National Pharmacy Association (NPA) - News updates

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Epanutin® oral suspension 30mg/5ml – actions during shortage

Pharmacy teams should be aware that Epanutin® oral suspension 30mg/5ml, manufactured by Pfizer, is currently out of stock until the end of July. Pfizer has imported stock of Dilantin oral suspension 30mg/5ml, from Canada, to help meet patient needs during the shortage. This medicine is unlicensed in the UK however is considered interchangeable with   the UK licensed version, Epanutin®, and a requirement for dose adjustments is not  anticipated. A Supply Disruption Alert has been issued by the Medicines & Healthcare products Regulatory Agency which includes the following key actions for healthcare professionals, including pharmacists: Identify and make contact with all patients currently being prescribed Epanutin® oral suspension 30mg/5ml to establish whether or not they have sufficient supply to last them during the shortage No further action is required for patients who have adequate supply until the end of July The following advice applies to patients who do not have enough of their medicine to last them during the shortage: Where appropriate, switch the patient to the unlicensed Canadian brand, Dilantin oral suspension 30mg/5ml Where  Dilantin oral suspension 30mg/5ml is not suitable, patients should be referred to a specialist in secondary or tertiary care for further assessment Where alternative preparations, other than Dilantin oral suspension 30mg/5ml, are prescribed – pharmacists  and prescribers should ensure the correct dose is prescribed and plasma levels are monitored If a licensed product is available, patients should be prescribed this;  patients who have been switched to unlicensed specials during the shortage should be switched back to the licensed Epanutin® oral suspension when it is back in stock Pharmacy teams who place an order for Epanutin® oral suspension 30mg/5ml   through Alliance Healthcare will receive a message to contact the Pfizer Customer Contact Centre to manage the order.…

Dispensing and prescribing errors – Scotland Patient Safety Incident report

Dear Superintendent, I am pleased to publish my Scotland Patient Safety Incident report for Quarter 4 of 2018 to the end of Quarter 1 of 2019, please click here to download: https://www.npa.co.uk/wp-content/uploads/2019/06/Patient-Safety-Incident-Report-Scotland-May-2019.pdf  In this report, I have included important patient safety updates, and an analysis of the most common patient safety incidents reported to us during this period. Continuing errors – concerns It is concerning to see certain error types continuing to occur despite being well publicised and highlighted in previous reports, which also included suggested ways of preventing such errors. Examples of such errors include: Allopurinol/Atenolol LASA errors Refer to the NPA resource on “look-alike sound-alike items” which lists common items (generic and brand) with similar names Delivery driver errors Ensure delivery drivers are following standard operating procedures when delivering pharmacy items that have been prepared by the pharmacy Summary of Scotland Patient Safety Incident Report analysis for Quarter 4 2018 to Quarter 1 of 2019 Medication error category The most common error category reported continued to be ‘wrong drug/medicine’ (32%) The ‘wrong strength’ error category accounted for 23% of all errors.…

Right on the money

“It’s no secret that community pharmacists are feeling the squeeze financially,” says Harpreet Chana, NPA Digital Programme Director. “The message is coming through loud and clear that the payment our members get from the NHS is not even enough to cover their wholesale bills. Something is going wrong somewhere.” The complexity in the system takes a significant share of the blame, with funding for drugs reimbursement coming via CCGs, remuneration for fees, allowances and advanced services via NHS England, and the retained buying margin, whilst it is delivered through reimbursement, is overseen by the Department of Health and Social Care. Then there are separate sums for flu (from the NHS vaccinations budget) and NUMSAS (the pharmacy integration fund). “Everyone thinks they understand the global sum, but even seasoned professionals have to double check which pots money comes from and how that drives prescribing behaviour,” says Harpreet. “From previous roles as Head of Pricing and then Head of Funding Strategy at the PSNC, I know first-hand how many contractors don’t understand how they got paid, what they should be monitoring month-on-month and how best to monitor it.…

NPA welcomes guidance on engaging with Primary Care Networks

Click here to view. NHS England and NHS Improvement want LPCs to help pharmacies “on a local footprint” to engage collectively with a PCN, by: – Engaging with CCGs and Local Medical Committees – Starting the conversation with local contractors – Understanding mutual benefits and local priorities – Agreeing ways of working between community pharmacies.  There are expected to be an average 10-11 pharmacies per network. An NPA spokesperson said: “The fact that the NHS has issued this guidance to LPCs shows that it sees community pharmacy as a significant player and wants community pharmacy to be fully engaged with Primary Care Networks when the time is right.  This guidance suggests sensible preparatory steps for LPCs and we look forward to further guidance in due course. We don’t yet have a complete roadmap to PCN engagement, but in truth there is bound to be an element of learning as we go.…

Epipen supply and dispensing medicines through ‘vending machine-style dispensers’

Dear Superintendent I would like to highlight and discuss two key topics that have recently been brought to my attention. EpiPen®autoinjector 300mcg – prescription validation process (UK) Following disruptions in production of EpiPen ® Junior and EpiPen® 300mcg adrenaline autoinjectors (AAIs); a prescription-only process has been introduced for EpiPen® 300mcg AAI by Mylan.  The prescription-only process limits patients to a maximum supply of two EpiPen® 300mcg AAIs per prescription and will continue until steady supply is re-established. This process does not apply to EpiPen ® Junior 150mcg AAI. The prescription-only process Supply against a prescription Send the anonymised prescription to Alliance Healthcare’s prescription validation service by email at scriptvalidation@alliance-healthcare.co.uk or by fax on 0330 332 8126 Ensure the Alliance Healthcare account number has been included Pharmacy teams should ensure they are faxing to the intended recipient Supply is limited to a maximum of two EpiPen® 300mcg AAIs per prescription Supply to schools Send the valid written requisition to Alliance Healthcare using the contact details above Supply is limited to a maximum of two EpiPen® 300mcg AAIs per order Supply for use in GP practice GP practices can email a request for EpiPen® 300mcg AAI to the Mylan customer service team at mguk_customer.services@mylan.co.uk; this will be forwarded on to the relevant department to be processed Ideally requests should be limited to a quantity of two EpiPen® 300mcg AAIs per order Healthcare professionals, including pharmacists providing vaccination services, should not routinely be holding stock of AAIs to treat anaphylactic reactions instead of adrenaline ampoules as part of a proper anaphylaxis pack.…

Epanutin Infatabs 50mg – action during shortage

Pharmacy teams should be aware that Epanutin Infatabs 50mg, manufactured by Pfizer, are currently out of stock. Pfizer has imported stock of Dilantin Infatabs 50mg, from Canada, to help meet patient needs during the shortage; this medicine is unlicensed in the UK. When dispensing against NHS prescriptions written for generic “Phenytoin 50mg chewable tablets” or as the branded “Epanutin Infatabs 50mg chewable tablets”, pharmacy teams should consider the advice below: Contact the prescriber where a licensed version of the prescribed medicine is not available If the prescriber chooses to prescribe the unlicensed medicine as an alternative, the prescription must be sent back to the prescriber for amendment to state “Phenytoin 50mg chewable tablets (Special Order)” or “Dilantin Infatabs 50mg chewable tablets (Imported (Canada))” The Medicines and Healthcare products Regulatory (MHRA) guidance on supply of  unlicensed medicines must be followed Reimbursement will be based on the medicine that has been prescribed Where the prescription states “special order”/“unlicensed special”/ “imported”, the pharmacy contractor will be reimbursed for dispensing the unlicensed product Where the prescription does not clearly indicate that an unlicensed special is to be dispensed, the prescription will be reimbursed at the NHS listed price for the licensed product Pharmacy contractors should endorse prescriptions written for an unlicensed special as follows: Quantity dispensed over pack size used Batch number Manufacturer’s/importer’s MHRA licence number Net price (less discount/rebates) per pack size used “SP”– capped fee of £20 All prescriptions for unlicensed medicines should be submitted in the red separator at the end of the month.…

Yellow Card Scheme – community pharmacy teams asked to share MHRA promotional videos

The Medicines and Healthcare products Regulatory Agency (MHRA) is asking community pharmacy teams to share two videos it has produced, which highlight the Yellow Card Scheme, with patients. The Yellow Card Scheme is an essential tool that the MHRA uses to monitor the safety of medicines, medical devices and herbal medicines. In a bid to increase reporting of side effects or issues with healthcare products, the MHRA has developed videos to help patients to produce a Yellow Card report; these are available on the MHRA’s YouTube channel as follows. How to report a side effect from a medicine How to report a problem with a medical device Community pharmacy teams should also share the videos with their online communities and other networks. For further information on this or any other query, please contact the NPA Pharmacy Services team on 01727 891 800 or email pharmacyservices@npa.co.uk.  Produced by the NPA Pharmacy Services team June 2019    …

Disopyramide capsules 100mg and 150mg – shortage

There are temporary supply disruptions of disopyramide in strengths of 100mg and 150mg as follows: Name of medicine Supply disruption information Disopyramide capsules 100mg Mylan and Sanofi will be out of stock from around mid-June 2019 to late July 2019 Disopyramide capsules 150mg Mylan will be out of stock from approximately mid-August 2019 until mid-September 2019 A Supply Disruption Alert has been issued by the Medicines & Healthcare products Regulatory Agency which includes the following key actions for healthcare professionals, including pharmacists: Identify and make contact with all patients currently being prescribed disopyramide capsules in strengths of 100mg or 150mg to establish whether or not they have sufficient supply to last them during the shortage No further action is required for patients who have adequate supply The following advice applies to patients who do not have enough of their medicine to last them during the shortage: Switch patient to an unlicensed special/imported version Patients for whom an unlicensed special/imported version is not suitable should be referred to a specialist in secondary care for further assessment If a licensed product is available, patients should be prescribed this; those patients switched to unlicensed specials should be switched back to licensed versions when they are back in stock For further information on this or any other query, please contact the NPA Pharmacy Services team on 01727 891 800 or email pharmacyservices@npa.co.uk.  …

Class 2 drug alert – Pharmacy level recall – Paracetamol tablets 500mg

Early May bank holiday 2020 – change

The early May bank holiday is set to move to Friday 8 May 2020 from Monday 4 May 2020 to coincide with the 75th anniversary of victory in Europe (VE) day on 8 May 2020.  The movement of the bank holiday will allow people to pay tribute to current and previous members of the UK armed forces. The change in bank holiday is only applicable to England, Wales and Northern Ireland. Pharmacy contractors should be aware that the change in bank holiday may impact normal service and in particular may affect the dispensing of Controlled Drug (CD) instalment prescriptions over pharmacy closed days. The NPA Pharmacy Services team has developed guidance on the dispensing of instalment CD prescriptions over bank holidays. Pharmacy contractors should  notify the relevant organisation of their  intent to remain open or close during bank holidays using the appropriate template form which is available to download, complete and submit as follows: England – NHS England in Chapter 36, Annex 1 Once completed, send to the local NHS England team Wales – Primary Care Services – form HN1 Once completed, send to the local Health Board Northern Ireland – Health and Social Care Business Services Organisation Once completed send to the address stated at the top of the form The NPA will issue a further reminder and additional guidance on the change in bank holiday closer to the date.…