; Southern Derbyshire Prescribing Newsletter November Rectal Examination
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Southern Derbyshire Prescribing Newsletter November Rectal Examination


Southern Derbyshire Prescribing Newsletter November Rectal Examination

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  • pg 1
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
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.

                                                             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
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
kathy.mann@doh.gsi.gov.uk                              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:                         kirsty.mclean@mail.sderby-ha.trent.nhs.uk
§ The items are drawn from Trust's stock.

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