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Minutes from the Medway and Swale Drugs & Therapeutics Committee
Postgraduate Centre L&D Room EC091
Medway Hospital, Gillingham, Kent, ME7 5NY
Wednesday 17 December 2014 12:00pm - 2:00pm
1. Members
Richard Patey (RP)
Louise Dark (LD)
Oni Odelade (OO)
Bal Minhas (BM)
Yvette Bartlett (YB)
Bukky Francis (BF)
Dr Las Ayathurai (LA)
Korede Ibitoye (KI)
Dr Maam Mamum
Dr Zika Petrovic
In attendance
Gail Simpson
Sylvie Hurst
Dr Suman
Laura Musson
Dr Laza
Sarah Christie (SCh)
Chair; Consultant Paediatrician, Medway Foundation Trust
(MFT)
Chief Pharmacist, MFT
Prescribing Advisor, Medway Clinical Commissioning Group
(CCG)
Prescribing Advisor, Swale Clinical Commissioning Group
Associate Chief Pharmacist – Clinical Services, MFT
Formulary Pharmacist, MFT
GP, Swale CCG
Pharmacist, MCH
Elderly Care Consultant, MFT
Consultant Anaesthetist, MFT
MS Specialist Nurse, MFT
MS Specialist Nurse, MFT
Physician Consultant, MFT
Anti-Microbial Pharmacist, MFT
Microbiologist Consultant, MFT
Pharmacy Secretary
2. Apologies for absence
Manpreet Pujara
3. Matters Arising
4. Minutes of the last meeting held and action points
LD stated to amend the decision for FLUNARIZINE as below:
NOT approved. The committee advised that a business case should be submitted and
pharmacy department will be available to support the process.
Action Log Review
The action log was reviewed – refer to log for updates.
5. Conflict of Interest
None
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6. New Drug Applications / Changes to Current Formulary Status
Bio-Kult Capsules
LM presented the application. BioKult (food supplement) is a probiotic capsule which will
replace Actimel yoghurts as probiotic therapy for the reduction of ‘antibiotic associated
diarrhoea’. The advantages are the capsules are low in sugar and do not require
refrigeration, they can be taken by both gluten and lactose intolerant patients. The capsules
are currently used at DVH and they have no concerns with its use and patients tolerate it
well. Cost is 11p per capsule with the daily recommended prophylactic treatment being two
capsules, totalling 22p per patient per day compared to 58p for Actimel yoghurts. There is
currently no evidence but neither is there for Actimel yoghurts. Pharmacy would store the
capsules and distribute. Antimicrobial policy will be updated if approved.
Decision: APPROVED for hospital use only.
_________________________________________________________________________
Fosfomycin
Dr Laza presented the application. Fosfomycin trometamol will be used for acute
uncomplicated lower UTIs in adults caused by extended spectrum beta-lactamaseproducing bacteria (ESBL) to avoid hospital admissions. The drug is currently unlicensed in
the UK; however several Trusts have started using it for ESBL infections. This was
discussed in detail and the main concern was how to manage the varied cost of the drug in
the community as different chemists will get from different sources and the cost implication
will be significant being an unlicensed product. The option of dispensing from the hospital
pharmacy only was also discussed and patients will have to come into the hospital to collect
the drug. This is the process is thought to be used at EKHT. Estimated patient usage is 100
patients per year.
Decision: Agreed to go on formulary.
Action: Internal guidelines needed and pro-forma/guidelines for GP’s – Antimicrobial
Pharmacist and CCG
_________________________________________________________________________
Ocular Lubricants
Action: OO to compare costs with MTW and bring back to next DTC. MTW to provide
limited list, BF to contact MTW.
7. Guidelines/Pathways
Stroke Care Assessment Pathway
Use on routine drugs. Confirm that a Pharmacist has seen the document.
AKI Policy
Dr Suman explained that Dr Syed will now be leading on the AKI policy and will be
presented to the committee in Feb or March.
High Risk Medication List (for falls)
Dr Suman explained that there is map of medicine for GPs which is already in use and the
high risk medications are the same. It was decided that this will be adjusted to be used by
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both primary and secondary care.
Decision: Agreed to use as a joint document.
Action: Review date to be changed. Logos to be added to individual pathways. To be
uploaded to Formulary website.
DMARDs Guidance
OO met with Dr G George to discuss the DMARD guidance. The following points were
raised.
1. They will prescribe for the first 4-6 weeks providing template document is given
ensuring blood test is carried out by GP.
2. Consultant will see patients within 6 months and review new patients within 6-9
months.
3. Stable patients will be review annually.
4. Monitoring to be replaced with BSR guidance?
Action: OO to contact Service Lead Manager and cc Ann Marie Moore.
_________________________________________________________________________
Process for Anticoagulation Self-testing
Anticoagulation self-testing strips not on formulary. Action: KI to highlight to MCH
_________________________________________________________________________
Constipation Pathway
Dr Suman feels the constipation pathway for adults should also be a shared
guidance/pathway management for both primary and secondary care.
Action: Dr Suman and Miho Ikegami (Elderly Pharmacist) are currently working on the
pathway. To be presented in February at DTC. Draft also needs to go to CCG.
8. PRGC Policies
The policies were noted.
Action: MM1 form to be updated with criteria; BM to speak to Karen
9. Formulary Adherence
BF presented an approved drugs spreadsheet recording drug reviewed within the last 6
months (May 14 to Nov 14). Spreadsheet discussed in detail.
10. MHRA Safety Alerts
Noted
11. NICE
NICE TA 320 – Dimethyl fumarate for treating relapsing-remitting MS
Patients will get the choice of starting oral medication, with better efficacy which does not
need to be injected.
Decision: APPROVED
Action: Review and discuss next meeting once pathway received electronically.
12. Any Other Business
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Never Ever Event
A Never event occurred due to a patient being prescribed and administered oral
Methotrexate 2.5mg daily for the treatment of Rheumatoid Arthritis. This drug should only be
prescribed weekly. The error was identified during drugs reconciliation, after four daily doses
had been given. All medical and nursing staff to be reminded of the Safety Alert which can
be found on the intranet. LD is leading the investigation. It is going to become compulsory
that Junior Doctors are not to prescribe unless competently assessed.
Future DTC Meetings
Agreed future meetings to take place 3rd Wednesday of the month.
Date of next meeting
Wednesday 21st January, 2014 (PG Centre TBC)
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