Committee Decisions

The Medicine Safety Committee has developed "Pizotifen safety advice" for healthcare professionals to consider when prescribing and monitoring patients on pizotifen.

March 2024 - local guidance for Improving the Reporting of Medication Incidents has been updated - see below

Patient safety events in health and social care, including general practice, should be reported via the LFPSE  eForm:

Learn from patient safety events (learn-from-patient-safety-events.nhs.uk)

If you have indicated that the event happened outside of your practice, please save a pdf copy of the LFPSE submission and email it to: syheartlandsicb.medicinesafetyincidents@nhs.net

Primary Care specific information can be found here: NHS England » Primary care information on the new national learn from patient safety events service

Further information and advice can also be found in our local Medicines Management Guide to Prescribing https://surreyccg.res-systems.net/pad/Guidelines/Detail/4401 "Section 9 Patient Safety Reporting".

Local guidance has been updated to support healthcare personnel when recording an incident via the LFPSE service.

See document called "What makes a good LFPSE report" 

Preparing for pregnancy posters:

• Advice for Healthcare Professionals (For displaying in clinical areas within practices where appropriate) - to support prescribers when prescribing to consider how medicines might affect a pregnancy should this be an issue in the future.            
• Know your medicines (For displaying in patient waiting areas) - Encouraging patients to ask questions about their medicnes allowing them to make informed decisions about their care.

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Committee have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Committee have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Committee have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

The Surrey Medicines Safety Committee have made recommendations in relation to the prescribing of alprazolam.

Alprazolam is not recommended on the grounds of safety - see attached document for further advice.

Summary Care Record (SCR) is a national database that holds electronic records of important patient information such as current medication, allergies, and details of any previous adverse reactions to medicines, created from GP medical records. The quick guide has been produced to support its safe use.  

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

Resources to support the safer administration of enteral calcium and phosphate supplements in neonates and children can be found within the position statement: 
https://nppg.org.uk/wp-content/uploads/2023/03/Position-Statement-Calcium-and-Phosphate-V1.pdf

The MHRA published in the Drug Safety Update (December 2022) an update on the safety of valproate, in regards to its effect on unborn children.
Since then, teams across Surrey Heartlands Health and Care Partnership have received a number of questions around the suggestions to make valproate prescribing safer, that were published by the MHRA, and the implementation of these. The document below ("Response to MHRA alert") clarifies the MSC current position with regards to Valproate prescribing for people of childbearing potential.

The MHRA published in the Drug Safety Update (December 2022) an update on the safety of valproate, in regards to its effect on unborn children.
Since then, teams across Surrey Heartlands Health and Care Partnership have received a number of questions around the suggestions to make valproate prescribing safer, that were published by the MHRA, and the implementation of these. The document below ("Response to MHRA alert") clarifies the MSC current position with regards to Valproate prescribing for people of childbearing potential.

Although there may have been historic prescribing of metolazone for hypertension in parts of Surrey, metolazone has not been formally assessed for this indication in Surrey Heartlands.  Prescribing for hypertension should be in line with NICE NG136 whilst the local Surrey Heartlands hypertension guidelines are being updated (https://surreyccg.res-systems.net/PAD/Guidelines/Detail/4397)

Where metolozone is being prescribed, please take note of the important safety information below:

When initiating patients on metolazone the licensed, branded Xaqua preparation should be prescribed.

Any switch between products should take into account the difference in bioavailability between Xaqua and other available unlicensed products.

Switching from the unlicensed (imported) product to Xaqua may require a reduction in dose by half, or for the same dose to be used but adjust the frequency from daily to alternate days.

The tablets have a single score-line and can be divided into equal halves.

The Medicines Safety Committee is leading ongoing work with local specialists around the review of patients currently prescribed unlicensed metolozane. Where there is any doubt about the intended product, please consult the specialist for advice.  

When initiating patients on metolazone the licensed, branded Xaqua preparation should be prescribed.

Any switch between products should take into account the difference in bioavailability between Xaqua and other available unlicensed products.

Switching from the unlicensed (imported) product to Xaqua may require a reduction in dose by half, or for the same dose to be used but adjust the frequency from daily to alternate days.

The tablets have a single score-line and can be divided into equal halves.

The Medicines Safety Committee is leading ongoing work with local specialists around the review of patients currently prescribed unlicensed metolozane. Where there is any doubt about the intended product, please consult the specialist for advice.  

Clozapine - IMPORTANT Information for primary care - can be found in the attachment below

For EXTERNAL USE ONLY

Potassium permanganate is routinely used in the NHS as a dilute solution to treat weeping and blistering skin conditions, such as acute weeping/ infected eczema and leg ulcers.
Supplied in concentrated forms, either as a ‘tablet’ or a solution, it requires dilution before it is used as a soak or in the bath. These concentrated forms resemble an oral tablet or juice drink and if ingested are highly toxic.
If potassium permanganate is to be used in a patient’s home, a risk assessment must be undertaken before prescribing
The form below has been agreed by MSC and can be used for the risk assessment for patients.

Clozapine - IMPORTANT Information for primary care - can be found in the attachment below

The Medicine Safety Committee has developed a "Safer Prescribing aide-memoire" for primary care to provide guidance on safe prescribing of sodium valproate (for women of child bearing age) in line with the Medicines and Healthcare products Regulatory Agency (MHRA) recomendations. 
It includes  a summary of how to manage these patients within primary care, links to clinical resources and  searches/ templates available on clinical system  (EMIS Web and SystmOne)

The Medicine Safety Committee has developed a "Safer Prescribing aide-memoire" for primary care to provide guidance on safe prescribing of sodium valproate (for women of child bearing age) in line with the Medicines and Healthcare products Regulatory Agency (MHRA) recomendations. 
It includes  a summary of how to manage these patients within primary care, links to clinical resources and  searches/ templates available on clinical system  (EMIS Web and SystmOne)

The ‘Community Pharmacy Incident Reporting Communications Process ’ was agreed for use within Surrey Heartlands to aid the sharing of intelligence across organisations, to support healthcare to learn from mistakes and to take action to keep patients safe.

See document below

The National Patient Safety Alert  published August 2020, 'Steroid Emergency Card to support early recognition and treatment of adrenal crisis in adults'

and the

NPPG Position statement 2021-02 'Use of Steroid Medication Warning Cards for Children and Young People'

gives clear guidance on when to issue a Steroid Emergency Card and which card to use. See links and resources below for further information.

The ‘Process for reporting medicines safety incidents identified in a social care setting’ was agreed for use within Surrey Heartlands to aid the sharing of intelligence across organisations and to support health and social care to learn from mistakes and to take action to keep patients safe.

See document below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below