DRAFT MINUTES OF THE ONE HUNDRED AND THIRTY EIGHTH MEETING MEETING HELD ON THURSDAY 18 TH JULY 2013 IN THE POSTGRADUATE MEDICAL CENTRE ROOM 2, NDDH

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1 DRUG AND THERAPEUTICS COMMITTEE DRAFT MINUTES OF THE ONE HUNDRED AND THIRTY EIGHTH MEETING MEETING HELD ON THURSDAY 18 TH JULY 2013 IN THE STGRADUATE MEDICAL CENTRE ROOM 2, NDDH Present: xxxxxx xxxxxx ST4 Rheumatology xx xxxxxx Locality Medicine Optimisation Pharmacist xx xxxxxx xxxx Director of Pharmaceutical Services xx xxxxxx xxxxxx Senior Nurse Emergency Care xx xxxxxx xxxx GP Waterside Practice, IIfracombe xx xxxxxx xxxxxx Non Medical Prescribing Lead xx xxxxxx xxxx Medicines Information Pharmacist xx xxxxxx xxxxxx Consultant Rheumatologist (chair) xx xxxxxx xxxxxx Lead Pharmacist Community Services xx xxxxxx xxxxxxxxx CNS Intravascular Therapy xx 1. ALOGIES FOR ABSENCE Apologies have been received from D xxxxxx xxxxxx xxxxxx xxxxxx xxxxxx xxxxxx xxxxxx xxxxxx h. 2. MINUTES OF THE PREVIOUS MEETINGS To approve the draft minutes of the meeting held on Thursday 16 TH May KM confirmed that under 12.1 PGDs East that xxxxxx was referring to combined oral contraception and progesterone only contraception. SK Ear Pain Protocol why still coming up? Approved! KM Just in case boxes confirmed with TN (xxxxxx xxxxxx) that this SOP was approved as well as authorised witness destruction. To approve the draft minutes of the sub-committee meeting held on 20 th. The minutes were approved. 3. MATTERS ARISING AND OUTSTANDING (not separately listed) Action points from the meeting held on Thursday 16 th May Posiflush review paper being prepared for September looking at all evidence. KW will present after September. Guideline for Atropine - this has been to PIG and has been returned to the author for minor amendments. NF to inform CA once complete. KW NF/CA Cellulitis Pathway - This is going to FIG. The GPs are not really using as urging high dose flucoxacillin. Now only using in a handful of patients, East/RD+E do not have a cellulitis pathway like this. CA asked if we still need this. SK mentioned that it is historic. CA commented that it is used to change practice. SK to discuss with xxxxxx if this document Page 1 of7

2 still needs to exist. SK ACS Pathway This was not on agenda but should have been. Trialled for four weeks. Dr C Gubbs happy to roll out. GRACE score not available on line with some computers but MA did not agree as available on other digital platforms. Approved for use. 6.1 Action plan to ensure Medicines Policy and related SOPs available for skilled not registered staff employed by NDHT. KM is still looking at the SOP for unregistered staff to administer tablets. Struggling to obtain M.A.R. sheets produced to allow them to sign against, thought could be a community pharmacist role but CA said LPC were considering this. CA suggested using it in a Torrington pilot with domiciliary pharmacist. 7. Controlled Drug Witness Destruction Record This was approved last time PGDs East not resolved xxxxxx is the Accountable Officer at Children s Hospice South West. Will pass onto xxxxxx xxxxxx. NF SK reported that the Acute Trust s Medicines Working Group was the new name for interim meetings of the D.T.C. This to be reviewed after six months to see if it is still necessary. 4. NICE GUIDANCE (Appendix 2) To note NICE guidance published since the last meeting but yet to be discussed at the FIG meeting. 4.1 Technical Appraisal Guidance No. Title Date of issue TA287 Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism TA288 TA289 TA290 TA291 Approved by NICE. Dapagliflozin in combination therapy for treating type 2 diabetes Approved by NICE. Ruxolitinib for disease related splenomegaly or symptoms in adults with myelofibrosis NF stated not approved by NICE. Mirabegron for treating symptoms of overactive bladder Approved by NICE but not as first line. CA stated that the GPs are unhappy as some consultants appeared to be prescribing it first line and referring patients to GP to prescribe as first line. NICE is quite clear use it at the end of the pathway after other therapies have been tried and failed. Pegloticase for treating severe debilitating chronic tophaceous gout NF stated not approved by NICE. Page 2 of7

3 4.2 Clinical Guidelines No. Title Date of issue CG164 Familial Breast Cancer classification and care of people at risk of familial breast cancer and related risks in people with a family history of breast cancer CG165 CG166 CG167 Noted. Hepatitis B (chronic): Diagnosis and management of chronic hepatitis B in children, young people and adults Noted Ulcerative colitis: management in adults, children and young people Noted Myocardial infarction with ST-segment elevation Noted July MEDICINES INFORMATION/ Formulary Management Across Devon Flixonase nasules are on the RD+E Formulary therefore they should be included on the formulary. Receiving Analgesia On Time TN had attended the Listening to Patients Experience Group and patients were receiving their analgesia on time. Availability of Oramorph as Treated As A Controlled Drug The Medicines Policy may need updating on restating status of compliance as other Trusts do not treat as a Controlled Drug. Medicines Policy will be reviewed. KM 6. MEDICINES LICY See item 5 last item. 7. NON MEDICAL PRESCRIBING LICY Clarification around competencies of Non-Medical Prescribers if not attending forums They need to demonstrate competencies in other ways. Approved? 8. STANDARD OPERATING PROCEDURES KW talked about the overarching policy. There was a newer edition to that circulated re community setting and delegation to unregistered nurse. KM spoke about the NPSA alert on MEDUSA will be in BOB to establish re risk rating. Medusa link to become live on BOB. SOP for Harmonised Injectable Medicines Policy This was approved. SOP for Harmonised Administering Injectable Medicines Policy This was approved. SOP for Harmonised Preparing of Injectables This was approved. Page 3 of7

4 Draft SOP Administration of Buccal Midazolam This is a SOP for the Dental Service and was approved. SOP for Patients Own Drugs in the East This is the procedure for checking medicines and cutting down on waste.nf mentioned there is no mention of green bags for Ds on admission. CA to talk to NF re current practice of the ambulance trust. CA/NF NF mentioned re the flowchart that may not be ward stock as nurse required to order supplies. CA requested flow chart to be clarified as quantity of sufficient medication. Agreed that 14 days is sufficient. Approved. 9. GUIDELINES/PATHWAYS/LEAFLETS Management of Severe Pre-Eclampsia and Eclampsia Guidelines SK commented re the use of Mg SO4 for seizures and nefedipos? on page 17. Clarification is required on the interaction between nefedipine and Mg SO4 Should they be co-presented? Nefedipine first line. Not approved as yet. 10. OTHER LICIES (Appendix I) Aclidinium Policy (commissioning) - noted Glycopyrronium Policy (commissioning) - noted Indacterol Policy (commissioning) - noted Duputren s Policy for Devon (CPC), Exogen Pulsed Ultrasound Policy for Devon (CPC) and Focal Hyperhidrosis Policy for Devon (CPC) Do these need to be discussed at DTC? SK and CA queried if it would be finalised at FIG or decided at CPC. SK to feedback what the trigger for this is? Why did it go to CPC? SK 11 PATIENT GROUP DIRECTIONS SK updated everyone on the last PGD meeting. SK would like to be kept informed of up and coming PGDs. xxxxxx xxxxxx would expect a medical lead signature. All PGD raisers Agreed to try and bring MIU protocols into line with each other and in line with PGDs. Also agreed that DTC will sign off and approve PGDs in future NDHcT PGDs For ratification; Metronidazole v1.04 Awaiting xxxxxx xxxxxxxxx signature EC Page 4 of7

5 Ipratropium v2.0, Salbutamol v2.0 and Prednisolone These are BTS guidelines for use in MIUs for acute asthma. 13. MIU PROTOCOLS These have been approved and signed off To ratify the following protocols Hydroxycarbamide Protocol This is from RD+E Joint Oncology Committee. It was issued in 2010 with a six year review date plus no author. It has been sent back to the anonymous author to clarify that it has been validated in Denosumab Shared Care Protocol CA commented that there has been no discussion with the CCG re this. SK commented there is no current funding for shared care denosumab on osteoporosis (approved by CPC as guideline). CA commented there is no funding in primary care. CCG will not agree to this. NF suggested zoledronic acid as an alternative as no funding. CA/NF suggested it be commissioned via Homecare by CCG. 14. NF stated that this was something that needed to be resolved between the Trust and the CCG. SK and NF to write to oncology to explain the current situation. DTC UPDATED TERMS OF REFERENCE/COMPLIANCE RERT SK to participate in the North and East Formulary Group. Author accredited to xxxxxx xxxxxx. SK suggested NF become author. Attendance should be 66% (4 Out of 6). NF/SK SK NF ALL SK page 4 agenda items to be received two weeks before the date of the meeting as papers need to be distributed one week before the meeting. NF as secretary to chair meetings in SK s absence clarified as NF as no one designated secretary. CA requested her correct job title to be updated. to make all corrections on paperwork.. ALL NF 15. PATIENT SAFETY 15.1 Safer Treatment Action Group The final minutes of the meeting held on 16 th April 2013 were received No comments were made. xxxxxx xxxxxx has become a member of this group and their terms of reference have been revamped; focussing on drug related themes and patient safety issues. Page 5 of7

6 16. DTC SUB-GROUPS 16.1 Antibiotic Working Group. To note that no further meetings have been held since 6 th meeting due in February February Next 16.2 Anticoagulant Working Group Next meeting to be arranged Chemocare Committee The last meeting was held on 27 th November 2012.To be removed from agenda as committee has been disbanded Medical Gas Committee Noted that the next meeting is being held on Friday 12 th July 2013 KM stated that air also needs to be included in the Terms of Reference. Membership needs to include a Non-Medical Prescribing Lead Venousthromboprophylaxis Working Group As this group has now been disbanded remove this item from the agenda. LP/AD LP/AD 17. OTHER PRESCRIBING GROUPS (Appendix N) 17.1 Clinical Policy Committee and Formulary Interface Group To be Standing Agenda items. The minutes of the CPC meeting held on 11 th were received NHS (North Devon) Prescribing Interface Group The final minutes of the meeting held on16th April 2013 were received RD+E and North Devon Joint Oncology Sub Committee Chemotherapy Group The minutes of the meetings held in 8 th April 2013 and 10 th were received RD+E Joint Haematology Chemotherapy Governance Sub-Group The minutes of the meeting held on 15 th May 2013 were received. CHEMO GOVERNANCE MEETING The next minutes are to be received at a later date are from the meeting held on 24 th May NEW FORMULARY INTERFACE GROUP The minutes of the meeting held on 24 th May 2013 were received To Note the Guidance Approved By The Peninsula Health Technology Commissioning Group No items to report. 18. QUALITY ASSURANCE GROUP NF reported there was no feedback from the Quality Assurance Group. 19. ANY OTHER URGENT BUSINESS 19.1 GP Referral Letters These have been approved by PIG and are being used from today. Feedback to be brought back to this meeting. CA asked how this has been cascaded response was Page 6 of7

7 by from xxxxxx and xxxxxx xxxxxx. NF has spoken to the ophthalmologists. 20. DATES AND TIMES OF NEXT MEETINGS 12.45pm on Thursday 19 th September (full) 12.45pm on Thursday 17 th October (Acute Medicines Working Group) Page 7 of7