VIEWS: 7 PAGES: 3 POSTED ON: 9/10/2010
Southern Derbyshire Prescribing Newsletter November Rectal Examination
SOUTHERN DERBYSHIRE PRESCRIBING NEWSLETTER November 2000 Edition 52 child's condition, nebulised therapy may be Inside this newsletter: considered. In the case of children aged 3 to 5 years, a dry powder inhaler (DPI) may also be considered. § PAG update § Choice of device to be made within the MDI § CFC-free salbutamol inhalers and spacer range should be primarily § Wasted medicines governed by specific individual need and the likelihood of good compliance. Once § Zanamivir for flu these factors have been taken into account, § PSU website choice should be made on the basis of cost § Nurse prescribing update minimisation. The Prescribing Advisory Group will be PAG update considering how best to implement the guidance. Biphasic insulin lispro (Humalog Mix25) Insulin aspart (NovoRapid) Shared care guidelines-olanzapine and quetiapine: These guidelines were approved The introduction of insulin analogues has and copies are attached to the newsletter. resulted in changes in practice in the use of insulin for intensive treatment. This is where the goal of therapy is tight glycaemic control (HbA1c < 7.5%) without episodes of severe CFC-free salbutamol inhalers hypoglycaemia. Lispro insulin (Humalog) is already included on the Prescribing Guide. Just a quick reminder about changing patients over to CFC-free salbutamol Humalog Mix 25 was approved for use in inhalers. It appears that stocks of the CFC the small group of patients who want to containing versions are diminishing fast! achieve tight glycaemic control and are unable to do so with conventional insulins. However, there have been a number of anecdotal accounts of problems with the new Insulin aspart (NovoRapid) was also CFC-free salbutamol inhalers. In particular, approved. Pen cartridges are no longer examples of the MDIs ‘jamming’, ‘sticking’ or interchangeable between Novo-Nordisk and ‘clogging’ have been reported. In at least one Lilly pens and Novo pens may tend to be case a hospital admission resulted from the preferred by patients. inability of a patient to make the inhaler work. NICE guidelines These problems are related to the industry- wide change to HFA propellant, as no one NICE issued guidelines on Inhaler systems brand seems to be affected more than any (devices) in children under the age of 5 years other. HFA produces a more gentle exit velocity with chronic asthma in August 2000. The than did CFCs, which allows a build up of conclusions are outlined below: deposited ingredients in the delivery § For children under the age of 5 years with mechanism. This is particularly prevalent with chronic stable asthma both corticosteroids ‘suspension’ products such as salbutamol and and bronchodilator therapy should be leads to the problems listed above. routinely delivered by pressurised metered dose inhaler (MDI) and spacer system, with All of the suppliers recognised this as a a facemask where necessary. potential problem during product § Where this combination is not clinically development. As a result, all CFC-free MDIs effective for the child and depending on the include detailed instructions on enhanced cleaning procedures which patients need to undertake. It seems likely that, in many of the influenza is circulating within the community reported cases, patients were unaware of the and who are able to commence treatment new cleaning requirements, or had not within 48 hours of the onset of symptoms. followed them sufficiently well. It is important to reinforce to patients that they must Zanamivir is NOT recommended for follow the cleaning instructions supplied otherwise healthy adults with influenza. with their new inhalers. Practices should not prescribe zanamivir at present, as NICE’s guidance does not apply until influenza is known to be circulating in Wasted medicines the community. This will be triggered across England and Wales by the PHLS and when The DOOP service (pharmacy collection of new GP consultations for ILI have risen above wasted medicines) estimated that in Southern the baseline level of 50 consultations per Derbyshire we threw away medicines to the 100,000 population per week. value of £400,200 in July to September this year. This only includes those medicines PAG will be considering how best to implement returned to pharmacies so the true figure is the NICE guidance on zanamivir on December much more! 12th 2000. Prescribing Advisers have been undertaking NICE guidance is available on the internet at: repeat prescribing audits in practices across http://www.nice.org.uk/nice-web Southern Derbyshire to identify ways of reducing unnecessary waste in prescribing by: The Department of Health’s supplementary guidance is available on: § Reducing length of supply http://www.doh.gov.uk/zanamivirguidance § Prescribing of equivalent quantities § Removing items no longer required § Regular medication reviews Prescribing Support Unit website § Including directions on all prescriptions The Prescribing Support Unit (PSU) is a small In the next few months a campaign is being unit, based in Leeds, funded by the NHS launched, aimed at the public, which will Executive. The main aim of the unit is to include traffic lights with the message: provide analytical support for policy initiatives concerned with primary care, especially those STOP Before you ask for a repeat involved with improving the cost effectiveness prescription. of prescribing. THINK If you have stopped any of your medicines have you told your Their website provides useful information on: GP? § Prescribing cost and volume measures, GO AHEAD If you are happy that you still e.g. NIC, DDD, ADQ. need this prescription go ahead § Patient denominators, e.g. PUs, ASTRO- and order it, giving your doctor PUs, STAR-PUs, Low income scheme index, adequate notice. prescribing allocations Patients will also be asked not to stockpile The address is www.psu.co.uk. medication. Nurse prescribing update Zanamivir for flu If all goes to plan there will be a further three The National Institute for Clinical Excellence PCT's in Southern Derbyshire from April 1st (NICE) has now published its guidance on the next year. For those District Nurses and use of zanamivir (Relenza). Supplementary Health Visitors in Erewash, Amber Valley and guidance has also been produced by the Derby East and West this will mean local Department of Health. Both of these management and a specific PCT prescription documents have been posted to GP practices. pad. Chris Simpson and I will try to ensure that the transition goes smoothly and that you NICE recommends zanamivir for the treatment will all continue to get the support you require. of at risk adults who present within 36 hours of the onset of influenza like illness (ILI) when The steering group is developing a training bid, § The items in stock are not prescription only which if successful will ensure that medicines, or pharmacy medicines, which development needs will be met. Any nurse who must be dispensed under supervision of a is eligible to undertake the Nurse Prescribing pharmacist. Course and has not yet got a course date please contact Bev Harris on 01773 525063 or There is no prohibition on these items being Sue Slade on 01773 525004. transported in a nurse’s car. In light of this information I am working with the community Guidelines on rectal examination Pharmacy and operational managers to develop a stock list of items which can be kept The RCN have recently published guidelines on in the clinic bases for nurses to access. rectal examination. Free copies of ‘Digital Rectal Examination and Manual Removal of Pharmaceutical representatives Faeces - A Guide on the Role of the Nurse’ can be obtained on 0845 772 6100. Work is being Following discussions with the Nurse undertaken to develop a Trust wide Policy Prescribing Steering Group and the Trust the taking into account the recommendations following policy should be adhered to: within the guidelines. § Staff should not see representatives on their own. NPF's § If you have arranged for a representative to meet with your locality group then you We are still awaiting the arrival of the must inform your community service BNF/NPF for those staff who were issued with manager. the Purple NPF. We are doing our best to find § The representative should only discuss out what has happened to them and we will items that are in the wound distribute them as soon as they arrive. management guidelines and not new products. Consultation to extend nurse prescribing § If free samples are distributed they MUST not be used on patients. If you The consultation document is now out and wish to carry out a trial on one of their Chris Simpson and myself will be sending in a products you must first discuss this with Southern Derbyshire wide response. In order your locality lead clinician and community to do this we will be arranging meetings at pharmacist (Malcolm Steward). which you will be able to put forward your views. Staff wishing to send in their own Bibliography comments should address them to: Some articles you may find of interest: Mrs Kathy Mann, Department of Health § Williams M. An extension of responsibility. MPI-PPB, Room 6E43 Nursing Times 1999; June 9 No1 § Hemingway S, Flowers K. Nurse Prescribing in Quarry House, Quarry Hill the field of community mental health nursing. Leeds LS27UE. Nursing Times 2000; October 26 Vol96 No13 § Gooche S. Nurse prescribing and the Crown Alternatively e-mail responses to: review. Professional Nurse 2000; July Vol14 No firstname.lastname@example.org 10 § King B. Prescribing: the role of the tissue Stock items viability nurse. NT 2000; Sept 7 Vol96 No36 § Baird A. Crown2: the implications of nurse Rosemary Cook, Nursing Officer -Primary Care prescribing for practice nursing. British Journal of Community Nursing 2000; Vol5 No9 DOH has stated that it is not good practice to use items which have been prescribed for one For further information please contact: Bev person for the care of another person or for Harris, Nurse Prescribing Project Manager, stock. This applies even if they are in excess of Babington Hospital, Derby Rd, Belper the requirements of the original person. This demonstrates the need for accurate Comments and questions as ever are welcomed. prescribing, to avoid unnecessary wastage. Please contact Kirsty MacLean or Dr Alan Meakin It has been recognised that nurses working in the community may need to access stock 01332 626322 items. This is acceptable providing the following principles are applied: email@example.com § The items are drawn from Trust's stock.
Pages to are hidden for
"Southern Derbyshire Prescribing Newsletter November Rectal Examination"Please download to view full document