Minutes of Rotherham Medicines Optimisation Group (RMOG)

Transcription

1 Minutes of Rotherham Medicines Optimisation Group (RMOG) Date/time: Wednesday 3 August, 1pm 3pm Venue: Board Room Chair (Interim): Dr Wareham Minutes: Jill Brown Escalations to Clinical Governance Committee from the meeting on 3 August : 1. Good practice noted on 3 August : 1. 1 Attendance Dr Conrad Wareham (CW) Surinder Ahuja (SA) Professor Al-Wali (WAW) Khuram Amini (KA) Osman Chohan (OC) Stephen Davies (SD) Christina Dezelak (CD) Stuart Lakin (SL) Diana Mowbray (DM) Ruth Roddison (RR) Eloise Summerfield (ES) (Medical Director) (Chair) (Medicines Evaluation Pharmacist) (Minutes) (Consultant Microbiologist) (Oncology Pharmacist) (Chief Pharmacist) (Chief Pharmacist RDASH) (Medicines Information Pharmacist) (Head of Medicines Management RCCG) (Paediatric Pharmacist) (NMP Lead) (Prescribing Advisor (RCCG) In Attendance Apologies Dr Muthusamy (6.1), Mr Faraj (6.2), Sheena Joseph (6.3), Gareth Darnell(13.1), Dr Khandeel (13.1) Ms Susan Douglas, Ellie Monkhouse, Dr Ravi Nalligounder, Dr K Shuker, Carole Taylor Quoracy The meeting was quorate 2 Declarations of interest None declared 3 Minutes of the last meeting Minutes of the last meeting were accepted as a true and accurate record

2 4 Matters arising from last meeting 8.4 Shared Care Protocol: Testosterone The SCP is awaiting comments from Consultant Diabetologists. WAW advised that it should say Consultant Endocrinologists. Agreed that urology approvals have been received and the SCP should be made available for use for urology patientsto amend SCP. To make available for use in Urology patients ES to update CCG website with this SCP for use in urology only by the end of August Extend to include endocrinology when comments received 5. Action log Discussed and updated 6 Formulary Requests 6.1 Secubitril/ valsaratn Dr Muthusamy attended to present a pathway to ensure compliance as requested at the last meeting. Evaluation in six months Invite to present a review paper to RMOG Dr Muthusamy March Ulipristal Acetate (Esmya ) Mr Faraj attended. Ulipristal is currently on the formulary for up to a 3 month treatment pre-operatively for moderate to severe symptoms of uterine fibroids in adult women of reproductive age. To prepare a pathway and guidance for prescribing by GPs Mr Faraj September or October The licensed indication has been extended to include for intermittent treatment of moderate to severe symptoms of uterine fibroids in adult women of reproductive age; up to 18 months course; the intention is for prescribing to be continued after three months by GPs. It was unclear which patients would fit the criteria and should receive this; a pathway was required. Further, GPs can prescribe but would require a guidance. Decision Pending Name of Committee: Drug & Therapeutics Group Page 2 of 8

3 6.3 Budesonide prolonged release tablets (Cortiment ) Sheena Joseph attended. This preparation is licensed for mild to moderate ulcerative colitis. NICE have produced an Evidence Summary: New Medicine for Cortiment and this was presented. Currently Entocort is on the formulary. The Group questioned the need for Cortiment to be included on the formulary and why this was preferable to currently available preparations. The summary from NICE did not recommend this product. More information as to its use and which patients it will be made available to is required before a decision to include on formulary can be made. Resubmission for consideration will be required Closed Decision: Declined 6.4 Enstillar cutaneous foam an alternative to Dovobet gel. Enstilar foam licensed for treatment of psoriasis vulgaris in adults offers an alternative to Dovobet gel at the same price. Significantly improved results at four weeks were seen in one study compared to eight weeks of Dovobet gel. The Group asked whether Enstilar would be used as per the study. SA to ask Consultant Dermatologists. Post meeting: Dermatologists will use the product in accordance with the SPC. The product is for intermittent use. Dermatologists do not usually see patients after 4 weeks. for use in accordance with license. 6.5 Emollient Isomol - an alternative to Doublebase gel This is a much cheaper alternative to Doublebase gel. The CCG have approved its use and currently GPs are prescribing it. Doublebase gel will remain on the formulary for those Name of Committee: Drug & Therapeutics Group Page 3 of 8

4 7 Annual Work Plan 8 Guidelines/ Policies/ Procedures who are currently using it. Decision: 8.1 Anticoagulation Policy: NOACs update 1.Apixaban as first line NOAC: The Anticoagulation/ VTE Group has recommended Apixaban as first line NOAC for indications where warfarin is not appropriate eg treatment of AF, DVT, PE and as extended prophylaxis for elective hip and knee surgery. To communicate the decision to Dr Alfred and the Anticoagulation / VTE Group. 2.Apixaban for Lower limb plaster cast: Dr Reynard was unable to attend the meeting. The Group wanted to know what the evidence and rationale for apixaban was in this setting and why a NOAC was chosen when NICE recommends a low molecular weight heparin. To communicate back to Mr Reynard and Anticoagulation/VTE Group. SA August Decision: Refer to the Anticoagulation/ VTE Group for a discussion and recommendation. 8.2 Shared Care Protocol - Testosterone for Urology use only To update CCG website with this SCP for use in urology only ES August 8.3 Shared Care Protocol Melatonin in Sleep Disorders A proposed agreement between paediatrics and the CCG. Now require input from RDASH. SL/SD September 8.4 Shared Care Protocol The CCG has seen a rise in prescribing cost of OC to meet with Nurse OC September Name of Committee: Drug & Therapeutics Group Page 4 of 8

5 Rifaximin rifaximin over the last year. The reason could be due to the NICE TA last year. Information is lacking as there is no Lead Gastroenterologist in post. Require a trajectory on how we compare to other Trusts in the prescribing of Rifaximin Specialist 8.5 For Information - SOP Methotrexate oral once a week for inpatients Discussed at the Medication Safety Group and for approval at the next meeting. Comments; To make the changes on splitting doses and to seek advice on formatting. OC/SA September Some patients have split doses once a week and this needs to be mentioned. These are Guidelines containing SOPs not an SOP. 8.6 Critical Medicines List new draft Discussed at the Medication Safety Group and for approval at the next meeting. To re-draft in the light of comments. OC/SA October Comments: Extensive list how will this be disseminated to the Trust? Will require re-formatting into user friendly one-two page summary 8.6 Antimicrobial prescribing for patients in the community The Pathway provides guidance on prescribing restricted antimicrobials for patients in the community. Costs will be reclaimed from the CCG by RFT pharmacy need to consider how to re-charge. Principle of the pathway approved OC and SL to discuss and agree detail of arrangements outside of meeting OC/SL Closed 9 PGD s (renewals) 9.1 Breathing Space Salbutamol MDI dose inhaler Salbutamol Nebuliser Solution Name of Committee: Drug & Therapeutics Group Page 5 of 8

6 Prednisolone Ipratropium Doxycycline Amoxicillin 9.2 Radiology Chlorphenamine 9.3 Ophthalmology Eye drops for surgery Tropicamide 1% eye drops Proxymetacaine eye drops 9.5 PGD new Acute Pain Team: Lidocaine 4% w/w cream (LMX 4 ) 9.6 Patient Specific Direction for the administration of Tuberculin PPD TB Nurse This is a Nurse led service. The doctor to preauthorise prescription 10 Formulary Issues 10.1 Liothyronine CCG has classed this drug as RED Posaconazole CCG has classed this drug as RED Medicine shortages For information: 11 New NICE Guidance To be cross charged to NHS England. Diamorphine 5mg Injection and Diamorphine 10mg Injection 11.1 Technology Appraisals Distribution report to Lead Implementer received for May 12 Bulletins/ Newsletters Name of Committee: Drug & Therapeutics Group Page 6 of 8

7 12.1 MHRA Drug Safety Updates June and July Newsletter. To be disseminated to all consultants 12.2 Horizon Scanning July Newsletter 13 Quality 13.1 Discussed in the Medication Safety Group Humulin R U- 500 insulin a Patient Safety Alert was circulated Paracetamol oral dose for underweight patients a meeting has been arranged to finalise the advice as part of Regulation 28 action plan. To use the online e-bnf and e-bnfc available via the Medicines Formulary icon on each desktop at TRFT only a Patient Safety Alert was circulated Administration of medicines by paramedics in A&E Paramedic represented by Gareth Darnell in attendance. To bring back to the next meeting. OC/GD September Requesting permission to administer supplied list of medicines alongside PGDs. This is interim measure until paramedics are allowed to train to prescribe. To ensure that the paramedic service works with local guidance in A&E and is consistent with all staff working practices in A&E. Decision: Pending 14. Minutes of Sub Groups Minutes of Antimicrobial Stewardship Group Medication Safety Group Minutes June Noted 15. Minutes of other Groups DONCASTER and BASSETLAW AREA PRESCRIBING COMMITTEE - April/May/June Noted Barnsley APC Report -June Noted Name of Committee: Drug & Therapeutics Group Page 7 of 8

8 16 Items approved by Chair outside of the meetings 16.1 Rasburicase for Tophaceous gout 16.2 Ustekinumab for induction of remission and maintenance of Crohn's disease and to treat the Psoriasis 17 Items for escalation None 18 Any other business None 19 Date of next meeting 7 th September 1pm 3pm in the Pharmacy Seminar Room Name of Committee: Drug & Therapeutics Group Page 8 of 8