An update on UKMi resources to support your clinical practice

1. An update on UKMi resources to support your clinical practice Vanessa Chapman, Chair UKMi

2. Key learning points • Who is UK Medicines Information (UKMi)? • What resources are available from UKMi? • How to access UKMi resources. • How UKMi develop and produce the information.

3. Who is UKMi? • Medicines Information Services in the NHS support the safe, effective and efficient use of medicines by the provision of evidence‐based information and advice. • The service has two broad functions: • to support medicines optimisation for individual patients • to support medicines management within NHS organisations • There is a network of medicines information centres based in the pharmacy departments of most hospital trusts and regional (England, Northern Ireland and Scotland) and national (Wales) centres

4. What are UKMi core values? • Apply evidence-informed principles in provision of impartial, evaluated, accurate and timely advice to promote safe and effective use of medicines • Provide professional advice to support and influence clinical decisions with respect to patient-centred care • Be readily accessible and responsive to user needs • Network to share information and experience at local, regional and national levels

5. Governance processes • All outputs are produced in line with clear writing guidelines • All outputs have standardised evidence-gathering and are based on current evidence where available. • All outputs are reviewed on a regular basis and removed when no longer current. • Majority of outputs published through collaboration of regional MI centres in England, Scotland, Wales and Northern Ireland.

6. Aligning outputs to the principles of medicines optimisation • DH – Leading the nation’s health and care

7. UKMI Information available via SPS website • Clinical • UKMI Medicines Q&As • Advice about medicines in lactation • NICE bites • Daily current awareness newsfeed • Drug shortage advice

8. Medicines Q&As • Medicines Q&As aim to answer common questions, or a question that is difficult or time-consuming to answer. • They are concise, provide an evaluation of the evidence and offer advice on the basis of the available evidence. • Analysis has shown that, on average, using a Q&A can save a health-care professional an hour of time. • They are generallyreviewed every 2 years, but may be updated sooner if new information becomes available. • There are currently just over 200 Medicines Q&As published. https://www.sps.nhs.uk/articles/about-ukmi-medicines-qas/

9. Medicines Q&As- examples • Which opioids can be used in renal impairment? • What medicines should be avoided by patients suffering from “sulfa allergy”? • What is the most appropriate antidepressant to use in patients with epilepsy? • What need to be considered when prescribing for lactose intolerant adults? • Is there a calcium and vitamin D preparation which is suitable for a vegetarian or vegan? • How should conversion from oral morphine to fentanyl patches be carried out? • How do you switch between tricyclic, SSRI and related antidepressants? • How do I use iron dextran total dose infusion for correction of iron deficiency anaemia? • Codeine and breastfeeding: Is it safe and what are the alternatives? • Can epoetin be used in Jehovah’s Witness patients in accordance with their beliefs?

10. UK Drugs in Lactation Advisory Service (UKDILAS) • Evidence-based risk-assessed information for every medicine available in the UK in terms of safety during breastfeeding. • In addition a number of evidence summaries (as Q & As) • Guidance regarding the general principles of medicine use during breastfeeding  • Alternatively, contact us for complex situations on: • ukdilas.enquiries@nhs.net • Follow us on Twitter @ukdilas

11. Drugs in Lactation

12. NICE Bites • NICE Bites summarises key recommendations from NICE guidance. • Generally no longer than two sides- usually published monthly.

13. Drug shortages • In conjunction with the Commercial Medicines Unit (CMU), UKMi produce summaries of clinical advice for shortages of medicines considered critical to patient care. • Advice includes alternatives and practical ways to manage the situation. • Guidance should be tailored to the local situation and formulary choices.

14. UKMI Information available via SPS website • Commissioning/ formulary • Horizon scanning information - medicines in development • Prescribing Outlook • Monthly newsletter • Patent expiries

15. Horizon scanning • Information on all medicines in phase III clinical trials through the licensing phases to 2 years post-launch. Includes trial information, status, potential launch and commissioning plans and published evaluations if available. Tailored to the indication and formulation where relevant.

16. Prescribing Outlook • The Prescribing Outlook Series assesses potential impact of new drugs and national guidance on the health economy. • It includes information on drugs with launches planned over the next 12 to 18 months and on marketed drugs with new major indications as well as information on NICE guidance, NHS England and other national targets that may have budgetary implications. • Prescribing Outlook New Medicines and National Developments • Prescribing Outlook – cost calculator

17. New Drugs newsletter • Monthly newsletter that highlights recent significant medicines regulatory changes and new medicines monographs added to the SPS website. An occasional Focus section lists medicines in development for specific conditions, for example asthma. This can be used when updating sections of the formulary.

18. Patent expiries • Information on patent expiry of most medicines in the UK. • Includes information on extensions to basic patent, where known. • Access restricted so must register AND log-in to access

19. UKMI Information available via SPS website • Safe use of Medicines • In-use product safety assessments • Missed/ delayed doses • Drug monitoring in primary care • High risk injectable medicines advice • Medicines safety summaries • Stability of medicines stored in fridge • Stability of medicines in compliance aids

20. In-use product safety assessments • UKMi Product Safety assessments describe the in-use medication safety considerations and risks resultant from a product’s presentation or other characteristics. • The validated tool was developed with the Safe Medication Practice and Medical Devices Team at NHS England, as well as a range of medication safety and specialist pharmacists in various NHS settings.  • The tool (full and abbreviated) can be used as part of the evidence-gathering for D&TCs. • UKMi also produce full assessments of all launched products considered to have potential in-use risks.

21. In-use product safety assessments

22. Omitted or delayed doses • A document, originally produced in support of the NPSA alert, which categorises the risks of delay or omission for each drug or drug class using a traffic light system.

23. Drug monitoring in Primary care • This document is intended to support local discussions on how to monitor commonly prescribed high risk medicines in primary care.  The monitoring parameters are derived from a range of guideline sources, other reference sources and expert opinion. 

24. High Risk Injectable Medicines • Specimen list produced using the NPSA’s risk assessment tool. It is intended to assist organisations to generate their own list of high risk injectable medicines prepared in clinical areas and to provide a basis for this local risk assessment.

25. Medication safety summaries • UKMi produce a monthly presentation for Medication Safety Officers (MSOs) with the latest information on medicines in relation to patient safety. • We cover all UK, EU and significant US safety alerts, significant shortage advice and a summary of the recent published literature on medication safety. • The slides are made available for all to use. Feel free to keep yourself up to date, catch up on some CPD or use them to present to your own teams monthly.

26. Drug storage • Where possible we provide advice on suitability for use if a medicine has been inadvertently stored outside of the fridge. • We also cover the majority of preparations as to their suitability for inclusion in a compliance aid.

27. Other SPS material • RMOC recommendations and resources • Patient Group Directions • Material from Medicine Use and Safety network • Material from QA pharmacy network • Material from UKMi working groups

28. Where is all this information? • All on the SPS website (www.sps.nhs.uk). • Best to use the search box at the top. • Everything relating to a medicine will be on the ‘Medicine’ page for that drug. Simply go to the relevant page and scroll down through the articles, and various sections for the one you want.

29. Searching the website • For general articles, search by specific keywords. • Or go via the relevant networks pages- e.g. try UKMi Horizon scanning group to access Prescribing Outlook or the Patient safety working group for the MSO Observatories. • A useful document on searching the website is on the front page.

30. How to use all this advice?

31. Case study - MSO • Monthly update on your webinar. Slides available afterwards or if you couldn’t join on the day. • High-risk injectable guidance when reviewing your Trust policy. • Omitted and delayed doses to assist you in individualising your own guidance. • Lots of relevant Medicines Q&As. • Use the in-use Product Safety Assessments and tool when introducing high-risk medicines into your Trust

32. Case Study – Formulary / commissioning pharmacist • Sign up for monthly New Medicines newsletter to see what has changed. • Check the ‘New medicine’ section of the SPS website when you get a new drug request. • Watch out for Prescribing Outlook in September – vital for budget planning. • Use Prescribing Outlook to see when national guidance is expected- might help you plan your formulary update • Don’t forget the cost calculator. • Check the patent expiries if doing a formulary review.

33. Case Study – Clinical pharmacist • Sign up to Medicines Awareness Daily as a great way to stay up to date. • Always check the Medicines Q&As- they can save you stacks of time. • Check suitability in lactation- there is usually an alternative if your drug isn’t compatible. #don’tsaystoplookitup • See if there is advice on alternatives if there is a shortage. We might have done all the work for you. • Download our NICE Bites as a quick summary of that recent NICE guidance- great for CPD too.

34. Case study – pharmacy technician • If you dispense a lot of compliance aids- we have most preparations classified on the website. • What to do if the fridge has been unplugged- again!! • Check the Medicines Q&A – there are lots on lactose-free options or options for patients who can’t take solid doses etc., etc. • Remember to browse the monthly medication safety presentation- great for keeping up to date.

35. Also…… • Don’t forget – • You can always give your local MI pharmacist a ring or drop them an email. • Visit us in the Exhibition at Congress today or tomorrow • Watch out for us on Twitter- coming soon…..

36. Thank you for listening Any questions?