Minutes of the meeting held on Thursday 10th March 2016

In the Boardroom, Management Suite,4th floor, 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 (Acting Chair)
Mrs A Ritchie / Pharmacist Team Manager Procurement and Formulary - Joint Secretary
Mrs S Mavani / Pharmacist Team Manager Medicines Governance – Joint Secretary
Ms C Johnson / Interface Lead Pharmacist, Greater East Midlands Commissioning Support Unit.
Ms K Broad / Specialist Pharmacist – C&PJPG/HCD, Cambridgeshire & Peterborough CCG
Dr D Woolf / Consultant Paediatrician
Dr C Jephcott / Consultant Oncologist
Dr M Sahni / Consultant Anaesthetics
Ms S Drake / Deputy for Angeline Boaden
Miss A Lazzari / Deputy for Guy Sabbagh
Mr P Taylor / Consultant General Surgery

Minute Taker: Mrs A Stimson, PA to the Medical Director and Deputy Medical Director

16/14Apologies for Absence

Dr R Mittra, Mr A Massraf, Dr D Mlangeni, Ms A Boaden, Mr K Claire

16/15 / Minutes of the Formulary and Medicines Management Meeting heldon Thursday 21st January 2016.
The minutes were agreed as a true and accurate record of the meeting.
16/16 / Matters arising from the minutes:
  • 16/03 Terms of Reference:
C.McIntyre to discuss the proposal to split the meeting with the Chair, Callum Gardner. Update: CG and CM have discussed this and decided to keep the meeting to the current format. CM advised that no further comments were received;the Terms of Reference were approved.
  • 15.16.13 Guidance for Post-operative Analgesia after Day-case Arthroscopic Shoulder procedure: This is still on hold.
  • 15/27.4 Protocol for the Prescribing and Administration of Tecfidera (Dimethyl Fumarate): This is still not ready and to be deferred to a future agenda.
  • 15/46.12 Guidelines for the Management of Anticoagulant reversal in Adults: this item is on hold until the inpatient anticoagulant chart is approved
  • 16/09.2 Items from C&PJPG – A.Ritchie to email relevant clinicians with the outcomes: AR advised that it has not yet been possible to do this. Most clinicians will be aware of the outcomes from the recommendations in the documents they have previously seen and commented on. Action: AR
  • 16/10.2.4 Dysphagia Labels Proposals: SM confirmed that some comments have been received. The preference is for clear but this is not on the formulary and is double the price of the non-clear. Also, the thick is almost double the price of the standard. The committee approved the label and the principal of the sticker. However, in terms of the preferred product Resource Clear, a full Formulary submission will be required.
  • 16/10/.3.1 Policy for prescribing, dispensing and administering Methotrexate. This policy has been fully approved and is now available on Sharepoint.
  • 16/13 Issue of two prescription charts, one for TB and another for Post Exposure Prophylaxis (PEP).SM confirmed that this has been passed onto Yolanda Abunga (Hepatitis/TB Pharmacist Advanced) to pick up.
  • 16/13 Standard infliximab chart needed to ensure the correct administration: Item is on the agenda.

16/17 / Formulary Items given Chair’s Approval, New Drug Requests and Updates:
Chairs Approval: CG confirmed that chair’s approval had been given for:
  • Granisetron patch
  • Gold injection (Myocrisin)
  • Epilim for a child
New Drug Requests:
16/17.1 – Jemma Hendley, Advanced Dietician in attendance
  • Nutilis Complete Stage 1&2 pre-thickened supplements
JH advised current supplements cannot be thickened as they separate out.
  • Prosource TF & Jelly
This is a higher protein, lower calorie product which would only be used with specific patients. A flowchart will be available to advise how and when to use.
  • Fortisip Compact Protein
JH advised that this is a straight swap, this product has extra protein in it which will reduce the number used therefore reducing the cost.
16/17.2- Dr E Wawrzkowicz, Consultant Paediatrician in attendance
  • Dymista
EW explained that Dymista would only be used for adolescents already on long term antihistamines and steroids whoare not suitable for other immunotherapy. ED explained that new allergy guidelines are shortly being released and it is expected that Dymista would be included in the guidelines to support. The request is for the Trust to retain prescribing and for five patients only.
Outcome: All new drug requests were approved.
16/18 / 16/18.1 NICE Technology Appraisals published January & February 2016:
  • TA375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.No response received yet.
  • TA376 - Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases. Not applicable as we do not use within the Trust.
  • TA377 - Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated. Fully implemented.
  • TA378 - Ramucirumab for treating advanced gastric cancer or gastro–oesophageal junction adenocarcinoma previously treated with chemotherapy. Fully implemented.
  • TA379 - Nintedanib for treating idiopathic pulmonary fibrosis.
No response received yet as Jon Naylor is currently off. CG understands that Papworth should be dealing with this rather than PSHFT as treatment is instigated there with ongoing prescriptions by us.
  • TA380- Panobinostat for treating multiple myeloma after at least 2 previous treatments. Is applicable, but drug not yet used within the department.
  • TA381- Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy. Fully implemented.
  • TA382 - Eltrombopag for treating severe aplastic anaemia refractory to immunosuppressive therapy (terminated appraisal). For information only
  • TA383 -TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis. Pending response.
  • TA384 - Nivolumab for treating advanced (unresectable or metastatic) melanoma. Pending response.
  • TA385 - Ezetimibe for treating primary heterozygous-familial and non-familial hypercholesterolaemia. Pending response.
16/18.2 NICE Clinical Guidelines published January & February 2016:
CG advised the following have been published, these are for information purposes only:
  • NG33 - Tuberculosis
  • NG35 - Myeloma: diagnosis and management
  • NG36 -Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over
  • NG37 -Fractures (complex): assessment and management
  • NG38 -Fractures (non-complex): assessment and management
  • NG39 -Major trauma: assessment and initial management

16/19 / Horizon Scanning
CG advised the following are for forward planning purposes:
16/19.1 - New Drugs Online newsletter January 2016
16/19.2 - NICE Technology Appraisals in Development expected publication March to September 2016
16/20 / Unlicensed Medicines Update.
16/20.1 Hydrex Risk assessment
This risk assessment has been disseminated for review. PT advised that he looked in the library and found a book dated 1982 where chlorhexidine is quoted as effective. The Trust did try to move away from alcohol skin prep, however the infection rate increased so we reverted back. The risks of burns with alcohol skin prep are well known. Chloraprep is more expensive than Hydrex; otherwise, there is nothing different between the two. This has been discussed in depth at the Hospital Infection Control Committee and it has been noted that Addenbrookes are using Hydrex again.
Outcome: The committee approved continuing to use.
16/21 / Medicines Optimisation:
  • 16/21.1 - Formulary Reviews including previous submissions.
  • 16/21.2 - Items from C&PJPG.
  • 16/21.3 - High Cost Drugs – GPAs, IFRs etc.
  • 16/21.4 - Shared Care Guidelines:
-16/21.4.1 Midodrine Shared Care Guideline for Orthostatic Hypotension.
-16/21.4.2 Methotrexate Shared Care Guidelines.
Comments on the two policies: In the Methotrexate Share Care Guidelines there is a hyperlink which does not work; it also makes reference to Epic which is the notes system at Addenbrookes. Amendments to be made.
Outcome: The committee approved the shared care guidelines subject to the amendments and addition of Trust contact details.
16/22 / Trust policies and guidelines for approval:
16/22.1 Policies/Documents given Chair’s Approval: None received.
16/22.2 New Policies/ Guidelines/Documents:
  • 16/22.2.1 - Order form foraflibercept (Eylea) 40mg/ml.
  • 16/22.2.2 - Order form for ranibizumab (Lucentis)
These are two new order forms for Ophthalmology
  • 16/22.2.3 - Guidance for Post-operative Analgesia after Day-case Arthroscopic Shoulder Procedures.
There were significant concerns with this guideline the first time it was submitted. This version still includes the tracked changes. The initial concerns raised related to the patient information leaflets being hard to follow/understand and that they needed to be made more explicit. The original author has left the Trust. SM will liaise with Craig Reston regarding identifying someone else to lead on this.
Action: SM
  • 16/22.2.4 - Patient information leaflet: Post-operative pain relief after day-case arthroscopic shoulder surgery.
As above.SM will liaise with Craig Reston regarding identifying someone else to lead on this.
Action: SM
  • 16/22.2.5 –Universal abatacept prescription chart.
Outcome: Prescription approved when barcoded and addition of brand name.
  • 16/22.2.6 - Universal infliximab Prescription chart v 6.
There are three brands of infliximab, with another on the way. It is a requirement that the brand be specified on the prescription, the prescription will be amended slightly so that the prescriber may do this.
Outcome: Prescription approved when barcoded and with amendment.
  • 16/22.2.7 - Universal tocilizumab Prescription chart.
Outcome: Prescription approved when barcoded and addition of brand name.
  • 16/22.2.8 - Universal vedolizumab Prescription chart.
Outcome: Prescription approved when barcoded and addition of brand name.
  • 16/22.2.9 - Protocol for the Administration of Fingolimod (Gilenya®) in Multiple Sclerosis.
Query as to where this would sit on Sharepoint. These needs to be approved by local Medicines Governance Committee, with full endorsement here at FMMC rather than QGOC.
  • 16/22.2.10 - V2 Guideline for Intravenous Ciclosporin Administration in Severe Ulcerative Colitis
Previous feedback on this guideline was that it was too lengthy. The author has subsequently shortened and made it more user friendly. Addition to policy needed to show that it is for adults only.
Outcome: Approved following addition to state for adults only
  • 16/22.3 - Policies/ Guidelines for Review: None

16/23 / Reports from Groups and Subcommittees/ Associated Medicines Update:
  • 16/23.1 Antibiotic Prescribing Group
Nikki Phillimore is completing a prevalence audit and the results will be disseminated shortly.
  • 16/23.2 Medication Safety Committee (Safer Prescribing Group)
There is ongoing training for FY2s and educational sessions for GPSTs. Another pharmacist educator has been recruited to assist with junior doctor prescribing and they will be training within ED as well.
  • 16/23.3 IVIG demand management panel
Discussion regarding IVIG and decision that the meeting either needs reinstating or it needs to be incorporated within the FMMC bi-annually. Often different members would be required, therefore reinstating would be the way forward.
  • 16/23.4 Thrombosis Committee
Anticoagulation chart has been changed, it now incorporates NOACS; this has been added to the guidance and prescribing section. Anticoagulant chart has now been taken to QGOC for final endorsement.
  • 16/23.5 Oxygen & Medical Gases
Oxygen prescribing is on the risk register. In terms of a solution the proposed new drug chart would solve this; these forms are available and should be used on every ward and in ED. This should remain on the risk register until the new drug chart is in full use and compliance with oxygen prescribing audited. The delay with this is that the new drug chart is not EDM compatible.
  • 16/23.6 NMAG
No update
16/24 / Any Other Business:
S.Mavani: At the Medication Safety Committee it was noted that there needs to be a caveat added regarding there being a second checker when prescribing drugs, to highlight the fact that Community Midwifes are lone workers and therefore a second checker will not be available to them.
Outcome: CG approved for this caveat to be added to the policyfor Safe and Secure Handling of Medicines, where it refers to second checking drugs.
S.Mavani: Rob Dennis has resubmitted document with Lecicarbon added to the prescription chart. There was a query as to why a PGD is required as already has a prescription. In summary, colorectal specialist will see the patient; sign which product is required, the patient is then seen in pre-assessment clinic and the nurse supplies the relevant products. The PGDTrust Approval Group are happy with the logistics and the procedures to be followed.
Date of Next Meeting: Thursday 26th May 2016 at 12.45pm, in the Pharmacy Seminar Room, 1st Floor, PCH

Minutes of Formulary and Medicines Management CommitteePage 1 of 6

10thMarch 2016