary has been published and it is currently being distributed in the NHS.

New or revised content in this version includes updated advice in the following areas:

• Updated guidance on pain management in palliative care
• Updated advice on the management of hereditary angioedema
• Revised guidance on the treatment of endocarditis
• Updated advice on the risk of malignancy with long-term use of calcitonin
• Several new drugs or indications have been added

The web version has already been updated but requires registration or an Athens account for continued access. The printed version is available for purchase.

Action: All clinicians should start using BNF 65 as soon as the print version arrives. The web version can be used to access the latest information if necessary.

SMC Update - April 2013

April 8, 2013 at 3:40 pm | In Prescribing Extra - Drugs |  Print | No Comments

The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.

Insulin degludec (Tresiba^®) has been rejected for use in the treatment of diabetes mellitus in adults. The manufacturer failed to make a sufficiently robust economic case.

Insulin glargine (Lantus^®) has been accepted for restricted use in the treatment of diabetes mellitus in adults, adolescents and children aged 2 years and above. The restriction recommends use in patients with Type 1 diabetes when efforts to achieve better glycaemic control result in unacceptable levels of nocturnal hypoglycaemia or to aid carer administration. In patients with Type 2 diabetes use is recommended for patients who experience recurrent episodes of hypoglycaemia or require assistance with their insulin injections.

Timothy grass pollen allergen (GRAZAX^®) has been rejected for use as a disease-modifying treatment of grass pollen induced rhinitis and conjunctivitis in adults and children. The manufacturer failed to make a submission.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

OneTouch Verio glucose meters recalled

April 4, 2013 at 3:25 pm | In Prescribing Extra - Other |  Print | No Comments

The manufacturer of the OneTouch^® Verio^® IQ and OneTouch^® Verio^® Pro blood glucose testing meters have written to healthcare professionals advising that these meters either fail to provide a warning or provide an incorrect result when blood glucose levels are very high. As a result users of both meters are being advised to access a replacement meter.

In the case of the IQ meter, when glucose levels are 56.8mmol/L or above the meter will turn off instead of displaying a message warning the user that their glucose level is extremely high. In the case of the Pro meter, when glucose levels are 56.8mmol/L or above the meter will display an inaccurate reading that is the difference between the actual level and 56.8mmol/L. For example, if the real level is 59.1mmol/L the display would read 2.3mmol/L (59.1-56.8 = 2.3).

Patients can be advised to call 0800 279 9118 to access a replacement meter. Both affected meters use the OneTouch Verio testing strip so it might be prudent to identify patients who are prescribed these strips and advise them accordingly.

Action: Clinicians should be aware of this issue and advise affected patients of the need to obtain a replacement meter.

QOF 2013-14

April 3, 2013 at 1:22 pm | In Prescribing Extra - Other |  Print | No Comments

The turn of the financial year brings into effect several changes to the Quality and Outcomes Framework (QOF). The changes are available in summarised form and there is also a detailed document.

Particular areas of change are:

• Introduction of a new rheumatoid arthritis clinical domain
• Patients with hypertension with elevated cardiovascular risk should be prescribed a statin
• Younger hypertensive patients have a tighter blood pressure target
• Newly diagnosed diabetics should be referred to an education programme
• Men with diabetes should be assessed for erectile dysfunction
• Pulse oximetry should be assessed in COPD patients with an MRC dyspnoea score of 3 or more
• Cancer care reviews must be completed within 3 months of diagnosis
• Depression requires a bio-psychosocial assessment at diagnosis and again at 10-35 days after diagnosis
• 15 month review windows have been reduced to 12 months
• Many payment thresholds have been raised

Action: Clinicians should be aware of these changes and make any necessary changes to clinical practice as soon as possible.