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Clinical Pharmacist's monthly news round-up: the top 10

What has been happening in the world of pharmacy? Here’s our pick of the must-read news.

1. NHS England to fund specialist services

Specialist pharmacy services have secured two years of commissioning by NHS England, chief pharmaceutical officer for England Keith Ridge has confirmed, ending uncertainty over their funding.

The Department of Health supported the £7.1m-a-year services, which include aseptic medicines preparation and the provision of medicines information, for one year after the NHS restructure, but further funding was uncertain. Now NHS England has committed to commission the services directly for an initial two-year period and engage with clinical commissioning groups over subsequent funding, says Ridge. The agreement follows the publication of his review of the services.

David Branford, who chairs the Royal Pharmaceutical Society’s English Pharmacy Board, says the agreement will allow enough time to understand fully the complexity of the services and implement the review’s recommendations. “We are particularly supportive of the recommendation for specialist commissioning at a national level as we believe this will reduce the problem of variability … across the NHS,” he adds.

2. New care pathway for dying people published

A new care pathway for dying people has been developed in England to replace the Liverpool Care Pathway.

The new approach focuses on five priorities, including patient involvement in treatment decisions, sensitive communication between staff and patients, and an individual care plan that is delivered with compassion. It was developed by the Leadership Alliance for the Care of Dying People, an alliance comprising 21 organisations including the General Pharmaceutical Council.

Chief executive of the GPhC Duncan Rudkin says the regulator, in conjunction with the alliance and all pharmacy stakeholders, “will continue to take forward this collective vision of what care for dying people should look like”.

The GPhC will take account of the pathway when it reviews its standards of conduct, ethics and performance in 2014–15 and education standards in 2015–16, and will work with the Royal Pharmaceutical Society to produce guidance for pharmacists. “Discussions regarding this guidance have begun,” says RPS head of corporate communications Neal Patel.

3. Aspirin scrapped for AF

Aspirin should no longer be used to prevent stroke in patients with atrial fibrillation (AF), the National Institute for Health and Care Excellence recommends in new guidance.

Patients with AF are up to five times more likely to suffer a stroke. Those who cannot tolerate warfarin are commonly given aspirin instead. However, after reviewing new evidence NICE has concluded that aspirin is not as effective as anticoagulants at preventing stroke and that its safety profile, regarding bleeding, is less favourable than previously thought. The use of aspirin is also thwarting the effective use of new-generation oral anticoagulants, NICE says.

4. Patient records pilot

Community pharmacists will have access to patients’ summary care records (SCRs) under a pilot programme involving up to 100 sites in England.

Alison Hemsworth, programme manager for the community pharmacy contractual framework at NHS England, revealed the plans during the National Pharmacy Association annual conference last month. The success of the pilot will determine whether SCR access is rolled out nationally, she said. NHS England will call for expressions of interest from local professional networks and the pilot is expected to begin this autumn. It is being implemented by the Health and Social Care Information Centre.

5. Report raises concerns over dementia treatment

Grave concerns about the inappropriate prescribing of antipsychotic medicines have been raised in a Mental Welfare Commission report on dementia care in Scotland.

Care records for 336 dementia patients revealed that 84% were taking at least one psychotropic medicine and 35% were taking three or more. The report says this level of polypharmacy, without evidence of regular review, is concerning. It also criticises the lack of pharmacy involvement in dementia care and recommends that pharmacy should be a core part of the multidisciplinary team that conducts patient reviews.

Scotland health secretary Alex Neil called the report’s findings a “disgrace” and said the Scottish Government will implement all 20 recommendations. Action has begun on the recommendation to develop a plan to reduce inappropriate prescribing of the type identified, said Scotland’s public health minister Michael Matheson.

Alex MacKinnon, the Royal Pharmaceutical Society director for Scotland, says the Government and NHS in Scotland should commit to mandatory input from pharmacists in dementia care.

 6. Research highlights hospital safety failures

Patients’ lives could be saved through changes in six categories of hospital practice, researchers say, after an analysis of deaths related to hospital safety incidents identified “systemic failure”.

The analysis, published in PLoS Medicine (24 June 2014), found that 2,010 adult deaths in NHS hospitals in England between June 2010 and October 2012 were reported as being due to unsafe care. Researchers reviewed the patient safety incident report for each death and classified incidents into six broad categories of systemic failure: mismanagement of deterioration (35% of incidents); failure of prevention (26%); deficient checking and oversight (11%); dysfunctional patient flow (10%); equipment-related errors (6%); and other incidents where the underlying problem was unclear (12%).

Bryony Dean Franklin, executive lead pharmacist (research) and director of the Centre for Medication Safety and Service Quality, says there is likely to be some under-reporting and data quality variation, meaning the real safety risks may be greater.

7. Unlicensed medicines

Pharmacists must provide as much written information as possible about doses, expiry dates and storage instructions when supplying unlicensed medicines, new General Pharmaceutical Council guidance states.

The GPhC says patients rely on pharmacy advice because not all unlicensed medicines have patient information leaflets. It sets out five principles governing the preparation of unlicensed medicines, including methadone, in a pharmacy. The guidance covers the quality of the medicines, condition of pharmacy premises and importance of conducting risk assessments and training staff.

8. Adverse skin reactions

Two potentially fatal and rare cutaneous adverse reactions — Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) — have a significant likelihood of recurrence, researchers have found.

In a Canadian cohort study reported in JAMA (4 June 2014), 7.2% of 581 patients who survived a first episode of SJS or TEN were later readmitted to hospital with a recurrence (median 1,283-day follow-up). Most episodes of SJS and TEN are induced by treatment with medicines including allopurinol, cephalosporins and carbamazepine. The researchers advise extra discretion when using these medicines to treat patients with a history of SJS or TEN.

9. Elderly care projects win 2014 Care Awards 

Two projects focused on improving care for older patients triumphed at this year’s Pharmaceutical Care Awards.

A project by pharmacists in Derry, Northern Ireland, was chosen by judges as the winning entry out of six finalists who presented their projects at The Royal Institution in London on 19 June 2014.

The project evaluated the impact of providing a pharmaceutical care pathway to older people discharged from a hospital to an intermediate healthcare setting. A consultant pharmacist managed patients’ pharmaceutical care for at least 30 days after discharge. The team reported improvements in patient care standards, readmission rates and inappropriate prescribing.

Audience members voted a second project, by a team from Northumbria Healthcare NHS Foundation Trust, as the initiative with the most potential for replication elsewhere. The project involved care home residents and their families in decisions about medicines.The awards are run jointly by The Pharmaceutical Journal and the Royal Pharmaceutical Society with the support of GlaxoSmithKline.

10. Baby death linked with contamination

Contamination during the manufacture of an ITH Pharma parenteral nutrition product has been confirmed as the cause of a spate of blood poisoning cases in newborn babies.

ITH Pharma issued a product recall on 4 June 2014 after the product was linked to a baby’s death. A further 22 babies in neonatal intensive care units across England have suffered blood poisoning linked with the product, which was contaminated with Bacillus cereus, a bacterium found in dust and soil.

An ongoing investigation, led by the UK Medicines and Healthcare products Regulatory Agency and Public Health England, indicates that the contamination occurred in a particular sterile manufacturing area at ITH Pharma on 27 May 2014.

Gerald Heddell, the MHRA’s director of inspection, enforcement and standards, says: “We … believe this was an isolated incident and that appropriate immediate action has been taken at ITH Pharma’s facility to avoid a recurrence. Therefore we are allowing this critical product to be supplied to patients while our investigation continues.”

Citation: Clinical Pharmacist DOI: 10.1211/CP.2014.20065771

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