NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Primary Care

PostScript Primary Care - July 2012

EMIS dosage direction mismatches

There is a potential risk for prescribers to inadvertently link incorrect associated text to the typed in dosage (abbreviated text) despite prompts designed to avoid this, eg Take two tablets daily linked to 1OD. Mismatches have already been identified in some NHSGGC practices using EMIS which have resulted in prescriptions containing incorrect dosage directions with the potential for patient harm. 

Example of how a mismatch may occur -

  • The prescriber adds the new dose instruction and abbreviation ‘Take one tablet daily’
  • The prescriber is prompted to check the spelling and create the associated text.  At this stage, the prescriber may change their mind about the dose and change the text to ‘Take two tablets daily’
  • A second pop up box appears prompting the prescriber to confirm what they would like to appear on the prescription (the associated text)
  • A warning screen appears to ensure the prescriber realises that this text will now be associated with this dose abbreviation for all future prescribing of medication with this form, eg tablet
  • Any future prescribing which uses the dose abbreviation ‘Take one tablet daily’  will now contain the associated text ‘Take two tablets daily’  on the prescription
  • In addition to new prescribing, any editing of existing repeat prescriptions (including those migrated from GPASS) which use the dosage abbreviation ‘Take one tablet daily’ will be updated with the associated text dose information ‘Take two tablets daily’
  • This mismatched dose instruction associated text now applies to all users of the system
  • A short video demonstrating how a mismatched dosage link can be created can be viewed HERE 

EMIS have updated the functionality to help practices identify mismatched dosage text and associated text which may have been created in their EMIS system.  Additionally, NHSGGC has developed an electronic tool to assist practices in identifying whether any prescriptions have been inadvertently changed so prescribers can review and amend the affected patient records. 

Practices must identify whether or not they have any mismatched dosage abbreviations and associated text. A link to the tool can be sent to practices by contacting the prescribing team at prescribing@ggc.scot.nhs.uk or it is also available via your local prescribing support team who can help run the search. It is the responsibility of the practice to action the results of the search. Further correspondence on this is to follow. 

Triptolerin

Triptorelin is the NHSGGC Formulary and West of Scotland Cancer Network (WOSCAN) first-choice gonadorelin analogue for the treatment of advanced prostate cancer. Triptorelin has similar efficacy to other gonadorelin analogues and is more cost effective. Where triptorelin is used prior to or following radiotherapy, it is acknowledged that this may involve ‘off label’ prescribing but WOSCAN perceives there should be no adverse clinical consequences for patients. 

Decapeptyl® SR 11.25mg is restricted for the treatment of advanced prostate cancer in patients for whom the use of triptorelin is appropriate and would benefit from reduced frequency of administration compared with Decapeptyl® SR 3mg. Triptorelin 22.5mg injection (Decapeptyl® SR) for the treatment of locally advanced, non-metastatic or metastatic prostate cancer should be used in accordance with NHSGGC Protocol. Gonapeptyl Depot® has not been recommended by SMC for the treatment of advanced prostate cancer. 

A guide for switching patients is currently being developed by the Prescribing Team and should be available in August. 

Buccal midazolam (Epistatus®) – Vision Prescribing Issue

Since switching to the new drug dictionary Gemscript, an issue has been highlighted in Vision which may affect a small number of patients prescribed Epistatus®

As Epistatus® is classed as an unlicensed branded special it is no longer prescribable on Vision. Therefore patients previously prescribed ‘EPISTATUS buccal soln 10mg/ml’ on Vision will now be changed to ‘Midazolam 10mg/ml oromucosal solution (Drug Tariff Special Order)’. To ensure patients continue to receive supplies of Epistatus® the practice should annotate the dosage details with ‘Epistatus’. 

Special Products Limited is currently seeking UK marketing authorisation from the MHRA for Epistatus® and if granted this product will then be included in the Vision dictionary. 

New GGC Paediatric Formulary

The GGC Paediatric Formulary was endorsed by ADTC at the last meeting and is now available as a PDF on the GGC Prescribing website.  The Formulary is primarily aimed at prescribers working within Paediatric Services within the Health Board, but will also provide GPs with a useful information resource.  In addition to the licensed medicines included, there are also several unlicensed medicines, unlicensed preparations and unlicensed indications for use of licensed medicines, all of which are clearly annotated.  The Formulary will be updated following each meeting of the NHSGGC Paediatric Drug and Therapeutics Committee.  To avoid confusion with prescribers, the main GGC Formulary is to be renamed the GGC Adult Formulary and entries that are purely for use in children will be removed in due course. 

Capecitabine incident

A recent Datix report highlighted an incident whereby a patient in the community was able to obtain a GP10 script for capecitabine which was then dispensed by the community pharmacist although it should have been supplied in secondary care. The patient’s treatment programme continues to be managed by secondary care and the additional quantity supplied could have placed them at unnecessary risk. 

GPs are reminded that prescribing of capecitabine (and most cytotoxic drugs in BNF section 8.1 used in cancer chemotherapy) within GGC should be initiated and maintained in secondary care following a clear treatment plan. Any requests for additional supplies in the community should be referred back to secondary care for clarification. 

Safe use of insulin training

Insulin safety and reducing harm from insulin is a work strand of the current Scottish Patient Safety Programme. The ‘Safe use of insulin’ e-learning course is a useful resource accessible to all staff which has been designed for all healthcare professionals who prescribe, prepare, handle or administer insulin and is part of a series of initiatives developed to improve insulin prescribing across the NHS. 

Updated GGC diabetes guidelines

Updated guidelines for the management of diabetes are available in the Clinical Guideline Electronic Resource Directory. Since the 2009 edition, several new agents have been added and NICE and SIGN have also issued new guidance on various aspects of diabetes care. 

New Synonyms and electronic Formularies now available

Updated versions of Vision and EMIS electronic Formularies and EMIS Synonyms are now available to download from StaffNet. Medicines Management LES practices are required to install the relevant files on their prescribing system to support prescriber decision making.