Preventing fatalities from medication loading doses

NPSA Rapid Response Review 108 http://www.nrls.npsa.nhs.uk/resources/?EntryId45=92305

The NPSA produced a report in November 2010 entitled “Preventing fatalities from medication loading doses”.  One of the actions specified by the report concerns community healthcare professionals and when to challenge abnormal doses of the identified critical medicines.

The following medicines and actions have been identified for primary care prescribers in Leeds:

• Aspirin - to confirm maintenance doses greater than 150mg daily
• Amiodarone – to question doses given more than once a day (unless the loading dose regimen has been clearly stated)
• Clopidogrel - to confirm maintenance doses greater than 75mg daily
• Digoxin – to question all doses greater than the BNF recommended i.e. 125-250 micrograms for atrial fibrillation, 62.5-125 micrograms for heart failure (adjusted for age and renal function)
• Prasugrel – to question maintenance doses greater than 10mg daily
• Warfarin - to be vigilant and to ensure adequate monitoring

Leeds health economy traffic light drug classification

Look out for the new Traffic Light system to be launched on the 1st November 2011. This will be promoted on Leeds Health Pathways, and at TARGET events.

Leeds Health Economy uses a traffic light system for the classification of medicines.
A brief summary of the reviewed classifications are:

• Green – Medicines generally considered appropriate for prescribing in both primary and secondary care
• Amber – Medicines normally considered as requiring either:
- Recommendation by a specialist – Level 1
- Initiation by a specialist – Level 2 
- Specialist initiation and ongoing monitoring requirements – Level 3
• Red – Medicines for specialist use only
• Grey – Medicines recommended for restricted use within the Leeds Health Economy
• Black Light – Medicines not recommended for routine use within the Leeds Health Economy

A combined Traffic Light list is available on Leeds Health Pathways. The list includes links to amber drug guidelines. Access to the Leeds Teaching Hospitals Trust NetFormulary is also available through Leeds Health Pathways.

"Specials" Tariff

From 1st November 2011 new arrangements come into force for the reimbursement of ‘specials’.  The NHS Business Services Authority Prescription Service Division has announced that full details of the ‘specials’ tariff will be available in the November 2011 Drug Tariff. In the meantime guidance from the Department of Health and an initial list of specials to be listed in the November 2011 Tariff can be found at: http://www.nhsbsa.nhs.uk/3473.aspx.

Community Pharmacists are advised to pay particular attention to the prescription endorsement requirements as missing information may result in delayed payments.

Support European Antibiotic Awareness Day

Antibiotic resistance is one of the most significant threats to patient safety in England, Europe and worldwide. The number of infections due to antibiotic-resistant bacteria is growing.
Every year, European Antibiotic Awareness day is held on 18th November. It is a Europe-wide public health initiative aimed at encouraging responsible use of antibiotics.

To support European Antibiotic Awareness Day and the promotion of prudent antibiotic use, the European Centre for Disease Prevention and Control (ECDC) have created information and educational materials for use in all Healthcare settings. 

The Department of Health has made available a number of downloadable resources including: leaflets, posters and non-Prescription pads which can be printed and given to patients as an aide memoire as to why antibiotics have not been prescribed at a consultation. In addition the Royal College of General Practitioners has produced a booklet called ‘When should I worry’ (available in a downloadable format or for purchase in hard copy format) for use in primary care consultations with parents about the management of respiratory tract infections (coughs, colds, sore throats, and ear aches) in children.

This awareness day also links well with our local initiatives around antibiotic prescribing and reductions in healthcare associated infections.  A selection of posters and leaflets will be distributed to GP practices over the next few weeks to get you started.  Further supplies can be obtained from the following links:

• A limited number of hard copies can be ordered from http://www.dh.gov.uk/en/Publicationsandstatistics/DH_4067330
• “When should I worry” leaflet http://www.whenshouldiworry.com/booklet-final.pdf