Monitoring of patients prescribed lithium
|
|
- Earl Clark
- 6 years ago
- Views:
Transcription
1 POMH-UK Topic 7 Monitoring of patients prescribed lithium Please use the following to cite this report: Prescribing Observatory for Mental Health (2009). Topic 7 baseline report. Monitoring of patients prescribed lithium: baseline. Prescribing Observatory for Mental Health, CRTU069 (data on file).
2 Clinical background Lithium is licensed for the treatment of bipolar affective disorder and depression. Essentially it is used in three situations the acute treatment of mania, prophylaxis in bipolar disorder and to augment antidepressants in treatment refractory recurrent depression. Its use for these indications is supported by the NICE guidelines for depression (NICE, 2004) and bipolar disorder (NICE, 2006). Lithium also appears to protect against suicidality in both unipolar depression (Guzzetta et al, 2007) and bipolar illness (Goodwin et al, 2003). In addition, lithium is licensed for the treatment of aggressive or self-mutilating behaviour, and is occasionally used to increase the white blood cell count in patients who take clozapine (Paton, 2005). For most patients, lithium is a long-term treatment; in patients with bipolar disorder, it is recommended that lithium should be taken for at least 3 years (Goodwin, 1994). The side-effect profile of lithium is well established. Common side-effects include an upset stomach, fine tremor, polydipsia (thirst), polyuria (passing more urine than usual; Movig et al, 2003; Livingstone & Rampes, 2006), weight gain (Sachs et al, 2006; Livingstone & Rampes, 2006) and hypothyroidism (underactive thyroid). Lithium has a narrow therapeutic range, that is, there is a small margin between an effective dose and a toxic one. The therapeutic range is generally accepted to be mmol/L; blood should be taken 12 hours after the last dose. The lower end of this range is used for elderly and infirm patients, and the upper end for younger patients, particularly those being treated for an episode of mania. For the long-term treatment of bipolar disorder, Severus et al (2008) concluded from the available evidence that the optimal serum level range for lithium was between mmol/l, but that when initiating long-term treatment, clinicians should aim for levels of mmol/l, with higher levels possibly being of benefit for patients with predominantly manic symptoms. There is little information to guide choice of lithium level when it is used in treatment refractory depression or its other indications. If the concentration of lithium in the blood is too high, blurred vision, muscle weakness, coarse tremor, slurred speech, confusion, seizures and renal damage may all occur. All patients who take lithium should have regular blood tests to ensure that the amount of lithium in their blood is within the therapeutic range. Lithium is an element, so unlike the majority of drugs is not metabolised by the liver; it is almost wholly excreted in the urine. Any changes in kidney (renal) function, fluid balance (such as dehydration) or electrolyte levels (such as a low level of sodium in the blood - hyponatraemia), can potentially lead to lithium accumulation which in turn can lead to renal damage and toxicity. All patients who receive treatment with lithium should have their renal function (electrolytes and creatinine/e-gfr) checked regularly. Lithium treatment increases the risk of clinical hypothyroidism up to 5-fold, the risk being particularly high in women who are years of age (Johnston & Eagles, 1999). The effects of lithium on the thyroid are complex; lithium is thought to interfere with iodine uptake, alter the structure of thyroglobulin,
3 decrease the release of T4, inhibit the peripheral conversion of T4 to T3 and possibly exacerbate pre-existing autoimmunity (Livingstone & Rampes, 2006). The clinical symptoms of hypothyroidism overlap with those of depression and may therefore remain undiagnosed and untreated unless specific screening tests are undertaken. All patients who receive treatment with lithium should have their thyroid function tests (TFTs) checked regularly. Recommendations for monitoring patients receiving lithium With respect to plasma lithium levels, the NICE guideline for bipolar disorder (2006), Drugs & Therapeutics Bulletin (DTB, 2005), the Summary of Product Characteristics (SPC) for Priadel and the British National Formulary (BNF) all recommend that plasma lithium is checked every 3. The British Association for Psychopharmacology guidelines for bipolar disorder (Goodwin, 2003) recommend every 3-6. With respect to renal and thyroid function, the NICE guideline for bipolar disorder and the DTB recommend that U&Es, creatinine and TFTs are checked every 6, the BNF every 6-12 and the BAP guideline for bipolar disorder recommends every 12. These monitoring recommendations are summarised in the table below. Source Priadel SPC BAP guideline for bipolar disorder 2003 DTB 2005 NICE guideline for bipolar disorder 2006 BNF 2007 Serum lithium -6 Target range (mmol/l) (up to 1.5mmol/L in acute mania) U&Es and TFTs Should be reassessed periodically Every Every mmol/L (Option of up to 1.0) Every 6 (U&Es more often if interacting drugs are co-prescribed) Every 6-12 In primary care, the Quality and Outcomes Framework (QOF) sets targets for the monitoring of patients receiving lithium. The measures collected for each practice are the proportion of patients receiving lithium who have had their TFTs and creatinine checked in the previous 15 (mental health standard 4) and have had a plasma lithium level within the therapeutic range documented in the previous 6 (mental health standard 5). Lithium treatment is commonly associated with weight gain, and given the potential adverse consequences for physical health, it is reasonable to expect that weight/bmi checks will form part of the annual physical examination for patients who receive this treatment.
4 Audit standards 1: The following tests/measures should be completed before initiating treatment with lithium a) Renal function tests; urea and electrolytes (U&Es) including creatinine (or e-gfr or creatinine clearance) b) Thyroid function tests (TFTs) c) Weight or BMI or waist circumference 2: The following tests/measures should be conducted during maintenance treatment a) Serum lithium level every 3 b) U&Es and TFTs every 6 c) Weight or BMI or waist circumference during the last year Monitoring lithium in clinical practice There are a number of published audits of lithium monitoring. These audits cover all care groups; children and adolescents (Craig et al, 2006), adults (Butler & Taylor, 2000), the elderly (Olugbemi & Katona, 1998; Head & Denning, 1998) and people with learning disabilities (Buckley & Sharrand, 2003). All report that practice could be improved. For example, Craig et al (2006) found that a third of patients did not have baseline laboratory tests before lithium was prescribed, Butler & Taylor (2000) that 7% of patients had not had a plasma lithium level measured for over a year and Glover & Lawley (2005) that a third of patients had no recorded results for U&Es or TFTs in the last year. Glover & Lawley (2005) also reported that 75% of patients considered that they had not received enough information about lithium treatment. Despite the recognised need for lithium monitoring, and the availability of national guidelines and Trust prescribing frameworks, local audits tend to find that lithium monitoring is inadequate. Lithium Related Patient Safety Incidents Reported to the National Patient Safety Agency (NPSA) The National Patient Safety Agency (NPSA) is a Special Health Authority which was established in 2001 to coordinate efforts to identify and learn from patient safety incidents. Its roles include the following: Collect and analyse information on adverse events Assimilate other safety-related information Learn lessons and ensure that they are fed back into practice Where risks are identified, to work with partners to produce solutions to prevent harm.
5 How incidents are reported The information the NPSA uses is gathered from a variety of sources, the mainstay of which is the Reporting and Learning System (RLS). This is the system through which anybody can report patient safety incidents to the NPSA, and it is through these reports that it can identify trends and patterns and analyse what is going on throughout the NHS. The RLS is not intended to replace or duplicate the work of the Medicines and Healthcare Regulatory Authority (MHRA) in identifying and/or quantifying adverse reactions to prescribed medicines that are used appropriately in routine clinical practice. The focus of the RLS is to identify systems errors that may be preventable. Reports are received in a number of ways: Local NHS Trusts are linked via local risk management systems to the NPSA and so incidents reported to those trusts are forwarded to the NRLS automatically. Practitioners and staff can choose to report directly to the NPSA using the form on the agency s website, and in this case have the choice whether or not to share that report with their local trust. In the case of large community pharmacy chains, most choose to send reports directly from head office once they have been reported from branches using internal reporting mechanisms. Patients and carers can also report using the web based form. The NPSA also receives information from other agencies such as the Medicines and Healthcare Regulatory Authority, the Healthcare Commission, the NHS Litigation Authority and various professional indemnity organisations such as the Chemist Defence Association and the Medical Defence Union. Finally, the NPSA receives information from international partners all across the world. All of these information sources put together represent a vast array of information from which the NPSA tries to get to the root of what is going wrong and do something about it. The NPSA currently receives up to 100,000 error reports a month from the NHS, and of these up to 10,000 reports a month relate to medication incidents. A review of medication incidents related to the use of lithium reported to the RLS identified a total of 567 incidents. The majority of these incidents were submitted from within mental health services (see table below) Care Setting Total Mental health service 317 Acute / general hospital 160 Learning disabilities 32 Community nursing, medical and therapy service (incl. community hospital) 30 Community pharmacy 23 General practice 5 Total 567
6 Out of the total of 567 incidents, two were identified as resulting in severe harm to the patient, 34 in moderate harm, and the remainder in low or no harm. A further analysis of the RLS data allowed a breakdown by Stage during the medication process. This identified that the administration and prescribing stages are the most prone to error (see table below). Stage During Medication Process Total Administration / supply of a medicine from a clinical area 279 Prescribing 115 Preparation of medicines in all locations / dispensing in a pharmacy 107 Monitoring / follow-up of medicine use 27 Other 29 Advice 10 Total 567 By analysing the data further, a breakdown can be made showing the type of error that has been reported. As can be seen by the data in the table below wrong dose or strength was the most commonly reported type of error. This is consistent with all medication data submitted to the RLS. Medication error type Number Wrong / unclear dose or strength 124 Wrong frequency 77 Omitted medicine / ingredient 71 Wrong drug / medicine 74 Other 70 Wrong quantity 46 Mismatching between patient and medicine 29 Contra-indication 23 Wrong / transposed / omitted medicine label 11 Wrong storage 6 Wrong formulation 7 Adverse drug reaction (when used as intended) 9 Wrong / omitted / passed expiry date 8 Unknown 5 Wrong method of preparation / supply 4 Wrong / omitted patient information leaflet 2 Wrong / omitted verbal patient directions 1 Total 567
7 Perhaps the real learning from reports to the RLS comes from looking at the narrative within the reports. The following are examples of errors relating to the monitoring of lithium that have been reported and are fairly representative of the type of errors that the NPSA receives: 1. Lithium level of 0.97mmol/L treated as normal" in a 61 year old with symptoms of lithium toxicity, as this fell within the local lab range of mmol/l. The patient later developed life threatening toxicity and renal failure. 2. Emergency admission of patient for lithium toxicity in a critical condition. Unfortunately his lithium levels were out of date. The last level (5 old) was within the therapeutic range, hence his lithium was reauthorised. Unfortunately, it appeared his outpatient appointments had been subject to cancellations hence his lithium levels were not being regularly monitored. Patient at time of report was being ventilated. 3. Patient on treatment for depression with lithium which was monitored by his G.P. The lithium level had gone up but it was still within therapeutic levels (but may have been toxic for him). He had a stroke and died. His clinical state may have been worsened by the effects of a high lithium level. The concern was that if the lithium level is not above normal it is not flagged up on the system even though it may have doubled in reality. 4. Patient was seen in community and was diagnosed with lithium toxicity. Lithium levels were three times higher than last time they were checked, and well above therapeutic range. On discovering patient blood results, patient was immediately transferred to A&E before transferring her to the Medical Admissions Unit for treatment for renal failure. 5. Patient on lithium for many years. Discharged on diuretic but lithium dose was not reduced. Readmitted three weeks later with life threatening lithium toxicity. Lithium levels are increased when diuretics are added.
Patient Safety Alert NPSA 2009/PSA005 Safer lithium therapy
Patient Safety Alert NPSA 2009/PSA005 Safer lithium therapy December 2009 Supporting information Contents 1. Overview...2 2. Further details of the actions recommended...2 2.1 Alert actions...2 2.2 Additional
More informationDrug Name: Lithium Clinical Indications: Treatment and prophylaxis of mania; bipolar disorder; augmentation therapy in treatment resistant depression
SHARED CARE PROTOCOL AND INFORMATION FOR GPS Drug Name: Lithium Clinical Indications: Treatment and prophylaxis of mania; bipolar disorder; augmentation therapy in treatment resistant depression Version:
More informationPOMH-UK QUALITY IMPROVEMENT PROGRAMME LITHIUM MONITORING. Thomas R. E. Barnes
POMH-UK QUALITY IMPROVEMENT PROGRAMME LITHIUM MONITORING Thomas R. E. Barnes LITHIUM Evidence-based guidelines support the use of lithium in the prophylaxis of bipolar disorder, protecting against both
More informationSHARED CARE GUIDELINE
SHARED CARE GUIDELINE Title: Lithium Treatment in Adults aged 18-65 years Scope: Pennine Care NHS Foundation Trust NHS Bury NHS Oldham NHS Heywood, Middleton and Rochdale NHS Stockport NHS Tameside & Glossop
More informationLithium Shared Care Protocol and Information for Oxfordshire GPs
Summary Lithium Shared Care Protocol and Information for Oxfordshire GPs 1. Lithium is predominantly used in the following situations: a. The acute treatment of mania b. Prophylaxis in bipolar disorder
More informationMental Health Medicines Management Pilot. Community Pharmacy Lithium Support Service Guidance
Mental Health Medicines Management Pilot Community Pharmacy Lithium Support Service Guidance Approved Version 1 Date of First Issue Review Date Date of Issue Author / Contact Aaron Coulter Group / Committee
More information:Connected care. Norfolk and Suffolk NHS Foundation Trust
:Connected care Norfolk and Suffolk NHS Foundation Trust An off-the-shelf Therapeutic Drug Monitoring system developed by the NHS, for the NHS. Clinicians Hospital GP Nurse Practitioner Requesting Doctor
More informationSTUDY ON LITHIUM MONITORING AMONGST PATIENTS IN A COMMUNITY MENTAL HEALTH AND PRIMARY CARE SETTING IN RURAL ENGLAND
Medicinska naklada - Zagreb, Croatia Conference paper STUDY ON LITHIUM MONITORING AMONGST PATIENTS IN A COMMUNITY MENTAL HEALTH AND PRIMARY CARE SETTING IN RURAL ENGLAND Nicholas Savage 1, Jessica Green
More informationNHS GG&C -Mental Health Services. Lithium Ward Bundle
Lithium Ward Bundle Lithium is a useful drug, particularly in the maintenance treatment of bipolar affective disorder, recurrent depression and self injurious behaviour. It is widely used and most patients
More informationDear Colleagues, NATIONAL STANDARD FOR MONITORING THE PHYSICAL HEALTH OF PEOPLE BEING TREATED WITH LITHIUM
Directorate of Chief Medical Officer T: 0131-244 6930 E: john.mitchell4@gov.scot Dear Colleagues, NATIONAL STANDARD FOR MONITORING THE PHYSICAL HEALTH OF PEOPLE BEING TREATED WITH LITHIUM Lithium is a
More informationNPSA SAFER LITHIUM THERAPY GUIDELINES FOR NHS LANARKSHIRE
NPSA SAFER LITHIUM THERAPY GUIDELINES FOR NHS LANARKSHIRE Implementation Date Spring 2013 Review Date Spring 2016 NPSA Safer Lithium Therapy Guidelines for NHS Lanarkshire BACKGROUND On 1 st December 2009
More informationMERSEY CARE NHS TRUST HOW WE MANAGE MEDICINES. MM11 - High-Dose Antipsychotic Use Guidelines (local guideline) KEY ISSUES
MERSEY CARE NHS TRUST HOW WE MANAGE MEDICINES MM11 - High-Dose Antipsychotic Use Guidelines (local guideline) Medicines Management Services aim to ensure that (i) Service users receive their medicines
More informationpat hways Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16
pat hways Anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs) Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16 Options for local implementation NICE
More informationEssential Shared Care Agreement: Lithium
Ref No. E042 Essential Shared Care Agreement: Lithium Please complete the following details: Patient s name, address, date of birth Treatment (indication, dose regimen, brand name) Monitoring (proposed
More informationFormulary and Prescribing Guidelines
Formulary and Prescribing Guidelines SECTION 3: TREATMENT OF BIPOLAR AFFECTIVE DISORDER This section provides information regarding the pharmacological management of Bipolar affective disorder in secondary
More informationCLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES
National Patient Safety Alert RRR018 Preventing Fatalities From Medication Loading Doses (November 2010) MMCP05 CLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES INTRODUCTION
More informationlithium record book This record book contains information that will also be held in your patient records.
lithium record book This record book contains information that will also be held in your patient records. lithium record book This record book contains information that will also be held in your patient
More informationGREATER MANCHESTER INTERFACE PRESCRIBING GROUP
GREATER MANCHESTER INTERFACE PRESCRIBING GROUP On behalf of the GREATER MANCHESTER MEDICINES MANAGEMENT GROUP SHARED CARE GUIDELINE FOR THE PRESCRIBING OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
More informationBNSSG Shared Care Guidance Please complete all sections
NHS Bristol NHS North Somerset NHS South Gloucestershire North Bristol NHS Trust University Hospitals Bristol NHS Foundation Trust Weston Area Health NHS Trust BNSSG Shared Care Guidance Please complete
More informationCLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES
National Patient Safety Alert RRR018 Preventing Fatalities From Medication Loading Doses (November 2010) CP11 CLINICAL PROTOCOL THE PREVENTION OF FATALITIES FROM MEDICATION LOADING DOSES INTRODUCTION The
More informationLithium Therapy. Record book
Lithium Therapy Record book Record book This record book contains information that will also be held in your patient record. Take this record book with you each time you: - see your GP; - attend a clinic;
More informationLithium Good Practice Standards
Lithium Good Practice Standards Safe Lithium Treatment Scope This document is intended to support the safe use of lithium in mental health services including Forensic and Learning Disability services across
More informationClinical. High Dose Antipsychotic Prescribing Procedures. Document Control Summary. Contents
Clinical High Dose Antipsychotic Prescribing Procedures Document Control Summary Status: Version: Author/Owner/Title: Approved by: Ratified: Related Trust Strategy and/or Strategic Aims Implementation
More informationBuccal Midazolam For the treatment of prolonged epileptic seizures, clusters of epileptic seizures and status epilepticus.
Oxfordshire Clinical Commissioning Group, Oxford University Hospitals NHS Trust and Oxfordshire Health NHS Foundation Trust Shared Care Protocol and Information for GPs Buccal Midazolam For the treatment
More informationLithium continuing care guideline summary (refer to full guidelines for further information)
Lithium continuing care guideline summary (refer to full guidelines for further information) Formulary status YELLOW: Specialist initiation with GPs continuing care once patients are on a stable dose Lithium
More informationMedicine Errors. H.Beadle, L.Baxendale, Clinical Governance Pharmacists. Coventry and Warwickshire Partnership Trust Medicines Management Team
Medicine Errors H.Beadle, L.Baxendale, Clinical Governance Pharmacists Coventry and Warwickshire Partnership Trust Medicines Management Team 2015 Why Should Errors Be reported? Learning Prevention of future
More informationProcedure Reviewed By: Narinder Sangha Deputy Chief Pharmacist STANDARD OPERATING PROCEDURE
Written By: Objective By: ed By: To ensure safe and consistent working practice throughout Black Country Partnership Foundation Trust (BCPFT) and to avoid unnecessary harm to patients on lithium therapy
More informationBarns Medical Practice Service Specification Outline: Hypothyroidism
Barns Medical Practice Service Specification Outline: Hypothyroidism DEVELOPED March 2015 REVIEW August 2019 Introduction The thyroid is a gland in the neck which makes two thyroid hormones, thyroxine
More informationDeveloped By Name Signature Date
Patient Group Direction 2155 version 2.0 Administration / Supply of Inhaled Salbutamol in Asthma by Registered Practitioners employed by Torbay and South Devon NHS Foundation Trust Date of Introduction:
More informationPOLICY DOCUMENT. Pharmacy MMG/MPG. Approved By and Date Medicines Management roup March March 2016
POLICY DOCUMENT Document Title High dose and combination antipsychotic guidance Reference Number n/a Policy Type Prescribing and Treatment Guideline Electronic File/Location Clinical Resources/Pharmacy/Prescribing
More informationNAS NATIONAL AUDIT OF SCHIZOPHRENIA. Second National Audit of Schizophrenia What you need to know
NAS NATIONAL AUDIT OF SCHIZOPHRENIA Second National Audit of Schizophrenia What you need to know Compiled by: Commissioned by: 2 October 2014 Email: NAS@rcpsych.ac.uk The National Audit of Schizophrenia
More informationAREAS OF RESPONSIBILITY FOR THE SHARING OF CARE
Effective Shared Care Agreement (ESCA) Midodrine ESCA: For the treatment of severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been ruled out and other forms of treatment
More informationfor adults engaged with the Family Wellbeing Service Isle of Wight In Community Pharmacy for Isle of Wight Public Health Commissioned Services
The supply of Champix (Varenicline) Tablets 500mcg and 1mg by registered community pharmacists for smoking cessation / management of nicotine withdrawal for adults engaged with the Family Wellbeing Service
More informationThe Prescribing Observatory for Mental Health 10-year report. Supporting rational, effective and safe prescribing in mental health services
The Prescribing Observatory for Mental Health 10-year report Supporting rational, effective and safe prescribing in mental health services Authors: Professor Thomas Barnes and Carol Paton Joint-heads of
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationShared Care Guidance. Vigabatrin
North of Tyne Area Prescribing Committee Shared Care Guidance Vigabatrin July 2014 (Review date July 2016) This guidance has been prepared and approved for use in Newcastle, North Tyneside and Northumberland.
More informationSHARED CARE GUIDELINE FOR LITHIUM. 1. Aim/Purpose of this Guideline. 2. The Guidance
SHARED CARE GUIDELINE FOR LITHIUM 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical, nursing and pharmacy staff in the safe and appropriate prescription and administration of lithium.
More informationBNSSG Shared Care Guidance Please complete all sections
NHS Bristol CCG NHS North Somerset CCG NHS South Gloucestershire CCG North Bristol NHS Trust University Hospitals Bristol NHS Foundation Trust Weston Area Health NHS Trust BNSSG Shared Care Guidance Please
More informationPrescribing for substance misuse: alcohol detoxification. Clinical background
Prescribing for substance misuse: alcohol detoxification POMH-UK Quality Improvement Programme. Topic 14a: baseline Clinical background 1 2014 The Royal College of Psychiatrists. For further information
More informationA LITHIUM REGISTER FOR ADULTS WITH INTELLECTUAL DISABILITIES - CAN IT WORK?
The British Journal of Developmental Disabilities Vol. 53, Part 1, JANUARY 2007, No. 104, pp. 37-45 A LITHIUM REGISTER FOR ADULTS WITH INTELLECTUAL DISABILITIES - CAN IT WORK? Sabyasachi Bhaumik, Joanna
More informationPROCEDURE REFERENCE NUMBER SABP/EXECUTIVE BOARD/0017/PROCEDURE15 PROCEDURE NAME MEDICINES PROCEDURE 15: METHOTREXATE
PROCEDURE REFERENCE NUMBER SABP/EXECUTIVE BOARD/0017/PROCEDURE15 PROCEDURE NAME MEDICINES PROCEDURE 15: METHOTREXATE BRIEF OUTLINE OF THIS PROCEDURE This procedure sets out the requirements for prescribing,
More informationAtomoxetine Effective Shared Care Agreement For Attention Deficit Hyperactivity Disorder (ADHD)
Atomoxetine Effective Shared Care Agreement For Attention Deficit Hyperactivity Disorder (ADHD) Section 1: Shared Care arrangements and responsibilities Section 1.1 Agreement to transfer of prescribing
More informationMedicines Optimisation Strategy
Clinical Reducing Dosing Errors with Opioid Medicines (Controlled Drug SOP): Document Control Summary Status: Version: Author/Owner/Title: Approved by: Ratified: Related Trust Strategy and/or Strategic
More informationPrescribing antipsychotics for children and adolescents
POMH-UK Topic 10a baseline report Prescribing antipsychotics for children and adolescents September 2010 Prepared by the Prescribing Observatory for Mental Health-UK for Coventry and Warwickshire Partnership
More informationDocument Details. Ibuprofen 200mg tablets and Ibuprofen oral liquid 100mg in 5ml
Title Document Details Patient Group Direction (PGD) Ibuprofen 200mg tablets and Ibuprofen oral liquid 100mg in 5ml Trust Ref No 1445-36348 Local Ref (optional) Main points the document The treatment of
More informationShared Care Guideline Metolazone for fluid management in CKD (Adults)
Shared Care Guideline Metolazone for fluid management in CKD (Adults) It is vital for safe and appropriate patient care that there is a clear understanding of where clinical and prescribing responsibility
More informationNICE Clinical Guideline 169 Acute Kidney Injury Local Implementation Gap Analysis
NICE Clinical Guideline 169 Acute Kidney Injury Local Implementation Gap Analysis Please tick appropriate box in response to questions below and return to Michelle Timoney (michelle.timoney@nhs.net) by
More informationA themed review of patient safety incidents involving anti-cancer medicines 1 November June 2008
A themed review of patient safety incidents involving anti-cancer medicines 1 November 2003 30 June 2008 October 2010 Executive Summary National Patient Safety Agency 2010. Copyright and other intellectual
More informationStandards of Lithium Treatment Monitoring In a Teaching Hospital in South India among Bipolar Affective Disorder
The International Journal of Indian Psychology ISSN 2348-5396 (e) ISSN: 2349-3429 (p) Volume 5, Issue 1, DIP: 18.01.098/20170501 DOI: 10.25215/0501.098 http://www.ijip.in October-December, 2017 Original
More informationAvoiding harm in primary care
Avoiding harm in primary care Liz Price senior risk adviser Session content Claims of negligence What are they? duty of care liability / causation timescales defence What are the common causes? analysis
More informationLithium Prescribing and Monitoring Guidelines
Lithium Prescribing and Monitoring Guidelines When using this document please ensure that the version you are using is the most up to date either by checking on the Trust intranet or if the review date
More informationPolicy on Pharmacological Therapies Practice Guidance Note Reducing Dosing Errors with Opioid Medicines V04
Policy on Pharmacological Therapies Practice Guidance Note Reducing Dosing Errors with Opioid Medicines V04 Date issued Issue 1 Nov 2018 Planned review Nov 2021 PPT-PGN 18 part of NTW(C)38 Pharmaceutical
More informationMethylphenidate Shared Care Agreement For attention deficit hyperactivity disorder (ADHD) in adults Effective Shared Care Agreement
Methylphenidate Shared Care Agreement For attention deficit hyperactivity disorder (ADHD) in adults Effective Shared Care Agreement Section 1: Shared Care arrangements and responsibilities Section 1.1
More informationIdentifying and reducing medication errors in mental health
Identifying and reducing medication errors in mental health Hilary Scott Chief Pharmacist South Essex Partnership University NHS Trust with valuable input from Ian Maidment, Senior Lecturer in Clinical
More informationESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride (South Staffordshire Only)
E099 ESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride (South Staffordshire Only) NOTE: Please complete details on P1 &3 Send one copy to GP, Patient and
More informationDepression: selective serotonin reuptake inhibitors
Depression: selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression. citalopram and fluoxetine
More informationMMG004 GUIDELINES FOR THE USE OF HIGH DOSE VENLAFAXINE AND THE COMBINATION OF VENLAFAXINE AND MIRTAZAPINE IN THE TREATMENT OF DEPRESSION
MMG004 GUIDELINES FOR THE USE OF HIGH DOSE VENLAFAXINE AND THE COMBINATION OF VENLAFAXINE AND MIRTAZAPINE IN THE TREATMENT OF DEPRESSION Page 1 of 13 Table of Contents Why we need this Guideline... 3 What
More informationShared Care Agreement for Donepezil
ESCA: for the treatment of Alzheimer s disease SECONDARY CARE SECTION TO BE COMPLETED BY INITIATING DOCTOR Patient s Name: Date of Birth: NHS Number: ESCA Date: One copy of information leaflet given to
More informationNorth of England Cancer Network. Policies and Procedures. Standards for the Safe Use of Oral Anticancer Medicines
\ North of England Cancer Network Policies and Procedures Standards for the Safe Use of Oral Anticancer Medicines NECN Oral Anticancer medicine Policy version 1.6 Page 1 of 17 Issue Date: Feb 2017 Contents
More informationSmoking Cessation Pharmacotherapy Guidelines
Smoking Cessation Pharmacotherapy Guidelines INTRODUCTION This guideline is based on public health guidance 10 Smoking Cessation Services issued by the National Institute for Health and Clinical Excellence
More informationIEHP UM Subcommittee Approved Authorization Guidelines Electroconvulsive Therapy- ECT
Electroconvulsive Therapy- ECT Policy: IEHP considers ECT medically necessary for members with the following disorders: 1. Unipolar and bipolar depression. 2. Bipolar mania. 3. Psychotic disorders including
More informationInformation leaflet for primary care: Agomelatine
Information leaflet for primary care: Agomelatine Background information Agomelatine is an antidepressant indicated for the treatment of major depressive episodes in adults. Agomelatine is a melatonin
More informationLow back pain and sciatica in over 16s NICE quality standard
March 2017 Low back pain and sciatica in over 16s NICE quality standard Draft for consultation This quality standard covers the assessment and management of non-specific low back pain and sciatica in young
More informationWest Suffolk Clinical Commissioning Group (WSCCG) Safety audit for methotrexate prescribing for patients in primary care
West Suffolk Clinical Commissioning Group (WSCCG) Safety audit for methotrexate prescribing for patients in primary care Year 2013-2014 Safety 100% of patients prescribed oral methotrexate should have
More informationQuality, Safety and Sourcing in Unlicensed Medicines
Quality, Safety and Sourcing in Unlicensed Medicines with Andrew Trouton Managing Director, UL Medicines Agenda Welcome What is an unlicensed medicine? When should you consider using an unlicensed medicine?
More informationESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride or Asenapine
Ref No: E053 ESSENTIAL SHARED CARE AGREEMENT FOR Risperidone, Olanzapine, Quetiapine, Aripiprazole, Amisulpride or Asenapine NOTE: Please complete details on P1 &3 Send one copy to GP, Patient and file
More informationElements for a Public Summary. VI.2.1 Overview of disease epidemiology
VI.2 Elements for a Public Summary VI.2.1 Overview of disease epidemiology Schizophrenia Schizophrenia is a mental disorder often characterized by abnormal social behaviour and failure to recognize what
More informationAdditional information to support. The National Patient Safety Agency s Rapid Response Report Risks of incorrect dosing of oral anti-cancer medicines
Additional information to support The National Patient Safety Agency s Rapid Response Report Risks of incorrect dosing of oral anti-cancer medicines Reference: NPSA/2008/RRR001 - issued on 22 January 2008
More informationFactsheet. Buccolam (midazolam) 10mg in 2mL oromucosal solution. Management of seizures in adult patients
North Central London Joint Formulary Committee Factsheet Buccolam (midazolam) 10 mg in 2 ml oromucosal solution Management of seizures in adult patients Start date: May 2017 Review date: May 2020 Document
More informationSHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR ALCOHOL DEPENDENCE INDICATION
SHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR ALCOHOL DEPENDENCE INDICATION Naltrexone is used as part of a comprehensive programme of treatment against alcoholism to reduce the
More informationPatient Group Directions Policy
Patient Group Directions Policy Category: Summary: Equality Analysis undertaken: Valid From: Date of Next Review: Approval Date/ Via: Distribution: Related Documents: Author(s): Further Information: This
More informationPrimary hypertension in adults
Primary hypertension in adults NICE provided the content for this booklet which is independent of any company or product advertised Hypertension Welcome NICE published an updated guideline on the diagnosis
More informationHigh Dose Antipsychotic Therapy (HDAT) guideline
Document level: Trustwide (TW) Code: MP18 Issue number: 2 High Dose Antipsychotic Therapy (HDAT) guideline Lead executive Medical Director Author and contact number Lead Clinical Pharmacist 01625 663 857
More informationPOLICY FOR THE SAFE USE OF ORAL METHOTREXATE IN SECONDARY CARE. September 2011
POLICY FOR THE SAFE USE OF ORAL METHOTREXATE IN SECONDARY CARE September 2011 WHSCT Policy for the safe use of oral methotrexate in secondary care Page 1 of 8 Policy Title Policy for the safe use of oral
More informationPatient Group Direction for SALBUTAMOL INHALER (Version 02) Valid From 1 October September 2019
Version Control This PGD has been agreed by the following organisations FCMS PDS Medical Doncaster CCG Lancashire CCGs including East Lancashire, Fylde and Wyre and North Lancashire CCGs Change history
More informationDeveloped By Name Signature Date
Patient Group Direction 2156 version 2.0 Administration of Ipratropium 250mcg/ml Nebuliser Solution in Acute Asthma by Registered Practitioners employed by Torbay and South Devon NHS Foundation Date of
More informationSHARED CARE PROTOCOL FOR THE PRESCRIBING AND MONITORING OF MEDICINES FOR ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)
SHARED CARE PROTOCOL FOR THE PRESCRIBING AND MONITORING OF MEDICINES FOR ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) 1. Introduction This protocol describes how patients prescribed medicines for ADHD
More informationPatient Group Direction (PGD)
Patient Group Direction (PGD) Supply of Nitrofurantoin for uncomplicated Urinary Tract Infections in females aged 16 years and over (Telford and Wrekin and Shropshire Pharmacies Only) For the supply of
More informationBipolar Affective Disorder Formulary Guidance [3] (adapted from NICE guideline CG185)
Bipolar Affective Disorder Formulary Guidance [3] (adapted from NICE guideline CG185) 1. Introduction These Guidelines are intended for routine use. However there will be instances where they are not suitable
More informationAcute Kidney Injury. Patient Information Leaflet
Acute Kidney Injury Patient Information Leaflet What is Acute Kidney Injury (AKI)? Acute Kidney injury is a rapid fall in kidney function in a person who has become unwell. It can happen over hours or
More informationIN USE PRODUCT SAFETY ASSESSMENT REPORT FOR COLISTIMETHATE SODIUM
BACKGROUND IN USE PRODUCT SAFETY ASSESSMENT REPORT FOR COLISTIMETHATE SODIUM SUMMARY OF ASSESSMENT AND ITS FINDINGS Colistimethate sodium (colistin sulfomethate sodium) is licensed in the UK to be given
More informationUse of unlicensed medicines and off-label uses
Use of unlicensed medicines and off-label uses 25 Promoting hope and wellbeing together What is this leaflet about? Your doctor or pharmacist has given you this leaflet because a medicine that you have
More informationGuidance on Safe Prescribing of Melatonin for Sleep Disorders in Children, Young People and Adults
Guidance on Safe Prescribing of Melatonin for Sleep Disorders in Children, Young People and Adults Ref: PHARM-0025-v3 Status: FINAL Document type: Guidelines Guidance on Safe Prescribing of Melatonin Page
More informationGwent Shared Care Protocol LITHIUM (BNF section 4.2.3) for all licensed indications (see section 1 below)
Gwent Shared Care Protocol LITHIUM (BNF section 4.2.3) for all licensed indications (see section 1 below) Protocol No. 22 General guidance 1. Licensed indication 2. Therapeutic use & Background information
More informationundiagnosed type 1 diabetes in children is a medical emergency. A Healthcare Professionals guide to an early diagnosis
undiagnosed type 1 diabetes in children is a medical emergency. A Healthcare Professionals guide to an early diagnosis Improving early diagnosis of diabetes in the young How can we diagnose Type 1 diabetes
More informationSHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR OPIOID DEPENDENCE
SHARED CARE GUIDELINE FOR THE MANAGEMENT OF PATIENTS ON NALTREXONE FOR OPIOID DEPENDENCE INDICATION Naltrexone is a pure opiate antagonist licensed as an adjunctive prophylactic therapy in the maintenance
More informationMetformin MR to low cost branded generic (Sukkarto SR) Switch Protocol
Metformin MR to low cost branded generic (Sukkarto SR) Switch Protocol Applies to HaRD CCG employed Pharmacists and Medicines Optimisation Technicians. These protocols are produced by the NY&AWC MM team
More informationWhat s new in the treatment of bipolar disorder?
What s new in the treatment of bipolar disorder? Dr. David Cousins MRC Clinician Scientist Institute of Neuroscience Newcastle University NCMD 2017 What s new in the treatment of bipolar disorder? Dr.
More informationESCA: Cinacalcet (Mimpara )
ESCA: Cinacalcet (Mimpara ) Effective Shared Care Agreement for the Treatment of Primary hyperparathyroidism when parathyroidectomy is contraindicated or not clinically appropriate. Specialist details
More informationSummary of the risk management plan (RMP) for Aripiprazole Mylan Pharma (aripiprazole)
EMA/370707/2016 Summary of the risk management plan (RMP) for Aripiprazole Mylan Pharma (aripiprazole) This is a summary of the risk management plan (RMP) for Aripiprazole Mylan Pharma, which details the
More informationDocument Details. Patient Group Direction
Document Details Title Patient Group Direction (PGD) Salbutamol Aerosol Inhaler and salbutamol Nebulised Solution Trust Ref No 1569-34313 Local Ref (optional) Main points the document Treatment of acute
More informationCommunity alcohol detoxification in primary care
Community alcohol detoxification in primary care 1. Purpose The purpose of this primary care enhanced service is to improve the health and quality of life of people whose health may be compromised by their
More informationTreatment monitoring protocol for Dimethyl fumarate therapy in active Relapsing Remitting Multiple Sclerosis
Treatment monitoring protocol for Dimethyl fumarate therapy in active Relapsing Remitting Multiple Sclerosis This protocol provides monitoring guidance for adult patients requiring Dimethyl fumarate therapy
More informationHow to Refer to Mental Health Services - Making referrals to York and North Yorkshire community adult mental health services
How to Refer to Mental Health Services - Making referrals to York and North Yorkshire community adult mental health services The following guidance has been supplied by Leeds and York Partnership Foundation
More informationTacrolimus (Adoport, Prograf, Modigraf or Advagraf )
Shared Care Guideline DRUG: Tacrolimus (Adoport, Prograf, Modigraf or Advagraf ) for Renal Transplant (Adults) Introduction: Indication: Prophylaxis of transplant rejection in kidney recipients Tacrolimus
More informationAdult Neurodevelopmental Services. ADHD Shared Protocol
Adult Neurodevelopmental Services ADHD Shared Protocol Issue 1: April 2016 1 2 Adult Neurodevelopmental Service Shared Care Protocol for Adult Attention Deficit Hyperactivity Disorder (ADHD) 1. BACKGROUND
More informationAppropriate Use of Prescribed Oral Nutritional Supplement (ONS) in the Community
Appropriate Use of Prescribed Oral Nutritional Supplement (ONS) in the Community Aim This guideline sets out a recommended procedure for the identification and treatment of malnutrition to ensure Oral
More informationNumber of records submitted: 14,750 Number of participants: Part 1 = 146 hospitals (120 trusts); Part 2 = 140 hospitals (119 trusts)
British Thoracic Society Smoking Cessation Audit Report Smoking cessation policy and practice in NHS hospitals National Audit Period: 1 April 31 May 2016 Dr Sanjay Agrawal and Dr Zaheer Mangera Number
More information