Minutes
Date: Monday 25th April 2016
Time:2-4.30pm
Subject:Drugs & Therapeutics Group
Venue:Main Meeting Room, Mill View Hospital
Chair:Jed Hewitt, Chief Pharmacist - Governance
Minuted By: / Ray LyonPresent: / Jed Hewitt, Ray Lyon, Dr Richard Whale, Sue Wallace, Colleen Sutton,
Dr James Fallon, Dr Aman Sardana, Jane Eastwood (for Una Hobson),
Jules Haste, Fionnuala Plumart (for Kathryn Steele), Dr Birbal Chopra,
Dr Doug Handyside, Dr Daniel Hume, Philip Foster,
Dr Mohammad Inayat.
1. Apologies: / Trudie Morgan, Jayne Bruce, Dr Bijil Arackal, Helen Idle, Paul Wilson,
Fiona Brown, Kathryn Steele, Jane Tatum, Una Hobson.
Dr Duncan Anderson has stepped down as S&F representative.
The Chairman thanked him for his contribution.
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6.27
6.28
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8. / Minutes of the Meeting held on 26th January 2016were agreed and approved as a correct record subject to one minor alteration – item 6.9
Declaration of Conflicts of Interest
Update on items previously discussed and brought forward:
Name / Potential conflict of interest / Pharmaceutical Co.
Jed Hewitt / Conference fees and travel expenses / Lundbeck
Dr Richard Whale / Speaker fees / Janssen/Lundbeck/
Sunovion
Dr Doug Handyside / Attendance at Dementia 2016 Conference sponsored by Nutricia / Nutricia
Metformin for the reduction of weight gain/prevention of diabetes in patients being treated with antipsychotics.
New guidance from the British Association for Psychopharmacology (BAP) has just been published. It will be considered at the next meeting.
Vortioxetine for the treatment of major depressive episodes that have not responded to two antidepressants.
It was confirmed that Hastings & Rother and Eastbourne, Hailsham & Seaford CCGs have coded green (GPs can initiate), whilst the other CCGs in Sussex have coded blue, (GPs to prescribe only after secondary care initiation).
Proposal to switch stable patients from Concerta XL® to Matoride XL®. Also new patients and those having dose changes that need a 12 hour XL preparation.
Proposal and information leaflets approved by CCGs. Item complete.
Insulin Prescription & Administration Record
New document available. Item complete.
Community Long-Acting Injection Chart
Noted that final minor amendments will be made at the next Pharmacy Forum.
Needle-Safe Initiative
Jayne Bruce not at meeting, but the Chair advised that various initiatives have been progressing well across the Trust.
Formulary and Related Prescribing Guidance
Coastal West Sussex CCG Prescribing Agreement
Noted and accepted. Ray Lyon to send out to senior doctors and NMPs in Coastal West Sussex locality.
Guanfacine for the treatment of ADHD in children and adolescents 6-17 years old for whom stimulants are not suitable, not tolerated or have been shown to be ineffective.
- Supported to go to CWS APC first, with other CCG-APCs to follow.
- But first need to produce prescribing guidelines and updated ESCA, plus add proposal to audit initial use.
- Ray Lyon to organise in liaison with Graham Brown (CAMHS pharmacist).
NG10: Violence and aggression: short-term management in mental health, health and community settings
and
NG11: Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges
- Still being finished covering action points in January minutes. Trudie Morgan and Jules Haste to complete as a priority action.
- Agreed to finally approve between meetings by e-mail to avoid further delay. Jed Hewitt to circulate to Group members as soon as available.
- Agreed that the RT e-learning module can be updated to reflect the new RT policy without it coming to the next DTG meeting, or being circulated to Group members. Jed Hewitt to organise / finalise.
Agreed no DTG action necessary as no direct impact on Trust medicines use.
NG33: Tuberculosis
Agreed that this guidance must be shared with HR and Occupational Health departments. Also that it should be made available to clinical staff via the Physical Health section of Susi. Jayne Bruce to action.
NG34: Sunlight exposure: risks and benefit.
NG35: Myeloma: diagnosis and management.
NG36: Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over.
NG37: Fractures (complex): assessment and management.
NG38: Fractures (non-complex): assessment and management.
NG39: Major trauma: assessment and initial management.
NG40: Major trauma: service delivery.
NG41: Spinal injury: assessment and initial management.
NG42: Motor neurone disease: assessment and management
NG43: Transition from children’s to adults’ services for young people using health or social care services
NG44: Community engagement: improving health and wellbeing and reducing health inequalities
Agreed no DTG action necessary in response to any of these NGs as they do not have any direct impact on Trust medicines use.
NG45: Routine preoperative tests for elective surgery.
Agreed no DTG action necessary as no direct impact on Trust medicines use.
TA 375: Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.
TA376: Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases.
TA377: Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated.
TA378: Ramicurumab for treating advanced gastric cancer or gastro-oesophageal junction adenocarcinoma previously treated with chemotherapy.
TA379: Nintedanib for treating idiopathic pulmonary fibrosis.
TA380: Panobinostat for treating multiple myeloma after at least two previous treatments.
TA381: Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy.
TA382: Eltrombopag for treating severe aplastic anaemia refractory to immunosuppressive therapy (terminated appraisal).
TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis.
TA384: Nivolumab for treating advanced (unresectable or metastatic) melanoma.
TA385: Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia.
TA386:Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis.
Agreed no DTG action necessary in response to any of these TAs as they do not have any direct impact on Trust medicines use.
QS120: Medicines optimisation
Agreed that this Quality Standard will be actioned by the Chief Pharmacists in liaison with members of the Pharmacy Forum.
Clinical Policies, Protocols and Guidance
Prolonged Epileptic Seizure Treatment Guidelines
Approved subject to correction of typos and clarification of first-line product choice according to care setting. Jed Hewitt to finalise.
Guidance on the Treatment of Antipsychotic Induced Hyperprolactinaemia in Adults
- Agreed that this document should also provide advice for CAMHS clinicians and be (re)submitted to both the CAMHS sub-group and the DTG for approval.
- Jed Hewitt to refer to Graham Brown(CAMHS pharmacist).
Approved subject to inclusion of an additional reference to auditing new medicines. Ray Lyon to finalise.
Medication-related Audits / RL/RW
RL
RL
TM/JHa
JHe
JHe
JB
RL / JHe
JHe
JHe / GB
RL
8.1 / Pharmacy audit of Acuphase®use: April 15 to March 16
To be reviewed at next meeting. / RL
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16. / Finance and Drug Budgets
No specific issues raised and currently no direct cost pressures.
Horizon Scanning
Iloperidone
Noted that this drug for the treatment of schizophrenia in adults is available in the USA and is currently being considered by the European Medicines Agency. Expected EU launch is late 2016. To be reviewed as more information becomes available.
Paliperidone Long-acting Injection for 3-monthly administration
Noted that this new formulation (Trevicta®) has received marketing authorization from the European Medicines Agency. It will be licensed for the maintenance treatment of schizophrenia in adult patients who are clinically stable on 1-monthly paliperidone palmitate injection, but UK availability and price are not yet known.
Patient Information Leaflets
No new submissions or renewals were considered at this meeting.
Group Protocols (MAUPs) & Patient Group Directions (PGDs)
No new submissions or renewals were considered at this meeting.
Drug Safety Updates from the MHRA
Alerts from January, February and March that impact on Trust prescribing and/or other areas of clinical practice were considered.
- Noted that galantamine (Jan) and valproate (Feb) issues have already been addressed in the last edition of the D&T newsletter.
- No other new items relevant.
Minutes of the January meeting were received with no comments.
HMP Ford and HMP Lewes Drugs & Therapeutics Committees
Minutes were received from both Groups with no comments.
Any other business
- Prescribing by F1 doctors:
- Monitoring long-acting (depot) injections:
- Psychotropic prescribing in people with LD:
Confirmation of next 3 meetings:
(All 2pm til 4.30pm in Mill View Hospital,main meeting room)
- Tuesday – July 26th
- Monday - October 31st
- Monday - January 30th
Trust Consultants
Trust Service Directors
Trust Quality Directors & Clinical Directors
Chief Pharmacists of NHS acute care Trusts in Sussex
Prescribing Leads and Chief Pharmacists of CCGs in Sussex (and where appropriate, others where Trust services are provided)
Non-medical Prescribers via NMP Lead
Trust website
Contact:Jed Hewitt, 01323 444108 or Ray Lyon, 07833 527412
Chief Pharmacists / RL
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