Minutes of the Meeting Held on Thursday 24Th November2016

Minutes of the meeting held on Thursday 24th November2016

In the Pharmacy Seminar Room, 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 (Deputy Chair)
Mrs A Ritchie / Pharmacist Team Manager Procurement and Formulary - Joint Secretary
Mrs S Mavani / Pharmacist Team Manager Medicines Governance – Joint Secretary
Dr D Woolf / Consultant Paediatrician
Ms S Drake / Orthopaedic Trauma Practitioner
Ms K Broad / Specialist Pharmacist – C&PJPG/HCD, C&PCCG
Mr S Cook / Chief Pharmacist, Hinchingbrooke Hospital
Mr D Chittenden / Senior Finance Business Partner
Ms A Boaden / Non-medical prescribing lead
Ms L Knight / Rheumatology Nurse Specialist

16/62 Apologies for Absence:

Dr R Mittra / Consultant Geriatrician
Ms C Johnson / Interface Lead Pharmacist, Greater East Midlands Commissioning Support Unit
Dr K Jephcott / Oncology Consultant
Lesley Crosby / Deputy Director of Nursing
Mr K Claire / Lead Pharmacist, Peterborough and Borderline PCG
Dr D Mlangeni / Consultant Microbiologist

From January 2017 joint meetings will be held with the Drug and Therapeutics Committee at Hinchingbrooke Hospital. The January meeting will be held in Hinchingbrooke Hospital, the March meeting in Peterborough City Hospital.

16/63 / Minutes of the Formulary and Medicines Management Meeting heldon 19th September 2016: theminutes were agreed
16/52: Terms of Reference: approvedto besent to QGOC for final endorsement.
16/58.2.2 Guidelines for the use of LAT gel for paediatric wounds at Peterborough City Hospital Emergency Department. This gel is unlicensed so a risk assessment is required.
Outcome: unlicensed risk assessment received, guidelines now approved.
16/58.3.2 Neonatal Abstinence Syndrome
This policy now mentions SSRIs. Therefore, more detail regarding what updates have been made is required on the version control.
Outcome: amendments done, now approved.
16/64 / Action Log: The action log was reviewed and updated accordingly.
Terms of Referenceapproved and to go to QGOC for endorsement.
Post operativeanalgesia after day case arthroscopic shoulder procedure guidance – has been given Chairs Action.
Merging of QA form – keep as separate forms as there are more policies without medicines than with them. So Trust QA and Pharmacy QA kept as separate documents SMavani retains pharmacyQAs.
Degarelix – ARitchie had raised primary care rebates with Cambridgeshire and Peterborough CCG.
Unlicensed med policy – approved. SM to update section on responsibilities of pharmacy technicians
16/65 / Formulary Items given Chair’s Approval – for information.
Desmopressin nasal spray: for a needle phobic patient with von Willebrand's.
Zonisamide: for patient with loss of consciousness investigated for epilepsy.
Aripiprazole: for hallucinations recommended by psychiatrist.
Perampanel: for drug resistant epilepsy. The formulary is to be revised in line with the NICE Guidance and the local Management pathway:Treatment of epilepsy in adults.
16/66 / New formulary submissions:
Enstilar(Dr Banfield attended the meeting). New non-alcoholic foam spray preparation for psoriasis. No in-depth data for comparisons with alternative products. Comparable by cost until patent of alternative expires.Would not initiate in hospital, it would be for GPs to initiate but it is not in Cambridgeshire and Peterborough CCG formulary. Start with gel first and just use Enstilar for those who cannot tolerate gel. CCG concerned use of this would spread and there is aneed to produce guidance of when appropriate. Dr Banfield was invited to attendthe C&PJPG meetingin January to answer the GP and CCG queries. Committee deferred the decision pending the outcome of January’sC&PJPG meeting. Outcome: Deferred
Degludec: is in local CCG formularies and would mainly be initiated by GPs, there is interest to initiate it in appropriate patents in this Trust. The committee agreed to add Degludec to the Trust formulary with the restrictions agreed by Cambridgeshire and Peterborough Joint Prescribing Group:
- type 1 patients with significant nocturnal hypoglycaemia despite using an optimised regimen of analogue basal insulin.
- “Chaotic patient” an d who may be at significant risk of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS) (previously known as (Hyperosmolar non –ketotic diabetic state or hyper HONK), if daily basal insulin is missed.
-Patients with psychological problems (e.g. eating disorders or patients with intermittent compliance issues with insulin injections, who are not supervised by a daily carer and do not qualify to receive district nurse injections of daily Glargine, and
who may be at significant risk of DKA or HHS if daily basal insulin is missed.
-Patients who require analogue basal insulin but have established allergic reactions to levemir or glargine. Outcome: added to Trust Formulary with restrictions
Ultibro Breezhaler ( Dr Naylor):
Dr Naylor had completed a formulary submission for this product. The product has been added to the Cambridgeshire and Peterborough CCG formulary following assessment and discussions at C&PJPG, it is a second choice LABA / LAMA combination product in the COPD pathway. The committee agreed to add Ultibro Breezhaler to the formulary as second line choice.
Outcome: added to Trust Formulary as second line choice.
The committee agreed that the Trust’s inhalers in the formulary be reviewed and updated in line with Cambridgeshire and Peterborough CCG and Lincolnshire formularies. The proposed change would be brought to the committee for discussion and approval.
16/67 / NICE Technology Appraisals published September and October 2016
No information was available from Quality Governance about whether the indications are treated in the Trust to inform whether the products should be added to the formulary.A Ritchie to ask for information.
TA406 Crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer.
TA407 Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors.To be added to formulary for this indication.
TA408 Pegaspargase for treating acute lymphoblastic leukaemia.
TA409 Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion. To be added to the formulary for this indication.
TA410 Talimogene laherparepvec for treating unresectable metastatic melanoma.
TA411 Necitumumab for untreated advanced or metastatic squamous non-small-cell lung cancer.
TA412 Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases.
TA413 Elbasvir–grazoprevir for treating chronic hepatitis C. Added to the formulary post meeting.
TA414 Cobimetinib in combination with vemurafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma.
TA415 Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor. To be added to the formulary for this indication
TA416 Osimertinib for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer.
16/68 / Unlicensed Medicines Update:
Enalapril oral solution:paediatric patient unable to swallow the tablets
LAT gel: only used in ED for wound debridement or closure
3.4 Diaminopyridine: For Lambert Eaton Myasthenic Syndrome.Categorised as high risk so that it is only prescribed on a named patient basis only
16/69 / Medicines Optimisation:
16/69.1 Formulary section rolling review:no section has been reviewed yet because of the potential merger.
Inegy had been approved in May for treatment of alopecia, the one patient in whom it had been used had shown a good response.
Removing 0.5 mg Warfarin. Need to speak toTim Jones. Not on new anticoag chart. 2 regional patient incidents leading to patient deaths. Named patient basis if required. SMavani to speak to Paeds and then decide. Check at Addenbrookes Paediatrics.
16/69.2High Cost Drugs:forecasting had been asked for both 2017-18 and 2018-19 This was very difficult as clinicians do not know which drugs they may want to use. NHSE may allocate budget and the Trust would need to argue a change if they needed a different amount. There is a High Cost Drug Task and Finish Group that is trying to address current issues with High Cost Drugs processes.
16/69.3 Shared Care Guidelines: Apomorphine Shared Care Guideline; this guideline had been discussed at C&PJPG the previous afternoon and a few minor changes were required and were to be presented in January. The committee otherwise thought that the guideline was acceptable.
At the C&PJPG it had been raised that nurses from Britannia were treating and training patients in the hospital and in the patient’s home, they were also changing doses of apomorphine and other Parkinson’s Disease medications. The Pharmacist Team Manager for Medicine was going to check out what agreements are in place and update at next meeting.
Hydroxycarbomide: shared care guidelines. If our prescribers agree we will put their contact details on the shared care guideline agreed at C&PJPG and use that one.
Gold Shared Care:A Ritchie to check with rheumatology how to ensure our Trust’s shared care guideline and Addenbrooke’s shared care guideline are the same.
16/70 / Trust policies and guidelines for approval:
16/ 70.1 Policies/Documents given Chair’s Approval:
Guidance for Post-operative Analgesia after Day-case Arthroscopic Shoulder Procedures has been given Chairs Action. Outcome: Approved
16/70.2 New Policies/ Guidelines/Documentsfor committee approval:
Guideline on the Prescribing of Medicines that are Available for Purchase over the Counter: from Lord Carter work. Over counter medications should be brought in by patients although this could be difficult for elderly patients. The NHSE recommended to get over counter. Paracetamol costs more to the Trust than it costs patients to buy from shops. Added extra line “if patient is unable to get” (Kelly to send sentence to Claire). Contracts need to negotiate with Lincolnshire; need a process in place. If non-urgent then patient can have a note to take to GP to be prescribed. That information needs to be on the sheet. Communications will announce once it is completely sorted.
Smoking cessation:liaise with smoking cessation clinic.
Hayley Topping and team need to target FP10s. FP10s used at Stamford as there is no pharmacy. Discharge summary must state OTC so GP knows the medication is not for prescribing. Outcome: Approved.
OTC Prescribing Poster: To include outpatient pharmacy opening times.
Outcome: Approved
Guideline for the Use of High Strength Insulin: ARitchie spoke to the pharmacist who produced this. Discussed at Diabetes Group. Outcome: Approved
16/70.3 ExistingPolicies/ Guidelines/ Documents for Review:
Guideline for the Management of Hyperosmolar Hyperglycaemic State (HHS):this is a review document; the author list needs changing and the version doesn’t say what changes made. Needs to go to QGOC. Outcome: Approved
Policy for the Supply, Administration, Safe Handling and Storage of Controlled Drugs:
Change regarding CD register with a separate one for Patient Own Drugs and CD register. PODs arenot being given back to patients. Outcome: Approved
Policy for the Safe and Secure Handling of Medicines:the critical medicines list has been updated. Patient own CD book. Issues around FP10 registers; black listed should not be dispensed. Some areas have to audit of FP10s being used and procedures are not in place. This is part of action plan from Mazaars and matrons are to lead on this. To read “must” retain records. Delegated action for ward managers or those in charge of the area. Telephone number to ring if prescriptions are stolen.
Outcome: Approved
Guideline for management of suspected Acute Coronary Syndrome Non-steleration Myocardial Infarction: this is a reviewed document. A number of changes are required. Chairs action once amended or back to the next meeting.
Outcome: not approved.
Guideline for Continuing care of Patients with ACS: some small changes need and then approved. Outcome: Approved
16/71 / Reports from Groups and Subcommittees/ Associated Medicines Update:
The Chair asked that feedback from C&PJPG be added to future agendas.
16/71.1 Antibiotic Prescribing Group:newAntimicrobial Pharmacist starting February if all checks go okay. Hinchingbrooke 8a post going out to advert again and there may be some slight changes.
16/71.2 IVIG demand management panel:it was agreed that an adhoc meeting was required to decide if this meeting is still needed and who should attend the meeting.
16/71.3 Thrombosis committee: plan to change over charts next Tuesdays but supplies have already issued to some wards. Jackie Aistrupwill manage this. SMavani listed changes and to check if other policies reflect the new charts.Warfarin should be used as first line treatment.
16/71.4 NMAG: next meeting tomorrow
16/72 / Any Other Business:
Discussion on setting up a folder on the Y drive as some documents are too large to send. Submission and summary to be sent but list references. Send around policies still.
Administration of this meeting: there are problems with this.
Spreadsheet of attendance: Dr Gardner requested a copy of this going back for 2 years.
Organisational changes with merger: a similar meeting is held at Hinchingbrooke but with no nursing representation. The January meeting to be held in Hinchingbrooke Hospital.
Meeting finished at 15.06
Date of Next Meeting: Thursday 26th January 2016 at 9.45 in the Pharmacy Training Room, Hinchingbrooke Hospital.

Minutes of Formulary and Medicines Management CommitteePage 1 of 6

24 November 2016