Wirral Home Blood Glucose Testing Guidelines – updated
The Wirral Home Blood Glucose Testing Guidelines have been updated to include a cost effective ketone testing meter called the Glucomen Areo 2K.
The Glucomen Areo 2K meter is the most cost effective if a patient requires both blood glucose and ketone testing. The testing strips required for this meter are the Glucomen Areo sensors (for blood glucose) and the Glucomen Areo β Ketone sensors (for ketone testing).
NICE BITES: Antimicrobial stewardship: changing risk-related behaviours in the general population.
Recently a NICE Bites has been published providing a summary of prescribing recommendations from NICE NG63 – Antimicrobial Stewardship: changing risk-related behaviours in the general population.
The guideline aims to change people’s behaviour to reduce antimicrobial resistance and the spread of resistant microbes. It includes making people aware of:
- Measures to prevent and control infection that can stop people needing antimicrobials or spreading infection to others
- How to correctly use antimicrobial medicines
- Dangers associated with the overuse and misuse of antimicrobial medicines
- Self-care – where to obtain advice
The NICE BITES bulletin should be read in conjunction with NICE NG15 – Antimicrobial Stewardship: systems and processes for effective antimicrobial medicine use.
The Wirral CCG Cardiovascular Clinical Group has recently discussed the need for GPs to have more information about DOACs, including cost. The document at the link below is taken from the Wirral Oral Anticoagulant Guidelines, but has been updated to include current costs.
Warfarin 500 microgram tablets
The 500 microgram warfarin tablets should not be used to avoid confusion with other white tablets and 5mg doses of warfarin. The 1mg tablets can be easily broken in half or cut with a tablet cutter to achieve a 500 microgram dose.
The Cardiovascular Clinical Group has confirmed that Wirral GPs should not prescribe warfarin 500 microgram tablets. ScriptSwitch messages already highlight this information. Community pharmacies have been asked to support this.
The use of post-dated prescriptions is generally not recommended unless being used for delayed antibiotic prescribing. All prescribers should carefully consider the necessity and potential consequences of issuing a post-dated prescription, for situations other than delayed antibiotic prescribing. Alternatives such as repeat dispensing may be a more suitable solution.
An incident occurred recently in which a pharmacy inadvertently dispensed a post-dated prescription for a controlled drug before the date on which it became effective. Whilst investigation into this case is ongoing, we believe it resulted in the patient commencing new treatment of a controlled drug at three times the intended starting dose.
Post-dated EPS prescriptions have less potential to cause problems when compared to handwritten or printed prescriptions, as a post-dated EPS prescription will ‘held’ on the spine and won’t be ‘released’ before its due date. This does not however cancel all risks.
Three examples of potential harm are shown below, but these are not exhaustive.
- The prescription may be issued in advance and harm may result.
- It may result in additional prescriptions being issued if the patient (or carer, relative etc.) claims to have lost post-dated prescriptions. An incident occurred in Cheshire in the recent past in which a GPs intention was to better manage controlled drug abuse by using post-dated prescriptions but doing so actually resulted in more prescriptions being provided.
- Treatment needs to be discontinued (and/or changed) or the dose adjusted*.
* Whilst post-dated EPS prescriptions will be held until the date they become in to effect, it is still necessary to cancel these if treatment changes. For paper prescriptions, the patient would need to be informed of any changes in a timely fashion.
Why – is a posted dated prescription necessary?
What – are the potential risks?
How – can/will I manage the risks?
Do – I have any alternatives (e.g. repeat dispensing)?
Please note: for delayed prescribing of antibiotics using post-dated prescriptions is still recommended where appropriate.
Case Study: over-ordering of fentanyl patches via repeat prescriptions (MLCSU Medicines Safety Assurance Tool January 2017)
Patient A had a problem with his fentanyl patches falling off and was replacing them after one to two days. This resulted in Patient A over-ordering fentanyl patches via repeat prescriptions. Patient A over a 12 month period was legitimately prescribed 520 days’ supply of fentanyl patches.
A teenage friend of Patient A’s son was found dead after ingesting a fentanyl patch. Patient A’s son had been stealing his father’s patches and had given one to his friend. Patient A had suspected his son of stealing his fentanyl patches. A full investigation was undertaken and it was noted there were various points at which the excessive amount of prescribed fentanyl patches could have been picked up. These included the staff printing off the repeat scripts, the doctors signing the repeat scripts and the pharmacy staff dispensing the prescriptions.
Nystatin Dose Update
On the 15th March 2017, there was a dose change for nystatin in the BNF and BNFc. The BNF and BNFc now state that “The nystatin dose for oral candidiasis in the BNF has historically reflected the posology recommendations in the Nystan® Summary of Product Characteristics (SPC). Following discussions with the MHRA the dose has been updated and now reflects current posology recommendations for generic nystatin products.”
The dosage for nystatin for oral candidiasis in the BNF and BNFc is now:
- Child - 100,000 units 4 times a day usually for 7 days, and continued for 48 hours after lesions have resolved.
- Adult - 100,000 units 4 times a day usually for 7 days, and continued for 48 hours after lesions have resolved.
Miconazole oral gel remains the first choice for the treatment of oral candidiasis.