Vision coming together…


by Kazeem Olalekan MRPharmS

I took my daughter to the optician recently and it got me thinking: What an amazing thing: vision! We all need it and all the better if it is a good one.

In October last year, I wrote a blog about the 2020 vision of the University Hospitals Southampton.  In that blog, I made reference to the fact that the Trust has now gained a Foundation Trust status. In a subsequent blog, I reported the great news that the Hospital will continue to deliver quality service to children with heart disease in the South of England.

With such a vision and a solid foundation, then the next logical step is to build. With all eyes focused on the 2020 vision, the hospital has announced recently that it is going ahead with the building of a new state-of-the-art £70 million children’s hospital. This new children’s hospital will bring all the paediatric services under one roof for the first time. This is great news for Southampton and great news for the region.

The model of care that will be adopted will enable children to be treated closer to home. This is a wonderful opportunity for everyone connected with the Trust, myself included! No wonder Paula is very proud and will like to see services under one roof where she will have access to all the equipment and specialist services.

Don’t you just love it when a vision starts to come together! I wish the Trust the best of luck with this landmark development.

For those who need further information, then contact:

Telephone: 023 8079 5270
Web: www.childrenshospital.uhs.nhs.uk
Email: childrenhospital@uhs.nhs.uk

Apps Updates! – MicroGuide; NICE Guidance; CPPE; NICE BNF; NICE BNFc

by Kazeem Olalekan MRPharmS

If you follow our blog, you will know that we are passionate about apps (you know..iphone (OS), android and possibly others – I know Microsoft is working very hard to narrow the gap on its rivals – so when we get our hands on a phone that uses windows mobile, we will add that to our review list).

This post is just to let you know what has been happening to the apps we have reviewed so far:

1. MicroGuide (App Store , Android Play Store)

In August last year, we reviewed the MicroGuide app developed by Dr Sanjay Gupta in collaboration with Dr Kieran Hand and Dr Adriana Basarab; all of University Hospitals Southampton NHS Trust. There are some exciting updates since our review and they are:

  • We paid what we considered a reasonable fee of 69p for the app then. Guess what? You can now download it for free! – voilà
  • They have included the Paediatrics Guide to treatment of including dosing hyper-links – paediatrics is a passion of mine so I am very happy!
  • It now includes the Septic shock and severe sepsis algorithm for adults.
  • The app is now also available on the Android Play store – so if you have an android phone, you can now download the app.
See screenshots below:

Screenshot of the version 2 of the MicroGuide app

Frankly, if you work in a secondary care setting, or work within the University Hospitals Southampton NHS Trust, you should have this app on your iphone – period! You know what is missing? A powerful search feature! Can Dr Gupta make that happen? – There is a challenge!

2. NICE Guidance app (App Store, Android Play Store)

We were full of praise to the National Institute of Health and Clinical Excellence (NICE) when we reviewed their app in April of this year. We gave the app a mark of 9.99999998 out of 10!! Well, the App has just undergone a re-vamp and we are at a lost as to where to go from such as high starting point. Not to be confused with NICE Guidelines, an app by Open Health Care UK (which retails at a great value price of £1.49), the NICE Guidance app is free to download but you will need an NHS Athens password to use it. I guess the two apps serve different purposes. Anyone working within the NHS should be able to obtain an Athens password and use the NICE Guidance app for free. If you do not work within the NHS, then NICE Guidelines app will be a great alternative. So what has changed?

  • The interface has changed slightly (see screenshots below) – the future, we must add is still orange!.
  • You could do everything that made the first app we reviewed so good – So in addition to the main menu that included a. Conditions & Diseases, b. Public Health, c. Bookmarks and d. Search button; you now have e. Treatment, Procedures & Devices and f. Guidance by type. These are wonderful enhancements.
  • A great new addition is the Updates where you get a list of guidance that have just been updated – amazing! – This is an wonderful improvement.

Screenshots of new NICE Guidance app

 Can you guess what we think yet? Yep, you guessed it: 10 out of 10. Go get yours, We’ve got ours!

3. CPPE – App (App Store; Android Play Store)

So in May 2012 we reviewed the CPPE App. We liked it of course. At the time I noted that the app is Easy to use, Challenging and Fun. Well nothing has changed. The app remain a valuable tool for pharmacists and technicians to keep abreast of things going on the pharmacy world. So the question is: Have you taken the e-challenge issue 25?

In the CPPE news you will find information on:

  • Preventing medication errors in hospitals – podcast now available
  • Business continuity management guide
  • Advances in anticoagulation: new oral treatments
  • Useful apps for pharmacy – revised guide
  • Changes to CPPE website
  • Safeguarding children and vulnerable adults
  • Type 2 diabetes – a new focal point workshop
So the folks at CPPE continue to do a great job to keep us informed. Screenshots below.
Screenshots of CPPE app
We were full of praise to the NICE team in June when they launched the NICE BNF.  I remember now…my words were: “Hee Heee Heeeeeeeeeeeeeeeeeeeeee  Haaaaaaaaaaaah!”. My final comment in that review was: “Thanks NICE….and by the way can I ask for similar app for BNF for Children? That will be of great help to paediatric pharmacists like myself.” Just like magic, the nice people of NICE launched the NICE BNFc (App Store; Android Play Store). It works just like the previous NICE BNF and I have been using it since. I only have three words to say: Thanks a lot. Screenshots below:
Screenshots of the NICE BNFc app

 

Who will show clinical leadership?

by Kazeem Olalekan MRPharmS

I cannot help but notice, with concern, the latest news item by in which  Boots the Chemist is to offer ‘3 for 2’ mix and match promotion across its entire healthcare range this week (link). Clearly the customer will welcome an opportunity to pay less for products in these chastened times. If that is the laudable aim of Boots the Chemist, then why not reduce the price of individual products. Multiple buy offers are perfectly acceptable for general heathcare products but will be of concern for ‘Pharmacy, P’ medicines. The danger will always be the risk of encouraging people to buy more items than is needed which can pose public health issues. I support the Royal Pharmaceutical Society (RPS) statement on this (link):

 

The Royal Pharmaceutical Society is clear that medicines are not normal items of commerce and should not be treated as such. Encouraging consumers to buy more pharmacy-only medicines than they need will not improve the health of the public.

Whilst we support initiatives that make it easier for patients to access medicines, in our view multi-buy promotions are not appropriate for this category of medicines.

 

The statement from the RPS also said that Boots must ‘ensure  their advertising and marketing to consumers is aligned with the professional and legal obligations of pharmacists…Boots must support the professional and clinical decisions made by their pharmacists including where a sale is refused’.

I am writing this to highlight the subject of clinical leadership. Clearly Boots wants to differentiated itself in an otherwise competitive pharmacy market. If that is the case, then I can suggest a better way of differentiation:

Variation in treatment

The issue around ‘postcode lottery’ was highlighted recently (link).  It revolves around a situation where some patients are  offered treatments in some parts of the NHS  whilst others are deprived. The NHS wants to introduce a scorecard system to reveal doctors not using the latest drugs. It is also clear that the NHS has shown leadership in accepting that pharmacists have important role to play in the management of patients’ medication through the introduction of Medicines Use Review (MUR) and New Medicines Services (NMS). Against this background, what happens to the person that has had to pay via the private route for a prescription which was denied by the NHS in their region. Who does their MUR and NMS? It should be viable to charge a small fee for the service but it is not beyond the ingenuity of pharmacy organisation through working with industry, to map out a way to make sure that anyone prescribed a National Institute for Health and Clinical Excellence (NICE) approved drug (on NHS or on Private Scripts) receives the valuable MUR and NMS services.

I will like to see pharmacy organisations differentiate themselves here and not through the process of encouraging the purchase of medicines that may not be needed. Empowering and Training of pharmacists and pharmacy staff is critical here.

My challenge to these pharmacy organisations is: Who will show clinical leadership?

I will like to see more of this:

Diabetes and stroke risk tests at pharmacies in Wales

and less of the multi-buy offer on pharmacy medicines.

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Did you miss any of these?

by Kazeem Olalekan MRPharmS

In August a number of communications on medicines safety were sent out to healthcare professionals via the MHRA. If you missed any of it then here are the summary. Full details are available on the MHRA website.

Number 1:

ONDANSETRONE – QTC prolongation – new dose restriction for intravenous ondansetron given for chemotherapy-induced nausea and vomiting in adults.


In summary, a single dose of intravenous ondansetron given for the prevention of chemotherapy-induced nausea and vomiting (CINV) in adults, must not exceed 16 mg (infused over at least 15 minutes).

because:

Ondansetron causes a dose-dependent prolongation of the electrocardiographic-corrected QT interval (QTc), which can lead to Torsade de Pointes, a potentially life-threatening heart arrhythmia. Because of this potential safety risk, there are new dose restrictions in place for use of IV ondansetron.


Information provided by  GSK (GlaxoSmithKline)

Number 2:

TAMIFLU – Concentration of oral suspension to be changed from 12 mg/mL to 6 mg/mL


In summary,

  • Concentration of TAMIFLU® for Oral Suspension will be changed from 12 mg/ml to 6 mg/ml
  •  The dispenser will be changed from milligrams (mgs) to millilitres (mLs)
  •  The EU SPCs will be changed to include amended dosing tables to include a column for the volume in millilitres based on the new 6mg/ml formulation.

Prescriptions for Tamiflu® oral suspension should state the dose in millilitres and the new 6 mg/ml concentration should be used when available

This is very important to Pharmacists looking after children who might need this medication. My first thought is: Do we have protocols within my NHS Trust that has the old doses? (Next Step).


Information provided by  Roche

Number 3:

DEPOCYTE – Possible risk of sterility failure at manufacturing site – product recall in Europe


In summary,

DepoCyte (cytarabine liposome injection) authorised for the treatment for lymphomatous meningitis is the sole intrathecal liposomal cytarabine product licensed in Europe. A recent inspection by a Regulatory Authority identified critical deficiencies at the finished product manufacturing site, in particular, reduced sterility assurance in the manufacturing process, which gives rise to a possible risk
of sterility failure. At present, there is no evidence of any microbial contamination of product on the market or risk to patients.

In view of risk-benefit, the product is being recalled.

  • Patients currently receiving treatment with DepoCyte should be transferred to alternative therapy
  • No new patients should be initiated on DepoCyte treatment until further notice
  • In exceptional circumstances, in patients currently receiving treatment and for whom alternative treatments are not appropriate (e.g. for those patients who cannot tolerate more frequent injections), physicians may request a supply of DepoCyte for a specific patient in order to continue the treatment. Healthcare professionals should monitor patients closely for signs and symptoms of infection, including central nervous system infections, which could be linked to microbial contamination of DepoCyte

Read the document for treatment alternatives


Information provided by  Pacira Limited

Number 4:

CALCITONIN – Increased risk of malignancies with the long-term use of calcitonin. Calcitonin should no longer be used in the treatment of osteoporosis.


In summary,

Due to the higher incidence of malignancies, the following is concluded:

  • Calcitonin should no longer be used in the treatment of established post-menopausal osteoporosis, since the risks associated with calcitonin outweigh the benefits in this indication.
  • Patients being treated for osteoporosis with calcitonin should be switched to alternative treatment during the next scheduled (or routine) appointment.

The benefits of calcitonin continue to outweigh the risks in the short term treatment of:

  • Paget’s disease only in patients who do not respond to alternative treatments or for whom such treatments are not suitable, e.g. in patients with severe renal impairment. Treatment in this indication should be limited in most cases to 3 months (Please see below, further information on recommendations to healthcare professionals).
  • Prevention of acute bone loss due to sudden immobilisation such as in patients with recent osteoporotic fractures, with treatment limited to two to four weeks.
  • Hypercalcaemia of malignancy.

Remember to use the Yellow Card Scheme to report suspected adverse effects.


Information provided by  Novartis

 

Case Study 6: Critical Evaluation

by Kazeem Olalekan MRPharmS

This July we have posted our 6th Case Study. We are quite proud about this one. Kazeem conducted an interview with Sue Gough, a Critical Evaluation Pharmacist at University Hospitals Southampton NHS Foundation Trust. It provides an insight into what these breeds of pharmacists do. They read the many clinical papers on medicines, crunch the figures and present that information to decision makers. It is sometimes a lot of tedious work but somebody has got to do it. Getting it right is important and critical to deciding which treatment is appropriate for use.

Yes, the work can be sometimes tedious, but this pharmacist is not taking it lying down! As our YouTube video will show (see below), she has a wide range of interests outside work that makes for a good balance between work and life.

 

Sue was quoted in the interview as saying:

 

In the past I have written reviews of medicines not yet launched on behalf of the National Prescribing Centre which is now part of NICE.

 

As a pilot study on behalf of the Department of Health, I wrote two reviews of unlicensed medicines and did quality control on two other reviews.

 

Listen to the full interview here

 

Saved – The future is bright.

by Kazeem Olalekan MRPharmS

I was delighted by the news that the National Paediatric Surgery Reviews has opted for option B which means that University Hospital Southampton NHS Foundation Trust (UHSFT) in partnership with Oxford Radcliffe Hospitals NHS Trust will continue to deliver first class quality service for children with heart disease in the South of England (1). In a statement by the Chief Executive of UHSFT, he acknowledge that in the future, there will no doubt be more national reviews of services and we need to keep quality at the centre of the way we shape, guide and decide location.

Whilst this is a well fought battle argued essentially on quality of and expansion of current provision, it is important that the Trust continue to provide quality clinical leadership which will result in excellent care for children with heart disease in the South of England. According to Mr Hackett, the support from across the country has been overwhelming.

I personally have no doubt that this will continue to be so.

New MUR Requirements

by Kazeem Olalekan MRPharmS

 

 

The latest update to MUR requirements (1) which applied from the 1st of July is refreshing. If I was commissioning the service for the first time, this is what it might look like. Nonetheless, evolution is not a bad thing. The requirements now look something like this:

  1. Recruit the patient, ensuring that at least half of your MURs every year are within the national target groups.
  2. Collect the patient’s written consent using the nationally approved consent wording.
  3. Undertake the MUR, using the suggested questions to guide your conversation with the patient if you wish.
  4. Make a clinical record for the MUR to allow the provision of ongoing care. This record must include the nationally agreed MUR dataset. A PSNC MUR worksheet is available, but pharmacists can design their own format for records or use a PMR system MUR module as long as the national dataset is captured. The national dataset for each MUR needs to be kept for a minimum of 2 years (this can be stored electronically if you wish).
  5. There is no longer a  requirement  to use the MUR form to record the details of an MUR and hence the requirement to give the patient a completed copy of the MUR form also ceases to apply. The pharmacist may decide to provide the patient with a note of the points agreed during the MUR if it is believed this would be helpful for the patient.
  6. Where you need to make the patient’s GP aware of an issue that arose during the MUR, complete an MUR Feedback Form and send this to the GP practice. You may also decide to speak to the GP before sending the Feedback Form, if the matter is urgent. A copy of the completed MUR Feedback Form can be given to the patient.
  7. If your PCT requests a quarterly report of your MUR activity, collate the data in the national MUR electronic reporting template and email it to the PCT. Templates to allow you to collate and report this data can be downloaded from the MUR section of the website, or your PMR system may create a completed reporting template for you at the end of each quarter.

More information about the service is available here.

Related documents on bookapharmacist.com:

1. Link (Time to Reflect – MUR Evangelist)

2. Link (Taxpayers’ Alliance report on MUR)

Yet another one from the nice folks at NICE – NICE BNF

by Kazeem Olalekan

Clearly I am excitable. When I learnt of the new iphone and Android app from the nice folks at NICE, then you know what is coming.

Hee Heee Heeeeeeeeeeeeeeeeeeeeee  Haaaaaaaaaaaah!

I’ll tell you why. I spent my top dollar about a year ago on a BNF Iphone app only to be told recently that it has been withdrawn and was signposted to another product: BNF 63 by MedHand. Don’t get me wrong: The MedHand product is a great product that represents value for money at £29.99. On my salary, that represent a big slice of my diminishing spare budget! The prospect of having to buy a new copy twice a year filled me with dread! I want to use technology, but at what price? So I get by with my copy at work and access on the internet at home. But if I have this information at my fingertip, I will use it more and be a better practitioner for it.

Enter NICE.

NICE has produced this stunning BNF app for iphone and android aptly called NICE BNF. It is free for those of us who work in the NHS with NHS Athens password. That is the best news for me today. The app has essentially the features you will expect from a great app including powerful search facility. I will therefore not ramble on. What I said about my previous review of a NICE app resonates with this one. What I will say is that this product is downloaded locally which is great for offline use. Brilliant.

Sit back and enjoy the screenshots below. Thanks NICE….and by the way can I ask for similar app for BNF for Children? That will be of great help to paediatric pharmacists like myself.

 

The App Icon

You will need an NHS Athens password. If you don’t have it
try here 

The BNF is downloaded to your local device

It does look pretty: won’t you say?

Just like the book…the preliminary bits, the chapters and the appendices

You can browse by chapters

You can set how you view it

You can bookmark it

The illustrations are there as it is in the book

Another top mark.

Febuxostat (Adenuric) and hypersensitivity reaction

by Kazeem Olalekan

Attention has just been drawn to the Drug Safety Update on Febuxostat (Adenuric) via the PJOnline website. In summary, there have been rare but serious reports of hypersensitivity reactions, including Stevens-Johnson syndrome and acute anaphylactic shock, with febuxostat (Adenuric). Febuxostat must be stopped immediately if hypersensitivity occurs, and must not be re-started in patients who have ever developed a hypersensitivity reaction to febuxostat.

The Safety Update provide the following advice to healthcare professionals:

  • Febuxostat treatment should be stopped immediately if signs or symptoms of serious hypersensitivity reactions occur – early withdrawal is associated with a better prognosis
  • If a patient has ever developed a hypersensitivity reaction with febuxostat, including Stevens-Johnson syndrome, febuxostat must not be re-started at any time
  • Most cases of hypersensitivity to febuxostat occur during the first month of treatment
  • Patients should be advised of signs and symptoms of severe hypersensitivity or Stevens-Johnson syndrome. These include: infiltrated maculopapular eruption; generalised or exfoliative rashes; skin lesions; facial oedema, fever, haematologic abnormalities such as thrombocytopenia, a single or multiple organ involvement (liver and kidney including tubulointerstitial nephritis), progressive skin rashes associated with blisters or mucosal lesions and eye irritation
  • A prior history of hypersensitivity to allopurinol and/or renal disease may indicate potential hypersensitivity to febuxostat

….and I only dispensed the product to one of my patients last Saturday. I will now find that patient and impart this caution….without scaring them of course!

Boots and Walgreens

by Kazeem Olalekan MRPharmS

The recent acquisition of 45% stake in Boots the Chemist by US Firm, Walgreen could be viewed as another good example of the special relationship between the US and the UK. It has been reported that the two companies have very little overlap. As a result, no job losses are expected from the deal. That is reassuring. It has been suggested in some quarters, that this is just the first salvo in the eventual take over of Boots by Walgreen.

This will not be unusual in this marketplace. After all Lloyds Pharmacy is owned by the giant German healthcare and pharmaceutical company Celesio. Tesco, Sainsburys, Asda and Cooperative Pharmacies are owned by there corresponding supermarkets. There are of course a variety of independent pharmacy operators in the UK.

In one word, bookapharmacist.com welcomes this development. In effect, it starts a process of moving a valuable UK business into the hand of a retail pharmacy operator. This contrasts sharply with the business being in the hand of a private equity operator KKR with a risk (sometimes over blown) of asset stripping. It clearly signals a move to really set the business on a solid path for the future. Boots, held by a private equity operator can only be viewed as an interim arrangement.

There is another reason why I feel this is a good move. It leads to better understanding of the UK and US healthcare markets which can only cement our special relationship. This, I hope, is a start of a process to make sure we look fundamentally at what is best about the two healthcare systems in order that we may learn lessons which will benefit my patients.

 

 

Transfer of Care – an update

by Kazeem Olalekan MRPharmS

The final report on the transfer of information about medicine when patients move between care setting has been published. It makes for an interesting read. The main recommendations are:

 

  •  All suppliers of IT systems to hospitals and general practice should ensure their systems can effectively transfer recommended core content of medicines records
  • All community pharmacies should have an NHS.net website address to enable secure communications between secondary and primary care
  • All clinical records should be structured in a recognised and nationally agreed format to assist interoperability and the transfer of information
  • National sharing of the most effective ways of signposting patients in secondary care to the post discharge Medicine Review Service and New Medicine Service provided by community pharmacists to enable patients to optimise benefits from their medicines
  • Commissioning of post-discharge MURs for vulnerable patients should be considered as part of the pharmacy contractual frameworks

 

The report quoted an audit conducted in 2010 across 50 acute trusts involving over 8600 patients. It found that when medicines were checked after admission most patients had at least one omitted drug or wrong dose (1). If all the elements of this report are implemented, then it will be the first most significant step in getting the right structures in place. This is however, just the beginning. The hard work of engaging with pharmacists at a local level should therefore begin. The recommendation to share most effective ways of signposting patients must be arrived at through proper engagement of the shareholders. Wessex Local Pharmacy Forum, in conjunction with Hampshire and Isle of Wight LPC and Dorset LPC have started the process of local engagement. The Transfer of Care events organised recently is a key example of this. I have posted a YouTube video of the feedback from that event (see below):

 

This report is the results of a six-month project involving over 30 healthcare organisations which volunteered to implement RPS guidance on transfer of medicines information. It will be a travesty if we don’t work together to make this a success. The project is endorsed by the Academy of Medical Colleges, Royal College of General Practitioners, Royal College of Nursing, Royal College of Physicians.

 

Time to get busy! I think we need an evangelist…an MUR Evangelist! I also think there is an evangelist in all of us.

 

(1) Dodds LJ. Unintended discrepancies between pre-admission and admission prescriptions identified by pharmacy-led medicines reconciliation: results of a collaborative service evaluation across East and SE England. IJPP 18 (Supp 2) September 2010 pp9-10

 

 

 

 

 

 

 

 

 

 

 

 

Advice for Pharmacists as Doctors strike

by Kazeem Olalekan

The Royal Pharmaceutical Society of Great Britain has issued advice to pharmacist on how to deal with requests for emergency supplies of regular medicines. The doctors go on strike this Thursday (21st of June). The key advise are:

  1. Liaise with your local GP. A clear understanding (and agreement) of when referral is acceptable without interfering the spirit of the strike.
  2. Advise patients to submit request for repeat prescription early. We must be prepared to deal with Emergency requests in the usual manner.
  3. Reassure patients that GP surgery will be open and staffed for urgent cases.
  4. Pharmacists are open in the usual manner to deal with minor ailments and other services.

The results are in…and everyone is a winner

by Kazeem Olalekan

Following from the recently completed election onto the National Pharmacy Board in England, Wales and Scotland; bookapharmacist.com is happy to note that this is an election it is proud of. Everyone is a winner: elected or not. We are releasing a YouTube video of the results.

 

 

Related posts:

tag: election2012

The silence of the pips

by Kazeem Olalekan

The publication of the final report  into the PIP debacle, by the NHS Medical Director, should signal the ‘silence of the pips’. The report is making it clear that:

  • There is no evidence of significant risk to human health.
  • PIP implant are significantly more likely to rupture by a factor of around 2-6; and this difference is detectable within 5-years of implantation.

This report should at least silence the pips and bring reassurance to worried patients. The process that led to this point has been very good.

  1. Health scare news item about substandard implants
  2. Patients rightly concerned and worried
  3. Some providers reluctant to act swiftly
  4. NHS stepped in to show leadership
  5. Patients re-assured allowing for space to conduct thorough review
  6. The review shows that risk is non-existent.

The question is: has the NHS done what is expected of it? I think so.

related reading:

Who mackem, who tackem and who usem?

Timely pips

Urgent: (Action Required within 5 days) – MHRA Class 3 Alert: Cyclizine Lactate Injection 50mg/ 1ml ampoules

by Kazeem Olalekan MRPharmS

Cyclizine Lactate Injection 50mg/ 1ml ampoules

PL 00156/0096

Martindale Pharmaceuticals Ltd is recalling all remaining unexpired ampoules of the above discontinued product as a precautionary measure. This is due to a GMP concern at a third-party supplier and their own site. It is likely that very little stock remains but Martindale Pharmaceuticals Ltd wishes to minimise any potential patient risk.

Action required within 5 days

MHRA Links: Link1  Link2