Current News
Lincolnshire Position Statement on the ongoing supply of Pancreatic Enzyme Replacement Therapy (PERT)
22nd August 2024 (Updated 28/8/24)
The ongoing supply issues surrounding pancreatic enzyme replacement therapy (PERT) has progressed. These intermittent supply issues mean some people are running out of PERT or experiencing difficulties or delays in accessing PERT. Therefore, there is a need for clinical and symptom management advice that is different to normal clinical practice. For the full statement please see here.
Please also see below wording and statement intended for patients.
Patient letter: Supply issues associated with Pancreatic Enzyme Replacement Therapy (PERT)
The ICB is working with United Lincolnshire Hospital Trust (ULHT) and community pharmacies to put in place a process to manage the current very severe shortage of pancreatic enzyme replacement therapy (PERT)
Advice has already been sent out to all clinicians on the management of patients affected by the supply problems. The ICB and ULHT have also jointly produced this letter, which is intended to provide further information and advice to patients. Please read this here.
Updated Lincolnshire Emollient Formulary Guidance
8th August 2024
The Lincolnshire Emollient Formulary Guidance has been updated in line with the recent Epimax Ointment and Epimax Paraffin-Free Ointment drug safety update. The drug safety update was issued following reports of ocular surface toxicity and ocular chemical injury.
The following changes have been made:
- ‘Do NOT use on the face, to avoid contact with the eyes’ added to Epimax Ointment and Epimax Paraffin-Free Ointment.
- Links to the drug safety update added to guidance for reference.
Please find the guidance here.
Please find the drug safety update here.
Diabetes Continuous Glucose Monitoring Updated Statement (CGM)
31st July 2024
In March 2022, the National Institute for Health and Care Excellence (NICE) reviewed the evidence and updated recommendations on continuous glucose monitoring (CGM) for both Type 1 and 2 diabetes management.
The Lincolnshire position statement regarding the use of continuous glucose monitoring (CGM) system for the management of diabetes had been updated in line with NICE recommendations NG17, NG18 and NG28. Please note that the initiation of CGM devices is currently only permitted within the specialist diabetes service teams in ULHT and LCHS for continuation in primary care.
The Lincolnshire Integrated Care Board Interim Position Statement on CGM updated for 2024 can be found here.
Lincolnshire Gabapentinoid Tapering Guidance
19th June 2024
Gabapentinoids (gabapentin and pregabalin) have been increasingly prescribed for chronic non-cancer pain despite a lack of evidence in this area. They are recommended by NICE (CG173) for neuropathic pain but commonly used off-label for other types of chronic pain. In 2019, gabapentinoids were reclassified in the UK as Class C drugs due to increased deaths from misuse. Side effects are common, and tolerance often develops. This guidance was developed to support clinicians who review gabapentinoid prescriptions in chronic (persistent) non-cancer pain patients, and to provide a careful, collaborative approach to tapering.
Please find the Lincolnshire Guidance here:
NHS_Lincolnshire_Gabapentinoid_Tapering_Guidance_V4_FINAL.pdf (lincolnshire-pacef.nhs.uk)
Updated Lincolnshire Guidance for the use of anticoagulants in the management of Non-Valvular Atrial Fibrillation (NVAF)
24th April 2024
Attached below is the updated Lincolnshire Guidance for the use of Direct Oral Anticoagulants (DOACs) in Non-Valvular Atrial Fibrillation.
The following changes have been made:
- Apixaban is now the most cost effective DOAC, and the guidance has been amended to reflect this. Generic apixaban (twice a day treatment) is to be used 1st line for patients with NVAF unless there is a specific clinical reason not to do so, Edoxaban is the next preferred option (once a day) currently if apixaban is not suitable.
- Page 10 which provides a table summarising the differences between the different DOACs now includes links to new resources on the Specialist Pharmacy Services (SPS) website.
- Appendix 5 which covers the calculation of Creatinine Clearance (CrCL) now includes additional details of the SystmOne renal calculator.
Please find the guidance here.
Updated GLP 1 RA Shortage Document
8th April 2024
This updated document was produced by the Association of British Clinical Diabetologists in support of ongoing national shortage of glucagon like peptide-1 receptor agonists (GLP1 RA agents) used in the management of type 2 diabetes. The situation is not expected to resolve until late 2024. Therefore, this document is aimed to support primary care teams in selecting appropriate antidiabetic agent alternatives if a GLP1 RA a type 2 diabetes patient is taking becomes unavailable. This document is outside the scope of use of GLP1 Ras for the management of obesity.
Please find the new document here.
2024
Summer Bank Holiday Pharmacy Rota
29th July 2024
ODS | Pharmacy Name | Address 1 | Address 2 | City/Town | Postcode | Summer Bank Holiday 2024 - 26th August |
FC096 | Tesco Pharmacy | In-Store Tesco | 65 Northgate | Sleaford | NG34 7BB | 10:00-16:00 |
FC922 | Nene Pharmacy Ltd | 184 Bridge Road | Sutton Bridge | Spalding | PE12 9SF | 14:00-16:00 |
FCM80 | Tritton Road Pharmacy | U1 Morrisons SuperMarket | Tritton Road | Lincoln | LN6 7QL | 10:00-12:00 |
FCX81 | Asda Pharmacy | Newark Road | North Hykeham | Lincoln | LN6 8JY | 10am – 4pm ( Lunch 12.30-1pm) |
FF878 | Tesco Pharmacy | In-Store Tesco | South Road | Bourne | PE10 9LS | 10:00-16:00 |
FFR51 | BOOTS | 58-64 Lumley Road | Skegness | PE25 3NG | 10:00 - 17:00 | |
FGC34 | Superdrug Pharmacy | 20-22A High Street | Stamford | PE9 2AY | 10:00-12:00 | |
FGR00 | BOOTS | 11-14 Hall Place | Spalding | PE11 1SA | 10:00-16:00 | |
FHY65 | BOOTS | 41-45 Southgate | Sleaford | NG34 7SY | 10:00 - 16:00 | |
FK029 | Asda Pharmacy | Sleaford Road | Boston | PE21 8EQ | 10am – 4pm ( Lunch 12.30-1pm) | |
FKN04 | Pharmacy Wise | 23 High Street | Sutton-on-Sea | LN12 2EY | 10:00-12:00 | |
FAL19 | BEACON PHARMACY | Skegness Road | Ingoldmells | Skegness | PE25 1JL | 14:00-16:00 |
FNG12 | Lincoln Co-op Chemists Ltd | Newland Health Centre | 34 Newland | Lincoln | LN1 1XP | 14:00-16:00 |
FNH76 | Tesco Pharmacy | Wragby Road | Lincoln | LN2 4QQ | 10:00-16:00 | |
FNR78 | BOOTS | 66/67 High Street | Stamford | PE9 2AW | 10:00-16:00 | |
FP299 | Parkside Pharmacy | Tawney Street | Boston | PE21 6PA | 14:00-16:00 | |
FP635 | BOOTS | St Johns Vicarage | 62 London Road | Grantham | NG31 6HR | 10:00-12:00 |
FQ149 | Lincoln Co-op Chemists Ltd | 15 Market Street | Gainsborough | DN21 2BL | 14:00-16:00 | |
FRJ49 | Asda Pharmacy | Union Street | Grantham | NG31 6NZ | 10am – 4pm ( Lunch 12.30-1pm) | |
FV707 | BOOTS | 26 Mercer Row | Louth | LN11 9JQ | 12:00-13:00 |
Spring Bank Holiday Pharmacy Opening Times
15th April 2024
Please find the updated Spring May Bank Holiday 2024 rota for 27th May:
ODS | Pharmacy Name | Address 1 | Address 2 | City/Town | Postcode | Spring Bank Holiday - Monday 27th May 2024 |
FCX81 | Asda Pharmacy | Newark Road | North Hykeham | Lincoln | LN6 8JY | 10:00-16:00 |
FK029 | Asda Pharmacy | Sleaford Road | Boston | PE21 8EQ | 10:00-16:00 | |
FRJ49 | Asda Pharmacy | Union Street | Grantham | NG31 6NZ | 10:00-16:00 | |
FKF52 | Ask Chemist | 13 Forbes Road | Boston | PE21 0PD | 14:00-16:00 | |
FFR51 | BOOTS | 58-64 Lumley Road | Skegness | PE25 3NG | 10:00 - 17:00 | |
FGR00 | BOOTS | 11-14 Hall Place | Spalding | PE11 1SA | 10:00-16:00 | |
FHY65 | BOOTS | 41-45 Southgate | Sleaford | NG34 7SY | 10:00 - 16:00 | |
FNR78 | BOOTS | 66/67 High Street | Stamford | PE9 2AW | 10:00-16:00 | |
FER87 | Boots Pharmacy | Beacon Park Health Centre | Churchill Avenue | Skegness | PE25 2RN | 14:00-16:00 |
FMQ05 | Boots, | 29 High Street | Mablethorpe | LN12 1AF | 10:00-12:00 | |
FWH94 | Hawthorn Pharmacy | Hawthorn Health Centre | Scotton Road | Gainsborough | DN21 3SB | 10:00 - 12:00 |
FWA76 | Knight Street Pharmacy | 22 Knight Street | Pinchbeck | Spalding | PE11 3RB | 14:00-16:00 |
FGR53 | Lincoln Co-Op Chemist | 121 Monks Road | Lincoln | LN2 5HT | 14:00-16:00 | |
FPX47 | Lincoln Co-Op Chemist | 2 Jerusalem Road | Skellingthorpe | Lincoln | LN6 5TW | 10:00-12:00 |
FJN65 | Lincoln Co-Op Chemist | Vanessa Drive | Gainsborough | DN21 2UQ | 14:00-16:00 | |
FP637 | Lincoln Co-Op Chemist | 176 Winchester Road | Grantham | NG31 8RX | 10:00-12:00 | |
FX130 | Lincoln Co-Op Chemist | 52 Eastgate | Louth | LN11 9PG | 09:00-17:30 | |
FHC57 | Riverside Pharmacy | 47 Boston Road | Sleaford | NG34 7HD | 14:00-16:00 | |
FGA80 | Stamford Pharmacy | 6 St Mary's Hill | Stamford | PE9 2DP | 10:00-12:00 | |
FC096 | Tesco Pharmacy | In-Store Tesco | 65 Northgate | Sleaford | NG34 7BB | 10:00-16:00 |
FF878 | Tesco Pharmacy | In-Store Tesco | South Road | Bourne | PE10 9LS | 10:00-16:00 |
FNH76 | Tesco Pharmacy | Wragby Road | Lincoln | LN2 4QQ | 10:00-16:00 |
Improving access and capacity using community pharmacy
22nd January 2024
Please see enclosed document around improving access and capacity using community pharmacy.
New virtual pain cafe
3rd January 2024
As part of our ongoing work to support people in Lincolnshire experiencing long term persistent pain, Lincolnshire’s NHS has launched a new virtual pain café.
There will be 10 virtual events throughout the year that people can join from the comfort of their own home and join others experiencing similar persistent pain, to learn new techniques, share experiences and look at alternatives to medication.
The sessions take place once a month on a Wednesday, over the course of 12months and will be around 20mins of teaching. There will also be some face-to-face sessions hosted in various locations across the county and more details will follow once confirmed.
The sessions will follow the 10 steps of the nationally recognised Live Well with Pain programme, with time to ask questions and share experiences where people feel comfortable.
These are open to anyone experiencing persistent pain and people can be an active participant, or sit with camera off and just listen, whatever they prefer.
Whilst the sessions have already started people can join at any time. email licb.patientmo@nhs.net for more information and dates.
Empowered Relief – Free patient pain workshops
3rd January 2024
We are pleased to have been able to now extend our free pain workshops for people living in Lincolnshire, following a successful pilot in 2023.
These workshops are part of Lincolnshire’s NHS work to provide alternatives to medications for people living with chronic non-cancer pain.
There is substantial evidence that non-pharmacological support for non-cancer chronic pain is safer and often more effective for managing symptoms and should be explored as a first step before prescribing.
Empowered Relief™ is an evidence-based, 2-hour virtual workshop on pain that rapidly equips people with the skills to effectively manage their pain. The session covers:
- How pain is processed in the brain and how to best manage it
- Simple skills that people can use everyday
- Creating a personalised plan for long-term relief
Workshops take place periodically throughout the year. The sessions are virtual and take place over Microsoft Teams. Patients can attend either workshop, which will be delivered by Dr Graham Dunthorne a Specialist Pain Management GP in the county, from the comfort of their own home.
People should register their interest by emailing licb.patientmo@nhs.net
Medicines Supply Issues & Shortages
To support the management of supply shortages, The Medicines Optimisation team recommends to access the Medicine Supply tool available on the Specialist Pharmacy Service website. Registering via NHS email is required through https://www.sps.nhs.uk.
Please see our Medicines Supply Issues and Shortages document to support you with the increasing number of reported stock issues.
This leaflet is designed to support primary care teams to care for patients with diabetes during the period of Ramadan fasting.
Management of Winter Illness
2nd February 2024
Winter illnesses are not always serious, but they can make patients feel very unwell, and this results in a greater burden of appointments on GP practices, and potentially pressure from patients to prescribe antibiotics.
We know that a lot of respiratory conditions such as flus and colds should not necessarily be treated with antibiotics, and that these conditions will often resolve themselves over time, but often the patients don’t know how long they should wait before seeking advice, or how to find this out. Patients are also often unaware of the side effects which can result from taking antibiotics, and there is a lot of education which needs to be done by healthcare professionals regarding this.
Please click here to view the full article.
Nutrition and Hydration Week 2024
8/3/2024
11th- 17th March 24 is Nutrition and Hydration Week. There has never been a more important time to raise awareness of the importance of eating and drinking well in later life.
With around 3 million people at risk of malnutrition in the UK we need to engage opportunities to raise the awareness of the risks and promote the good practices that can help prevent malnutrition and dehydration. Preventing malnutrition and dehydration improves health and well-being and helps to reduce the burden on the health and social care services in treating and supporting those suffering from under nutrition and dehydration.
Nutrition and Hydration Week is an annual event to educate people on the value of food and drink in maintaining health and wellbeing. and raise awareness of the work the speech and language therapists (SLTs) do to help people living with eating, drinking, and swallowing difficulties.
The week is also continuing focus on the following aims:
• Promoting the 10 Key Characteristics for Good Nutritional Care
• Promoting Mealtimes Matter and Protected mealtimes
• Encouraging the introduction of Nutrition Advocates /Champions to each health and Social Care Setting
• The introduction of minimum standards for good nutrition in all settings
• Sharing Good nutrition and hydration practice
• Promoting Continued Education and Professional Development especially in the health and social care sector for catering staff.
• Improve staff awareness of their own hydration and nutritional requirements.
Poor nutrition and hydration not only harms people’s health and wellbeing, but it can also reduce their ability to recover and leads to increased admissions to hospitals and care homes. Around 1 in 3 patients admitted to hospital or who are in care homes are malnourished or at risk of becoming so.
Malnutrition can be difficult to recognise and can happen very gradually, which can make it very difficult to spot in the early stages. Signs to watch out for include loss of appetite, weight loss, tiredness, altered mood and poor concentration.
The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool that identifies adults who are underweight and at risk of malnutrition.
Eating, drinking, and swallowing problems (known a dysphagia) can affect up to 10% of older people in hospital and 75% of care home residents. 1 in 17 people will develop dysphagia at some point in their lifetime.
If dysphagia is not treated appropriately, it can result in choking, dehydration, malnutrition, weight loss, pneumonia, and chest infections. Early identification reduces medical complications and improves nutrition, hydration, and overall physical and mental wellbeing.
Learn more about Nutrition and Hydration Week.
We all have a role to play in helping people to notice if they have started to lose weight without meaning to or if they are not drinking enough. It is everyone’s responsibility to encourage good nutrition and hydration intake and to raise awareness of simple tips to better nutrition and hydration intake.
Tresiba NPSA Update
15/12/23
In response to the medicines supply notification on 24th May 2023 regrading a shortage of Tresiba® (insulin degludec) FlexTouch® 100units/ml solution for injection 3ml pre-filled pens.
Some patients may have been switched to Tresiba® (insulin degludec) FlexTouch® 200units/ml solution for injection 3ml pre-filled pens. However the Medication Safety Officer (MSO) Network have now highlighted five reports of prescribing, dispensing and administration errors where some patients have been incorrectly advised to reduce the number of units of insulin to be administered. This document is to support clinicians on how to ensure patient safety when using Tresiba.
Please see the updated guidelines here: https://lincolnshire-pacef.nhs.uk/application/files/1917/0265/0967/NPSA_Tresiba_Summary.pdf
Additional information regarding supply: Tresiba® FlexTouch® 100units/ml pre-filled pens are out of stock until December 2024. Prescribers are advised to adhere to the recommendations
In the MSN supply tool https://www.sps.nhs.uk/shortages/shortage-of-tresiba-insulin-degludec-flextouch-100units-ml-solution-for-injection-3ml-pre-filled-pens/ and the National Patient
Safety Alert https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103242
Guidance for the management of the National Patient Safety Alert Methylphenidate, Lisdexamfetamine & Guanfacine
6th October 2023
Here is the ICS guidance on how to manage the recent NatPSA alert regarding the shortage of methylphenidate prolonged-release capsules and tablets, lisdexamfetamine capsules, and guanfacine prolonged-release tablets.
Lincolnshire Blood Glucose and Ketone test strips Formulary
5th October 2023
This guidance is an updated formulary for blood glucose and ketone test strips. It was produced by the Lincolnshire Diabetes Specialist Clinicians and Lincolnshire ICB Medicines Optimisation Team, and approved at PACEF September 2023. It is based on the NHS England Commissioning National Recommendations produced April 2023.
It provides guidance on appropriate, cost effective blood glucose meters, test strips and ketone test strips.
Full Guidance can be found here
NHS England have announced Changes to their Commissioning recommendations for blood glucose and ketone meters, testing strips (BGKT) and lancets Version 2, 12 October 2023.
• It has removed the AgaMatrix Agile and On Call Extra Mobile for first line treatment of gestational diabetes requiring a GDm-Health™ application due to technical issues with the software. (Page 7)
• They have also corrected their recommendation for type 2 diabetes - paediatrics to “On Call Extra” and not “On Call Extra Mobile”. (page 7)
• They have also advised that the launch date the Aga-Matrix Agile has now been delayed until December 2023. ( pages 6 & 9)
We have now updated our Lincolnshire joint formulary in line with the changes. The formulary and PACEF websites will be updated accordingly.
Self Care and Prescriptions During Winter
7/12/2023
This winter, the ICB is promoting self care and staying warm during the colder months.
You can find the latest updates from the ICB from our X account (formerly Twitter):
https://twitter.com/nhslincsicb?lang=en-GB
You can order prescriptions online through the following site to avoid delays and save time:
https://www.nhs.uk/nhs-services/online-services/how-to-order-a-repeat-prescription/
We are also encouraging both patients and staff to get their winter vaccines, more information can be found here:
https://www.nhs.uk/live-well/seasonal-health/keep-warm-keep-well/
Cervical Cancer Awareness Week
22/01/2024
Cervical screening is one of the best ways to protect yourself from cervical cancer. It's not a test for cancer, it's a test to help prevent cancer. Protect yourself — attend your cervical screening when invited.
https://www.nhs.uk/conditions/cervical-screening/
For any services in the Boston area, please see the enclosed poster shared by the Boston GP Practices.
PrescQIPP Clinical Masterclass - Acute and preventative treatment of migraine
22/1/2024
Please see below message from PrescQIPP about their upcoming webinar:
"On 24th January 1-2pm, we welcome Dr Callum Duncan to talk about Acute and preventative treatment of migraine.
Dr Duncan is a Consultant Neurologist at Aberdeen Royal Infirmary where he has run a headache clinic, along with Dr David Watson (GPwSI Headache), since 2008. He obtained his MBChB from Aberdeen University in 1999, during which he also obtained an intercalated PhD. He trained in General Medicine in Aberdeen, Neurology in Aberdeen and Edinburgh, and Headache in Aberdeen, Edinburgh, Glasgow and the NHNN Queen Square London.
He is chair of the SIGN 155 guideline group which updated guidance on pharmacological management of migraine in 2022 and 2023. He is a past secretary of the British Association for the Study of Headache (2016-2022) and chair of the development group for the Scottish National Headache Pathway (part of Scottish Government Modernising Patient Pathways initiative). He is currently undertaking a pharmacy project on migraine management in pharmacy with the Migraine Trust."
Wednesday 24th January 13.00 - 14.00
Clinical Masterclass Registration
2023
Wegovy® (Semaglutide)
5th September 2023
ICB Statement
Wegovy® (Semaglutide) has been launched in the UK on 4th September 2023. It is available to patients on the NHS only via NHS specialist weight management services. To obtain Wegovy® on the NHS those patients eligible for treatment under NICE TA 875 will need to be referred to/or currently under the care of NHS specialist tier 3 or 4 weight management services.
Novo Nordisk have confirmed that supplies will be sent direct to those centres providing this treatment. Wegovy® is licensed as an adjunct to a reduced-calorie diet and increased physical activity for weight management and should not be prescribed within primary care.
Pharmacy Holiday Opening Times
21/12/2023
Please find below opening times for local pharmacies over the holiday period.
Christmas Day
ODS | Pharmacy Name | Address 1 | Address 2 | City/Town | Postcode | Christmas Day 2023 - Monday 25th December 2023 |
FAM17 | BOOTS | Unit 1, The Carlton Centre | Outer Circle Road | Lincoln | LN2 4WA | 15:00-17:00 |
FER87 | BOOTS | Beacon Park Health Centre | Churchill Avenue | Skegness | PE25 2RN | 14:00-16:00 |
FGR00 | BOOTS | 11-14 Hall Place | Spalding | PE11 1SA | 10:00-1200 | |
FP635 | BOOTS | St Johns Vicarage | 62 London Road | Grantham | NG31 6HR | 14:00-16:00 |
FMK59 | Clover House pharmacy | Clover House | Boston Road | Sleaford | NG34 7HD | 10:00-12:00 |
FWH94 | Hawthorn Pharmacy | Hawthorn Health Centre | Scotton Road | Gainsborough | DN21 3SB | 10:00-12:00 |
FEC14 | Lincoln Co-op Chemists Ltd | 90 Jasmin Road | Birchwood | Lincoln | LN6 0QQ | 13:00-15:00 |
FNG12 | Lincoln Co-op Chemists Ltd | Newland Health Centre | 34 Newland | Lincoln | LN1 1XP | 10:00-12:00 |
FN019 | Newmarket Pharmacy | 155 NewMarket | Louth | LN11 9EH | 11:00-13:00 | |
FP299 | Parkside Pharmacy | Tawney Street | Boston | PE21 6PA | 10:00-12:00 | |
FGA80 | Stamford Pharmacy | 6 St Mary's Hill | Stamford | PE9 2DP | 14:00-16:00 | |
FKN04 | Pharmacy Wise | 23 High Street | Mablethorpe | LN12 2EY | 10:00-12:00 |
Boxing Day
ODS | Pharmacy Name | Address 1 | Address 2 | City/Town | Postcode | Boxing Day 2023 - Tuesday 26th December 2023 |
FCX81 | Asda Pharmacy | Newark Road | North Hykeham | Lincoln | LN6 8JY | 10:00-16:00 |
FK029 | Asda Pharmacy | Sleaford Road | Boston | PE21 8EQ | 10:00-16:00 | |
FRJ49 | Asda Pharmacy | Union Street | Grantham | NG31 6NZ | 10:00-16:00 | |
FH064 | BOOTS | 11 High Street | Sutton-on-Sea | Mablethorpe | LN12 2EY | 10:00-12:00 |
FNR78 | BOOTS | 66/67 High Street | Stamford | PE9 2AW | 10:00-16:00 | |
FW570 | Grantham Pharmacy | 17 High Street | Grantham | NG31 6PN | 10:00-12:00 | |
FWA76 | Knight Street Pharmacy | 22 Knight Street | Pinchbeck | Spalding | PE11 3RB | 14:00-16:00 |
FD243 | Lincoln Co-op Chemists Ltd | High Street | Ruskington | Sleaford | NG34 9DY | 14:00-16:00 |
FJN65 | Lincoln Co-op Chemists Ltd | Vanessa Drive | Gainsborough | DN21 2UQ | 14:00-16:00 | |
FAQ04 | Lloyds Pharmacy | South Square | Boston | PE21 6JU | 14:00-16:00 | |
FN019 | Newmarket Pharmacy | 155 NewMarket | Louth | LN11 9EH | 12:00-13:00 | |
FK184 | SIT FPW (Chemists) | High Street | Ingoldmells | Skegness | PE25 1NS | 14:00-16:00 |
FCV46 | Lincoln Co-op Chemists Ltd | 107 High Street | Saxilby | Lincoln | LN1 2HG | 14:00-16:00 |
FAM17 | Boots | Unit1, The Carlton Centre | Outer Circle Road | Lincoln | LN2 4WA | 10:30-16:30 |
New Years Day
ODS | Pharmacy Name | Address 1 | Address 2 | City/Town | Postcode | New Years Day 2024 - Monday 1st January |
FA306 | Rowlands Pharmacy | Hawthorn Road | Skegness | Lincolnshire | PE25 3TD | 14:00-16:00 |
FCX81 | Asda Pharmacy | Newark Road | North Hykeham | Lincoln | LN6 8JY | 10:00-16:00 |
FK029 | Asda Pharmacy | Sleaford Road | Boston | PE21 8EQ | 10:00-16:00 | |
FRJ49 | Asda Pharmacy | Union Street | Grantham | NG31 6NZ | 10:00-16:00 | |
FM543 | Beacon Pharmacy | Skegness Road | Ingoldmells | Skegness | PE25 1JL | 14:00-16:00 |
FEH98 | Lincoln Co-op Chemists Ltd | 226 Rookery Lane | Lincoln | LN6 7PH | 10:00-12:00 | |
FQ149 | Lincoln Co-op Chemists Ltd | 15 Market Street | Gainsborough | DN21 2BL | 14:00-16:00 | |
FX130 | Lincoln Co-op Chemists Ltd | 52 Eastgate | Louth | LN11 9PG | 12:00-13:00 | |
FMP75 | Lloyds Pharmacy | Boston West Business Park | Sleaford Road | Boston | PE21 8EG | 14:00-16:00 |
FNJ59 | Lloyds Pharmacy | 171 New Beacon Road | Grantham | NG31 9LJ | 10:00-12:00 | |
FGJ83 | Marisco Pharmacy | Stanley Avenue | Mablethorpe | LN12 1DP | 10:00-12:00 | |
FC922 | Nene Pharmacy Ltd | 184 Bridge Road | Sutton Bridge | Spalding | PE12 9SF | 14:00-16:00 |
FC096 | Tesco Pharmacy | In-Store Tesco | 65 Northgate | Sleaford | NG34 7BB | 14:00-16:00 |
FKH66 | Well Pharmacy | Sheep Market Surgery | Ryhall Road | Stamford | PE9 1YA | 10:00-12:00 |
FAM17 | Boots | Unit1, The Carlton Centre | Outer Circle Road | Lincoln | LN2 4WA | 10:30-16:30 |
FLD47 | Jhoots | Brayford Quays | Newland | Lincoln | LN1 1YA | 14:00-16:00 |
PrescQIPP Clinical Masterclass - Eczema management in primary care
15/12/23
Please see below message from PrescQIPP about their upcoming webinar:
"On 19th December we welcome Dianne Sanderson to talk about Eczema management in primary care.
Dianne worked in Community pharmacy for 24 years and then had a complete career change and spent some time in a Rheumatology department before moving into primary care. Dianne has been a practice pharmacist for 8 years and the lead pharmacist at Macclesfield PCN for the past 3 years, leading a team of pharmacists and pharmacy technicians. For the past 4 years, she has spent one day a week in the local NHS dermatology service where she oversees topical and oral treatments of acne, eczema and psoriasis. Dianne became an independent prescriber in 2016 and also does some academic teaching."
World Antimicrobial Awareness Week
31/10/23
World AMR Awareness Week (18th – 24th November 2023) is a global annual campaign aimed at improving awareness and understanding of antimicrobial resistance. Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.
The theme for WAAW 2023 is "Preventing antimicrobial resistance together". AMR is a threat to humans, animals, plants, and the environment. It affects us all.
The infographic below shows the number of predicted deaths caused by antimicrobial resistance in 2050 if we are unable to change the current trajectory. Experts predict that in just under 30 years, antimicrobial resistance will kill more people worldwide than cancer and diabetes combined. People will be dying of infections that were previously treatable.
Antimicrobial resistance currently adds over £1 billion to hospital treatment and societal costs in the EU, this is a continually increasing figure, and with an ageing population we will continue to use an increasing volume of antimicrobials, driving the problem further. From the 1930s to the 1960s, 14 classes of antimicrobial were introduced, but since 1968 there have been only five new drug classes developed. Since 1984, no new registered classes of antimicrobials for human treatment have been developed, so it is even more important that we protect the antibiotics that we do have, to ensure that they remain effective.
Antibiotics are wonderful life saving treatments, but we must only use them when we really need them, and it is everyone’s responsibility to protect them for the future.
Antibiotics in Lincolnshire
Unfortunately, in Lincolnshire we use more antibiotics than average, and we know that high use of antibiotics drives resistance. The good news is that this means that we are all capable of helping to improve the current situation and protect the world from future infections.
The graph below shows all ICB’s prescribing of antibacterial items per STAR-PU. The orange line depicts the national target. Lincolnshire ICB is in red at the right-hand side of the graph. We are the worst ICB in the country on this measure and prescribe more antibacterial items than anywhere else.
Optimising Antibiotic Course Length – Shorter is Better
We all need to work together on improving our use of antibiotics, and one of the areas that Lincolnshire ICB is going to focus on over the next twelve months is optimising antibiotic course length. Antibiotics should be prescribed for the shortest duration needed, and often, although seven-day courses have been historically prescribed, this is a longer course than is necessary for some conditions.
Unnecessarily long courses of antimicrobials are one of the factors driving antimicrobial resistance and an increased risk of C.Difficile infection in at-risk populations. Reducing course length is not only a good thing in terms of antimicrobial resistance, but also is potentially safer for the patient, as it reduces the incidence of adverse effects. Each additional day of antibiotic therapy is associated with a 4% increase in risk of side effects and a 3% increase in risk of resistance.
Looking purely at amoxicillin courses, we know that Lincolnshire prescribes roughly 32% of amoxicillin as 5-day courses and 63% of this as 7-day courses (the remainder is made up of other miscellaneous course lengths). The national average is 45% of 5-day courses, but some ICBs have reached up to 75% of amoxicillin being prescribed as 5 day courses, so we know there are massive gains which can be made on this in Lincolnshire. Data on this is free to access right down to practice level here: Optimising Antimicrobial Use Dashboard | PrescQIPP C.I.C
Antibiotic Research UK
Antibiotic Research UK (ANTRUK) is charity, founded in 2014, which aims to tackle antibiotic resistance by raising sufficient funds over the next five years to bring at least one new antibiotic treatment to market by the early 2020’s. The charity also aims to provide public and professional education and information for patients. It has lots of good information and support networks for patients who have been affected by antimicrobial resistance and provides a place for GPs to signpost these patients to. Support Antibiotic Research | Fight Antibiotic Resistance | ANTRUK
Get involved….
- Become an antibiotic guardian
- Check out your surgery’s 5 day vs 7 day prescribing of amoxicillin
- Run your own WAAW event.
- Review the resources available through the TARGET toolkit to see if they can help in your practice.
- Promote WAAW in your surgery through displays and posters.
- Keep an eye on upcoming comms from LICB for more information closer to WAAW itself.
References
- The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and clostridium difficile - PubMed (nih.gov)
- The New Antibiotic Mantra — “Shorter Is Better” - PMC (nih.gov)
- Antibiotic resistance as big a threat as climate change – chief medic | Antibiotics | The Guardian
- Antimicrobial resistance: a global threat | UNEP - UN Environment Programme
- Antibiotic Guardian – Pledge to be an Antibiotic Guardian
- World AMR Awareness Week 2023 (who.int)
- Antibiotic Research UK | Fighting Antibiotic Resistance
- Course: TARGET antibiotics toolkit hub (rcgp.org.uk)
- World Antimicrobial Resistance Awareness Week (WAAW) and European Antibiotic Awareness Day (EAAD) - GOV.UK (www.gov.uk)
- O'Neill Review into Antibiotic Resistance (parliament.uk)
PrescQIPP - Clinical Masterclass - Pharmacogenomics
8/11/23
Please see the following from PrescQIPP:
Tuesday 14th November 13.00 - 14.00
On 14th November we welcome Professor Sir Munir Pirmohamed to talk about Pharmacogenetics.
Munir is David Weatherall Chair of Medicine at the University of Liverpool, and a Consultant Physician at the Liverpool University Hospital Foundation NHS Trust.
He is Director of the Centre for Drug Safety Sciences, Director of the Wolfson Centre for Personalised Medicine and Director of HDR North.
Medication Safety Week
31/10/23
6th to 12th November 2023
This year’s campaign will focus on WHO CAN REPORT.
All healthcare professionals have a key role to play in the cycle of medicines safety. The MHRA want to explore the different perspectives that come from the various healthcare professional groups and how the information that they can provide will help make medicines safer.
How can you open the lines of communication around reporting adverse reactions to medicines and vaccines via the Yellow Card Reporting?
Have you used the Yellow Card Reporting?
What methods can you use to promote the use of the reporting tool within your work area?
Please support the campaign and talk to your patients and colleagues about side effects and how they can report suspected problems to the MHRA Yellow Card Scheme. https://yellowcard.mhra.gov.uk/
If using social media follow the hashtag #MedSafetyWeek and #MHRAYellowCard to help extend and magnify the message.
There are various promotional tools on the Yellow Card website - https://yellowcard.mhra.gov.uk/MedSafetyWeek
You can view case studies to see where yellow card reporting has made a difference - https://yellowcard.mhra.gov.uk/casestudies
If you fancy completing some CPD there are e-learning modules which can be found here - https://yellowcard.mhra.gov.uk/resources/elearning
Upcoming PrescQIPP Webinars
11th October 2023
Please see the below message from PrescQIPP regarding their upcoming webinars later this month:
Clinical Masterclass - Stoma management in primary care
Tuesday 17th October 13.00 - 14.00
In our Clinical Masterclass on 17th October 2023 1-2pm, we welcome Heather Ilett who will talk about Stoma management in primary care.
Heather has been a registered nurse for over 30 years, specialising in stoma care. Having worked in an Acute NHS Trust for 15 years and run a busy stoma community service, she has taken her experience in a different direction, working as Lead Stoma Nurse for Hertfordshire and West Essex Integrated Care Board (ICB).
Heather works with GPs and Pharmacists (ICB, practice and primary care network) as well as other health care professionals, providing stoma education sessions and supporting practices with reviewing their stoma prescribing. She is also integral in local stoma formulary and guideline development, as well as being an active interface between primary and secondary stoma care.
Register to attend the webinar here
Practice Plus Monthly Webinar
Wednesday 18th October 12.45 - 13.45
Medication Safety Research into Primary Care Practice
Dr Richard Keers ,Senior Clinical Lecturer in Pharmacy at the University of Manchester will bring us all up to date about medication safety research relevant to general practice , in particular the future of clinical decision support systems such as PINCER and improving the safety of mental health prescribing.
Register to attend the webinar here
Lincolnshire Prescribing Forums
Your next Lincolnshire prescribing forum is Wednesday 18th October 2023.
For more information please click here.
Diabetes Continuous Glucose Monitoring (CGM)
The Lincolnshire Integrated Care Board Interim Position Statement on CGM can be found here.
TARGET - Train The Trainer Session
What is the TARGET antibiotics toolkit?
TARGET stands for “Treat Antibiotics Responsibly; Guidance, Education and Tools”. Developed by the UK Health Security Agency (UKHSA), the Royal College of General Practitioners (RCGP) and the Antimicrobial Stewardship in Primary Care (ASPIC) Group, TARGET is the central resource to help primary care healthcare professionals and commissioning organisations improve antibiotic prescribing. Using the TARGET Antibiotics Toolkit resources will also enable primary care organisations to demonstrate compliance with the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance.
Details
Lincolnshire ICB will be hosting a virtual TARGET train-the-trainer session with the aim being to improve antimicrobial prescribing across the system. This half-day event will be run in collaboration with our regional antimicrobial stewardship lead and the national TARGET team. We will also have one of our consultant microbiologists Dr Reena Rambani attending to help deliver the material and present it from a Lincolnshire perspective.
This training will not only upskill your personal knowledge on infections and AMR but will also train you to deliver TARGET antibiotic workshops locally, so that you can cascade training to others.
There will be two clinical scenarios covered in the session, as well as the training on how to be a trainer. This training should help to reduce inappropriate antibiotic prescribing within Lincolnshire and make a big difference to the quality of care for our patients; it is an excellent opportunity to proactively help improve prescribing and reduce antimicrobial resistance.
This training session is open to all healthcare professionals who work with primary care prescribers and who could deliver training sessions to their colleagues (GPs, practice nurses, pharmacists, paramedics, care home nurses, ICB or PCN staff etc). The session is also free and will count towards your CPD (you will need to complete the pre- and post-event survey to be accredited as a trainer and get your CPD certificate).
We would like it if we could get at least one member of staff from each PCN, so that they can then cascade this training down, but we would love to see as many people as possible. The training will be via Teams and will run from 09:30 – 13:00 on 27th September. Further information about the event will be sent out to those who register.
GLP-1 receptor agonist supply disruption
There is an ongoing national shortage of glucagon like peptide-1 receptor agonists (GLP-1 RAs) licensed in the management of Type 2 Diabetes Mellitus (T2DM). Information available indicates that there are very limited, intermittent supplies of all GLP-1 RAs. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications and is not expected to return to normal until at least mid-2024.
This guidance aims to support clinicians in choosing suitable alternative glucose lowering therapies to GLP-1 RAs during this period of national shortage.
Clinicians are recommended to refer to the SPS Tool for Medicines Shortages for an up-to-date supply stock situation and clinical guidance on alternative treatment options; see links below:
Background information
Approach to weight loss management for obesity is multifactorial and should include dietary advice, weight loss targets, physical activity programmes, behavioural interventions and psychological support and pharmacological therapy such as semaglutide, a GLP-1 receptor agonists.
The National Institute for Health and Care Excellence (NICE) Technology appraisal guidance [TA875] Published: 08 March 2023 recommended the use of semaglutide (Wegovy®) alongside a reduced-calorie diet and increased physical activity to adults who have at least one weight-related comorbidity and a body mass index (BMI) of at least 30kg/m2 and over for managing overweight and obesity in an NHS specialist weight management service.
At present the product semaglutide (Wegovy®) has not been launched in the UK and currently there is no information regarding the product such as price or who will be able to prescribe. No date has been confirmed by the company Novo Nordisk as to when the product or information will be available. Semaglutide (Wegovy®) for weight loss will only be available to patients that meet the eligibility criteria outlined by NICE through a specialist weight management service. semaglutide (Wegovy®) was added to the formulary as a NICE TA875, but not given a traffic light classification until it becomes available in the UK and there is clarification how it will be used.
However, given the ongoing national shortage of GLP-1 receptor agonists caused by an increase in demand for these products for licensed and off-label indications, a National Patient Safety Alert – DHSC issued on 18-Jul-2023 requests that the off-label use of these agents for the management of obesity is strongly discouraged. All existing stock must be conserved for use in patients with diabetes because of the serious clinical implications in the management of patients with type 2 diabetes that these shortages pose.
The ICB DOES NOT support the use of GLP-1 receptor agonists for weight loss until there is clear guidance from NHS England and we are over the supply issue. In addition, we will put in place a clinically led pathway BEFORE this is authorised for use. Eligible people with T2DM who would like support with weight management should be signposted to available locally and nationally available weight management programmes.
Useful Resources
NICE Technology Appraisal Guidance [TA875] https://www.nice.org.uk/guidance/ta875
MHRA Central Alerting System: National Patient Safety Alert (NatPSA)
https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103235
Primary Care Diabetes Society PCDS_ABCD-GLP-1-RA-shortage_20230628.pdf (diabetesonthenet.com)
Healthier You. NHS Diabetes Prevention Programme – clinicians to complete the referral form embedded in your clinical system and send via email to scwcsu.lincolnshire@nhs.net
Other useful resources to support clinicians in choosing suitable alternative glucose lowering therapies to GLP-1 RAs during this period of national shortage
Type 2 diabetes in adults: management | Guidance | NICE
NG28 Visual summary on choosing medicines for type 2 diabetes in adults (nice.org.uk)
Shared decision making | Guidance | NICE
https://www.medicines.org.uk/emc#gref
PCDS_ABCD-GLP-1-RA-shortage_20230628.pdf (diabetesonthenet.com)
Patient useful resource/information
FAQs – GLP-1 RA shortages | Diabetes UK
World Sepsis Day - 13th September 2023
There are up to fifty million cases of sepsis annually and it causes at least eleven million deaths per year. One in five deaths worldwide is associated with sepsis.
What is Sepsis?
Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. It occurs when the body’s immune system (which normally helps to protect us and fight infection) goes into overdrive. It can lead to shock, multiple organ failure and sometimes death, especially if not caught early and treated promptly.
Sepsis mainly affects very young children and the elderly, and it is also more common in people with underlying health conditions or a weakened immune system; however, it can happen to anyone, including those who are otherwise fit and healthy.
Sepsis always starts with an infection, but no-one knows why sepsis goes on to occur in some patients but not others. Five people an hour die of sepsis in the UK, and it can be triggered by any infection, such as chest infections and UTIs. The infographic below shows common causes of sepsis.
How to Recognise Sepsis
In the UK, five people die with sepsis every hour. There is no single specific symptom of sepsis, and signs can be different in adults than in children, but making sure that you are aware of the signs can speed up diagnosis and treatment and help to avoid preventable deaths.
Sepsis can be especially hard to spot in babies, young children, people with dementia, or a learning disability, and people who have difficulty communicating, which makes it particularly important to be aware of the possibility of sepsis when assessing these patients.
Tools such as the National Early Warning Score (NEWS) have been developed; to help identify acute deterioration in patients and therefore to help identify sepsis. The benefits of a standardised early warning system, (and more information about NEWS) are discussed here NHS England » National Early Warning Score (NEWS)
Post Sepsis Symptoms
Sepsis can affect lives even after patients have left hospital and recovered from the acute infection. Roughly forty percent of surviving patients continue to experience both mental and physical symptoms. In most cases, these effects will only last for a few weeks, but for some people they can last months or even years.
Common Problems after Sepsis Recovery |
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Psychological/Cognitive |
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Sepsis Prevention
Sepsis is the number one cause of preventable death worldwide. Preventing infection is the best way to prevent sepsis, and this can be practised routinely in daily life with measures such as:
- Vaccination
- Clean water
- Hand hygiene
- Preventing hospital-acquired infections (HAIs)
- Safe childbirth
- Awareness
Useful Resources
The UK Sepsis Trust has various resources for both healthcare professionals and patients, including CPD accredited sepsis e-Learning modules to help you understand, identify, and manage sepsis. They provide support for people struggling with the aftereffects of sepsis and links to both online and face to face support groups. There are also several leaflets and resources available for patients, which deal with common questions and advice on coping with day-to-day life after sepsis.
The World Sepsis Day website hosts lots of information and resources which can be utilised in practice, including fact sheets, quizzes, infographics, posters, brochures, video clips, WSD wallpapers, and other event materials.
References and More information
The UK Sepsis Trust The UK Sepsis Trust Home Page | What is Sepsis? | Sepsis Symptoms
Word Sepsis Day Website WSD 2023 — World Sepsis Day - September 13
Sepsis: recognition, diagnosis and early management NICE guideline [NG51] Overview | Sepsis: recognition, diagnosis and early management | Guidance | NICE
NHS website Symptoms of sepsis - NHS (www.nhs.uk)
NHS England NHS England » Our work on sepsis
15th June 2023 is the UK's Clean Air Day!
Every year, air pollution causes up to 36,000 deaths in the UK. The World Health Organisation and the UK Government recognise that air pollution is the largest environmental health risk we face today.
What pollutes our air?
There are different types of pollution:
- Particles – particle pollution is made up of particles that are smaller than the width of a human hair. Normally these particles are too small to see, but on some days with especially high pollution levels they can mix with other types of pollution to make the sky look a little hazy.
- Gases – mostly come from burning fuels or other materials, levels are particularly high around roads. The gases mix with the air we breathe and are absorbed through the lungs.
- Chemicals – usually from liquids or solids that disperse into the air very easily (air fresheners, cleaning products, hair spray). Once mixed with the air these chemicals are very easy for us to breathe in.
- Mould – tends to grow in damp places and is released as spores in the air. Some spores, when breathed in, can cause breathing difficulties and in some people can trigger allergic reactions.
What is the pollution level where you live?
It is possible to view the pollution status in your area through the Defra UK air website. Typically there are higher pollution levels in large towns and cities and the burden of long-term exposure to air pollution in the UK is estimated to be equivalent to 29,000 to 43,000 annual deaths for adults aged 30 and over(6).
The pollution status is graded from pale green (low) to purple (very high). Adults and children with lung problems and/or heart problems, should reduce strenuous physical exertion, particularly outdoors on high pollution days.
What is the impact of air pollution?
The NHS accounts for 3% of all greenhouse gas emissions in the UK – to put this into context, this is more than the annual emissions from all aircraft departing Heathrow airport. Inhalers, particularly metered dose inhalers (MDI), contribute to 3% of all the NHS carbon emissions.(4)
Poorly controlled asthma and other respiratory conditions require the increased use of inhalers – there is evidence that greenhouse gas emissions are 8 times higher for patients with uncontrolled asthma3, and therefore there is an increased use of reliever inhalers – which have a higher carbon footprint. The greater the carbon footprint, the more carbon emissions being released into the atmosphere which increases air pollution. It is a vicious circle!
For further information about the global impact of air pollution, the World Health Organisation has lots of resources at Household air pollution (who.int)
Research shows that the most deprived areas are often disproportionately affected by air pollution, and that this is exacerbating health inequalities(1&2).
The evidence also suggests that good asthma control has one- third the carbon footprint of uncontrolled asthma. Reducing reliance on reliever inhalers and decreasing exacerbations will benefit patients and the environment.(3)
What can be done?
There are lots of ways to reduce carbon footprints. Understanding where your carbon emissions come from is the first step - take the quiz to understand more.
When it comes to what can be done in practice, here are ten ways to reduce the carbon impact of asthma(5):
- Support patients to take preventer inhalers regularly to stay well
- Recommend patients to recognise that regular reliever or rescue inhaler use is a sign that something is not right
- Use spacer devices with pressurised metered dose inhalers
- Ensure asthma patients receive at least an annual asthma check with the asthma nurse or doctor
- Promote asthma control by using less puffs of higher strength preventers
- Consider a switch to a dry powder preventer treatment (when children reach 12 years)
- Teach patients to know how to tell when their inhalers are empty (or full)
- Encourage patients to return empty or expired inhalers to pharmacies
- Advise patients to not smoke, avoid areas of high pollution and other asthma triggers
- Up to date inhaler technique videos available to patients
Take away points for prescribers:
- The best device is the one the patient can and will use
- If a pMDI is best for your patient, there are other ways to reduce the carbon footprint
- Spacers are a simple and effective way to make every puff count
What are the MO Team doing?
- We continue to promote best practice in inhaler use and support practices with data around their use.
- Investigating inhaler recycling opportunities in community pharmacy
- Car sharing and reducing our carbon footprint where possible
- Updating our respiratory guidelines to highlight which inhalers are low carbon
- Scoping out workstreams which enable the reduction of single use plastics
- Office plants! Every little helps!
References
Clean Air Hub | What is air pollution
- Epidemiology (archive.org)
- Microsoft Word - AQinequalitiesFNL_AEAT_0506.doc (defra.gov.uk)
- Greenhouse gas emissions associated with asthma care in the UK: results from SABINA CARBON | European Respiratory Society (ersjournals.com)
- NHS England and NHS Improvement (2020)
- Carroll W. Saving our planet one puff at a time. The Lancet vol 10 May 2022
- Clean Air Planner - Create your personalised air pollution action plan (cleanairhub.org.uk)
Anaphylaxis Awareness
What is anaphylaxis?
Anaphylaxis is the result of your body’s immune system overreacting to a harmless substance. It is a severe and potentially life-threatening reaction. Substances that can trigger the allergic reaction are known as allergens. Allergens can include food, drink, medicines, animals, plants, and many other things.
Signs & Symptoms of Anaphylaxis
The symptoms usually start very suddenly and can deteriorate rapidly so early treatment is vital. Symptoms can include:
- Breathing difficulties – Such as fast or shallow breathing
- Feeling lightheaded or faint
- Wheezing
- Clammy Skin
- Tachycardia (Fast Heart rate)
- Confusion and anxiety
- Collapsing or losing consciousness
- Swelling of the lips
- Hives (Itchy, raised rash)
- Feeling or being sick
- Stomach pain
Treatment
Anaphylaxis is a medical emergency and can be very serious if not treated quickly. If someone is showing signs of Anaphylaxis:
- Check if the person has an adrenaline auto-injector and assist them to administer it – Sometimes known as an EpiPen, Jext or Emerade.
- Call 999 for an ambulance immediately (even if they start to feel better) – let the ambulance control know you suspect anaphylaxis
- Remove the trigger if possible
- Lie the person down and raise their legs – unless they are having breathing difficulties and need to sit up to breathe. If they are pregnant, lie them on their left side
- Give another injection after 5 minutes if the symptoms do not improve and a second injection is available
Tips to reduce the risk of Anaphylaxis
- Identify any triggers so they can be avoided
- Carry 2 in-date adrenaline auto-injectors at all times, ensure they are in date.
- Using a medical wrist band can alert others to the issue and help with receiving prompt treatment if you are unconscious
More information on administring Adrenaline Auto-Injectors can be found here.
For World Sleep Day, we are putting a spotlight on Melatonin.
Melatonin is sometimes prescribed to aid sleep, and in Lincolnshire there is a shared care agreement in place to support the use of melatonin use in children and adolescents up to the age of 18 years, but no shared care guidance to support use in adults.
The NICE guidelines cover when adult prescribing of melatonin can be considered. Prolonged-release melatonin is licensed as monotherapy for the short-term treatment (maximum duration 13 weeks) of primary insomnia in people aged 55 years or over.
Studies indicate that melatonin given for three weeks improves sleep onset latency and sleep quality in patients over 55 years. Melatonin should always be used together with non-pharmacological interventions.
More than £17.8 million was spent on melatonin across England, Wales and Scotland in 2022, so it is essential that we ensure prescribing is appropriate, review ongoing prescriptions and deprescribe melatonin where possible (as it is intended for short-term use). The Lincolnshire picture is illustrated below, so you can see prescribing of melatonin within your PCN.
All patients prescribed melatonin for the following indications should have their treatment reviewed:
- Jet lag - this is not recommended on the NHS due to the limited and conflicting evidence of benefit
- Insomnia with Alzheimer’s disease
- More than 13 weeks stable dose treatment without benefit
PrescQIPP have produced some useful information for GPs and some support tools including a visual data pack, GP clinical system searches, an audit, deprescribing algorithm, patient information on melatonin drug holidays and deprescribing for jet lag. These are available here (registration is free).
2022
The focus for Medicines Safety Week for 2022 is the importance of reporting suspected adverse reactions to medications and vaccines, along with reporting issues with medical devices and other healthcare products via the Yellow Card scheme.
The Yellow Card scheme collects and monitors information on suspected safety concerns involving healthcare products such as side effects, or an adverse medical device incident. Side effects or issues can be reported on the Yellow Card website or via the app (Apple/Google Play) by healthcare professionals or the patient. Ensuring you advise your patients about the Yellow Card scheme can enable medication safety issues to be highlighted by the MHRA.
There are videos about the yellow card scheme, more information and e-learning modules on the Yellow Card website.
What are you doing for medication safety week?
Follow and use the #medsafetyweek on social media to keep up to date with all the activities.
World Antibiotic Awareness Week - 24th November (Day 5)
Antibiotic resistance is a problem for everyone, just because you have always used antibiotics correctly does not mean that you cannot catch resistant bacteria. Antibiotic Research UK is a charity which has more information and a great support network for anyone effected by antibiotic resistant infections. If you know someone who might need support, or if you are just interested, more information can be found here.
Become an antibiotic guardian and protect our antibiotics for generations to come.
Remember to take unused antibiotics back to your community pharmacies, so that they don’t end up in the environment leading to more resistant bacteria - see more information here.
Thank you to everyone who has been involved in Antibiotic Awareness Week - let's protect our antibiotics!
World Antibiotic Awareness Week - 23rd November (Day 4)
If you are labelled as penicillin allergic it can be much harder to treat your infections. We know that 1% of people have a true life threatening penicillin allergy, but that up to 10% of people carry it as a label on their record. If your allergy is actually a side effect (such as nausea or an upset stomach, it might be worth a chat with your GP, as at some point penicillin could be life-saving if it is needed to treat a serious infection.
Have a look at this poster from Antibiotic Research UK for more information.
If you have time, there are various webinars taking place over the next week linking in with the daily themes – check out the timetable and see if you have time to catch one.
Are you feeling like an antibiotic expert by now? Why don’t you have a go at a quiz to test your knowledge?
World Antibiotic Awareness Week - 22nd November (Day 3)
It’s important to make sure infections are correctly diagnosed, this helps us to provide the most appropriate treatment.
Remember that viral illnesses do not need antibiotics! Antibiotics aren't effective against viral infections. This includes the common cold, flu, most coughs and sore throats. It can be hard to explain this to patients or the general public, and the TARGET toolkit has some helpful advice.
Please find a link to a very informative antibiotic advert here.
If you have time, there are various webinars taking place over the next week linking in with the daily themes – check out the timetable and see if you have time to catch one.
If you don’t have time for a webinar, then enjoy another antimicrobial themed wordsearch.
World Antibiotic Awareness Week - 21st November (Day 2)
On Day Two of World Antimicrobial Awareness week, we are looking at the guidelines associated with using antibiotics and treating infection. Lots of infections do not need 7 days’ worth of antibiotics – 5 days is often enough.
Using the shortest effective antibiotic course is safer for patients and better for the planet (less harm, less antimicrobial resistance and, lower CO2 footprint. Be NICE! Over-treatment can cause more harm than good – each additional day of unnecessary antibiotic increases the risk of side effects by 3-7%.
Public Health England have produced a short video to help explain the issue of antimicrobial resistance, this can be found here: https://youtu.be/7PhmyNBWGik
As well as the National guidelines, Lincolnshire’s Microguide can be found here (insert link) and the TARGET antibiotic toolkit has lots of useful resources to help guide treatment.
If you have time, there are various webinars taking place over the next week linking in with the daily themes – check out the timetable and see if you have time to catch one.
If you don’t have time for a webinar, then enjoy another antimicrobial themed crossword.
World Antibiotic Awareness Week - 18th November (Day 1)
Day One of World Antimicrobial Awareness Week is all about preventing infection. There are small things that everyone can do to help protect themselves and to prevent antibiotic resistance. Many of these are things you will have done as routine during the COVID-19 pandemic – let’s keep going with them.
- Keep singing “Happy Birthday” when you wash your hands, watch an instruction video here.
- Get your vaccinations
- Keep hydrated – Make sure you have your tea break! More than 92 million people globally are affected by Urinary Tract Infections and staying appropriately hydrated can prevent them.
There are various webinars taking place over the next week linking in with the daily themes – check out the timetable and see if you have time to catch one here.
If you don’t have time for a webinar or would simply like a light activity, then enjoy an antimicrobial themed crossword!