NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Community Pharmacy

PostScript Community Pharmacy (Oct 2012)

To read this bulletin in PDF format click here.

This edition contains information on:

  • CMS leaflets – Glasgow Pharmacies
  • Warticon supply problem
  • CD ERRORS: Care required with pack sizes
  • ScriptSwitch
  • Seasonal Influenza Vaccination Programme
  • New medicines intervention service tools

CMS leaflets – Glasgow Pharmacies

Community pharmacy staff working in the former Greater Glasgow HB area are reminded that stock of the above leaflet is not available from the Primary Care Distribution Centre but should be ordered direct from the national contractor for NHS stationary. Any requests for CMS leaflets should be made to APS Stock management using the details below –

Telephone: 0131 629 9938

Fax : 0131 629 9967

Email: stockorders.DPPAS@apsgroup.co.uk

However, Glasgow pharmacies can order MAS leaflets from the Primary Care Distribution Centre.

Please note that pharmacies located within the Clyde area should order both of these forms direct from the Distribution Centre at Hillington in the normal manner.

Warticon supply problem

Podophyllotoxin 0.15% cream (Warticon®), which is used to treat external genital and perianal warts, is currently unavailable and supply problems may extend to March 2013.

Podophyllotoxin 0.5% solution (Condyline® solution, £11.50) is an alternative product and it is advised it should be prescribed in preference to Imiquimod® cream or Aldara® cream (£48.39) which, although is on the GGC formulary, is restricted to specialist initiation only (ie Sandyford Services). If community pharmacists are presented with a prescription in the meantime for Warticon®, please contact the prescriber to inform them of the out of stock issue and to request a new prescription for the alternative products suggested above.

If the pharmacist is suggesting an alternative to the prescriber, then Condyline® solution would be the best choice. However, it is probably advisable that you should check availability from your wholesaler before speaking to the GP. The current availability is fine but it may vary over next few months depending on whether demand outstrips supply.

CD ERRORS: Care required with pack sizes

We have received a few reports recently of balances of oxycodone preparations being wrong in community pharmacies. The explanation that has been provided is that the parallel imported product has been used. This is packed in boxes of 28 tablets, each labelled as containing 28 tablets with two boxes banded together to give a pack of 56. The pharmacist in each case believes that the error has originated because the person dispensing or checking has presumed that the total package contains 28; ie is 2 boxes of 14 when in fact the total package contains 56 tablets; ie 2 boxes of 28. Please ensure that when you are switching between packs that you closely review the quantity contained in each pack. Particular care is required where that are banded together in this way.

ScriptSwitch

From the 1st of September, ScriptSwitch software is being piloted on GP clinical systems in Inverclyde and East Dunbartonshire CH(C)P’s. ScriptSwitch is a prescribing support tool that provides automatic messages on the GP’s clinical system at the point of prescribing. Recommendations are health board specific. The NHSGGC recommendations contain information on drug safety information and complement current NHSGGC approved cost efficiency initiatives. If the prescriber chooses to accept the recommendation, the prescription is automatically changed to the recommended alternative. Recommendation messages only appear to clinicians when they issue an, acute, new repeat or new serial script.

Seasonal Influenza Vaccination Programme

The seasonal influenza vaccination programme commences in October 2012. Groups to be immunised under the NHS, and targets for these, remain the same as last year at 75% uptake. There is an informal target of 50% uptake for healthcare workers. Detailed information about patient groups and targets may be accessed, in the CMO letter (SGHD/CMO(2011)8).

The letter urges that vaccination in the 2012-13 programme should be undertaken as soon as possible, ideally in October/November. It also provides a reminder that it is the responsibility of all NHS contractors to consider vaccination of their employed staff. Apart from offering clinical benefits, seasonal influenza vaccination protects business continuity and many community pharmacy contractors already offer this to their staff. Incidence of severe egg allergy is relatively rare but the management of patients reporting this should be considered carefully.

Appendix 1 (see pdf) lists information on the ovalbumin, latex and aminoglycoside content of vaccines and there is an egg free vaccine available this season (Optaflu). GPs should be reminded when they order this vaccine:

  • They should order using a GP10A as with other flu vaccines but be aware that supply from wholesalers to community pharmacies may be limited this season.
  • A separate needle is required for administration of Optaflu
  • It is only licensed for adults
  • A small supply will be held at PDC for exceptional cases.

Several companies have indicated that there may be a 2 week delay in supply of flu vaccine at the start of the season. It is important that community pharmacies liaise closely with GPs to ensure that clinics are not organised until supplies of vaccine have been assured.

New medicines intervention service tools

This tool was added to the Pharmacy Care Record in April 2012 and was designed to support community pharmacists with a structured intervention with patients who received new medication from their GP or other prescribers. It should be treated as a guide for a CP in a discussion with a patient around key aspects of their new medication and allows this discussion to be recorded within the PCR. As with the High Risk Medicine tool, there is a direct link to the care planning section of the PCR, with pre-populated fields. NMIST may also provide a hook to engage potential patients into CMS as it demonstrates the pharmaceutical care aspect of the service. Full details are available here.

This guide should be read in conjunction with the PCR User Guide Version 6.