Postgraduate Centre EC091
Medway Hospital, Gillingham, Kent, ME7 5NY
Wednesday 20 May 2015 12:00hrs - 14:00hrs
1. Members
Richard Patey (RP) / Chair, Consultant Paediatrician, Medway Foundation Trust (MFT)
Dr Las Ayathurai (LA) / GP, Swale CCG
Louise Dark (LD) / Chief Pharmacist, MFT
Yvette Bartlett (YB) / Associate Chief Pharmacist – Clinical Services, MFT
Oni Odelade (OO) / Prescribing Advisor, Medway Clinical Commissioning Group (CCG)
Bal Minhas (BM) / Prescribing Advisor, Swale Clinical Commissioning Group
Bukky Francis (BF) / Formulary Pharmacist, MFT
Korede Ibitoye / Pharmacist, MCH
Dr Manpreet Pujara MP) / GP Medway CCG
Dr Maam Mamum (MM) / Elderly Care Consultant, MFT
In attendance
Dr Adrian Barnardo (AB) / Gastroenterology Consultant, MFT
Sandip Banerjee (SB) / Respiratory Consultant, MFT
Dr Saleh / General Medicine Consultant, MFT
Dr Saul Halpern / Dermatology Consultant, MFT
Sarah Christie / Pharmacy Secretary
2. / Apologies for absence
Zika Petrovic
3. / Matters Arising
ToR – changes agreed for 4.3.2; 7.1; 7.2; 9.4.9
Annual Report for DTC - noted
4. / Minutes of the last meeting held and action points
Minutes agreed.
Action Log Review
The action log was reviewed – refer to log for updates.
5. / Conflict of Interest
6. / New Drug Applications / Changes to Current Formulary Status
Monofer
Dr Saleh presented the application, he explained that Monofer is indicated for the treatment of iron deficiency anaemia and it has the advantage over the existing formulary option – Cosmofer as the infusion can be given over 30-60minutes (instead of 4-6 hours). Also the total dose can be given as a single infusion which means patients do not have to be stay as long in medical infusion suite.
An IV iron care pathway was also submitted with the application which will be followed when Monofer is administered. Dr Saleh also explained that the application has been discussed and agreed with the Haematologists
Decision: Approved; to replace Cosmofer
Action:
· IV iron Integrated Care Pathway (ICP) to be checked by pharmacy before final approval.
· Agreement with Obstetrics and Gynaecology department needs to be confirmed
· LD to email Divisional Lead about potential cost impact within the division on switching from cosmofer to monofer but time saving in medical infusion suite.
Ultibro Breezhaler/Duaklir Genuair
Dr Banerjee presented the application for Ultibro breezhaler; a new LAMA/LABA combination inhaler. He explained that there are currently three LAMA/LABA combinations in the market and all use different devices with once or twice daily dosing. The application was discussed in detail together with Duaklir which was another LAMA/LABA combination inhaler for COPD (the application was submitted by Dr Stewart but unfortunately could not attend the meeting). Anoro Ellipta is currently on formulary.
Decision: Both Ultibro and Duaklir Approved; to be reviewed in 12 months.
Epiduo Gel
Dr Saul Halpern presented the application. Epiduo gel indicated for cutaneous treatment of acne vulgaris when comedones, papules and pustules are present. He explained that it can be used as 1st line topical therapy in primary care. GPs will require better education. Pump dispenser only allows 0.5g at a time.
Decision: Approved; Zineryt to come off formulary
Mirvaso Gel
Dr Saul Halpern presented the application. Mirvaso is indicated for the symptomatic treatment of facial erythema of rosacea in adult patients. This is a first in class treatment and currently the only topical option available to patients.
Decision: Approved
Rifaximin
Rifaximin is prescribed for the reduction in recurrence of episodes of overt hepatic encephalopathy in patients over 18 years. It is estimated that a total number of 12 patients per year will need rifaximin, it is also hoped that it will reduce the number of hospital admissions. Patients who require rifaximin will be reviewed at 3 months.
Decision: Approved; it was decided that share care guidance was not needed and patient to be kept under secondary care. For review in 6 months
Action:
· Duration of treatment and who prescribes to be confirmed, potentially via homecare in the future if possible.
· Need to decide how repeat prescriptions will be dealt with by MFT pharmacy.
Dymista
Dr Stewart was not present to present the application but the committee discussed the application and felt nothing has changed significantly since last submission in March 2014.
Decision: NOT Approved
DuoResp Spiromax
Deferred till next meeting in June
7. / Guidelines/Pathways
Vitamin D guideline
Awaiting comments from clinicians – paediatric and care of the elderly
COPD Self-Management Plan
This plan was developed by Dr Banerjee for patients with COPD and a copy of the information sheet will be given to patients at discharge.
Action:
Form to be updated as follows:
· Name of person completing this plan and ‘counselling’ patient to be added to form.
· Re-wording of subsequent issues of rescue pack from GP if patient has used initial supply to state ‘IF YOU HAVE USED YOUR RESCUE PACK, PLEASE CONTACT YOUR GP FOR REPLACEMENT’
· Colour border round each box instead of full colour to save money on ink cartridges.
PR 2015-04: Alitretinoin for Darier’s disease
It was noted that Alitretinoin is not recommended for the treatment of Darier’s disease on local NHS
PR 2015-05: Use of biosimilars
Recommendation states to use product of lowest acquisition cost as first line for initiation. There was however a discussion around switching existing patients and what will be carried out in the whole of south east.
Action: to be discussed with rheumatology and bring back to next meeting. Await ongoing discussions with gastroenterology.
Insulin Degludec for diabetes mellitus – Briefing note
Noted
Overactive bladder (OAB) pathway
Final pathway noted and approved. LD advised to take off prices as this will change with time.
Management of Alcohol Withdrawal Syndrome
Dr Barnardo presented the pathway. The pathway is to be used to identify adult patients at high risk of alcohol withdrawal. The process must be used together with the two assessment tools:
· Fast Alcohol Screening Tool (FAST)
· Glasgow Modified Alcohol Withdrawal Scale (GMAWS)
All patients should be closely observed for signs of over sedation with regular observations
Biggest issue is communication. Turning Point will prescribe the medication. GPs and MEDOCC need to be educated. GPs will not prescribe medication if patients lose their drugs. Secondary care will prescribe patients with 24hr dosage unless weekend/bank holiday. Strength of diazepam to dispense on discharge to be clarified.
Action: LD to check street value of benzodiazepines with Turning Point.
8. / Formulary Adherence
Neuropathic pain audit
The report was reviewed and noted that it was a difficult audit to carry out from secondary care as there was lack of information of previous medications already tried. It was suggested that the audit should be carried out by GPs/CCG. Also to discuss with specialist team in secondary care the possibility of carrying an audit during their clinics.
9. / Drug Safety Updates (Mar 2015)
Noted
10. / NICE
· NICE TA 329 – Approved
· NICE TA336: Empagliflozin – Approved but form to be resubmitted to Governance
· NICE TA336: Rivaroxaban – for discussion at next meeting
· NICE TA337: Rifaximin - Approved
· NICE TA338: Pomalidomide – for discussion at next meeting
· NICE NG5: Medicines optimisation - for discussion at next meeting
11. / Any Other Business
MM asked if there is a guideline for orphan drugs – Yes.
LD asked to add unlicensed medicines as a standing agenda.
Date of next meeting
Wednesday 17th June 12:00 – 14:00, Dolphin Seminar Room, Green Zone, Level 2
4