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Medicines Management Matters

Medicines Management Team

Number: 7 | November 2020

In This Issue:

  • Important Update on Priadel
  • Sodium Valproate in Females of Childbearing Age
  • Stock Update
  • Care Home News
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Important Update on Priadel

Last month we contacted practices to advise that Priadel® would be discontinued and withdrawn from the UK market by April 2021 and patients would need to be switched to an alternative brand.

We have now received an update from NHSE to can confirm that Priadel® will NOT be withdrawn from the UK market by April 2021, and there is no longer a need to progress any switching of patients from Priadel® to an alternative brand of lithium by practices across the CCG.

This is as a result of the Competition and Marketing Authority (CMA) beginning a formal investigation into the activities of essential pharma and their earlier decision to withdraw Priadel® from the UK market. Click here for full information.

Consequently Essential Pharma have now withdrawn their earlier notice to remove Priadel® from the UK Market and will continue to make Priadel® available.

Essential pharma would now need to give DHSC at least 6 months’ notice if they decided to subsequently withdraw Priadel®. In addition while under investigation the CMA can impose temporary measures that would mean that a company could not make any changes until the outcome of the CMA investigation is completed, a process that could take several years to complete.

Therefore we will no longer be sending out guidance on switching patients and any patients who require Priadel® should continue to be managed in line with usual clinical practice and be reassured that stock will remain available.

We will update practices with more information as we receive it but if you have any questions with regard to the information above please get in touch.

Sodium Valproate in Females of Childbearing Age

We are aware that many practices have female patients of child bearing age (12-55 years) taking sodium valproate who require an annual risk acknowledgement form completing by their specialist as part of the Valproate Pregnancy Prevention Programme; https://www.gov.uk/drug-safety-update/valproate-epilim-depakote-pregnancy-prevention-programme-updated-educational-materials

The pharmacists at ELFT are happy to be contacted by practices with details of patients under the care of ELFT who are on valproate for a mental health condition and require an annual risk acknowledgement form completing

For Central Bedfordshire and Luton patients please contact  Chinedu: chined.ogbuefi@nhs.net

 

For Bedford patients please contact Tsana Simmonds: tsana.simmonds@nhs.net

Please include:

  • Indication
  • Whether you consider them high or low risk (e.g use of LARC, previous unplanned pregnancy)
  • If/when last seen by Mental Health Team

Patients who have had a hysterectomy or are confirmed as post-menopausal can be excluded.

Stock Update

Haloperidol

Following on from the discontinuation of haloperidol 500mcg capsules we recommended the use of the Haloperidol 5mg/5ml oral solution.  We have now been informed that there may be supply problems with this.

  • Haloperidol 5mg/5ml oral solution sugar free (Thame Laboratories) is out of stock until March 2021.
  • Limited supplies remain available from Pinewood Healthcare however they are unable to support any uplift in demand.
  • Haloperidol (Haldol®) 2 mg/ml oral solution is the only licensed oral solution that can support an uplift in demand.
  • Specials manufacturers have confirmed they can manufacture haloperidol 5mg/5ml oral solution sugar free.

Nalcrom®  

Reported to be out of stock until late November.  Unlicensed imports are available but will take longer to order.  Please allow for extra time for this when issuing prescriptions.

H2-antagonists

Suppliers of cimetidine tablets, famotidine tablets and nizatidine capsules have advised of changes to the availability of the following preparations:

Care Home News

Covert administration of medication – updated Ardens templates

As you are aware the Medicines Optimisation Care Home team launched the updated Covert Administration of Medication (Adults) – Best Practice Guidance in April 2020. This can be found in the Care Homes page on the BLMK Medicines Management website, link below:

https://medicines.blmkccg.nhs.uk/categories/care-homes/

The Medicines Optimisation Care Home team have recently worked with Ardens to update the current templates for covert administration on SystmOne. This is to support with the review process if covert administration is being considered.

The opening page for the template is shown below, highlighting the process and steps, including input from a pharmacist to support with medication review.

The template includes (as circled):

  • Link to Mental Capacity Assessment – further details below
  • Review date for covert administration – should be at least 6 monthly as a minimum, but more frequently if capacity fluctuates
  • Link to the local BLMK Covert administration guidance documents and review form

 

If covert administration is assessed as being appropriate and box ticked, this will automatically be read coded as ‘Xacu1 (Best interests decision to allow covert admin of meds under mental capacity)’, therefore can be used to set up searches.

Reminder:

Covert administration is only likely to be necessary or appropriate where:

  • A person actively refuses their medication AND
  • That person does not have the capacity to understand the consequences of their refusal (as determined  by the Mental Capacity Act 2005) AND
  • The medicine is deemed essential to the person’s health and wellbeing

The page below shows the Mental Capacity Act (MCA) assessment to be completed by prescribers. If the answer to a question is ‘No’, then evidence must be provided (e.g. answers to questions asked in the assessment). Additional notes can be free text in the notes section (as circled).

 

The Covert administration best practice guidance word templates (e.g. MCA assessment) can also be found in the SystmOne bureau folder in SystmOne should you wish to use these. However, the Ardens template may be the easier option for documentation.

Please ensure that copies of any assessments are also provided to carers, care homes etc, for their records and care plans. Additionally a review date must be set.

 

PDF Version available here:

Medicines Management Matters November 2020

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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