Meeting of the Borders Area Drugs and Therapeutics Committee was held on Wednesday, 11 th July 2012 at p.m. in the Estates Meeting Room.

Transcription

1 Meeting of the Borders Area Drugs and Therapeutics Committee was held on Wednesday, 11 th July 2012 at p.m. in the Estates Meeting Room. MINUTE Present: John Hammond (JH) (Chair), Alison Wilson (AW), Declan Hegarty (DH), Ros Anderson (RA), Liz Leitch (LL), Adrian Mckenzie, Olive Herlihy, Dr Peter Symms (PS), Gavin Gorman (GG), Ed James (EJ), Tom Cripps (TC) Apologies: None Invited to attend: Erica Reeves, Jennifer McDonnell Situation - A concise statement of the problem (What is going on now in relation to agenda item) Background - Pertinent and brief information related to the situation (What has happened) Assessment - Analysis and considerations of options (What your analysis of background information is Current Position/Outcome) Recommendation - Request or recommend action (What you want to be done) Date of Meeting Item No. Situation Background Assessment Recommendation Person Responsible Declaration of Interest: None 3. Draft minute from Minute from previous meeting Read and noted Approved as a true Chair ADTC of for accuracy. record. 4. Matters Arising From Previous Minute: Restricted number of Wards using increasingly out of Admin/BNF BNF s available. date copies. holders. Increase in available BNF s on wards needs to be rectified. Approval has been given to increase our order to cover all clinical areas and to retrieve previous copy when new Timescale 1

2 Lidocaine for localised neuropathic pain. Orlistat to aid weight loss in adults who are overweight (BMI>28kg/m²) Capsaicin for treatment of peripheral neuropathic pain in nondiabetic adults either alone or in combination with other medicinal products for pain. Buprenorphine & Naloxone tabs to replace Buprenorphine in the formulary. (Reduces risk of injection of buprenorphine). Chlordiazepoxide PGD Lofexidine draft PGD Alcohol Chlordiazepoxide detox guideline Opiate detox guidelines with Lofexidine Shortages with Xenical (orlistat) likely to last several months. Approved for up to 60 patients per year. BFC of Approved for patients with BMI >35 for GP use with input from dietetic service Awaiting guidance but approved for one patient. Using combination is more cost effective than using Buprenorphine alone. Some GP s are refusing to prescribe these drugs for home detox due to lack of control of how many tablets patients are taking. Consultant for Addiction Service is prescribing the drugs in the interim. OTC preparations can be prescribed on a GP10 when product unavailable due to shortages but issues around Request copy of previous audit done by pain team. Contact Perry Burgess and Joeleen McKean asking for guidance for GP s before goes into formulary. To be carried forward to next meeting. LL to liaise with Mike Kehoe & Adrian Mackenzie CPN s dictate how many drugs should be prescribed for patients. GP prescribe 120mg over the counter 60mg x 3 TID. Evidence BNF is issued. To come back to September meeting. Response from dietetic team was they will come back to next meeting with formulary amendment. To come back to September meeting Formulary updated and every patient has been switched to this. Two Addiction nurses to start prescribing course in September. Check what the evidence base is. To be raised again at the ACF. Dietetic team AMck/MK/ LL GG/AND s LL JH

3 Neuropathic Guidance Previously presented to ADTC but changes have been made as requested and also to add extra clarity as a result of drug applications to BFC on Patient Access Scheme Implementation Pack. Icatibant acetate Guidance Notes differing licence agreements for the product. Changes made to original application as requested. NHS Borders currently using a drug called Berinert based dose prescribed as a principle. Amended application to be brought to next meeting of the ADTC. NHS Borders currently using a drug called Berinert To be discussed at the Working Together to Improve the Use of Medicines meeting Find some examples. To come to next meeting. For noting. GG / GG ADTC members 5. Draft Minute of BFC meeting of 13 th June 2012 For information only ADTC to ratify NMA s from BFC meeting To approve or not to approve BFC decision ADTC Group Members 6. Applications for Approval from BFC of 13 th June 2012 Duloxetine New medicines application Treatment of diabetic peripheral neuropathic pain in adults and patients who are not diabetic. Cost of 1 month s treatment Approved for general use CAT A. Chair to write to applicant. Within one week from date of ADTC 3

4 Urea 5%, ceramide 0.1% For dry skin conditions. Cost of 1 month s treatment 2.80/50g, 9.80/500g White soft paraffin 13.2%, light liquid paraffin 10.5% Urea 10%, lauromacrogols 3% Cream - Glycerol 10%, light liquid paraffin 10%, white soft paraffin 5% Intensive ointment light liquid paraffin 50.5%, white soft paraffin 20% Lotion white soft paraffin 5% Enzyme alginogel with glucose oxidase and lactoperoxidase Natilizumab Emollient for inflamed, damaged, dry or chapped skin including eczema, psoriasis and other skin inflammatory conditions. For treatment of dry, scaling and itching skin. For treatment of dry skin conditions including eczema, psoriasis, ichthyosis, pruritus. For treatment of chronic wounds such as leg ulcers, diabetic ulcers, infected wounds, post surgical wound dressing etc. Cost of 1 months treatment 7.26/15g, 24.04/50g Treatment of multiple sclerosis. Cost of 1 months treatment 1,130 AMack to check whether or not on EMISS. Guidance in the formulary and if we approve to bring guidance to the next ADTC meeting. Cost of 1 month s treatment 1.40/50g, 3.98/150g, 5.99/500g, 11.62/1.05kg Cost of 1 months treatment 3.29/100g, 14.99/500g Cost of 1 months treatment 1.95/10g, 5.60/500g, 11.61/1.05kg To go to wound group. SMC approved and in use for AMack advised these were on EMISS. LL to revise the choice in the formulary. LL As above. LL As above. LL As above. LL Bring back to the next ADTC meeting Approved as CAT B Chair to write to applicant 4

5 Carboxymaltose For less than 5 patients per year Treatment of iron deficiency when oral iron preparations are ineffective or cannot be used. noting only. For approximately 5 patients in first year. Approved as CAT B and to be monitored. To be noted by group Ferinject Finasteride Treatment of male pattern baldness. Cost of 1 months treatment For one patient 7. New Medicine Applications: Exenatide Solution for Adjunctive therapy to basal injection, prefilled pen insulin with or without metformin and/or pioglitazone in adults with type 2 diabetes who have not achieved adequate glycaemic control with these agents. Cost of 8. Treatment Protocol Rivaroxaban of DVT in NHS Borders 1 month s treatment 69. NHS Borders Formulary Indication First Choice. Rivaroxaban will replace warfarin for this indication on 1/10/2012 Consultant to prescribe for a trial period of 6 months. Afterwards to liaise with GP to take over prescribing. Useful in patients who are on significant doses of insulin with poor glycaemic control and obesity. Treatment of first presentation of deep vein thrombosis and prevention of recurrent DVT and pulmonary embolism Preference is to stock one drug in the dept. Go back to applicant and ask if they happy to use first drug. On receipt of further information after the BFC meeting of it was rejected as not available on the NHS. GP can if they wish prescribe on a private prescription. Approved as CAT F. Chair to write to applicant. Information card for patients, dentists and pharmacists. Article to go in prescribing bulletin. To go to medical meeting for response from Consultants. LL BFC Group Chair LL

6 9. Medication Infusion Device Policy 10. Exceptional treatments policy for consideration of SMC Not Recommended Medicines. Updated ETP document. Replaces Infusion Devices Guidelines 2003 Guidance for Unlicensed medicines Off-label medicines Medicines which are awaiting consideration by SMC Medicines which have not been approved by SMC for use in Scotland Medicines contrary to agreed NHS Borders policy. For Information and Noting Only: 11. Rifaxamin Indication for use: Hepatic Encephalopathy. Patient has numerous hospital admissions for brittle hepatic encephalopathy current standard of care not working. following an acute DVT in adults. For sign off by the ADTC group. Exceptional Treatment wording to be removed and replaced by Individual Patient Treatment Request. Appeal for the process to be made clear that it would be the process not the outcome decision that can be appealed. Approved for specialist use for this one patient for 6 months and if no reduction in hospital admissions then review. It would be useful to have something for cleaning agents that you can use rather than just a ward stand. GG to take back comments and discuss with group. Changes to be made and added to the intranet and internet. Contact applicant to find out how many patients they may wish to use this on in the near future. GG SH/AW LL Medication Safety Bulletin produced to support Summarises the Approved and noted ADTC group

7 Bulletin 13. Yellow Card Centre Scotland 14. Antimicrobial Management Team Minutes clinicians involved in the prescribing and administration of paracetamol. YCC Scotland Minutes from January and April 2012 Antimicrobial Management Team meetings. paracetamol dosing advice approved by the ADTC in 2011 Health Board Report for NHS Borders Approved minute from AMT by group. To go into prescribing bulletin and recommended this was part of elearning. For noting by group ADTC members 15. A.O.C.B Working together to improve the use of medicines Duplication of items etc. on BFC agenda and ADTC agendas A national meeting on the 27 th September 2012 Similar or same items on both agendas. Invite to group members. Group to think about what topics are duplicated between both meetings. 16. Next Meeting: Wednesday, 12 th September 2012 at p.m. in the Committee Room, Education Centre GG/LL/AW ADTC Group