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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 RW 1 of 6 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.) 2 of 6 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. 3 of 6 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 4 of 6 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 RW 5 of 6 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 6 of 6