Minutes of the Meeting Held on Thursday 26Th May 2016

Minutes of the meeting held on Thursday 26th May 2016

In the Pharmacy Seminar Room, PCH

There were no declarations of interest with regard to items discussed.

In Attendance:

Dr C Gardner / Deputy Medical Director – Chair
Mrs C McIntyre / Chief Pharmacist
Mrs A Ritchie / Pharmacist Team Manager Procurement and Formulary - Joint Secretary
Mrs S Mavani / Pharmacist Team Manager Medicines Governance – Joint Secretary
Dr D Woolf / Consultant Paediatrician
Dr R Mittra / Consultant in General Medicine
Dr M Sahni / Consultant Anaesthetist
Ms A O’Sullivan / Deputy for S Drake
Dr G Sabbagh / Quality Governance and Compliance Manager
Mr A Massraf / Consultant Orthopaedic Surgeon
Dr D Mlangeni / Consultant Microbiologist
Ms J Watkinson / Specialist Pharmacist Contracts and Commissioning, C&P CCG
Ms V Gibson / PAC and Formulary Support Pharmacist, C&P CCG
Mr D Chittenden / Senior Finance Business Partner, Income

16/25 Apologies for Absence

Ms S Drake, Ms K Broad, Mr P Taylor

16/26 / Minutes of the Formulary and Medicines Management Meeting held on Thursday 10th March 2016.
The minutes were agreed as a true and accurate record of the meeting.
16/27 / Matters arising from the minutes:
·  16/16 Guidance for Post-operative Analgesia after Day case Arthroscopic Shoulder procedure. There is reluctance in the specialty to take this forward. AO’S suggested she raise it with the physiotherapists.
·  16/16 It was confirmed that a formulary submission is not required for Resource Clear as it is in the formulary. Speech and Language Therapists can now work under a PGD.
·  16/16 Issue of two prescription charts one for TB and another for PEP. SM to check situation with Yolanda Abunga (Hepatitis/TB pharmacist).
·  16/18 GS to send update on responses to NICE adherence post meeting.
·  16/21.4.2 Methotrexate shared care confirmed that amendments made and the guideline is now on the GP extranet.
·  16/22.2.10 Guideline for Intravenous Ciclosporin Administration in Severe Ulcerative Colitis – confirmed amendment fed back to author.
·  16/23.3 IVIG Demand Management Panel. CMc to confirm with Louise Wilmer when then meetings can be reinstated.
·  16/23.4 The anticoagulant chart has been endorsed and when requested amendments have been made will be sent for printing.
16/28 / Nomination of Deputy Chair.
No clinician felt able to become Deputy chair so Ms Mcintyre was nominated and agreed.
16/29 / Formulary Items given Chair’s Approval, New Drug Requests and Updates:
16/29.1 – Chair’s Approval
·  Degludec – Dr Satyanarayana. This was for a patient in Lincolnshire where GPs are able to continue therapy.
·  Pico dressings – Mr Parvaiz. It was decided that a formulary submission is not required as the dressing is not medicated.
·  Balsalazide – Dr Das
·  Foscavir injection – Ms Ramirez Florez
New Drug Requests:
16/29.2 – Inegy – Dr Banfield attended to present the submission.
The submission was to use Inegy for severe alopecia when other treatments (prednisolone, ciclosporin, methotrexate) had failed. This would be an off label use. Dr Banfield works in this area as a tertiary specialist in East Anglia.
The submission was approved and prescribing would remain in the trust.
Dr Banfield also raised prescribing of rapamycin topically for a 10 year old child with tuberous sclerosis and facial angiofibromas where treatment may need to be continued long term. It was suggested that an IFR should be completed and sent to NHSE.
16/30 / 16/30.1 NICE Technology Appraisals published March and April 2016:
·  TA386 Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis.
Applicable to the trust.
·  TA387 Abiraterone for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated.
No response from directorate.
·  TA388 Sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction.
Pending response from the directorate. An implementation plan will be required for C&P CCG and a pathway of when it will be used.
·  TA 389 Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine for treating recurrent ovarian cancer.
Pending response from directorate.
16/30.2 NICE Clinical Guidelines published March and April 2016:
·  NG46 Controlled drugs: safe use and management.
The trust’s Policy for the Supply, Administration, Safe Handling and Storage of Controlled Drugs will be revised as necessary.
16/31 / Horizon Scanning
The following are for forward planning purposes:
16/31.1 - New Drugs Online newsletter April 2016
16/31.2 - NICE Technology Appraisals in Development expected publication May to October 2016
16/32 / Unlicensed Medicines Update.
No forms have been submitted.
16/33 / Medicines Optimisation:
·  16/33.1 – Proposal to remove all systemic diclofenac products from the
formulary.
This proposal has been made because of the cardiovascular risks from diclofenac. There is no suitable alternative NSAID injection or suppository.
Tablets are no longer available in this trust. Since tablets were stopped the use of suppositories has increased six fold. The clinicians present could not agree with the proposal.
A suggestion was made to restrict use to inpatients where alternative therapy is not suitable and not to prescribe for outpatients or TTOs. A decision was made to check what Addenbrookes has agreed.
·  16/33.2 - Items from C&PJPG.
A GPA form will require completing before Degludec can be initiated, Degludec will need to be in PSHFT’s formulary first.
Oxycodone for acute use will remain hospital only. For chronic pain and palliative care morphine will be first line.
Fentanyl patches and buprenorphine patches will be restricted in primary care and the most cost effective brand will be prescribed.
Lidocaine patches have a limited licence but seem to be being used more widely. An audit is required to map where the product is being used and why. Hopefully this will allow for prescribing in primary care where appropriate – for example in the elderly where opioids may cause falls.
·  16/33.3 - High Cost Drugs – GPAs, IFRs etc
C&P CCG confirmed that GPAs are now sent to our contracts department.
·  16/33.4 - Shared Care Guidelines:
There were no shared care guidelines.
16/34 / Trust policies and guidelines for approval:
16/34.1 Policies/Documents given Chair’s Approval:
None received.
16/34.2 New Policies/ Guidelines/Documents:
·  16/34.2.1 Guideline for Paediatric Anaesthesia at PCH.
Doses had been added to the guideline but the specialist pharmacist had not confirmed the guideline and doses are all right.
·  16/34.2.2 Guideline for the Management of Acute Severe Colitis.
CG said he had many comments and would send them to SM.
·  16/34.2.3 Guideline for the Management of Patients with Stroke.
CG said he had many comments and would send them to SM.
·  16/34.2.4 QA Clinical Policies and Guidelines.
The form was discussed. It was agreed that policies will not be added to the agenda of future meetings until the Pharmacy QA document has been completed and signed. GS agreed that the Quality Governance & Compliance Department will help SM. SM, GS and Jim Walker to meet to agree a process for this.
16/34.3 Policies/ Guidelines/ Documents for Review:
·  16/34.3.1 Medicines Reconciliation Policy.
Approved
·  16/34.3.2 Procedure for Therapeutic Substitution of Medicines by Pharmacists / Therapeutic Substitution List
Procedure approved.
Revised list of drugs approved subject to amendments to calcium and vitamin D guidance note and ferrous fumarate exceptions and guidance notes. Calmurid cream added for substitution during shortage of Aquadrate.
·  16/34.3.3 Tecfidera protocol.
Approved
·  16/34.3.4 Universal Omalizumab Prescription chart.
Approved
·  16/34.3.5 Mannitol Policy
Approved
·  16/34.3.6 Non-Medical Prescribing Policy
Approved if title changed to Non-Medical Prescriber Policy and 5.4.1 changed to state list of signatures held in pharmacy.
·  16/34.3.7 Medicines Management Policy
Deferred to September’s meeting
16/35 / Reports from Groups and Subcommittees/ Associated Medicines Update:
·  16/35.1 Antibiotic Prescribing Group
There is a CQUIN for NHSE on piperacillin/tazobactam and Meropenem.
·  16/35.2 Medication Safety Committee
·  The meeting was held and chaired by SM in the absence of CG.
The same training as previous few years will be used for the FY1’s this summer intake.
·  16/35.3 IVIG demand management panel
No meeting
·  16/35.4 Thrombosis Committee
Increase in DATIX seen for patients on LMWH and DOAC, noted that some are for medical outliers. Posters to raise awareness of these issues have been drafted. The new anticoagulant chart should help resolve the problem and the word “anticoagulant” has been added to the label when DOACS are dispensed.
·  16/35.5 Oxygen & Medical Gases
The pipeline and cylinder policies are for renewal.
·  16/35.6 NMAG
No update
16/36 / Any Other Business:
The committee noted that the dose banding for chemotherapy had been approved at Cancer and Diagnostics Governance meeting.
A poster highlighting which drugs for diabetes can cause hypoglycaemia had been approved at the Diabetes Action Group. It was raised at Medication Safety Committee but could not be approved as there was no Chair. The committee approved if version control and a review date were added. It was suggested that distribution could be through the diabetes nurse specialists.
Date of Next Meeting: Thursday 21st July 2016 at 12.45pm, in the Executive Meeting Room, 4th Floor, PCH

Minutes of Formulary and Medicines Management Committee Page 1 of 5

26th May 2016