NHS Injectable Medicines Guide - UKMi

1 NHS Injectable NHS Injectable Medicines GuideMedicines GuideProject OutlineProject OutlinePeter GolightlyPeter GolightlyDirector Director --Trent Medicines Information ServiceTrent Medicines Information ServiceThe ConceptThe ConceptProvision of an authoritative and Provision of an authoritative and comprehensive single source of comprehensive single source of evidenceevidence--based information on based information on injectableinjectablemedicines Medicines for use throughout the NHS in the UK for use throughout the NHS in the UK and in other appropriate healthcare settingsand in other appropriate healthcare settingsto maximise patient safetyto maximise patient safetyThe DriverThe Driver3. Ensure essential technical information on injectablemedicines is available and accessible to healthcare staff in clinical areas at the point of injectablemedicines do not have a package insert providing essential technical information about preparation and administration, or the information is insufficient to fully meet the needs of all healthcare example, an incompatibility between the diluent, infusion, other Medicines or administration devices, and associated administration equipment.

2 This technicalinformation is not available in commonly used Medicines references such as the British National detailed Guide to the safe preparation and administration of common intravenous Medicines is available via NHSnet. The Injectable Guide is produced by pharmacists based in approximately 100 different UK hospitals and co-ordinated by the pharmacy department at Hammersmith Hospitals NHS Trust. A new partnership between The Injectable Guide and United Kingdom Medicines Information Service (UKMi) has been formed to expand and develop the content and availability. NPSA Patient Safety Alert 20 NPSA Patient Safety Alert 20 Promoting safer use of Promoting safer use of injectableinjectablemedicinesmedicines What sources are there now?What sources are there now? IV Guide IV Guide BNF BNF SPC/PIL SPC/PIL UCL IV GuideUCL IV Guide TrisselTrissel King Guide King Guide Hospital IV GuidesHospital IV Guides(>30)(>30) ContentContent PrimaryPrimary IV (mainstream and specialist)IV (mainstream and specialist) Epidurals / spinalsEpidurals / spinals Subcutaneous infusionsSubcutaneous infusions Other high risk situations/routesOther high risk situations/routes SecondarySecondary Specialist admin routesSpecialist admin routes Blood products (BNF)Blood products (BNF) Specialist drugs ( Specialist drugs ( BotoxBotox))

3 Lower risk IM and SC Lower risk IM and SC injectablesinjectables Licensed, unlicensed, offLicensed, unlicensed, off--labellabelPrioritised by riskPrioritised by riskNPSA Data ContentNPSA Data Content Reconstitution Reconstitution Concentration of final solution Concentration of final solution Example calculations Example calculations Dilution/flush solutions Dilution/flush solutions Stability in solution Stability in solution Administration rateAdministration rate Compatibility information Compatibility information (for commonly used mixtures in (for commonly used mixtures in specialist areas only)specialist areas only) Special handling informationSpecial handling information Specialist technical information Specialist technical information (where relevant) (where relevant) IMG Additional DataIMG Additional Data Adverse effects on injectionAdverse effects on injection Infusion pump informationInfusion pump information Product risk factor/assessmentProduct risk factor/assessment Electronic links to external sourcesElectronic links to external sourcesThe Core PartnersThe Core Partners IV Guide GroupIV Guide GroupSubject knowledge/experience; proven product; NHS-wide penetration; collaborative writing, multidisciplinary links UKMiUKMiUK wide; Evidence-based publications; reputation for quality and governance-based products; multidisciplinary links RPSGBRPSGBP rofessional umbrella; links with other professional organisations DoHDoHNHS-wide endorsement.

4 Policy and strategic linksExternal Partners/StakeholdersExternal Partners/Stakeholders Specialist clinical users/contributorsSpecialist clinical oncology, oncology, anaesthetics Multidisciplinary users/contributorsMultidisciplinary nurses, doctors, nurses, doctors, pharmacists Primary and secondary carePrimary and secondary care NHS and nonNHS and non--NHS healthcare providersNHS healthcare providers Pharmaceutical industryPharmaceutical industryDelivering the Product Delivering the Product --OptionsOptionsAvailable at pointAvailable at point--ofof--care/applicationcare/applic ation ElectronicElectronic MedusaMedusa NeLMNeLM ee--PrescribingPrescribing Commercial providerCommercial provider PC/laptop, PDA, phonePC/laptop, PDA, phone PaperPaper From eFrom e--version or standaloneversion or standalone Selective local printingSelective local printing Keeping upKeeping up--toto--date date (user and publisher issues)(user and publisher issues) Commercial publishingCommercial publishingProduction & Control OptionsProduction & Control Options1.

5 Principles 1. Principles Trained, accredited, committed and reliable Trained, accredited, committed and reliable writerswriters Comprehensive and guaranteed checking Comprehensive and guaranteed checking and governance frameworkand governance framework Multidisciplinary and Multidisciplinary and multispecialitymultispecialityinput input at all process stagesat all process stages User and stakeholder responsiveUser and stakeholder responsive Responsive to product changesResponsive to product changes Product is, at all times, upProduct is, at all times, up--toto--date and fitdate and fit--forfor--purposepurposeProduction & Control OptionsProduction & Control Options2. Structure2. StructureProject BoardProject BoardOverall management and strategic leadership, incl. Overall management and strategic leadership, incl. fundingfundingMajor stakeholders and national users groupsClinical Steering GroupClinical Steering GroupAdvising on clinical content, style, Advising on clinical content, style, format, and deliveryformat, and deliveryEditor/ professional group reps, patient safety repsEditorial GroupEditorial GroupMonograph consistency, policy Monograph consistency, policy adherenceadherenceEditor, IT, adminOperational Network Operational Network GpsGpsWriting and checkingWriting and checkingRegional UKMi Team Leads, writers, checkersTeam LeadsTeam LeadsCoCo--ordinate local writers/checkers, ordinate local writers/checkers, implement local training, implement local training, accreditation and QAaccreditation and QARegional UKMiHurdlesHurdles Writers and checkersWriters and checkers Multidisciplinary and specialist inputMultidisciplinary and specialist input NHSNHS--wide endorsement wide endorsement ((DoHDoH/NPSA)/NPSA)

6 Project & maintenance fundingProject & maintenance funding Delivery platformsDelivery platforms Creating Creating movemove--forwardforward and and embrace embrace changechange cultures cultures Maintaining longMaintaining long--term momentumterm momentumProject Summary 1 Project Summary 1 Develop an NHSD evelop an NHS-- Injectable Medicines Guide Injectable Medicines Guide to support patient safety and minimise risks to support patient safety and minimise risks with with injectableinjectablemedicinesmedicines Build on the current IV Guide and the interim Build on the current IV Guide and the interim work being undertaken to bring it upwork being undertaken to bring it up--toto--datedate Create a robust writing, training and clinical Create a robust writing, training and clinical governance frameworkgovernance framework Develop appropriate electronic and/or paper Develop appropriate electronic and/or paper delivery platformsdelivery platformsProject Summary 2 Project Summary 2 Create a management structure which Create a management structure which involves all key users, stakeholders and involves all key users, stakeholders and clinical disciplinesclinical disciplines Develop and implement a production plan for Develop and implement a production plan for all all injectableinjectablemedicines used in the NHS, Medicines used in the NHS, prioritised according to risk prioritised according to risk (n=~700)(n=~700)

7 Identify funding for a 2 Identify funding for a 2--3 year development 3 year development project and then ongoing maintenanceproject and then ongoing maintenance RollRoll--out across the NHS and make available out across the NHS and make available to nonto non--NHS healthcare providersNHS healthcare providersNext StepsNext Steps Stakeholder consultation on the Stakeholder consultation on the product and the projectproduct and the project Rewrite preliminary business planRewrite preliminary business plan DoHDoHfacilitate identification of fundingfacilitate identification of funding Start projectStart now for your helpand now for your helpIn developing the project, what are the In developing the project, what are the user and stakeholder views on:user and stakeholder views and content Format and content platforms Delivery platforms implementationSuccessful writing inputMultidisciplinary writing input