Transcript Document

NHS Formularies
Fiona Graham
Formulary Pharmacist
NHS Lanarkshire
Aim/background
• Why have a Joint Formulary?
-evidence based medicines
-limited range of drugs
-help reduce medication errors
-promotes seamless prescribing
-effective and economic prescribing
Aim/background (cont)
• NHS Lanarkshire Primary Care drug budget
2012/13 = £115M.
• Abridged version of the BNF
• NHS Lothian formulary framework
• Different Health boards
- different formularies.
- different formats
Formulary development
• Lanarkshire’s Area Drug & Therapeutics
Committee (Area D&T C)
• Formulary sub-groups
• Joint formulary covers Primary &
Secondary Care.
• 1° care vs 2°care – spend 2011/2012?
Formulary formats
• Last NHS Lanarkshire paper copy- Nov 2007
• Other Health Boards still printing paper editions.
• Formulary in NHS web sites…different
routes/different HBs.
• NHS Lanarkshire APP- iDevices/android phones
• GP Rxing systems:
NHS Lanarkshire-100 practices;360 GPs, locums
& Rxing nurses:– Vision eformulary- diagnosis based & A to Z
– EMIS eformulary- synonym based and A to Z.
Formulary- additional information
•
•
•
•
•
•
Primary Care- first line antibiotic policy
Acute Division – first line antibiotic policy
Antibiotic IV to oral switch therapy
Gentamicin and vancomycin protocols
Antidepressants- Swapping & Stopping.
Wound Management & Simple Dressings
Formulary
• Gluten Free formulary
Formulary compliance-primary care
• Prescribing Action Plan 2012/13
GP targets:–
–
–
–
–
–
–
–
ACE inhibitors
Angiotensin 2 antagonists
Proton pump inhibitors
NSAIDS
1st line antibiotics
1st line antidepressants
Wound Management Formulary
Triptans (new indication)
% items >98%
% items >98%
% items >95%
% items >88%
% items >91%
% items >78%
% items >80%
% items >70%
Formulary compliance (cont)
• PRISMS=
Prescribing Information System for Scotland
• Quarterly prescribing data for GPs
• Can measure formulary compliance
Formulary compliance –
•
•
•
•
nd
2
care
Prescribing Action Plan 4 (2012/13)
No % formulary compliance targets (yet)
Hospital JAC data provides some data
40% of hospital Rxing influences GP Rxing
Formulary amendments
• Want to change any drugs in the formulary?
• Formulary amendment request form with
the new cost effective/evidence.
• Submit to Area D & T via formulary
pharmacist for discussion or referral to
formulary sub-groups.
• May be asked to appeal in person.
Scottish Medicines Consortium (SMC)
• Advises Area D&T committees on new drugs, 2 weeks
in advance of public announcement.
• Area D & T Committee Prescribing Bulletin colour
codes formulary decisions in NHS Lanarkshire.
-Green = accepted for general use in Lanarkshire and
added to the Joint Formulary
-Orange = accepted for restricted use in Lanarkshire
and added to the Joint Formulary only for the
restricted use advised by the SMC
-Light orange = Not added to the formulary due to the
specialist nature of the treatment OR pending specialist
advice on formulary status. Non formulary use is
acceptable if the drug is used according to SMC
recommendations and local protocols.
-Red = not accepted for use in Lanarkshire and not
added to the Joint Formulary.
Future for Lanarkshire’s Joint
Formulary
• Web based version and APP– always the
most up-to-date.
• iPad mini; iPhone 6; android updates.
• Central servers for GPs prescribing systems
• Paper copy? No.
• APP- was launched in NHS Lanarkshire.
May 2012. Other Health Boards?
Main challenges for the future
•
•
•
•
National formulary?
EMIS &Vision GP prescribing systems
Further development of the NHS APP?
Other Health Boards will develop a
formulary App.
• % formulary compliance in 2° care?
THE END