Peterborough Hospitals Formulary and Medicines Management Committee
Minutes of the meeting held on Thursday 21st July 2016
In the Pharmacy Seminar Room, PCH
There were no declarations of interest with regard to items discussed.
In Attendance:
Deputy Medical Director – Chair
Pharmacist Team Manager Procurement and Formulary - Joint Secretary
Pharmacist Team Manager Medicines Governance – Joint Secretary
Consultant Paediatrician (left at 14.15 hrs)
Consultant Anaesthetist
Quality Governance Co-ordinator
Team Lead (S1 Access)
Specialist Pharmacist – C&PJPG/HCD, Cambridgeshire & Peterborough CCG
Colorectal Nurse Consultant / NMP Lead (left at 14.00 hrs).
Interface Lead Pharmacist, Greater East Midlands Commissioning Support Unit.
Dr C Gardner
Mrs A Ritchie
Mrs S Mavani
Dr D Woolf
Dr M Sahni
Ms H Topping
Ms S Drake
Ms K Broad
A Boaden
C Johnson
16/37
Apologies for Absence
Mr K Claire
Mr P Taylor
Mrs C McIntyre
Mr D Chittenden
Dr R Mittra
Dr D Mlangeni
Mr A Massraf
Dr G Sabbagh
Ms J Watkinson
Ms V Gibson
16/38
Lead Pharmacist, Peterborough and Borderline LCG
Consultant General Surgery
Chief Pharmacist (Deputy Chair)
Senior Finance Business Partner, Income
Consultant in General Medicine
Consultant Microbiologist
Consultant Orthopaedic Surgeon (has now resigned)
Quality Governance and Compliance Manager
Specialist Pharmacist Contracts and Commissioning, C&P CCG
PAC and Formulary Support Pharmacist, C&P CCG
Minutes of the Formulary and Medicines Management Meeting held on
Thursday 26th May 2016.
The minutes were agreed as a true and accurate record of the meeting.
16/39
Matters arising from the Minutes/Action Log:
16/40
Review of Terms of Reference
Minor changes to be made to the Terms of Reference.
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Remove Oxygen Committee.
Minutes of Formulary and Medicines Management Committee
21st July 2016
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16/41
Remove Medicines Policy sub-group.
Safer Prescribing is now Medication Safety.
Formulary Items given Chair’s Approval, New Drug Requests and Updates:
16/41.1 Chair’s Approval
Bevacizumab intravitreal injection for one patient – Dr Hornan.
Degludec insulin for one patient – Dr Sagi.
Zonisamide capsules for one patient for off licence use – Dr Guptha.
A request was made for Seebri inhaler for one patient by Dr Guptha – this was
declined as there have been several requests and a full formulary submission had
been requested.
16/41.2 New Drug Requests:
16/41.2.1 Lecicarbon A suppositories: not added to the formulary for patients with
faecal incontinence or for patients with defaecatory disorders. Lecicarbon A
suppositories only available as previously agreed on PGD through the pre-admission
clinic for bowel preparation prior to colonoscopy.
Outcome: not approved
16/41.2.2 Bevacizumab intravitreal injection: will be bought in an intravitreal
presentation. The committee decided that this unlicensed medicine would be
assessed as a low risk product and will be kept as stock in ophthalmology. Eye
department to fund this from within tariff and will not need to be identified as tariff
excluded and booked out to each patient.
Outcome: approved
16/41.2.3 Foscarnet for use in acute retinal necrosis. An intravenous presentation
that is supplied, used and made up in ophthalmology for intravitreal injection.
Outcome: approved
16/42
16/42.1 NICE Technology Appraisals published March and April 2016:
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TA390 Canagliflozin, dapagliflozin and empagliflozin as monotherapies
for treating type 2 diabetes: Not used in this Trust as initiated in community.
TA391 Cabazitaxel for hormone-relapsed metastatic prostate cancer
treated with docetaxel: Fully implemented
TA392 Adalimumab for treating moderate to severe hidradenitis
suppurativa: This is pending and will be implemented when CCG make GPA
available.
TA 393 Alirocumab for treating primary hypercholesterolaemia and
mixed dyslipidaemia: This is pending and will be implemented when CCG
make GPA available.
TA394 Evolocumab for treating primary hypercholesterolaemia and
mixed dyslipidaemia: This is pending and will be implemented when CCG
make GPA available.
TA395 Ceritinib for previously treated anaplastic lymphoma kinase
positive non-small-cell lung cancer: Fully implemented
TA396 Trametinib in combination with dabrafenib for treating
unresectable or metastatic melanoma: Melanoma not treated in this Trust
TA397 Belimumab for treating active autoantibody-positive systemic
lupus erythematosus: Fully implemented
Minutes of Formulary and Medicines Management Committee
21st July 2016
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16/42.2 NICE Clinical Guidelines published March and April 2016:
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16/43
NG47 Haematological cancers: improving outcomes
Horizon Scanning
The following are for forward planning purposes:
16/43.1 New Drugs Online newsletter May 2016.
16/43.2 NICE Technology Appraisals in Development expected publication July 2016
to December 2016.
16/44
Unlicensed Medicines Update.
Hydrocortisone oral suspension: It is too difficult to get accurate doses when using
tablets however it is £40 per bottle for liquid. The tablets disperse in water and the
liquid form is safer. Medical staff need to keep an eye on the age of patient this is
used for and to convert them onto tablets as they get older.
16/45
Medicines Optimisation:
16/45.1 Formulary Reviews including previous submissions.
Lecicarbon A: for use in pre-admission clinic, this has not been used much yet as
there was a delay in the approval of the prescription for the consultant to choose the
preferred medication, a PGD was signed last year.
16/45.2 Items from C&PJPG. Dymista was raised by an allergy specialist from
Addenbrookes and discussed but not approved. The committee agreed that as there
is evidence from use in our Trust it was suggested that our paediatric allergy
specialist and Addenbrookes specialist could consider a joint request.
16/45.3 High Cost Drugs: GPAs, IFRs etc.
16/45.4 Shared Care Guidelines:
16/45.4.1 Denosumab shared care guideline with South Lincolnshire:
Approved
16/45.4.2 Hydroxychloroquine shared care guideline: S Lincs GPs have
agreed to the shared care guidelines. Cambridgeshire and Peterborough GPs do
not require a shared care guideline.
16/45.4.3 Tocilizumab monitoring shared care guidelines: The C&PJPG
would not approve these guidelines as the GPs would require the monitoring to be
retained in the hospital.
16/45.4.4 Ciclosporin in Inflammatory Dermatoses shared care guidelines:
This has been approved at C&P JPG but does not mention the need to test for
pregnancy. A lot of monitoring is required but this is as stated in the NICE CKS
site.
16/46
Trust policies and guidelines for approval:
16/46.1 Policies/Documents given Chair’s Approval:
was given Chair’s approval.
Minutes of Formulary and Medicines Management Committee
21st July 2016
IV therapy for paediatrics
Page 3 of 5
16/46.2 New Policies/ Guidelines/Documents:
16/46.2.1 Personalised Care Plan for last days of life. A small change was
made on page 7 adding breathlessness. Guidelines can be used in most
patients.
Outcome: Approved
16/46.2.2 IV fluid therapy in children and young people: the fluids listed are
mostly licensed.
Outcome: Chair’s approval given
16/46.2.3 Premedication of intubation guideline: This is a network guideline.
Main suggestion is to use Remefentanil and is better. But Fentanyl is the main
one/ first line here at PCH.
Outcome:Approved
16/46.2.4 Nephrotic Syndrome in children, guideline for management:
Network guideline; Localised version with most drugs on the Formulary. There
are cost implications with on-going supply from hospital. The committee thought
that the order of the bullet points in 5.6.7.2 should be reversed it was suggested
that the comment should be made to Dr Aslam.
Action: S.Mavani to look into this.
16/46.2.5 Guidance for Post-operative Analgesia after Day case
Arthroscopic Shoulder procedure. The requested changes have not been
made to this document. This guidance is rejected until the amended changes are
made. C.Gardner will send through to S.Mavani.
Action: CG/SM
16/46.3 Policies/ Guidelines/ Documents for Review:
16/46.3.1 Flowchart for policies/guidelines/documents. H.Topping was
asked if the Pharmacy QA document can be merged with the Trust QA
document. The flowchart does not need changing but the version control must
be correct. Final version must be correct with the QA document ready to go to
NMAG, QGOC etc. Any feedback to Jim Walker.
16/47
Reports from Groups and Subcommittees/ Associated Medicines Update:
16/47.1 Antibiotic Prescribing Group: this is a national CQUIN to reduce
Meropenam use.
16/47.2 Medication Safety Committee (Safer Prescribing Group). Main worry is
that FY1 induction now reduced to 1 hour assessment; this is a Deanery decision.
The Trust must be assured that FY1s are safe to prescribe. Drug chart exercise to be
done before hand and if there are still concerns Pharmacy team will feed back
concerns. Meb Walji, Educational Pharmacist, is concerned about certain
prescribers in the Trust and has received no response to his concerns. There are ongoing prescribing issues. M. Walji to speak to pharmacists on wards and forward
copies to C.Gardner. If there is any risk of harm to patients then it may be necessary
to stop FY1 prescribing.
16/47.3 IVIG demand management panel. Louis Wilmer, Pharmacist Team
Manager is in the process of setting this up again.
16/47.4 Thrombosis Committee. The anticoagulant chart is being sorted out with
concerns regarding DOACs or NOACs. There are serious anticoagulation issues with
referrals not being done. Not always clear whether patients are on anticoagulants and
need referrals. A suggestion was made that pharmacy is not to give warfarin unless
Minutes of Formulary and Medicines Management Committee
21st July 2016
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the patient is on referral was one suggestion by the Dr Khalil but that is not practical.
16/47.5 Oxygen & Medical Gases. Oxygen Committee no longer meet so reports
are no longer provided. Oxygen agenda items to be discussed at Formulary and
Medicine Management Committee and so can be removed from Terms of Reference.
16/47.6 NMAG. Information regarding patient’s own CDs is now on a separate CD
register kept on the ward. Will be added to the CD policy.
16/36
Any Other Business:
16/48.1 Letter to AECP Group and Heads of Medicines Management via PAG
re: BNFs: this recommends the use of the online BNFs rather than the
books. It is not always possible for staff to get to a terminal to get online.
Meeting finished at 14.34
Date of Next Meeting: Thursday 15th September 2016 at 12.45pm, in the Board
Room, 4th Floor, PCH
Minutes of Formulary and Medicines Management Committee
21st July 2016
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