SERVICE SPECIFICATION

Supply of antivirals (oseltamivir and zanamivir) for treatment and prophylaxis of H1N1 influenza

Scope

This service is to provide antiviral therapy (treatment or prophylaxis) to patients who have been identified by a NHS Westminster GP or NHS Walk-in Centre as requiring therapy in the pre/early pandemic period. Stocks of antiviral drugs for this service will be provided by the PCT to the pharmacy at no cost from the centrally purchased national stockpile.

People with symptoms and others at risk will have been assessed by a NHS Westminster GPor NHS Walk-in Centre. Eligible patients are those where the GP or NHS Walk-in Centre has recommended antiviral therapy. All relevant details must be provided to the pharmacy before a supply is made.

This service is for patients registered with a NHS Westminster GP.

The service must be available during all opening hours (core & supplementary) and the drug will be supplied via patient specific direction.

Pharmacy Details

Pharmacy nameenter details

Pharmacy address enter details

Pharmacy telephone enter details

Pharmacy fax no enter details

Pharmacy e-mail enter details

Pharmacy opening hours enter details

Monday – Friday SaturdaySunday

Entered opening hours of the pharmacy

Authorisation of supply

  • The Prescriber will complete a FP10 prescription for oseltamivir or zanamivirand fax it to the pharmacy during opening times:
  • There should be an indication on the faxed form of who will pick up the supply.
  • The faxed copy or original FP10 should be endorsed “convenient stationary”

Supply

A supply can only be made against a faxed copy of an FP10 or the original FP10. In the majority of cases the pharmacy will be dealing with a faxed copy

On receiving a faxed FP10 request for supply, the pharmacist will:

  • Complete the Supply of Antiviral Medicine for flu form (Appendix 1a for treatment; 1b for prevention).
  • Label the appropriate pack(s) with all relevant details and issue the antiviral
  • Supply should be record on the pharmacy PMR (Patient Medication Record)
  • The additional information sheet for oseltamivir or zanamivir should also be given to patients.
  • Supply can only be made against FP10 from NHS Westminster GP Practices or Walk-in Centre.
  • The pharmacy does not need to obtain an original FP10 to reconcile against a faxed copy
  • Treatment requests should be collected by a nominated “flu friend”
  • Prevention requests may be collected by the patient or a nominated “flu friend”.
  • A “flu friend” should be specified on the faxed FP10 by the Prescriber
  • Proof of identity (patient or flu friend) should be sought for every supply
  • If identitycannot be verified e.g. not written on the FP10, no ID, language barrier. The Pharmacist should use their professional judgement
  • The pharmacy does not need to send off faxed copies of FP10s or original FP10s to the PPD.

Fluid repellent masks should be supplied to symptomatic patients or flu friends before a consultation. If possible consultations should be take place in a private consultation area.

Prescription charges

Prescription chargesare NOT payable for supplies made under this service regardless of patient exemption category.

Private Prescription Requests

Supplies should not normally be made against private prescriptions under this service. In exceptional circumstances the PCT may authorise supply using this route therefore on receipt of a private prescription for oseltamivir or zanamivirplease contact Sarah Watkins or Mandeep Butt in the PCT Medicines Management team on 0207150 8136/8132

Recording supplies made

  • The pharmacymust complete the supply form (Appendix 1a or 1b)
  • The supply should also be recorded in the private prescription log book.
  • The pharmacy will also maintain a running balance log (Appendix 2).
  • All completed records must be stored securely, and will form the basis for remuneration and audit.
  • Stock supplied by the PCT for use in this service cannot be used for any other service

Storage and submission of records

  • Faxed FP10 prescription forms together with the supply form completed for the same patient must be faxed to the PCT on a daily basis (7 days a week) by 10am.
  • Completed running balance logs (Appendix 2) must be faxed to the PCT by 10am each day for monitoring purposes.
  • Faxed FP10 forms, original FP10s, supply forms and balance sheets should be retained by the pharmacy. These will be collected by the PCT
  • The pharmacy should perform a daily stock reconciliation exercise before faxing balance logs, FP10s etc to the PCT. If stock levels cannot be reconciled, the PCT must be notified on that day.

Ordering stock of antivirals

  • The pharmacy should order stock responsibly for this service.
  • The pharmacy must fax their orders to the Medicines Management team at NHS Westminster for approval,using the documentation provided (Appendix 3).
  • Stocks will be delivered to the participating pharmacy from PCT allocation of national stockpiles.
  • Stock will be provided and delivered to the pharmacy without charge.

Storage

The antiviral supplies must be held securely, separated from other stocks (ideally in a locked cupboard) within the dispensary.

Fees

Fees will be paid according to the following schedule:

Service / Fee
Safe storage and handling of each weekly delivery of anti-virals from central store / £50.00
Supply of anti-virals (per patient) / £7.20

Useful contact details:

HPU / Telephone 0845 425 1752
NHS Westminster Medicines Management Team
Address / 3rd floor, 15 Marylebone Road, London, NW1 5JD
Telephone / 020 7150 8133 / Fax / 020 7150 8105
Email /

Supply of Antiviral Medicine for Flu - TREATMENT

Venue: Pharmacy name & address / Date:
1. Details of person providing the information/collecting antiviral – should be indicated on FP10
Name / ID seen yes no
ID type
Relationship to patient
Address / Tel. No.
Signature / Date
2. Patient’s details
Full name / Date of birth
(dd/mm/yyyy) / Age (in years)
Full address including postcode
Contact telephone number / Male Female
ID seen yes no
ID type / Weight (kg) if child
under 13 years old
3. Dose information for TREATMENT and supply record
Tamiflu®(oseltamivir)
Tick
 / Weight in kg
(of child <13 yrs) / AgeRange
(if no weight
available) / Strength / Dose / Supplied by:
signature / name
 / Body-weight  15 kg / 1-3 yrs / 30mg
capsules / One 30mg capsule TWICE
a day for FIVE days
 / Body-weight > 15-23kg / 3 -7 yrs / 45mg
capsules / One 45mg capsule TWICE
a day for FIVE days
 / Body-weight > 23-40kg / 7-13 yrs / 30mg
capsules / Two 30mg capsules TWICE
a day for FIVE days
 / Body-weight over 40kg / 13 + yrs / 75mg
capsules / One capsule TWICE a day
for FIVE days
 / Under 1 year of age – ONLY AFTER
HCP ASSESSMENT (2mg per kg dose) / 12mg/ml / ………mls to be taken
TWICE a day for FIVE days

Batch number: …………………………………Expiry date: …………

Relenza®(zanamivir)
Tick
 / Age / Strength / Dose / Supplied by:
signature / name
 / Adult or
child  5 yrs / 5mg
blisters / Inhale the contents of TWO
blisters TWICE a day for FIVE days

Batch number: ……………………………………Expiry date: ……………

Please attach faxed FP10 from GP and fax on a daily basis to:

Emma McCann, 3rd Floor 15 Marylebone Road, 020 7150 8105

Supply of Antiviral Medicine for Flu - PREVENTION

Venue: Pharmacy name & address / Date:
1. Details of person providing the information/collecting antiviral – should be indicated on FP10
Name / ID seen yes no
ID type
Relationship to patient
Address / Tel. No.
Signature / Date
2. Patient’s details
Full name / Date of birth
(dd/mm/yyyy) / Age (in years)
Full address including postcode
Contact telephone number / Male Female
ID seen yes no
ID type / Weight (kg) if child
under 13 years old
3. Dose information for PREVENTION and supply record
Tamiflu®(oseltamivir)
Tick
 / Weight in kg
(of child <13 yrs) / AgeRange
(if no weight
available) / Strength / Dose / Supplied by:
signature / name
 / Body-weight  15 kg / 1-3 yrs / 30mg
capsules / One 30mg capsule ONCE
a day for TEN days
 / Body-weight > 15-23kg / 3 -7 yrs / 45mg
capsules / One 45mg capsule ONCE
a day for TEN days
 / Body-weight > 23-40kg / 7-13 yrs / 30mg
capsules / Two 30mg capsules ONCE
a day for TEN days
 / Body-weight over 40kg / 13 + yrs / 75mg
capsules / One capsule ONCE a day
for TEN days
 / Under 1 year of age – ONLY AFTER
HCP ASSESSMENT (2mg per kg dose) / 12mg/ml / ………mls ONCE a day
for TEN days

Batch number: …………………………………Expiry date: …………

Relenza®(zanamivir)
Tick
 / Age / Strength / Dose / Supplied by:
signature / name
 / Adult or
child  5 yrs / 5mg
blisters / Inhale the contents of TWO
blisters ONCE a day for TEN days

Batch number: ……………………………………Expiry date: ……………

Please attach faxed FP10 from GP and fax on a daily basis to:

Emma McCann, 3rd Floor 15 Marylebone Road, 020 7150 8105

Name of site: ______
Tamiflu (Oseltamivir) / Relenza (Zanamivir)
30mg caps / 45mg caps / 75mg caps / Oral suspension
(12mg/ml) / 5mg
Date / Received/issued by / Stock in / Stock out / Stock in / Stock out / Stock in / Stock out / Stock in / Stock out / Stock in / Stock out
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Balance
To be faxed back on a daily basis to Emma McCann on 020 7150 8105

Order form for antiviral stocks

For pharmacy to complete:

Date :
Name of Pharmacy:
Address :
Tel. No. : Fax. No. :
Print name: Signature:
Supplies of antivirals / Agreed maximum stock levels / Agreed
minimum
stock
levels / No. of packs currently in stock / No. of packs required
oseltamivir 10 x 75mg caps / 40 / 10
oseltamivir 10 x 45mg caps / 16 / 2
oseltamivir 10 x 30mg caps / 32 / 4
oseltamivir oral solution / 4 / 1
zanamivir 5mg/blister x 20 / 4 / 1

NB: Please order by 10.00am Mon - Fri

St Mary’s Hospital Pharmacy Stores – supplied by:

Signature: ______Print Name:______

Courier details

Name of Courier Company: ______

Car ID No: ______DriverID No: ______

Name of driver ______Signature: ______

Community pharmacy - received by:

Signature: ______Pharmacist Name:______

Procedure for ordering further supplies

  1. You should order sufficient stocks to achieve the maximum level. If stocks fall below the minimum levels then you must phone the PCT Medicines Management team on 020 7150 8136
  1. This form should be filled in and faxed to the Medicines Management Team on 020 7150 8105
  1. The Medicines Management Team will approve the order and fax the order to St Mary’s Hospital pharmacy stores.
  1. St Mary’s Hospital pharmacy stores will supply the stock and sign off the faxed copy received from the PCT. The faxed copy will be kept by St Mary’s Hospital pharmacy stores and a copy of this will be given to the driver to take with the order to the pharmacy.
  1. The pharmacist receiving the stock must sign and date the returned copy of the form and retain it in the file provided for this service.
  1. Any queries please contact Medicines Management team at the PCT on 020 7150 8136

SERVICE LEVEL AGREEMENT & SERVICE SPECIFICATION

FOR PHARMACY SERVICES PROVIDED AS PART OF THE ENHANCED SERVICE

FOR THE SUPPLY OF ANTIVIRALS DURING PRE/EARLY PHASE PANDEMIC INFLUENZA

LEAD OFFICERS FOR AGREEMENT

The lead Project Facilitator is:

Name:Sarah Watkin

Position:Deputy Head of Medicines Managment

Telephone:020 7150 8136

Email:

Name: Mandeep Butt

Position: Head of Medicines Management

Telephone:020 7150 8132

Email:

The lead service provider officer for this agreement is:

Pharmacist Name:

Position:

Telephone:

SIGNING OF THE AGREEMENT

This document and the attached notes comprise the Agreement concluded between Westminster PCT and the pharmacy named above.

SIGNED (Pharmacist):………………………Date:…………...….….

SIGNED (PCT):…………………………Date:…………...….….

Westminster PCT contacts for Swine flu service

Pharmacy issuesMandeep Butt

Mobile: 07958484076

Security issuesDirector on-call

Mobile: 07776 146247

Pager: 08700 555500 (893191)

Senior Manager on-call

Mobile: 07979 063766

Pager: 08700 555500 (957110)

Additional information whilst taking Tamiflu®therapy for Flu

  • What does Tamiflu® do?

Tamiflu® is the brand name of an antiviral drug called oseltamivir. It works by preventing the flu virus replicating which can result in a reduction in the number of days a person is infected by flu and a slightly faster improvement in symptoms. Tamiflu® helps to limit the spread of the flu virus – it is not a cure for flu. It does not offer any ongoing protection once the course has finished.

  • Using oseltamivir capsules (Tamiflu®) for children and adults with swallowing difficulties

Children and adults who are unable to swallow capsules may receive appropriate doses of Tamiflu® by opening the capsules and pouring the contents of capsules into a suitable, small amount (one teaspoon maximum) of sweetened food product such as regular or sugar-free chocolate syrup, honey (only for children two years or older), light brown or table sugar dissolved in water, dessert toppings, sweetened condensed milk, apple sauce or yoghurt to mask the bitter taste. The mixture should be stirred and the entire contents given to the patient. The mixture must be swallowed immediately after its preparation.

Please follow these instructions to ensure proper dosing:

1)Hold the capsule(s) over a small bowl, carefully pull the capsule(s) open and pour the powder into the bowl.

2)Add a suitable, small amount (one teaspoon maximum) of sweetened food product (to mask the bitter taste) to the bowl and mix well.

3)Stir the mixture and give the entire contents of the bowl to the patient. The mixture must be swallowed immediately after its preparation. If there is some mixture left inside the bowl, rinse the bowl with a small amount of water and have the patient drink this remaining mixture.

  • Common side-effects

Most people tolerate Tamiflu® very well. However nausea and/or vomiting can commonly occur, particularly in children. These symptoms normally occur in the first one or two days and usually stop as treatment progresses.

Taking the dose of Tamiflu® with food (even a snack) can reduce the chance of the child feeling or being sick.

  • What should I do if I/my child vomit after taking the dose?

Vomiting can be a side effect experienced after taking a dose of Tamiflu®. It is uncertain how long it takes for the medicine to be absorbed after taking the dose. If vomiting occurs after the dose, do not take an additional dose. Continue with the next dose when scheduled and finish the course. If vomiting occurs after taking the dose more than once during the Tamiflu® course (e.g. on more than one of the ten days), please seek advice from your GP.

  • What should I do if I/my child forget to take a dose?

If you forget a dose do not take a double dose next time. If you remember sometime before the next dose is due, you can take the dose immediately and continue taking the next dose when due. If you remember only a few hours before the next dose is due, just carry on with the next dose – don’t double dose or take a “catch-up” dose.

  • When should I stop taking my Tamiflu®?

For the treatment of flu, Tamiflu should be taken continuously for 5 days. For prevention of flu, Tamiflu should be taken for 10 days. You should complete the course unless told to stop by a healthcare professional.

  • What else can I do to relive my flu symptoms?

Tamiflu will help to limit but not totally stop all flu symptoms. The important actions to take are to rest, drink plenty of fluids and use other symptomatic relief, for example paracetamol.

  • What do I do if my symptoms do not improve or get worse?

If your symptoms get rapidly worse or you develop breathing difficulties or symptoms persist for more than 5 days then you should contact your GP or NHS Direct on 0845 4647.

  • What can we do to protect ourselves and others against the flu?

The best thing you can do is follow good hygiene practices. This will help to slow the spread of the virus and will be the single most effective thing you can do to protect yourself and others from infection. It is especially important to follow the rules of good hygiene to prevent the spread of infection when you cough or sneeze.

These good hygiene rules are as follows:

Visit the Health Protection Agency website ( for the correct hand washing technique.

Produced 11th June 2009, updated 19th June 2009

Information sources:

  1. Package information: Tamiflu 30mg and 45mg hard capsules
  1. NHS Direct UKMI Working Group Medicines Fact Sheet: Tamiflu (oseltamivir) Produced 7th May 2009; updated 20 May 2009.
  2. Important Information about Swine Flu leaflet

Additional information whilst taking Relenza® therapy for Flu

  • What does Relenza® do?

Relenza® is the brand name of an antiviral drug called zanamivir. It works by preventing the flu virus replicating which can result in a reduction in the number of days a person is infected by flu and a slightly faster improvement in symptoms. Relenza® helps to limit the spread of the flu virus – it is not a cure for flu. It does not offer any ongoing protection once the course has finished.

  • How do I use Relenza®?

Relenza® needs to be inhaled via the mouth into the lungs as the absorption would be very poor if it was taken by mouth. The Patient Information Leaflet (PIL) provided in the Relenza® box contains astep by step diagram that shows how to use Relenza®correctly to ensure the medicine is taken properly.

If you are unsure how to use the device after reading the PIL, please speak with your local pharmacist.

  • Common side effects

Most people tolerate Relenza® very well. However, there have been rare reports of breathlessness and respiratory problems in people with or without a history of respiratory problems (e.g. asthma, COPD). If you experience any breathing difficulties, chest or throat tightness whilst taking Relenza® please discontinue the Relenza® and contact your GP immediately.

If you have a history of asthma or COPD, please discuss the use of Relenza® with your GP before beginning your treatment. Also refer to the next section on this leaflet for more specific advice.

Very rarely, some people may have an allergic reaction to Relenza®. If you experience a skin rash, hives or swelling of the face and/or throat then stop using Relenza® and contact your GP immediately.