RESPONSIBILITIES and ROLES. Specialist responsibilities
RESPONSIBILITIES and ROLES. A. Roles of NRCS
RESPONSIBILITIES and ROLES. Specialist responsibilities Diagnosis and initiation of azathioprine treatment, ensuring that there are no interactions with current therapy or disease states. Discuss the benefits and side effects of treatment with the patient/carer, including providing the patient with information leaflets and a monitoring record book if required. If appropriate, patients should be advised about the impact of treatment on fertility, pregnancy and breastfeeding. Men planning to conceive should also receive appropriate counselling. Undertake baseline tests including weight, blood pressure, ALT (or AST), eGFR, CRP, chest X-ray and TMPT levels) prior to starting therapy. Advise patient to be vaccinated against pneumococcus and influenza infection (via GP). Notify the patients GP that treatment has started and inform results of baseline tests. Prescribe azathioprine until a stable dose is reached and blood tests are stable for three months. Contact the GP to ask whether he or she is willing to participate in shared care (once the patient is stable). Shared care can only commence when GP written consent has been received Discuss the shared care arrangement with the patient so that the patient/carer is clear what needs to be monitored and when. Where applicable advise patient treatment is off-label Dose stabilisation: initial dosage adjustment until stable. Thereafter, during maintenance treatment, advice to the GP on any further dose adjustments required. If dose and bloods are stable for 3 months the GP, if agreeable, can monitor the patient as below Periodically review the patient’s condition and communicate promptly with the GP when treatment is changed. Have a mechanism in place to receive rapid referral of a patient from the GP in the event of deteriorating clinical condition. Advise the GP on stopping treatment (if appropriate). Report serious adverse events to the MHRA and GP Ensure that clear backup arrangements exist for GPs to obtain advice and support. General Practitioner responsibilities Reply to the request for shared care as soon as practicable. File copy in patient’s record and add shared care – specialist/GP read code 66S2 or XaK6z depending on GP clinical system. Ensure compatibility with other concomitant medication and prescribe azathioprine at the dose recommended. Once patient is stable and shared care has been agreed, monitor patient as below. Adjust the dose as advised by the specialist. Report to and seek advice from the specialist on any aspect of pat...
RESPONSIBILITIES and ROLES. Consultant / Specialist responsibilities
RESPONSIBILITIES and ROLES. Pharmacy undertakes to:
RESPONSIBILITIES and ROLES. 1 Initially prescribe and stabilise the patient on the treatment regimen and monitor transplant graft function.
RESPONSIBILITIES and ROLES. Specialist responsibilities 1 Discuss and supply appropriate information on Lithium treatment with the patient and carer for informed medication choice. 2 Arrange for baseline monitoring including weight, BP, renal and thyroid function, calcium levels and an ECG, where clinically indicated. 3 Treatment is then initiated with monitoring for side effects. Arrangement is made to issue a lithium booklet. Adverse events or side effects must be managed as per North Staffordshire Combined Healthcare’s protocol and report all adverse effects to MHRA. 4 Obtain consent with patient and/or carer for shared care arrangements with own GP, subject to patients own GP’s agreement. 5 Review dose titration, monitoring lithium levels (sample taken 12 hours post dose) at every dose change and at a minimum of three monthly intervals if there is no change in dose. 6 Continue with lithium prescribing responsibilities for a minimum of two weeks to overlap transfer arrangement. 7 Monitor plasma lithium level in accordance with the range agreed (sample taken 12hours post dose) at maximum of three monthly intervals if there is no change in dose or when doses change. Communicate results to GP promptly. 8 Arrange as a minimum for six monthly renal and thyroid function as suggested by NICE guidelines and annually check calcium levels. Communicate results to GP. 9 Agree on the frequency of medication reviews with the GP based on treatment plan and CPA strategy developed for individual service user. 10 Communicate promptly on all results, any treatment events including all risk assessments to the GP. GPs can access results via pathology system Written by (clinician): Written by (pharmacist): Date of issue: Approved by North Staffordshire Area Prescribing Committee (date): Review Date: Version number: General Practitioner responsibilities 1 Reply to the request for shared care as soon as practicable. 2 Maintain lithium prescribing as agreed with specialist team. 3 Ensure patients are aware of their blood testing requirements and results are communicated to the patient verbally and through the lithium booklet. 4 Communicate results to dispensing pharmacist to enable prompt lithium dispensing either via medication monitoring clinic letter or the lithium booklet. 5 Ensure results are checked and any abnormalities acted upon in liaison with the specialist team. 6 Consult for advice and report any concern that may affect treatment to the specialist team promptly. 7 Refer patient to the special...
RESPONSIBILITIES and ROLES. Specialist responsibilities 1 The Specialist (e.g. Rheumatologist, Care of the Elderly Physician or Osteoporosis Nurse) will discuss the benefits and side effects of treatment with the patient/carer/guardian and provide written information e.g.product information leaflet for Prolia®, ensure appropriate investigations have been obtained and agree that denosumab is the appropriate therapy for the patients’ condition.
RESPONSIBILITIES and ROLES. Specialist responsibilities 1 Identify those patients who will benefit from treatment with sirolimus. 2 Ask the GP if he/she is willing to participate in shared care and discuss the agreement with the patient. 3 Initially prescribe and stabilise the patient on the treatment regimen and monitor transplant graft function.4 Where possible provide the patient/carer with a patient-held record for monitoring and/or to alert other clinical staff to the treatment they are receiving. 5 Advise GP of the information provided to the patient and/or carer about the treatment and proposed shared care agreement. 6 Monitor sirolimus levels and advise patient and GP of dose changes. 7 Monitor efficacy of treatment and side effects. 8 Ensure clear back up arrangements exist for GPs, including direct telephone access for advice and support. 9 Evaluate adverse events reported by patient/GP and report to MHRA xxx.xxxx.xxx.xx/Xxxxxxxxxxxxxxxxx/Xxxxxxxxxxxxxxxxxxxxxxx/xxxxx.xxx 10 Educate patients in knowledge of drug therapy to maximise compliance and to be aware of when to seek medical advice. General Practitioner responsibilities
RESPONSIBILITIES and ROLES. Primary care Primary care physician to reply to the request from secondary care for shared care as soon as possible taking into account the extent of the care they are asked to be involved in eg. prescribing of lisdexamfetamine dimesylate, monitoring of treatment and/or patient's condition. If in agreement, the primary care physician is to prescribe lisdexamfetamine dimesylate at the dose at which the patient has been stabilised after communication with the secondary care specialist. Primary care physician to ensure a full understanding of their responsibilities for managing patients with ADHD on lisdexamfetamine dimesylate, including side-effects in line with the SPC. Primary care physician to report to and receive advice from the secondary care specialist on any aspect of patient care that is of concern. Primary care physician to refer the patient back to the secondary care specialist if the patient's condition deteriorates and/or they experience any adverse events. Particular attention should be paid to symptoms of: Abuse and misuse (eg. severe dermatoses, insomnia, irritability, hyperactivity, personality changes) Psychosis or mania; aggressive behaviour Exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease Tics Primary care physician to report to the secondary care specialist immediately if the patient is pregnant or thinks they may be pregnant. Primary care physician to ensure that monoamine oxidase inhibitors (MAOI) are not taken with lisdexamfetamine dimesylate. Caution is to also be exercised when considering prescribing: Extended- release guanfacine, extended-release venlafaxine, ascorbic acid and other agents that acidify urine, sodium bicarbonate and other agents that alkalinise urine, antihypertensives, narcotic analgesics, chlorpromazine, haloperidol, lithium carbonate. (For more information please refer to the SPC.) Primary care physician to check that the patient is attending their six monthly specialist ADHD clinics and thus continued prescription is required. Primary care physician to report any adverse events to the specialist and the MHRA - xxxx://xxxxxxxxxx.xxxx.xxx.xx/. Lisdexamfetamine dimesylate is a black triangle product. Secondary care - specialist Secondary care specialist to confirm diagnosis of ADHD according to DSM-IV criteria or the guidelines in ICD-10 based on a complete history and evaluation of the patient. Lisdexamfetamine dimesylate is indicated when response to previous methylphen...
