Produced by Sue Paddock on behalf of the NHS Rotherham Medicines Management Team Tel (01709) 302641 if further information required. / Rotherham Community Pharmacy Newsletter
December 2009 /
Advanced Services
See the article on reverse of this Newsletter. This is the first in a series suggesting topics for MURs.
Enhanced Services
Substance Misuse
Training:
- There is a requirement in the LES for pharmacists/staff to attend one annual training event relating to substance misuse. It has been agreed tohold 2 sessions (one in an afternoon and one in an evening), with a requirement to attend one session. Further details will be made available in due course.
- In addition the Royal College of General Practitioners (RCGP) Level 1 substance misuse course is delivered locally by Dr Russell Brynes twice a year with the next planned session on 28th April 2010. The Part 1Course is endorsed by the National Treatment Agency for Substance Misuseand is now multi-disciplinary.Pharmacists, nurses, drug workers and other healthcare professionals can now complete the certificate.Further details to follow in the New Year.
Reporting of Missed Doses:
A 3 month pilot project will commence from 11th January 2010 across all pharmacies providing supervised consumption in order to address the number of clients missing 3 supervised doses of their medication and having to be re-titrated or dropping out of drug treatment services. The pilot will require pharmacists to notify the drug treatment service after a patient misses just one dose as opposed to the current requirement of three. Full details will be circulated.
Pharmacy Based Needle & Syringe Exchange
The policy on equipment has been reviewed in light of the new NICE Guidance – PH18 Needle & Syringe Programmes (Feb 09). It has been agreed following consultation with pharmacists and the LPC to increase from a maximum of 10 sets of equipment to 50. New interim guidance will be issued pharmacists which will be followed up with further detailed guidance and training based on assessing service user needs.
For further information on any of the above areas contact: Debbie Stovin, Adult Drug Treatment System Manager on 01709 423503 / e-mail:
Public Health Campaigns
Safe Storage of Medication
A campaign supported by the Safeguarding Board is due to take place in January 2010 on the above. Currently messages re safe storage are provided verbally via a range of practitioners however this campaign will include a leaflet which can be given out within the pharmacy and also be used within drug treatment services to reinforce the key messages. Other materials will include a poster, banner pen and a questionnaire in order to undertake consultation with the client group.
Nurse Prescribers
The categories of nurses who are entitled to prescribe are:
- Community Practitioner Nurse Prescriber (previously District Nurse/Health Visitor prescriber) This group can only prescribe from the Nurse Prescriber Formulary, Part XV11B(I) of the Drug Tariff
- Nurse Independent/Supplementary Prescriber (previously EFNP/Supplementary Prescriber) These nurses can prescribe any licensed medicine for any medical conditional within their competencies, including some Controlled Drugs – see part XV(ii) of the Drug Tariff.
Each prescription should be annotated or stamped as above.
If you are unsure of the prescribing status of a nurse you can search the register of the Nursing and Midwifery Council at .
New Pharmacy Opening
Heritage Pharmacy will be opening at Laughton Common on 7 December 2009.
Rotherham’s re-designed continence is award winning
In April 2009 the prescribing of all continence products in Rotherham was transferred from practices to the expanded continence service. This involved in excess of 1000 patients. The service has welcomed feedback from patients via the patient opinion website. This patient feedback has been extremely positive and considerable previously unmet need has been uncovered. The project was submitted for the 2009 Nursing Times award and won the award for continence. The panel remarked
“This innovative project has delivered outstanding results and will continue to do so in the future”
Pictures of the event and a short video clip are available on the Nursing Times Website, viewer discretion is strongly advised.
Incident of the Month
Incident
A Rotherham Pharmacy took a call from someone claiming to be from Sheffield misuse team, asking him to dispense methadone from a faxed script.The alarm bell rang, as methadone should only be dispensed from an original script and wondered if this was a scam. We don’t know the source of this call.
Recommendations and sharing the learning
Be alert for possible fraudulent attempts to obtain Methadone
Article for the Community Pharmacy News Letter
Fracture Prevention– What’s the big deal
and how can community pharmacy help?
Falls are common in the older person with 30% of those over 65yrs and 50% of those over 85yrs falling once every year. Falls in the older person can result in fractures due to a decline in bone mineral density. After a hip fracture 50% of those who fall lose independence and 25% die. The total cost to the NHS as a result of falls in 1999 was three times the total NHS funding for mental health, coronary heart disease and primary care in England.
Problem 1 – where’s the calcium and vitamin D?
Bisphosphonates are recommended for the primary and secondary prevention of osteoporotic fractures in certain patient groups. Many people who are prescribed a bisphosphonate are not prescribed complementary calcium and vitamin D supplements. This may be because they have been assessed to have an adequate calcium intake in their diet and have sufficient exposure to daylight. However, this is not always the case especially for older people who live in Residential/Nursing Home or are housebound. There is also evidence that people from ethnic minorities may struggle to receive sufficient levels of vitamin D which may have been overlooked. These patient groups are more likely to require supplementation.
How can I help?
- Consider performing an MUR on any patients prescribed a bisphosphonate but not calcium and vitamin D.
- Consider performing an MUR on patients on sub-therapeutic doses of vitamin D i.e. daily doses lower than 800IU.
Problem 2 – reduced efficacy of bisphosphonates
It is well known that the co-administration of other medications, particularly calcium supplements, within 30 mins of a bisphosphonate reduces their absorption which reduces the efficacy. However, it is apparent from ad hoc observation that both calcium and bisphoshonates are often administered at the same time from Monitored Dose Systems (MDS), despite a warning on the label.
How can I help?
- In order to make it less likely that calcium will be given at the same time as a bisphosphonate in MDS consider putting the calcium dose at a different time of day to the bisphosphonate e.g. at lunch time rather than first thing in the morning.
- Consider performing an MUR on patients prescribed a bisphosphonate to ensure they understand the complicated dosing instructions.