In the Pharmacy Seminar Room, First Floor,PCH

Minutes of the meeting held on Thursday16th July2015

in the Pharmacy Seminar Room, First Floor,PCH

There were nodeclarations of interest with regard to items discussed.

In Attendance:

Mrs C McIntyre / Chief Pharmacist - Acting Chair
Mrs A Ritchie / Pharmacist Team Manager Procurement and Formulary - Joint Secretary
Mrs S Mavani / Pharmacist Team Manager Medicines Governance – Joint Secretary
Ms J Watson / Specialist Pharmacist – Commissioning Services, Medicines
Management, Cambridgeshire and Peterborough CCG
Ms K Broad / Senior Pharmacist – C&PJPG/HCD, Cambridgeshire and Peterborough CCG
Dr D Woolf / Consultant Paediatrician (Left the meeting at 13.40pm)
Dr C Jephcott / Consultant Oncologist (from 12.55 onwards)
Dr R Mittra / Consultant in General Medicine (from 12.45 onwards)
Mrs S Milne / Pharmacy Technician-Higher Level

15/23 Apologies for Absence:

Dr D Mlangeni / Consultant Microbiologist
Ms C Johnson / Interface Lead Pharmacist, Greater East Midlands Commissioning Support Unit.
Dr R Griffiths / Consultant Anaesthetist
Mr P Taylor / Consultant Surgeon
Ms A Boaden / Non-Medical Prescribing Lead
Dr C Gardner / Assistant Medical Director
15/24
15/25
15/26
15/27 / Minutes of the Formulary and Medicines Management Committee meeting held on 14th May2015
The spelling of Dr McDevitt was corrected and the minutes were agreed as a true record of the meeting.
Matters arising from the minutes
14/61.2 Guidelines for the Management of Infants Born to Mothers with Positive Serology for Hepatitis B, Hepatitis C and HIV.
It was confirmed that C Gardner had given Chair’s approval. D Woolf asked that Dr McDevitt be informed.
14/74.4 Policy for the Commencement of Propranolol for the Treatment of Capillary Heamangiomas in Rainforest Out-Patients Department.
It was confirmed that C Gardner had given Chair’s approval. D Woolf asked that Dr McDevitt be informed.
15/06.1 Local Clinical Guidelines for the Management of Patients with Stroke.
This is still outstanding, it could not be confirmed if C Gardner had spoken with Dr Owusu-Agyei.
15/06.6 Pre-assessment Guidelines for Registered Practitioners.
The version with the agreed changes is still awaited.
15/16.1 Clinical Guideline for the Management of Miscarriage up to 13 weeks and 6 days.
A Ritchie had met with L Rutherford. It had been confirmed that others in the region are following the same practice of using misoprostol by an unlicensed route and that a local risk assessment had been done. The committee requested that A Ritchie ask L Rutherford and C Drewett to produce a more robust risk assessment to include what others are doing and because there are licensed products albeit with restrictions in their use.
15/16.6 Guideline for the Recognition & Management of Delirium in Hospital: (Dr Olugbenro Akintade)
Further discussion took place to clarify how the committee wanted doses of lorazepam 0.5mg to be expressed. It was agreed that it should be changed to micrograms and written as ‘500 micrograms (0.5mg)’.
15/16.10 Nurse-led Skin Surgical Procedures Policy.
This policy has received Chair’s approval.
15/16.13 Guidance for Post-operative Analgesia after Day-case Arthroscopic Shoulder Procedure and patient leaflet.
Changes have been made to the patient information leaflet. A Ritchie and S Mavani will check these are satisfactory and will then send the policy to C Gardner for Chair’s approval.
15/17 NICE Technology Appraisals
A Ritchie expressed concern that rifaximin was approved for addition to the formulary at the May committee but that at present it remains classified as a hospital only drug by Cambridgeshire and Peterborough CCG. A Ritchie is to email M Langdon the Clinical Director of the Medicines Directorate to raise this and the need therefore to keep prescribing in the hospital.
A Ritchie also requested that the committee make a statement to be minuted when drugs in NICE TAs are added to the formulary.
15/21 Controlled Drug Policy
It was confirmed the changes were approved as minuted.
Chair’s approval given from the cancelled meeting March 2015
The following guidelines have received Chair’s approval:
Guidelines for the Therapy of Fungal Infections in Adults
Guidelines for the Use of Granulocyte Colony Stimulating Factors (G-CSF)
The Chair was not present to confirm if other products and policies had received Chair’s approval
Trust policies and guidelines for approval (Part 1)
15/27.1 Policies given Chair’s Approval
15/27.1.1 Intravitreal Injections by Registered Practitioners, Policy and Competency Assessment
The policy has been given Chair’s approval
15/27.1.2 Guidelines for the use of Variable Rate Intravenous Insulin Infusion (VR111) in Adult Patients
The policy has been given Chair’s approval
15/27.1.3 Policy for the Commencement of Propranolol for the Treatment of Capillary Heamangiomas in Rainforest Out-Patient’s Department
The policy has been given Chair’s approval
15/27.2 Policy for the Management of Inoculation Injuries to staff.
Although invited the author did not attended the meeting. The policy will be discussed at Hospital Infection Control Committee in September and need not come to this committee.S Mavani will speak with Lyn Cawdell regarding the prepacks available in ED.
15/27.3 Clinical Guideline for the Treatment of Hypokalaemia in Adults
The author Dr Steven Martin did not attend. A Ritchie and S Mavani to confirm that the products mentioned are still commercially available and if they are the policy is approved.
Post meeting note – a correction was made to the potassium strength for one of the commercially available bags.
Outcome: Policy approved
15/27.4 Protocol for the Prescribing and Administration of Tecfidera (Dimethyl Fumarate)
Catherine Semple attended and explained that this was a prompt for her to ensure best practice. The committee were concerned that sections of the current summary of product characteristics (SmPC) had been copied and if the SmPC were to change the protocol might not be updated. Roles and responsibilities need to be added to include Dr Thorpe and the homecare pharmacist. As there were several other amendments needed A Ritchie suggested that Catherine work with the Homecare Specialist Pharmacist
Outcome: Protocol to go for Chair’s approval once changes made.
15/27.5 Guidelines for the administration of medicines for adult patients labelled nil by mouth (NBM) in the peri-operative period
Charlotte Murray attended and explained that the guideline has been reviewed, reformatted and the drugs updated e.g. enoxaparin changed to dalteparin. The committee requested that all the newer oral anticoagulants be included and a reference to the appropriate SmPC be added. Charlotte Murray was asked to discuss the policy with Cheryl Jones who is writing the Pre-assessment Guidelines for Registered Practitioners to confirm no conflicting advice is given.
Outcome: Guidelines approved subject to changes being made it does not need to come back to the committee.
15/27.6 Guideline for the Management of Acute Severe Colitis
This had been deferred from May’s meeting as the authors did not attend. As no author attended again the committee decided that the guideline is to be discussed outside the meeting.
Outcome: not approved.
15/27.7 PCA new form and associated documents
Tracey Taylor attended the meeting and explained that the PCA it is a review of an existing document and that the main changes aresignatures of the nurse preparing the PCA and the nurse who attaches the PCA. The committee asked that the footer be amended and a bar code added for EDM.
Post- operative spinal analgesia observation chart the committee asked that the paracetamol dose stated be corrected.
Outcome: Approved subject to changes and it does not need to return to the committee.
15/27.8 Peripheral Venous Cannulation in Babies, Children and Young People Guideline
The committee asked that the term saline be changed to sodium chloride 0.9%, version control is to be added, Chloraprep spelling to be checked and corrected where necessary and allergies should be added in when checking patient history.
Outcome: When the amendments had been made the guideline should be sent to S Mavani to confirm and then it would be considered approved.
15/28
15/29
15/30
15/31
15/32
15/33
15/34
15/35
15/36
15/37
15/38 / Formulary Items given Chair’s Approval and New Drug Requests
Proshield cream and wash had been given Chair’s Approval, this wasfor a patient with a wound/burn over her back and had been recommended by the Tissue Viability Nurse.
15/28.1-Ganciclovir ophthalmic gel was requested for addition to the formulary by Susanna Ramirez-Florez. Dr Zee Lin attended to present the case for the need for ganciclovir ophthalmic gel and to answer questions.
The committee agreed that ganciclovir ophthalmic gel be added to the formulary as second line to aciclovir and for immunosuppressed patients.
15/28.2 Phoxillium haemofiltration fluid was requested for addition to the formulary by Stuart Booth. Alan Pope Charge Nurse from Critical Care attended to present the case and answer questions.
The committee agreed that Phoxllium haemofiltration fluid be added to the formulary with use of Prismasol 4 decreasing and potentially being removed from the formulary.
Horizon Scanning
D Woolf had asked for this to be added to the agenda, he had left the meeting before this item had been reached. A Ritchie will contact him to see if this is what he wanted and how it should get into the directorates.
Trust Policies and Guidelines for approval (Part 2)
15/30.1Guidelines for Nurse Led Face to Face, Telephone Assessment and Follow Up of Patients with Hormone Refractory Prostate Cancer
Claire Martin attended, it was confirmed that the specialist pharmacist had seen the guideline and that the comments she had made had been addressed. Page 15 refers to treatment with Cialis and needs to be changed to sildenafil because Cialis is not in the CCG formulary.
Outcome: Approved subject to change being made, and not to come back to FMMC
15/30.2 Guideline for the Management of Metastatic Spinal Cord Compression
Dr Hollingdale attended. Only minor admin. changes such as contact details needed.
Outcome: Guideline approved
15/30.3 Homecare Medicines Services Policy
A Ritchie explained the need for the policy following the publication of the department of Health’s Hackett report.
Outcome: Policy approved
15/30.4 Guidelines for the Prophylaxis of Pneumocystis Jiroveci Pneumonia in Haematology Patients
Dr Rege could not attend, but it was agreed before the meeting that Dr Jephcott would report back any actions and findings. There were no changes from the previous guidelines. L Wilmer to be asked if a risk assessment had been done for pentamidine.
Outcome: Guideline approved
NICE Technology Appraisals published June 2015
TA339-Omalizumab for previously treated chronic spontaneous urticarial
TA340-Ustekinumab for treating active psoriatic arthritis (rapid review of technology appraisal guidance 313)
TA341-Apixabanfor the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
TA342-Vedolizumab for treating moderately to severe active ulcerative colitis.
TA343-Obinutuzumab in combination with Chlorambucil for untreated chronic lymphocytic leukaemia.
TA344-Ofatumumab in combination with Chlorambucil or bendamustine for untreated chronic lymphocytic leukaemia.
The committee confirmed the addition to the formulary for the drugs when used in line with the NICE TAs.
QIPP/CIP initiatives
It was discussed that in future this item will be kept on the agenda for information only.K Broad and J Watkinson said that other trusts circulated the top 20 drugs by expense and the top 30 by expense for the CCG.
Unlicensed Medicines Update
15/33.1 Metoprolol Oral Solution-Dr Brian Gordon-Cardiology-Low Risk
15/33.2 Protirelin Injection 200micrograms-V.Puthie-Paediatrics-Low Risk
15/33.3 Glyceryl trinitrate Ointment 0.05%-Diana Yong-Paediatics-Low Risk
Patient Safety Alert-Risk of death or severe harm due to inadvertent injection of skin preparation solution.
For Information.
Draft Drug Chart
Copies of the draft drug chart had been circulated to the members for information.
Reports from Groups and Subcommittees
Discussion arose whether or not the minutes from these groups should be circulated to members, and whether or not all groups should be discussed at this meeting.
15/36.1 Antibiotic Prescribing Group
15/36.2 Medication Safety Committee (Safer Prescribing Group):
15/36.3 IVIG demand management panel
15/36.4 Thrombosis Committee
15/36.5 Oxygen Committee
15/36.6 C&PJPG
15/36.7 NMAG
Any Other Business
15/37.1 Dates for 2016 meetings:
Thursday January 21st 2016
Thursday March 10th 2016
Thursday May 26th 2016
Thursday July 21st 2016
Thursday September 15th 2016
Thursday November 24th 2016
Dates have been arranged to avoid clashes with other Trust meetings and Public Holidays.
15/37.2 Out-Patient Prescription
S Mavani circulated the Out-Patient Prescription to members which is under-going a review, SMavani had now changed the box at the top of the prescription to read allergies.
15/37.3 Antibiotic Prescribing
Angeline Boaden had contacted SMilne about some bizarre antibiotic prescribing from Lincolnshire Practitioners. This has now been referred to the Infection Control Pharmacist Nikki Phillimore who has responded to Angeline.
15/37.4 Format of Future Meetings
Discussion took place around the format of future meetings. Policies and Guidelines should have been fully scrutinised before arriving at the meeting, and that the Committee should only be giving final endorsement to the documents. Using the specialist pharmacists to scrutinise the policies was suggested.
15/37.5Dexamehasone
A discussion took place around dexamethasone and a change in product. A few years ago the MHRA made it a requirement that the strength of injection was expressed as the sodium phosphate salt i.e. 3.3mg in 1ml; prescribing is still as 4mg or multiples and this causes problems for the nurses administering. The 4mg strength of dexamethasone was discontinued a year ago. SMavani to write to NHS England, MHRA and nurse educators about this change.
Date of next meeting: Thursday 17th September 2015 Learning Centre Room 4, PCH

Minutes of Formulary and Medicines Management CommitteePage 1 of 6

July 2015