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Medicines Management Matters

Medicines Management Team

Number: 5 | July 2020

In This Issue:

Prescribing Incentive Scheme 2020/21

Ranitidine

Vitamin B and Alcoholism

Care Home Update

Useful Links

Formulary-Header-Image

Prescribing Incentive Scheme 2020/21

The Prescribing Committee reviewed the current Prescribing Incentive Scheme for 20/21 at its meeting in June and agreed to amend the following indicators in light of the impact on surgeries of the COVID pandemic:

  • Dry eye – the target for spend on dry eye self-care products will start to earn points from October (this was originally April)
  • Antimicrobials – the deadline for audit submission has been delayed to December and March
  • Opioid prescribing – the points to be awarded for opioid dose reduction are now allocated as follows:
  • 3 points for submission of opioid patient lists
  • 3 points for evidence of a pain related consultation (face-to-face or telephone) with every patient identified
  • 3 points for reducing the total morphine equivalent dose for the identified population by 10% by March 2021

Please contact the Medicines Management team if you have any questions or require support with elements of the PIS. The scheme will be reviewed again at the September Prescribing Committee to assess the need for further adjustments.

Ranitidine

As you will be aware supplies of ranitidine are now almost exhausted.

To summarise:

  • In Europe all suppliers of the active ingredient in ranitidine preparations have had their Certificate of Suitability (CEP) suspended – this means no stock will be manufactured for the foreseeable future.
  • All affected stock has been recalled
  • Extremely limited supplies of oral ranitidine remaining in wholesalers and pharmacies that has not been recalled can be supplied, but once exhausted, patients will need to be reviewed
  • All patients on ranitidine should be reviewed and stopped, stepped down to an antacid or changed to a PPI as clinically appropriate
  • Unless there is no other option, a patient should not be changed to an alternate H2-receptor antagonist to preserve stocks for patients where this is the only clinically suitable option. All H2 antagonists are now in very short supply
  • Guidance has been issued on changing formulations but if you require additional support please contact your locality lead or the Medicines Optimisation team via the email below.

Vitamin B and Alcoholism

Except for rare cases, the prescribing of Vitamin B in alcoholism is recommended only for short term use.  See attached Regional Medicines Optimisation Committee (RMOC) Position Statement. Click here

  In summary:

  • Due to a lack of evidence on their efficacy and safety, vitamin B complex preparations (vitamin B compound and vitamin B compound strong tablets) should not be prescribed for prevention of Wernicke’s Encephalopathy (WE) in alcoholism.
  • Vitamin B complex preparations should not be prescribed for preventing deficiency or for maintenance treatment following treatment for deficiency.
  • Vitamin B complex preparations should not be prescribed as dietary supplements. Patients who wish to use them for dietary supplementation should be advised to purchase them over the counter.
  • Vitamin B compound strong tablets may be prescribed on a short-term basis (10 days) for patients at risk of refeeding syndrome. This also applies to patients who are not harmful or dependent drinkers.
  • In rare cases where there might be a justifiable reason for prescribing vitamin B complex e.g. medically diagnosed deficiency or chronic malabsorption, vitamin B compound strong and not vitamin B compound should be prescribed as it represents better value for money.

Please read the full guidance in relation to thiamine prescribing and the prescribing of vitamin B for other indications.

Care Home Update

Homely Remedies Toolkit & Flowchart – extended until October 2020

The current BCCG Homely Remedies Toolkit and Flowchart for use by care homes has been extended until October 2020. This guidance will be reviewed with plans for it to be a BLMK system wide guidance document.

The toolkit and flowchart can be found on the Care Home Team page: Click here

 

USEFUL LINKS

Bedfordshire and Luton Joint Formulary information Click here

 Care Home Medicines Management information Click here

 Latest Joint Prescribing Committee newsletter Click here

 Latest Care Home newsletter Click here

 

Useful Links

Bedfordshire and Luton Joint Formulary
Care Home Medicines Management information can be found here
Joint Prescribing Committee newsletters can be accessed here
Care Home newsletters can be accessed here

Monthly prescribing practice reports are now available on TeamNet. Log in to see the most up to date data.

For further advice on any of the drugs/issues highlighted in this newsletter, please contact your Medicines Management Team: Tel 01525 624375. E-mail BEDCCG.bedsmeds@nhs.net

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