Download What`s New? – Vaccines

NHCCG Prescribing Forum
22nd September 2016
What’s New? – Vaccines (Vaccine update: Issue 248, June 2016
produced by PHE)
REMINDER – changes to the meningococcal C (MenC) vaccination schedule from 1 July
2016. Flyer now available to order.
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Due to the success of the MenC programe the infant dose of MenC that is normally given at three
months of age will be removed from the childhood immunisation schedule from 1 July 2016. The
infant dose of Men C that is given at 12 weeks of age should no longer be given.
• All children will continue to be offered a combined Hib/MenC vaccine when they reach one year
of age.
• This, along with the adolescent MenACWY vaccination, will help to provide protection to infants
and children.
• A flyer (product code 2904568) for parents and healthcare workers to explain these changes to
the MenC programme from 1 July is now available to download or order from the DH Orderline
(https://www.orderline.dh.gov.uk/ecom_dh/public/saleproduct.jsf?catalogueCode=2904568),
and can also be downloaded from the immunisation website
(https://www.gov.uk/government/publications/meningococcal-c-menc-vaccination-leaflet-forparents).
• Additionally, the complete routine and routine childhood schedules have been updated to reflect
this change
(https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/532787/PHE_Com
plete_Immunisation_Schedule_SUMMER2016.pdf).
What’s New? – Safety contd.
Dosulepin
(Medicines Optimisation news headlines July 2016 West Hampshire CCG)
Dosulepin is only licensed for the treatment of depressive illness in adults.
• Although it has been shown to be better tolerated than some alternative antidepressants, this is
outweighed by the increased cardiac risk and toxicity in overdose. NICE CG 90 says that patients
should not be initiated on it, or switched to it from other antidepressants.
• There is still a significant amount of use across all practices in North Hampshire (3,034 items
costing £9,996.02 in last 12months) and prescribers are urged to review any patients who are
taking this agent with the aim of gradually stopping treatment or switching to an alternative
antidepressant.
• Any patients at risk of suicide should be assessed urgently.
• Dosulepin is contraindicated in patients who have had a recent myocardial infarction and in
patients with heart block of any degree or other cardiac arrhythmias. It is also contra-indicated in
mania and in severe liver disease.
• Treatment should not be stopped suddenly unless serious side effects have occurred as patients
may experience unpleasant discontinuation symptoms. Slowly tapering the dose by weekly
reductions of 25-50mg can help prevent this.
• Where an SSRI is indicated, it is suggested that the dose of dosulepin should gradually be reduced
to 25-50mg/day and then the SSRI added at the usual starting dose. The remaining dosulepin
should then be slowly withdrawn over 5-7 days.
• Further information can be obtained from the Medicines Management Team.
What’s New? – savings contd.
DO NOT PRESCRIBE MEDICINES FOR DENTAL CONDITIONS ON FP10
(Medicines Management News Issue 28, July 2016 Midlands & Lancashire CSU)
National BMA and GDC guidance recommend that prescribing of dental products should be via a
dentist. There may be occasions whereby a patient requires dental products to be prescribed by a GP,
as part of an agreed care plan (e.g. mouth and neck cancer patients).
The key points are below:
In support of national recommendations for the treatment of dental pain and infections. It is
recommended that:
•GPs should not accept requests from dentists to prescribe medicines that the dentist could
prescribe.
•GPs should not accept requests from patients to issue FP10 prescriptions for items prescribed on a
private prescription by their dentist during dental treatment as a private patient.
•GPs are advised that dental abscesses must be treated by dentists and that antibiotic prescribing is
not routinely recommended (it is not recommended that GPs prescribe antibiotics while patients
await definitive treatment).
What’s New? – savings contd.
DO NOT PRESCRIBE MEDICINES FOR DENTAL CONDITIONS ON FP10 contd.
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Patients can purchase painkillers, such as paracetamol and ibuprofen, from community
pharmacies while awaiting dental treatment.
Patients should be advised of self-care measures and signposted to purchase over the counter
remedies for dental conditions where appropriate.
This does not affect a GPs ability to prescribe dental products where they are deemed to be an
appropriate part of the care that the GP is providing for a patient, and where the GP is happy to
take responsibility for that prescribing decision.
The Dental Formulary can be found in the BNF and The Drug Tariff; both are available on-line and
in paper versions.
What’s New? – Safety guidelines contd.
Bronchiolitis in children [QS122]
(Medicines Management team of Brent CCG)
This quality standard covers the assessment, diagnosis and management of bronchiolitis in
children.
• 1. Children with bronchiolitis are not prescribed antibiotics to treat the infection:
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Bronchiolitis is caused by a viral infection so antibiotics should not be used as treatment.
The number of children who have bronchiolitis and who then develop a bacterial infection is
extremely low.
Reducing unnecessary antibiotics will help prevent the development of bacterial resistance and will
also reduce costs.
2. Parents and carers of children with bronchiolitis are informed that medication is not being
used because the condition is usually self-limiting.
• 3. Parents and carers of children with bronchiolitis are given key safety information about
what to expect and when to be concerned if caring for the child at home.
https://www.nice.org.uk/guidance/published?fromdate=June%202016&todate=July%202016
What’s New? – Savings
Medicines Optimisation Prescribing Hints and Tips
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Cetirizine tablets
Cetirizine capsules
Betnovate RD® cream & ointment, 100g
Bethamethasone valerate 0.025% cream & ointment
Monuril® sachets 3g
Fosfomycin sachets 3g
Laxido® paed sachets
Movicol®paed sachets
Matoride® XL tabs 18mg, 36mg, 54mg
Concerta® XL tabs 18mg, 36mg, 54mg
Olanzapine orodispersible tabs 5mg, 10mg, 15mg, & 20mg
Olanzapine oral lyophillisates and Zyprexa® Velotabs 5mg,
10mg, 15mg, & 20mg
Rizatriptan odispersible tabs 10mg
Rizatriptan oral lyophillisates 10mg and Maxalt® Melt 10mg
Prednisolone 5mg + 10mg + 20mg (multiples = £10.50)
Prednisolone tablets 25mg (£75 for 56)
Ispaghula husk 3.5g effervescent granules sachets GF SF
Ispaghula husk 3.5g sachet
Venlafaxine modified- release tablets 75mg, 150mg
Venlafaxine modified- release capsules 75mg, 150mg
Tools Available
• Formulary Preferred List
• Scriptswitch
• Posters – Pain, Specials, Emollients, Cost Savings, Polypharmacy
• NHCCG Website
• West Hampshire Website:
– District Prescribing Committee recommendations
– Shared Guidelines, Red List
• [email protected]
• Eclipse System
• Patient Leaflets; antibiotics, self-care, prescribing detail aids
Resources
• MMT Pharmacist and Technician visit: Minimum ONCE a
month. (Remote access to carry out pre-agreed offsite audits)
• Access to Southampton Medicine Information Services
– [email protected]
• Access HHFT medicines Helpline (if queries re discharge meds)
– Dispensary 01962 824442 ,Pharmacy office 01962 824630
– Medicines Helpline 01962 824294 ,Clinical Office 01962 824833
• Community Pharmacy: Free Medicine Use Reviews or New Medicine
Service (will carry out over the phone consultation)
• 2016/17:MMT Recruiting a Nursing Homes Pharmacist to work with
Chris Gunner, Dieticians and medical services.
• An extra -1.2 w.t.e Clinical Pharmacists will support GPs with
Polypharmacy agenda.
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