11 e-Letters

published between 2015 and 2018

  • Correction to 2012 legal change

    The section in this paper which says pharmacists could prescribe controlled drugs from 2012 with the exception of schedule 1 and 2 CDs for drug misuse is misleading. Schedule 1 cannot be prescribed by anyone without out a licence to do so (this includes doctors) and schedule 1 contains substances of no medicinal use. Schedule 2 CDs can be prescribed by pharmacists for drug misuse, the only exception is diamorphine (and technically cocaine and dipipanone although these are not used). Diamorphine is prescribed as an injectable by prescribers on the Dept of Health approved list to do so and this list is restricted to medical doctors. Other schedule 2 drugs for addiction such as methadone and morphine (unlicensed) can be prescribed by pharmacist prescribers.

  • Some issues with dose administration aids/monitored dosage systems

    Monitored dosage systems (or dose administration aids) are widely used but it is important to reduce their inappropriate use by ensuring they are only issued on a case-by-case basis to address specific practical problems of medicines adherence. It should be assumed that patients can manage their medicines unless indicated otherwise. NICE guidance (1) states monitored dosage systems should be considered as an option to improve adherence on a case-by-case basis, and only if there is a specific need to overcome practical problems. This should follow a discussion with the patient to explore possible reasons for nonadherence and the options available to improve adherence, if that is their wish.
    • The inappropriate use of monitored dosage systems can make patients and carers less familiar with their medicines. Health literacy including awareness of medicines should be promoted.
    • Transferring medicines to monitored dosage systems carries the risk of human error. The stability of many medicines cannot be guaranteed outside their original packaging.
    • Patients who may benefit from monitored dosage systems include patients who have less ability to read or understand the instructions on standard medicines packaging, but who have the dexterity to use the devices and who wish to adhere to their medicines regimen.
    • Pharmacists should check compliance issues and provide a monitored dosage system only if compliance cannot be addressed by other methods a...

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  • Time to early reduction and immobilization or pain relief for extremity fracture
    Tze Hong Wong

    Comment 1: In case of stable patient, the priority of management for extremity fracture in emergency department would be early reduction with immobilization, pain relief is not the primary concern, on the other hand, early pain relief might put the patient in a risk of delayed reduction trial . As we know neurovascular compromise around fracture site is critical for fracture management, and so, instead of decreasing time...

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  • Government intervention in pricing has great impact on cost and therefore on value.

    Reading the editorial – “Value or cost: looking for the wider perspective”,the one thing that struck us the most was,when pharmacists determine value,one of the most important variables that they take into account is the monetary cost of the intervention,say antibiotics.This raised several questions in our minds.What if the antibiotics on the hospital formulary were priced at a point that their use in certain situations seemed unjustified to pharmacists,but would seem perfectly justified at lower price points?What if generics,available at a fraction of the price of the branded variety,were used in place of the brands?It seems to us that they would most certainly impact the way that “value” is calculated for that particular scenario.What if the pharmacist knew a perfectly good enough generic,but hospital policy allowed procurement,and hence prescribing of,only a more expensive brand?
    When hospital pharmacists try to assess the value of a new health technology,we feel that they would be well served if they took a long,hard look at the evidence.Sometimes claims might not be very genuine.And this could place heavy costs on the patients.A very contemporary example would be the pricing of cardiac stents. Cardiac stents are sold at a 300 to 400 percent mark up to Indian patients.A stent that costs Rs.20,000(Euro 284) if bought from a vendor would miraculously cost Rs.160,000(Euro 2273)at the hospital pharmacy,all other charges being separate.1The patient is not given the o...

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  • Deprescribing in the population with intellectual disabilities

    The population with intellectual disabilities are vulnerable in the prescribing and the deprescribing process.

    In the population with intellectual disabilities compared to the general population, the multi-morbidity burden is greater, occurs at much earlier age, and the profile of health conditions differs [1].
    People with intellectual disabilities use multiple medications and may have been taking them for many years. Extreme care in required when de- prescribing many medications in this population group. The principles of good de-prescribing during medication review in the population with intellectual disabilities, based on the British Pharmacological Society’s Principles for Good Prescribing 2010, provide a template for quality de-prescribing in this vulnerable population group.

    Principles of Good De-prescribing during Medication Review in the Population with Intellectual Disabilities and Behaviour Disorders. Based on the British Pharmacological Society’s Principles for Good Prescribing 2010
    1. Be clear about the reasons for de-prescribing.
    2. Take into account the patient with intellectual disabilities and behaviour disorders medication history before de-prescribing.
    3. Take into account other factors that might alter the benefits and risks of de-prescribing treatment in the patient with intellectual disability and behaviour disorders.
    4. Take into account the patient’s/carer’s/families/advocates ideas, concerns, and expec...

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  • Deprescribing in the population with learning/intellectual disabilities
    Bernadette Flood

    Vulnerable populations are vulnerable because they are susceptible to harm in health care environments. It is important that the healthcare issues specific to the population with learning/intellectual disabilities are considered when prescribing and deprescribing.

    Deprescribing tools must be validated in the population with learning/intellectual disabilities to ensure safety and quality care. People with learn...

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  • UK hospital patient discharge
    Michael J Wilcock

    Dear Editor

    Wright and colleagues report on a single centre survey of inpatient perceptions and experiences of the current discharge process, and identify improvement opportunities in relation to waiting for medicines, and lack of counselling by pharmacists.(1) Problems such as low awareness among inpatients of pharmacy services, or pharmacists citing challenges to achieving patient medication counselling have b...

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  • RE: Improving illiterate patients understanding and adherence to discharge medications.
    Regis Vaillancourt

    Dear Editor:

    We read Clayton's report published in the BMJ with great interest. Clayton and his team's quality improvement project demonstrated how the use of symbols and pictures at Lahore, Pakistan, help increase patient adherence.

    The International Pharmaceutical Federation (FIP) and the Children's Hospital of Eastern Ontario (CHEO) research group have been studying the use of pictograms for many...

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  • A vital point
    Pradip De
    Well done folks! We do not have a formalized A4 type of paper to fill up prior to the procedure, but we carry out most of these checks without ticking boxes. We have a pathway, which includes almost all of these and is normally checked by the Endoscopy nurse and a cancer specialist nurse. Only an independent bronchoscopist (not the trainee) is allowed to check the safety prior to add the patient in the list for the procedure. I...
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  • Actions following this improvement project
    Kevin Gibbs

    As a result of this quality improvement project we have changed the adult fluid prescription used within the Trust. We have redesigned the prescription section to have a clearer space to document patient related cautions, such as heart failure; and included a printed prompt for 'Indication' on each prescriptions line.

    Conflict of Interest:

    None declared