27th August 2010
CONFERENCE 2010 - York
The programme and application form for the conference on 12th November are now available to download.
16th August 2010
DEXAMETHASONE INJECTION SURVEY
Sarah Charlesworth, pharmacist at palliativedrugs.com would welcome your feedback on the injectable dexamethasone situation. Please read the attachment below and respond to Sarah via email
thank you
dexmathasone injection query
4th August 2010
SPCPA EVENT IN SEPTEMBER
The Scottish Palliative Care Pharmacists Association is holding a one-day event in Glasgow on Friday 3rd September. The programme looks really interesting and they have kindly extended the invitation to PCPN members. Please click on the links below for the programme and application form.
We have invited them to attend our event in November as it is a little closer geographically than usual and we hope to meet some of their members in York
SPCPA event registration form
SPCPA programme 3.9.10
14th July 10
MIXING OF MEDICINES OUTCOME OF CONSULTATION
The Department of Health has issued a statement on the mixing of medicines and a link is available below. The statement discourages mixing unless it is unavoidable and in the patient's best interests. It recommends that where possible, mxing should take place in a pharmacy. Whilst this is potentially possible for TPN and IV additives, it is impractical in most palliative care settings.
To date, prescribers (including non-medical prescribers) may mix or direct others to mix POMs but the legislation change needed to permit mixing of CDs is still awaited.
click here for the DH statement
The National Prescribing Centre has created a guidance document which some members of the PCPN worked on. It also seems fairly discouraging but hopefully will provide frameworks that organisations can work with. The requirement for prescribers to state the precise mixture and diluent may be challenging to non-specialists and work is going on between some specialist centres and PCTs to provide additional guidance.
click here for the NPC guidance
Please let us know how you are managing to deal with this
18th May 10
CONFERENCE 2010 on FRIDAY 15th NOVEMBER in YORK
We have booked King's Manor, part of the University of York for this year's conference. York is easily accessible by rail from most parts of the UK and the Manor is 10 minutes walk from the main station.
Please note the date. As this is venue is run as a business, we need numbers to be confirmed earlier than usual. If you are intending to come, please apply for study leave etc as soon as possible! We still intend to keep the cost low - hopefully around £50
The programme is being planned and as usual, we welcome short presentations from members in the regular slot. Let Margaret know asap if you have something you would like to share and then we can add that to the programme from the start
14th April 10
NPSA Alert - Reducing harm from omitted and delayed medicines
This alert was sent out in February with an action date for February 2011. All hospitals are required to draw up a list of those medicines that are regarded as essential in their therapeutic area but antibiotics and anticoagulants have been highlighted as the cause of many reported incidents in the general medical setting. An informal consensus from some members has indicated that all drugs in symptom control may be regarded as essential but it would be helpful fo hear from members who have started to look at compliance with thie alert so see if we could create a PCPN document and save some work.
If anyone is interested in creating a working party for this please contact Margaret Gibbs
m.gibbs@stchristophers.org.uk
NPSA Alert
Easter 2010
More consultation by the MHRA
The department of health is looking at strengthening the chain of supply for medicines in order to reduce the number of counterfeit drugs entering the supply chain and also to discourage parallel exporting - the likely cause of some drug shortages. Whilst this is commendable, amongst the proposals is the requirement for all pharmacies who supply an outside organisation to have a wholesaler dealing licence. Some hospital and community pharmacies may already hold such a licence but in the past, there was a general agreement that if the supply constituted less than 5% of the pharmacy's sales, a licence would not be required. Obtaining a licence has both a financial and a regulatory impact and it is possible that both these issues may force supplying pharmacies to consider the feasibility of continuing to supply a hospice or other outside body.
click here to link to the relevant MHRA page
The PCPN has written a response to the consultation and two members were among a group of palliative care professionals who attended a meeting at Help the Hospices to write a response on behalf of that umbrella body.
If any member has any comments to make on this, please contact one of the committee.
Breakthrough pain
and the potential financial implications of change in practice.You will have seen plenty written about newer approaches to the management of breakthrough cancer pain and in particular the use of the new fentanyl products. We would be very interested to know what is going on in your units - which products are being used, whether your colleagues are changing their approach in the light of the new APM guidelines. The manufacturers are very keen to hear feedback on which products are being chosen and why and our views are valuable to them for future product development.
Please email m.gibbs@stchristophers.org.uk with your observations and opinions.
Also - have you read the article by Bruera et al in the most recent edition of the Journal of Pain and Symptom Management........... This topic will be on the agenda at the Oxford Course this year - naturally!
Labelling of medicines
One of the main manufacturers of analgesia for palliative care is requesting our members' involvement in a workshop looking at improved packaging for their products. The date and venue are yet to be decided but if anyone is interested in being involved, please email Margaret as above.
9th December 09
Mixing of medicines (in syringe drivers etc)
The National Prescribing Centre has been asked by the Department of Health to develop practical guidelines for healthcare professionals and NHS organisations to support the imminent changes to legislation which will permit mixing of medicines in specific circumstances.
A Focus Group meeting has been arranged in London on January 15th. The organisers have approached the PCPN to seek a community pharmacist with pallliative care involvement to attend in addition to those already approached.
Please contact Margaret Gibbs (m.gibbs@stchristophers.org.uk) as soon as possible if you are interested
10th August 09
link to newsletter
30th July 09
The NHS clinical knowledge summaries website has just released a document on the care of malignant ulcers of the skin in palliative care. These summaries replace Prodigy guidance and are evidence based. They are naturally a little coy about some of the practices we use but mention the use of topical analgesia and tranexamic acid but sensibly recommend these are speciallist approaches. It may be helpful for presentations to D&T committees and is available on their website and at the link below
CKS - malignant ulcers
2nd July 09
Positive news from the MHRA
The CHM has agreed to amend Medicines Policy to allow mixing drugs in palliative care - and in other clinical situations where it has become recognised practice. A formal announcement will be made later this week or next on the MHRA website. The legislation will not be changed until October but in the meantime, continuing practice is covered by the statements issued by the MHRA and our professional bodies
11th June 09
This week's Pharmaceutical Journal
Please look out for a great opportunity to do some relevant CPD and read a thorough review of opioid-induced consipation - link to follow post-publication but this is a scoop!
GMC CONSULTATION ON END OF LIFE CARE
Last week, Margaret Gibbs and Abi Jenkins attended a conference to discuss the updated end of life care guidance that has been prepared by the GMC. It was a thoroughly interesting day with presentations and attendence by doctors, other HCPs and patients.
As many people as possible are invited to read and comment on the draft and we would urge you to and your local colleagues to be part of this
plenty of information and the guidance available at this link
GMC EoLC consultation
2nd June 09
New guidelines on the NHS Evidence, Supportive and Palliative Care website
Formerly the National Library for Health, this website offers up to date guidelines on an increasing number of symptoms. Recent additions include annual evidence updates on pain and gastrointestinal symptoms
link to website
28th May 09
Discontinuation rumours.....
We have heard recently that Nystan suspension and Zoton fas-tabs may be being discontinued. Having spoken to the companies, we can confirm that neither seems to be true. Some of the Nystan product range is ceasing production but not the suspension. Zoton fas-tabs are only to be available in the 28 pack size, no longer the 14.
24th March 09
We reported the discontinuation of dexamethasone 500mcg tablets in November 08. Alternative suppliers have now been identified. It is available through IDIS but the NHS purchasing and supply dept is buying a Chemidex product and is sourcing an SPC for this licensed product. Meanwhile, Essential Generics is also able to supply via usual wholesalers. The cost is inevitably far higher than before. The Unichem price is £29.50 for 28 and the code for this is 1146091
5/3/09
An article entitled Opioid Antagonists, Naloxine and Naltrexone - Aids for Pain Management - is available on the Pain-Topic.org website.
It reports the paradoxical effects of these drugs as adjuvants for enhancing rather than attenuating the effects of opioids.
This puts me in mind of the presentation we were given by Ben Zylic at our conference in 2007 - available on the members only section of the site
link to article
Tonight on BBC Radio 4 at 8pm
Could Shipman Happen Again?
12 February 2009
Ann Alexander talks to key players in the Harold Shipman case to ask if adequate systems are now in place to prevent such an atrocity re-occurring.
The programme includes an interview with Dame Janet Smith.
9/2/09
The National Electronic Medicines Library has released the latest annual update on gastro-intestinal symptoms in palliative care.
The link to the main page is
http://www.library.nhs.uk/palliative/
29/12/08
I am pleased to report that our host PCT has taken the pragmatic approach to the MHRA letter and has sent out a memo to encourage staff to continue their practice.
Please feel free to pass this on for others to use as an example.
memo from Bromley PCT
24/12/08
SEASONS GREETINGS TO ALL PCPN MEMBERS AND ALL GOOD WISHES FOR 2009
15/12/08
RPSGB and NMC STATEMENTS ON MIXING IN SYRINGE DRIVERS
Both organisations have issued statements on the MLX365, supporting the MHRA view that no action would be taken against professionals continuing their practice unless something untoward occurs (- an interpretation of the phrase 'each case would be taken individually') The PJ printed an article on the issue this week quoting the PCPN's response.
link to RPSGB statement
link to NMC statement
We will let you know of any individual organisations' responses when they become available. Members can share news and views on this issue on the forum pages.
MEMBERSHIP SURVEY - new deadline
The return rate for the membership survey has not been brisk! We appreciate that you are all busy people but we really want your opinions on the future of the Network.
Please take a few minutes to complete and return to Colin Hardman, who eagerly awaits your forms. We are extending the deadline to 1st January 2009
click here to open the survey
thank you
9/12/08
Please click on the link below to read a statment on behalf of the PCPN, which has been requested by the Pharmaceutical Journal.
PCPN STATEMENT ON THE MHRA LETTER MLX356
6/12/08
CONSULTATION LETTER FROM THE MHRA ON MIXING IN SYRINGE DRIVERS
MLX365
The MHRA has released this letter for comment as promised following the initial announcement in May. However, since taking further legal advice, they have added some very alarming new information. As well as it being illegal for non-medical prescribers to prescribe mixtures of drugs in syringes, it now appears that "as the law currently stands, there are actually no circumstances in which practitioners can legally mix medicines" (paragraph 11)
The MHRA is working hard to minimise the effect this information will have on our practice, which they appreciate has been shown to be safe and effective. We can forsee that although some hospices may be able to make provisions for nursing staff to continue to prepare syringes, it may be difficult to persuade Acute Trusts and PCT staff to do the same.
The letter includes wording as follows; (paragraph 13)
"The agency has recognised that the present legal position has the potential to obstruct the provision of effectuve pain relief to patients receiving palliative care. We have therefore issued a statement which makes clear that the MHRA would not consider taking enforcement action for breaches of medicines legislation by doctors, Nurse or Pharmacist Independent prescribers engaging in the long standing accepted practive of prescribing and adminstering (and providing directions for others to administer) a mixture of licensed medication via a single injection or a syringe driver unless it would be in the publice interest to do so. This also applies to those mixing and administering medicines in accordance with the directions of a prescriber."
A copy of the statement is attached at the end of the consultation letter
The law needs to be changed promptly but until it is, this is going to be a very difficult time.
Please let us know how your organisation deals with this situation.
We will, of course, be responding as a Nework but urge your organisations to respond as soon as practical too
20/11/08
CONFUSION WITH PRESCRIBING STRONG OPIOIDS
We are very keen to collect examples of prescribing and dispensing errors involving strong opioids. For example, a patient admitted today to St Christopher's Hospice brought in a box containing oxycodone immediate release capsules labelled 'Take ONE twice a day when required'.
We feel that the change of opinion demonstrated by the two RPSBG statements on branded prescribing of strong opioids is a huge safety issue and we would like to gather evidence to show that generic prescribing causes confusion and therefore great risks for patient safety as well as sub-optimum pain management.
Please photocopy labels (annonymised) or incident forms and send to Margaret Gibbs at St Christopher's Hospice (51-59 Lawrie Park Road, Sydenham, SE26 6DZ)
20/11/08
DEXAMETHASONE SHORTAGES
There have been ongoing problems with dexamethasone injection supplies of late. the 8mg injection will not be available again until June 09 but the 4mg supplies are expected back in the wholesalers next week. We would like to hear from anyone who is using an alternative corticosteroid for injection.
Also, the 500 microgram dexamethasone tablet has been discontinued - was anyone informed about this in advance? Imported brands may be available but naturally more expensive.
10/11/08
NICE PROPOSALS ON END OF LIFE MEDICINES RECOMMENDATIONS
The National Institute for Health and Clinical Excellence has announced that changes to its technology appraisal process will mean that NICE will be able to provide its independent advisroy bodies with additional information on the use of medicines that can extend life in some patients with rarer terminal illnesses. These proposals are subject to a five-week consultation process.
NICE Press release 5.11.08
If anyone has any idea how relevant this is please can they let one of the committee know !!
SIGN GUIDELINES AND RESPONSE IN THE BMJ
BMJ articles last week cover the new SIGN guidelines for the control of pain for adults with cancer and also a comment about some of the issues not covered fully in these - safety concerns with immediate-release opioids for breakthrough pain and the lack of clear guidance in the use of ketamine
guidelines;
http://www.bmj.com/cgi/content/extract/337/nov05_1/a2154
comment;
http://www.bmj.com/cgi/content/extract/337/nov05_1/a2234
3/11/08
MEMBERSHIP QUESTIONNAIRE
We discussed the future of the PCPN at our conference in Birmingham. We need to know how you would prefer to see the Network developing and how you would like us to communicate with you. In addition, changes to the professional body for pharmacists presents us with a choice of ways forward for specialist groups such as ours. We would welcome your responses to the attached questionnaire.
Once completed, please return to Colin Hardman, co-chair of the Network at the email address given on the form.
PLEASE RESPOND BY 30th NOVEMBER
2008 MEMBERSHIP SURVEY
