Specialist responsibilities. Arrange comprehensive assessment of the child and be responsible for making the diagnosis and considering alternative diagnoses, co-morbid diagnoses and cautions/ contraindications to treatment. • Initiate treatment with stimulants. Prescribe by brand for sustained release preparations. Inform the GP promptly about changes in treatment or dosage, any important adverse events or if other interacting medicines are prescribed/recommended. • Monitor the patient's condition and response to treatment regularly and keep the GP informed. • Provide a comprehensive baseline physical assessment as recommended in the NICE guidelines, and ensure that height, weight, blood pressure, pulse and appetite are monitored at the recommended time intervals using the chart in the appendix. Communicate the results of tests to the GP as soon as possible. • Explain the possible side effects of the drug and interactions to parents. • Provide written guidance for parents (at specialist’s discretion). • Be available for back-up advice on any of the above during working hours. • Report all suspected adverse drug reactions (in children under 18 years of age), to the Medicines and Healthcare Regulatory Agency (MHRA) via xxx.xxxx.xxx.xx/xxxxxxxxxx • Send a letter and shared care agreement form to the GP to obtain consent to share prescribing and monitoring responsibilities. • Advise GP’s of any dosage adjustments required, when to refer back, and when and how to stop treatment. • Ensure clear arrangements for back up, advice and support. ESCA for ADHD- Dexamfetamine Page 3 of 8 Version 1.0 December 2018 General Practitioner responsibilities • Prescribe Dexamfetamine once notified by the specialist. • Ensure that the treatment is not continued if the patient fails to attend the specialist clinic for over a year. • Check that patient is being monitored as specified in section on specialist responsibility. • Report to and seek advice from the specialist on any aspect of patient care that is of concern to the GP and may affect treatment. • Refer back to the specialist if the patient’s condition deteriorates. • Monitor the patient for side effects and report all suspected adverse drug reactions (in children under 18 years of age), to the specialist and to the MHRA via xxx.xxxx.xxx.xx/xxxxxxxxxx • Stop the treatment if advised by the specialist. Parent/carers role • Ask the specialist or GP anything he or she does not understand about the treatment. • Try to put into practice any behavioural or...
Specialist responsibilities. Clarify place of drug in patients current therapy Review the patient's condition and monitor response to treatment regularly as outlined in the monitoring requirements below. Undertake cardiac, hepatic and renal monitoring. To report any change in the clinical condition of the patient to the GP and provide advice regarding continuation/discontinuation of Dronedarone. Outline to the GP when therapy may be stopped assuming no improvement is recognised in the patient’s condition. Advise GPs of when to refer back, and when and how to stop treatment. Report adverse events to the CSM. Ensure clear backup arrangements exist for GPs, for advice and support. Give patients the information leaflet and card for Dronedarone and discuss the interaction with grapefruit juice. General Practitioner responsibilities Reply to request to participate in shared care arrangement as soon as practicable. To prescribe Dronedarone as requested by the Cardiology Consultant/Electrophysiology team Liaise with the hospital Consultant regarding any complications of treatment. Report suspected side effects to the Consultant and MHRA. Report to and seek advice from the Specialist on any aspect of patient care that is of concern to the GP and that may affect treatment. Refer back to the Specialist if the patient’s condition deteriorates. Stop treatment if advised to do so by the Specialist. Patient's role Read the information provided and give consent for the chosen treatment. Inform Consultant and GP of any other medication they may be taking or start taking during treatment, including over the counter medicines or herbal remedies. Store and handle medication safely. Report to the specialist or GP if he or she does not have a clear understanding of the treatment. Share any concerns in relation to treatment with the Consultant/GP Report any adverse effects to the specialist or GP whilst taking Dronedarone SUPPORTING CLINICAL INFORMATION Indications
Specialist responsibilities. 1. Discuss with the patient options for treatment and the suitability of azathioprine. 2. Discuss the potential benefits and side effects of treatment with the patient. 3. Following agreement with the patient, initiate Azathioprine titrate to an effective dose and stabilise the patient on an appropriate maintenance dose before seeking to initiate shared care (Usually by 3 months). 4. Ask the GP whether he or she is willing to participate in shared care by emailing the shared care request letter, (continue to prescribe until GP has agreed to take over prescribing). 5. Explain the intention to share care with the patient/ carer. 6. Perform monitoring of Height, weight, blood pressure, FBC, U&E, LFTs, albumin, CRP, eGFR, VZV, TPMT specifying frequency of blood monitoring and communicate the results with the GP. 7. Communicate to the GP the established regimen and when to refer back to specialist care. 8. Initiate and stabilise treatment. Supply 3 months (in instalments as appropriate). 9. Inform GP and patient of dosing adjustments. 10. Have a mechanism in place to receive rapid referral of a patient from the GP in event of abnormal blood results or deteriorating clinical condition. 11. Ensure clear backup arrangements exist for GPs to obtain advice and support and be available for review if requested. Report adverse events to the MHRA on a Yellow Card xxx.xxxx.xxx.xx/xxxxxxxxxx, and to the GP and appropriate Medicines Optimisation team. General Practitioner Responsibilities
Specialist responsibilities. Arrange comprehensive assessment of the patient and be responsible for making the diagnosis and considering alternative diagnoses, co-morbid diagnoses and cautions/ contraindications to treatment Seek carer/family views on baseline function. For adults with ADHD, drug treatment should be the first line treatment unless the person would prefer a psychological approach Drug treatment for adults with ADHD should be started only under the guidance of a psychiatrist ,nurse prescriber specialising in ADHD, or other clinical prescriber with training in the diagnosis and management of ADHD Following a decision to start drug treatment in adults with ADHD, methylphenidate should normally be tried first. Atomoxetine or dexamfetamine should be considered in adults unresponsive or intolerant to an adequate trial of methylphenidate (this should usually be about 6 weeks). Caution should be exercised when prescribing dexamfetamine to those likely to be at risk of stimulant misuse or diversion Initiate treatment with methylphenidate. Prescribe by brand for sustained release preparations. Send a letter and the shared care agreement form to the GP to obtain consent to share prescribing and monitoring responsibilities. Inform the GP promptly about changes in treatment or dosage, any important adverse events or if other interacting medicines are prescribed/recommended Monitor the patient's condition and response to treatment regularly and keep the GP informed Provide a comprehensive baseline physical assessment as recommended in the NICE guidelines, and ensure that height, weight, blood pressure, pulse and appetite are monitored at the recommended time intervals. Communicate the results of tests to the GP as soon as possible. Blood pressure and pulse should be monitored 3 monthly. Explain the possible side effects of the drug and interactions to the patient. Provide written guidance for patient (at specialist’s discretion) Be available for back-up advice on any of the above during working hours Report all suspected adverse drug reactions to the Medicines and Healthcare Regulatory Agency (MHRA) via xxx.xxxxxxxxxx.xxx.uk Send a letter and the shared care agreement form to the GP to obtain consent to share prescribing and monitoring responsibilities Advise GP of any dosage adjustments required, when to refer back, and when and how to stop treatment Ensure clear arrangements for back up, advice and support General Practitioner responsibilities Prescribe the recommended drug once n...
Specialist responsibilities. Identify patients requiring sulfasalazine and counsel patients appropriately Undertake pre-treatment testing/assessment as per speciality guidelines 1,2 and record Varicella status Adjust dose during initial monitoring period Monitor and prescribe according to speciality guidelines until handover is appropriate (including when dose changes are made) a minimum of 6 weeks. Provide patient with hand-held information on sulfasalazine, and explain ongoing monitoring requirements Review efficacy of treatment at regular intervals and ensure drug treatment changes are communicated to the patient and GP. This will include at least an annual review whilst on treatment Report any adverse events to the MHRA and GP Note: this shared care guideline applies to several different specialities and pre prescribing checks will vary according to local practice. GP will be informed of any relevant findings. Primary Care Prescriber Responsibilities: Subsequent prescribing of sulfasalazine 500mg tablets at the dose recommended In static doses, monitoring of FBC and LFT monthly for first 6 months then every 3 months. U&Es every 3 months in year 1, every 6 months in year 2, then annually. Monitor for adverse effects throughout treatment and check for drug interaction on initiating new treatments Provide patient with pneumococcal polysaccharide vaccine and flu vaccination unless contra- indicated If shared care is declined, the practice should inform the named consultant within 14 days of receipt of the request Report any adverse events to the MHRA and specialist team Note: this shared care guideline applies to several different specialities and pre prescribing checks will vary according to local practice. GP will be informed of any specific additional requirements. MONITORING REQUIREMENTS Monitoring schedule More frequent monitoring (monthly) is appropriate in patients at higher risk of toxicity. White Cell Count <3.5x109/l Mean cell volume >105 f/l Neutrophils <1.6 x109/l Creatinine increase >30% over 12 months and/or calculated GFR <60ml/min/1.73m2 Unexplained eosinophilia >0.5 x 109/l ALT and/or AST >100 U/l Platelet count <140 x109/l Unexplained reduction in albumin <30 g/l Contact specialist team urgently and consider interruption in treatment if any of the following develop: Whilst absolute values are useful indicators, trends are equally important, and any rapid fall or consistent downward trend in any parameter warrants extra vigilance. This list is not exhaustive; refer to...
Specialist responsibilities. Discuss the benefits and side effects of treatment with the patient. Check FBC (including numerical platelet count) and plot readings before initiation. Also test urine for protein and check skin for rash. Initiate treatment. Ask the GP whether he or she is willing to participate in shared care, and agree with the GP as to who will discuss the shared care arrangement with the patient. Dose stabilisation: initial dosage adjustment until stable. Thereafter, during maintenance treatment, advice to the GP on any further dose adjustments required. Monitor FBC. Withhold until discussed with specialist team if WBC<3.5x109/l, platelets <150x109/l, neutropenic (<2.0x109/l) a rash (usually itchy) or oral ulceration occur. If abnormal bruising or severe sore throat present, check FBC immediately and withhold until results are available. If 2+ proteinuria or more, check MSSU: If infection present treat appropriately. If sterile and 2+ proteinuria or more persists, withhold until discussed with specialist team. 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 Ensure that clear backup arrangements exist for GPs to obtain advice and support. General Practitioner responsibilities Report to and seek advice from the specialist on any aspect of patient care that is of concern to the GP and may affect treatment. Adjust the dose as advised by the specialist Refer back to specialist if condition deteriorates. Report adverse events to specialist and MHRA. Stop treatment on advice of specialist. Patient's role Report to the specialist or GP if he or she does not have a clear understanding of the treatment. Share any concerns in relation to treatment with sodium aurothiomalate Report any adverse effects to the specialist or GP whilst taking sodium aurothiomalate SUPPORTING CLINICAL INFORMATION Indications Sodium aurothiomalate is licensed for the treatment of rheumatoid arthritis, including paediatric conditions Dosage and Administration Sodium aurothiomalate should be administered only by deep intramuscular injection followed by gentle massage of the area. The patient should remain under medical observation for a period of 30 minutes after drug administration. Contraindications Pregnancy Myocrisin is contraindicated in patients with gross renal or he...
Specialist responsibilities. To ensure patient meets eligibility criteria and requirements To ensure patient diabetes health care plan in place To agree personal targets with patient To encourage patient to attend all education and engage with 9 processes of care To provide a copy of this Patient/Carer agreement to the GP, along with outpatient clinic letter To enter patient data into audit (ABCD national audit) To review benefit after 6 months and inform GP of outcome and if continuation is indicated. To recommend locally agreed best value blood glucose test strips for any ongoing monitoring requirements* GP responsibilities Only prescribe 2 sensors per month (28 days) Do not issue additional prescriptions for faulty sensors – patient must secure replacements via Xxxxxx Prescribe locally agreed best value blood glucose test strips for any ongoing monitoring requirements, in appropriate quantities* Only prescribe for 6 months initially. Specialist will review benefit and communicate if continuation is indicated Encourage patient to attend all education and engage with 9 processes of care Continuation criteria Achieve specific target outcome(s) Fulfil patient requirements and responsibilities Patient agreement: The information above has been explained to me. I will see whether FGS helps me manage my diabetes in the ways I have agreed - my “personal target outcomes”. I agree to do everything described above under "patient requirements” and “patient responsibilities”. I understand that I will receive NHS Freestyle Libre sensors for 6 months. After that they will only be continued if I have achieved the personal target outcomes and complied with the patient requirements and responsibilities. Patient signature ……………………………………………………………… Date……………………………………………………….. * Specialist opinion estimates ongoing strip requirements of up to three per day. See Choosing a Blood Glucose Meter and Ketone Testing and Sick day Rules Guidance Flash Glucose Monitoring Adult Patient Agreement Form
Specialist responsibilities. Ensure this shared care agreement has been emailed to the primary care prescriber. The clinic / discharge letter must be available to the primary care team in a timely manner Primary care responsibilities: Read the associated shared care document for this drug prior to acceptance of the agreement.Please refer to one of the following, for relevant shared care documents: The Surrey PAD (xxxxx://xxxxxxxxx.xxx-xxxxxxx.xxx/pad/) The Guildford & Waverley and Royal Surrey County Hospital Foundation Trust Joint Formulary xxxx://xxx.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx.xxx.xx/ The Crawley and Horsham & Mid Sussex CCGs Joint Formulary xxxx://xxx.xxxxxxxxxxxxx.xxx.xx/ Once complete, please email this form back to the relevant consultant and put a copy in the patient’s notes. Agreement to undertake shared care (Yes/No): If NO, please state why:
Specialist responsibilities. 1. Discuss the benefits and potential side effects with the patient. Provide patient with relevant drug information to enable informed consent to therapy. 2. Check for possible drug interactions with dalteparin and patients existing/current medication. 3. Undertake baseline monitoring and all other monitoring as stated in the monitoring requirements section above. Ensure patient understands the role and importance of monitoring. 4. Responsible for determining whether anti-Xa monitoring is required, interpreting the result and advising of any dose change required. 5. Initiate treatment and prescribe until dose is stable, adjusting the dose if indicated. 6. Monitor patient’s initial reaction to and progress on the drug. 7. Provide GP with diagnosis, relevant clinical information, baseline results, treatment to date, treatment plan, specialist contact details and duration of treatment before consultant review. 8. Failure to complete all the required information will result in a delay until all information has been supplied. Patients will be considered suitable for transfer to GP prescribing ONLY when they meet the criteria listed above for shared care. 9. Ensure that the patient has an adequate supply of medication until GP supply can be arranged. 10. Continue to monitor and supervise the patient according to this protocol while the patient remains on this drug, and agree to review the patient promptly if contacted by the GP. 11. Provide GP with details of outpatient consultations, within 14 days of seeing the patient or inform GP if the patient does not attend appointment. 12. Provide GP with advice on when to stop this drug and who is responsible for this. 13. Act upon communication from the GP in a timely manner. General Practitioner Responsibilities
Specialist responsibilities. 1. Discuss the benefits and potential side effects with the patient. Provide patient with relevant drug information to enable informed consent to therapy.
