Download Date - Sussex Partnership NHS Foundation Trust

Minutes
Date:
Time:
Subject:
Venue:
Chair:
Tuesday 26th January 2016
2 - 4.30pm
Drugs & Therapeutics Group
Main Meeting Room, Mill View Hospital
Jed Hewitt, Chief Pharmacist - Governance
Minuted By:
Ray Lyon
Present:
Jed Hewitt, Ray Lyon, Dr James Fallon, Sue Wallace, Helen Idle, Jayne Bruce,
Ashleigh Bradley, Jules Haste, Trudie Morgan, Wendy Harlow, Dr Richard
Whale, Phil Foster, Dr Dan Hume
1. Apologies:
Paul Wilson, Fionnuala Plumart, Dr Doug Handyside, Dr Birbal Chopra, Jane
Tatum
2.
Minutes of the Meeting held on 26th October 2015 were agreed and
approved as a correct record.
3.
Declaration of Conflicts of Interest
Ray Lyon
Funding for adherence training on-line.
Sponsorship for Regional Chief
Pharmacists’ meeting - organized and
chaired as part of a rota of chief
pharmacists.
Lundbeck
Lundbeck
Dr Richard Whale
Article prep. Consultation.
Speaker consultation
Speaker consultation
Sunovion
Lundbeck
Jannsen
All other attendees had nothing to declare.
4.
Update on items previously discussed and brought forward:
4.1
Terms of Reference
Item complete. Document available on Trust website.
4.2
Metformin for the reduction of weight gain/prevention of diabetes in
patients being treated with antipsychotics.
 Agreed Ray Lyon would produce evidence for our specialists to share
with GPs if they want more information when suggested that it may be
beneficial for a patient.
 Richard Whale to send a new review to Ray.
4.3
New Drug Application Process
Item complete. Document available on Trust website.
4.4
Proposal to restrict the Trust’s Formulary choice of non-reversible
monoamine-oxidase inhibitor (MAOI) antidepressant to phenelzine
Item complete. Document available on Trust website.
4.5
NICE NG15: Antimicrobial stewardship: systems and processes for
effective antimicrobial medicine use
Item complete. Following further discussion and agreement at Pharmacy
Forum, new (DoH) resources are available on the Trust website.
RL
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4.6
NICE Guidance:
NG17: Type 1 diabetes in adults: diagnosis and management.
NG18: Diabetes (type 1 and type 2) in children and young people:
diagnosis and management
NG19: Diabetic foot problems: prevention and management.
Item complete. Documents available on Trust website. (Physical health).
4.7
Guidelines for prescribing and monitoring anticoagulant therapy
Item complete. Documents available on Trust website.
4.8
GP Resource Pack (antipsychotics in dementia) and Guidelines for
treating Behavioural & Psychological Symptoms of Dementia
Item complete. Documents available on Trust website.
4.9
Guidelines for prescribing and monitoring anti-diabetic therapy
Item complete. Documents available on Trust website.
4.10
Guidelines for treatment of ADHD in adults
Item complete. Documents available on Trust website.
4.11
Guidance on Managing Patients with Musculoskeletal Disorders
Item complete. Documents available on Trust website.
4.12
Guidelines for the Secondary Prevention of Osteoporotic Fragility
Fractures in Post-Menopausal Women
Item complete. Documents available on Trust website.
4.13
Protocol to allow nursing staff to organize leave medication for informal
patients
Item complete. Documents available on Trust website.
4.14
Guidelines for the use of hypnotics and for the use of benzodiazepine
anxiolytics on adult inpatient units
Item complete. Documents available on Trust website.
5.
Formulary and Related Prescribing Guidance
5.1
Coastal West Sussex CCG Prescribing Agreement
Will be completed before the next DTG meeting.
5.2
5.3
PF / RL
Proposal to switch stable patients from Concerta XL to Matoride XL as
well as new patients and those having dose changes that need a 12 hour
XL preparation
 Approved following CAMHS subgroup’s approval.
 Ray Lyon will share with the clinical commissioning groups.
RL
Vortioxetine for the treatment of major depressive episodes that have not
responded to two antidepressants
 Supported for 3rd line and to recommend ‘green’ status to the clinical
commissioning groups – ie for initiation / use in both primary and
secondary care settings.
 To go to next Coastal West Sussex APC meeting initially.
(Post meeting note – The Coastal West Sussex APC have approved its
use as ‘blue’, meaning initiation by a specialist only. This decision was
made because NICE approved its use for a first or recurrent major
depressive episode only.)
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5.4
Guanfacine for the treatment of ADHD in children and adolescents 6-17
years old for whom stimulants are not suitable, not tolerated or have
been shown to be ineffective.
 Expecting NICE TA in March 2016. This will help decision making in
April if published in time.
 CAMHS DTG sub-group have recommended it is not used prior to the
NICE publication.
 Nice TA for review at next meeting.
6
Nice – New Technological Appraisal Guidance & Clinical Guidelines
6.1
NG10: Violence and aggression: short-term management in mental
health, health and community settings
And
NG11: Challenging behaviour and learning disabilities: prevention and
interventions for people with learning disabilities whose behaviour
challenges
 The RT Policy will come back to next meeting as more work needs to
be done including:
 Piloting the Broset violence management tool on Pavilion ward and
Woodlands unit.
 Arrange pilot of the new physical health monitoring checklist on Pavilion
and Woodlands.
 Agreed to remove Acuphase® section from the document.
 Learning Disabilities section to be added.
 Some other suggested minor changes to be made.
6.2
NG22: Older people with social care needs and multiple long-term
conditions
Agreed no action necessary as no direct impact on Trust medicines use.
6.3
NG23: Menopause: diagnosis and management
Agreed no action necessary as no direct impact on Trust medicines use.
6.4
NG24: Blood transfusion
Agreed no action necessary as no direct impact on Trust medicines use.
6.5
NG25: Pre-term labour and birth
Agreed no action necessary as no direct impact on Trust medicines use.
6.6
NG26: Children’s attachment: attachment in children and young people
who are adopted from care, in care or at high risk of going into care
Agreed no action necessary as no direct impact on Trust medicines use.
6.7
NG27: Transition between inpatient hospital settings and community or
care home settings for adults with social care needs
 Agreed Jane Bruce to take to the nurse leadership meeting for review.
 Ray Lyon to put an article in the Drugs & Therapeutics newsletter on
reminding patients to get further medication supplies, after discharge,
from their GP.
6.8
6.9
GB / JHe
JHe
JHa/TM
JHa/TM
TM
TM
TM
JB
RL
NG28: Type 2 diabetes in adults: management
Agreed that this is a Physical Health resource and should be added to the
same website section as those documents listed in agenda item 4.6
JB
NG28: Intravenous fluid therapy in children and young people in hospital
Agreed no action necessary as no direct impact on Trust medicines use.
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6.10
NG30: Oral health promotion: general dental practice
Agreed no action necessary as no direct impact on Trust medicines use.
6.11
NG31: Care of dying adults in the last days of life
 Trust will be championing this through Lindridge Care Home.
 The final resource will be available on Susie under the physical health
resources section. (Jane Bruce to action)
6.12
to
6.21
Agreed no action necessary in regard to the following TAs as they do not
impact on Trust medicines use:
and
6.23
to
6.29
TA357: Pembrolizumab for treating advanced melanoma after disease
progression with ipilimumab
TA358: Tolvaptan for treating autosomal dominant polycystic kidney
disease
TA359: Idelalisib for treating chronic lymphocytic leukaemia
TA360: Paclitaxel as albumin-bound nanoparticles in combination with
gemcitabine for previously untreated metastatic pancreatic cancer
TA361: Simeprevir in combination with sofosbuvir for treating genotype 1
or 4 chronic hepatitis C (terminated appraisal)
TA362: Paclitaxel as albumin-bound nanoparticles with carboplatin for
untreated non-small-cell lung cancer (terminated appraisal)
TA 363: Ledipasvir-sofosbuvir for treating chronic hepatitis C
TA364: Daclatasvir for treating chronic hepatitis C
TA365: Ombitasvir-paritaprevir-ritonavir with or without dasabuvir for
treating chronic hepatitis C
TA366: Pembrolizumab for advanced melanoma not previously treated
with ipilimumab
TA368: Apremilast for treating moderate to severe plaque psoriasis
TA369: Ciclosporin for treating dry eye disease that has not improved
despite treatment with artificial tears
TA370: Bortezomib for previously untreated mantle cell lymphoma
TA371: Trastuzumab emtansine for treating HER2-positive, unresectable
locally advanced or metastic breast cancer after treatment with
trastuzumab and a taxane
TA372: Apremilast for treating active psoriatic arthritis
TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating
juvenile idiopathic arthritis
TA374: Erlotinib and gefitinib for treating non-small-cell lung cancer that
has progressed after prior chemotherapy
6.22
TA367: Vortioxetine for treating major depressive episodes
See agenda item 5.3
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7.
Clinical Policies, Protocols and Guidance
7.1
Insulin Prescription & Administration Record
 It has been trialled and well received.
 Approved for use & to be printed on green card.
 The pharmacy team will support introduction.
7.2
Community Long-Acting Injection Chart
The update was approved.
8.
Medication related Audits
8.1
POMH-UK Audits
Updated timetable for national audits accepted for information.
8.2
Covert Administration Audit – report.
Accepted with no requests for further information or comment.
8.3
Pharmacy Intervention Audit – report.
Concerns were raised about allergy box completions and the current
availability of the “not yet ascertained” response. It was agreed to review this
part of the chart again with KSS colleagues.
9.
Finance and Drug Budgets
No report provided by Finance and no concerns raised.
10
Horizon Scanning
10.1
Iloperidone
Noted that this drug for the treatment of schizophrenia in adults is available in
the USA and is currently being considered by the European Medicines Agency.
Expected EU launch is late 2016. It will be reviewed as more information
becomes available.
11.
Patient Information Leaflets
No new submissions or renewals were considered at this meeting.
12.
Group Protocols (MAUPs) & Patient Group Directions (PGDs)
 PGDs for olanzapine (both inpatient and community), diazepam
(community only) and lorazepam (inpatient only) were approved.
 Suggested that now that oral olanzapine is no longer part of the RT
policy, quetiapine be considered as an alternative. Richard Whale to
propose equivalent does of quetiapine as alternatives to the current
10mg (adults under 65) and 5mg (adults over 65) doses of olanzapine.
13.
Drug Safety Updates from the MHRA
Noted that the content of the alerts issued in October, November and
December did not impact on Trust prescribing and/or other areas of clinical
practice. Therefore no action necessary.
14.
CAMHS Drugs & Therapeutics Sub Group
Received verbal confirmation that Matoride proposal had been approved at the
sub-group meeting in January. (Minutes not yet available).
15.
HMP Ford and HMP Lewes Drugs & Therapeutics Committees
Minutes of the Lewes prison sub-group meeting in November received.
No comments or concerns.
RL
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16.
Any other business
Jane Bruce reported that the Trust is progressing the needle-safe initiative and
that all non-safe products will be taken off the catalogue. Also that a new
needle-safe protocol has been prepared and will be launched at a series of
Trust events. It was agreed that information / aide memoires could be handed
out to nursing staff at the Medicines Management training days run by
pharmacy staff.
Confirmation of next 4 meetings:
(All 2pm til 4.30pm in Mill View main meeting room)




Monday 25th April 2016
Tuesday 26th July 2016
Monday 31st October 2016
Monday 30th January 2017
Distribution: Members of the Drugs & Therapeutics Group
Trust Consultants
Trust Service Directors
Trust Quality Directors & Clinical Directors
Chief Pharmacists of NHS acute care Trusts in Sussex
Prescribing Leads and Chief Pharmacists of CCGs in
Sussex (and where appropriate, others where Trust
services are provided)
Non-medical Prescribers via NMP Lead
Trust website
Contact:
Jed Hewitt, 01323 444108 or Ray Lyon, 07833 527412
Chief Pharmacists
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