Medicines Management Resource for Chronic Kidney Disease
Early identification and management of chronic kidney disease (CKD) patients is essential in limiting individual disease progression and the development of complications. Improvement in the care of patients with CKD can also bring benefits in other therapeutic areas such as cardiovascular disease. This CKD medicines management resource includes supporting information for primary care teams around clinical issues, signposts to further useful resources and contains an educational slide set.
Medicines Management Resource for Chronic Kidney Disease (February 2017)
CEPP National Audit - Medicines Management for Chronic Kidney Disease
This Clinical Effectiveness Prescribing Programme (CEPP) National Audit: Medicines Management for CKD has been developed to further support the safe management of CKD patients with the intention of improving the identification of relevant patients, their medicines management and therapeutic outcomes. This is a joint piece of work between AWPAG, NWIS and Welsh Renal Clinical Network.
CEPP National Audit - Medicines Management for Chronic Kidney Disease (February 2017)
This educational pack aims to support the appropriate prescribing of hypnotics and anxiolytics across Wales by providing key health professionals with a practical approach for the initiation and review of hypnotic and anxiolytic prescribing. It includes examples of support material which can be used or adapted for this purpose.
Material to Support Appropriate Prescribing of Hypnotics and Anxiolytics Across Wales (December 2016)
Pull-out sections (MS Word)
Appendix 1. Assessment tools
Appendix 2. Information for patients
Appendix 3. Guides for healthcare professionals
Appendix 4. Hypnotic and anxiolytic reduction or withdrawal resources
This guidance aims to provide healthcare professionals with information to better inform patients on how to manage dry eye syndrome using good eyelid hygiene. This resource also contains dry eye syndrome prescribing guidelines and guidance on when referral should be made. It is envisaged that this will be used by healthcare professionals in both primary and secondary care settings.
Dry Eye Syndrome Guidance (December 2016)
The purpose of this guidance is to raise awareness of the recommendations on routine vitamin supplementation for babies, children, and pregnant and breastfeeding women, including vitamin D. This document outlines the Healthy Start scheme, which supports low-income families, and also provides guidance for non-beneficiaries.
Vitamins for Babies, Children, and Pregnant and Breastfeeding Women (November 2016)
This resource pack provides healthcare professionals with signposting and access to appropriate, relevant and up-to-date information on the non-pharmacological and pharmacological management of persistent (chronic) non-malignant pain in non-specialist settings.
Persistent Pain Resources - Medicines Used in Persistent Pain (October 2016)
Persistent Pain Resources - Signposting to Persistent Pain Resources (October 2016)
Persistent Pain Resources - Ten Key Messages (October 2016)
Persistent Pain Resources - Shared Decision-Making Toolkit (October 2016)
Persistent Pain Resources - Educational Slide Set (October 2016)
The aim of the counselling checklist is to assist healthcare professionals, working in community pharmacies, primary care and secondary care, in the essential counselling of patients on the safe and effective use of opioid patches. The inclusion of a checklist for patients/carers to refer to following counselling will also encourage the safe use of opioid patches.
Safeguarding Users of Opioid Patches by Standardising Patient and Caregiver Counselling (September 2016)
Amiodarone has an important place in the treatment of severe cardiac rhythm disorders where other treatments either cannot be used or have failed; however, its use requires regular monitoring due to potential toxicities. Primary and secondary care clinicians have recognised that it would be beneficial to review all patients taking amiodarone in Wales to establish the need for ongoing treatment. The enclosed documentation has been developed to assist this process.
Prescribing of Amiodarone for Atrial Fibrillation and Atrial Flutter in Wales (September 2016)
The use of low molecular weight heparin (LMWH) involves a diverse group of health professionals and patients. There is an education requirement to support the safe use of LMWHs and to promote best practice.
This document aims to ensure that all patients receive appropriate anticoagulation in a timely manner and to address prescribers’ concerns relating to the safe prescribing of LMWH. It is intended to promote consistent advice to patients via efficient and consistent clinical pathways for the prescribing and supply of LMWH.
Prescribing of Low Molecular Weight Heparin in Wales (September 2016)
NHS Wales wishes to develop prudent, innovative partnerships that benefit patients and achieve improved health outcomes for the people of Wales. This may be achieved through projects within short- and long-term partnership arrangements based on Prudent Healthcare Principles. This guidance aims to encourage an open and transparent approach to partnership working between NHS Wales, primary care contractors, the pharmaceutical industry and the allied commercial sector.
Guidance for Partnership Working (September 2016)
The guidance document ‘Advice on the Role of Oral Anticoagulants for the Prevention of Stroke and Systemic Embolism in People with Atrial Fibrillation’ was endorsed by AWMSG in October 2012. The evidence, range of therapeutic agents and licensed indications of the newer oral anticoagulants have changed since this publication. The National Institute for Health and Care Excellence Clinical Guideline 180: Atrial fibrillation: the management of atrial fibrillation was published in June 2014 and has been taken into consideration.
A multidisciplinary anticoagulation subgroup with membership from across Wales reviewed and updated recommendations for consideration by AWPAG and AWMSG.
The document covers the safe and effective use of: oral anticoagulants for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation, and warfarin for all indications.
All Wales Advice on the Role of Oral Anticoagulants (February 2016)
All Wales Advice on the Role of Oral Anticoagulants - Recommendations only (February 2016)
Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation
An All Wales risk/benefit assessment tool for oral anticoagulant treatment in people with atrial fibrillation has been developed, to be completed and documented prior to initiating treatment and as an annual review for patients taking oral anticoagulants.
The purpose of the guidance is to set out a framework to standardise the involvement of the health care support worker (HCSW) in the processes involved in medicines management and to ensure that only appropriately trained HCSWs, with the right knowledge and skills, can provide support with medication and its related tasks.
The All Wales Policy for Medicines Administration, Recording, Review, Storage and Disposal (MARRS) has been developed as a response to medicines practice issues identified as part of the Trusted to Care report, published in 2014. It provides a standards framework for health boards and trusts in Wales, which must be implemented through local procedures.
The purpose of the policy is to set out the minimum standards of practice that must be adopted by all healthcare employees involved in the administration, recording, review, storage and disposal of medicines in Welsh hospitals. The implementation of these standards will ensure that medicines administration and practices are of a consistently high standard and that patients, staff and visitors to Welsh hospitals are protected from the harmful effects of medicines through robust medicines storage practices.
Primary Care Antimicrobial Guidelines
The following guidelines have been developed by the All Wales Antimicrobial Guidance Group, based on the Public Health England/British Infection Association ‘Management of Infection Guidance for Primary Care for Consultation and Local Adaption’, and aim to provide comprehensive standardised guidance for the use of antimicrobials/treatment of infections in primary care across Wales.
Primary Care Antimicrobial Guidelines (September 2015)
Guidance on Antimicrobial Prophylaxis Related to Caesarean Section
This document aims to provide guidance regarding the timing and type of antimicrobial prophylaxis that should be offered to women undergoing Caesarean Section in Wales.
Guidance on Antimicrobial Prophylaxis Related to Caesarean Section (September 2015)
Recent data have suggested that the longer-term use of bisphosphonate treatment (particularly > five years) may be associated with increased risk of drug-related side effects, particularly atypical femur fracture. This document outlines an All Wales strategy to modify this risk via reassessment of patients and consideration of ‘drug holidays’. Information provided for prescribers includes a review process for patients prescribed bisphosphonate therapy for five or more years.
Guidance to Support the Safe Use of Long-term Oral Bisphosphonate Therapy (September 2015)
The All Wales Choose Pharmacy Formulary was initially developed to support the implementation of the Welsh Government ‘Choose Pharmacy’ service in pharmacies in two pathfinder sites in Wales. Choose Pharmacy aims to improve patient access to consistent, evidence-based advice for the management of common ailments. The formulary was developed using recognised resources and involved multi-professional consultation to ensure the provision of consistent advice by pharmacists and GPs; the advice contained in the formulary regarding the appropriate management and selection of medicines for a range of common minor ailments will therefore be relevant to all professionals involved in the management of such conditions . The formulary may be updated periodically, so please check that you are accessing the latest version.
All Wales Choose Pharmacy Formulary (2015)
This document provides guidance for health professionals regarding prescribing situations not covered by the NHS, including private care and private prescriptions, unlicensed medicines, prescribing outside national guidance, prescribing duration, foodstuffs, complementary medicines and alternative therapies, common ailments, fertility treatment, erectile dysfunction, prescribing for self and family, visitors from overseas, travel and occupational health vaccines.
Prescribing Dilemmas - A Guide for Prescribers (2015)
This Handbook for Homecare Services in Wales has been adapted from the Handbook for Homecare Services in England, which was published by the Royal Pharmaceutical Society (RPS) in May 2014.
Handbook for Homecare Services in Wales (2014)
Appendix 1 - All Wales Homecare Medicines Patients' Charter
Appendix 2 - Patient Information Leaflet
Appendix 3 - NHMC Template for Patient Registration and Consent Form
Appendix 4 - Template Homecare Patient Satisfaction Questionnaire
Appendix 5 - Home Suitability and Needs Assessment Checklist
Appendix 6 - Simplified Homecare Suitability and Needs Checklist
Appendix 7 - NHS Wales Health Board and Trust Model Policy for Use of Homecare Services
Appendix 8 - Example Technical Agreement
Appendix 9 - Key Performance Indicators for Homecare Service Providers
Appendix 10 - National KPI data Collection Template (Spreadsheet)
Appendix 11 - Example Product Quality Assessment for an Unlicensed Compound Antibiotic (Quality Control North West)
Appendix 12 - Procedure for Transferring Patients between Homecare Services
Appendix 13 - Use of Pharmacy Systems to Support Homecare Services (DH Homecare Strategy Board)
Appendix 14 - TBA – Wales-specific IT Strategy
Appendix 15 - Example Job Description Homecare Pharmacist
Appendix 16 - Example Job Description for a Homecare Pharmacy Technician
Gluten-free products are an essential part of the clinical treatment of coeliac disease. The All Wales Guide to Prescribing Gluten-free Products aims to support general practitioners and other healthcare professionals in the management of patients with coeliac disease, and aid the decision-making process in relation to prescribing Advisory Committee on Borderline Substances (ACBS)-approved gluten-free foods.
All Wales Guide to Prescribing Gluten-free Products (2013) (Updated 2014)
Primary Care Prescribing Analysis 2012-2013 Gluten-free Products
This document reviews the prescribing of gluten-free products in Wales, with reference to the All Wales Guide to Prescribing Gluten-free Products document.
Primary Care Prescribing Analysis 2012-2013 Gluten-free Products (2013)
In an aging population with much co-morbidity, it is not uncommon for patients to be prescribed a large number of medicines. The need to ensure that the benefits of medicines continue to outweigh any risks is essential, in particular where there is a high risk of adverse effects. This guidance provides support and additional information for clinicians when prioritising medication for a patient who may be prescribed multiple medications for a range of conditions, and includes summary tools and links to other documents/information where appropriate.
Sections of Polypharmacy - Guidance for Prescribing are available below as separate pull-out documents:Polypharmacy - Patient Information Leaflet on Medicines Review
Smoking continues to be the leading preventable cause of illness and premature death in Wales. Smoking cessation interventions are a cost-effective way of reducing ill health and preventing premature death, and the use of pharmacotherapy alongside support for behavioural change can improve quit rates significantly. This guide supports the appropriate prescribing and supply of smoking cessation pharmacotherapy in NHS Wales for smokers who are motivated to quit. Phased prescribing and supply is promoted to more closely target the individual’s needs during their quit attempt and reduce the potential for wastage.
These educational resource materials aim to support the appropriate prescribing of tramadol in NHS Wales by providing key healthcare professionals with resource materials to review the prescribing of tramadol within the complex context of pain management.
The materials have been developed with regard to promoting the appropriate use of tramadol and raising awareness of the risks associated with the misuse and diversion of supplies of tramadol.
The educational resource pack includes an introduction, audit materials for primary care, secondary care and overdose admissions through emergency departments, an educational slide set, WeMeReC bulletins, a patient information leaflet and a shared decision-making toolkit. The resources can be adapted locally and Word (or PowerPoint) versions of the documents can be requested from AWTTC.
Audit Materials (2013) (Updated 2014)
Educational Slide Set (2013) (Updated 2014)
WeMeReC Maps (2013)
WeMeReC Things to Know (2013)
Patient Information Leaflet (2013)
Shared Decision-Making Toolkit (2013)
This document is a review of the 2011 guidance and provides recommendations and guidance relating to the prescribing in Wales of denosumab (Prolia) for the prevention of osteoporotic fractures in postmenopausal women, and is intended to complement NICE TA204.
Prescribing of Denosumab (Prolia) in Wales: Review (2013)
Shared Care Protocol (2013)
This protocol has been produced by Aneurin Bevan Health Board. It is used to facilitate the self administration of intranasal fentanyl preparations for patients admitted to non-specialist palliative in-patient settings within Aneurin Bevan Health Board.
Supply and Administration of Intranasal Fentanyl Protocol (2013)
This educational pack aims to support the appropriate prescribing of proton pump inhibitors across Wales by providing key health professionals with a practical approach for the initiation and review of proton pump inhibitors prescribing. It includes examples of support material which can be used or adapted for this purpose.
Proton Pump Inhibitor and Dyspepsia Resource Pack (2013)
A 28-day prescribing interval has been promoted across the UK, primarily to reduce waste from unused medicines. A literature search was undertaken to review the evidence base for 28-day prescribing to promote a geographically consistent, evidence-based approach to prescribing in NHS Wales where possible. The recommendations made are a consensus position of the All Wales Prescribing Advisory Group (AWPAG) following consultation with stakeholders.
Review and Guidance for Prescribing Intervals (2013)
A standardised All Wales Paediatric Steroid Replacement Therapy Card has been developed to support the emergency treatment of children with adrenal insufficiency. The card aims to aid ambulance and hospital admission teams in administering appropriate steroid replacement therapy for affected patients, and will be issued to families of the patient by paediatricians, along with the necessary education and advice.The following document provides background information and an A4 example of the card. A wallet-sized version (available in English or Welsh) is available on request from AWTTC.
Drug treatments for erectile dysfunction may only be prescribed in NHS Wales under certain circumstances. Welsh Health Circular (WHC) (99) 148, published in 1999, provided guidance for NHS Wales on the identification and management within specialist services of men diagnosed as suffering severe distress resulting from erectile dysfunction. WHC (99) 148 has been reviewed and the following document provides updated recommendations regarding the prescribing of treatments for erectile dysfunction. This guidance supersedes Welsh Health Circular WHC (99) 148.
Guidance on Prescribing for Erectile Dysfunction (2012)
Prescribing guidelines for contraception initiation in primary care have been developed by AWPAG, based on work by NHS Greater Glasgow and Clyde, in order to reduce variation across the Health Boards and increase patient safety. A PowerPoint version of the chart for local adaptation is available on request from AWTTC.
The AWMSG document Statin Template Guidance: Use of Statins in Primary and Secondary Prevention of Vascular Disease has been superseded by NICE Clinical Guideline 181 and has therefore been archived. NICE CG181 can be accessed here: www.nice.org.uk/guidance/CG181.
If you would like to request a copy of the original AWMSG Statin Template Guidance, please email firstname.lastname@example.org.
Warfarin monitoring aims to stabilise a patient’s international normalised ratio (INR) within set limits to help prevent serious side effects, while maximising effective treatment. This document contains recommendations for best practice in relation to the monitoring of warfarin therapy in Wales
Warfarin Monitoring (2012)
Dronedarone (Multaq), for the indication maintenance of sinus rhythm after successful cardioversion in adult clinically stable patients with paroxysmal or persistent atrial fibrillation (AF), has been considered in light of its safety profile. This document addresses outstanding issues relating to the prescribing of dronedarone.
Prescribing of Dronedarone (2011)
The need for medicine reminder charts upon discharge from hospital was raised as an issue following anecdotal examples of difficulties experienced by patients. The current situation and measures required to alleviate issues raised are discussed in this document, and a template medicine reminder chart for local adaptation has been provided.
Patient Information at the Point of Discharge: Medicine Reminder Chart (2011)
Medicine Reminder Chart (Standard)
Medicine Reminder Chart (Long)
Patients need to be able to take their medication safely and obtain discharge medication in a manner that avoids delays and appropriately uses the NHW Wales resources. Many hospitals have not been able to provide medication directly to the patient upon discharge in cases where the patient has previously been receiving a monitored dosage system (MDS). The purpose of this document is to reduce risk and variation in the discharge process in Wales for patients that have been receiving an MDS prior to admission and continue to require an MDS on discharge.
Monitored Dosage Systems Guidance (2011)
Monitored Dosage Systems Standards (2011)
Some adults have difficulty swallowing oral solid dosage forms such as tablets and capsules; therefore prescribers must work with the patient and/or carer(s) to address their needs. This guideline provides a framework for healthcare professionals to support their prescribing decisions in response to the increased demand, complexity and cost of some “specials”. This guidance was developed by Betsi Cadwaladr University Health Board and endorsed by AWMSG as an example of good practice.
Prescribing Medicines for Adults who are Unable to Swallow Oral Solid Dosage Forms - Full document (2010)
Prescribing Medicines for Adults who are Unable to Swallow Oral Solid Dosage Forms - Summary document (2010)
Sip feed is a term which is often used to describe oral nutritional supplements that are given to increase nutritional intake in people recognised as malnourished or at risk of malnutrition. This document describes key priorities for the prescribing and supply of sip feeds in Wales, and is intended to complement NICE guidance on nutrition support in adults (CG32).
Prescribing and Supply of Sip Feeds (2006)
This paper contains a proposed National Prescribing Incentive Scheme with supporting documentation and recommendations for its successful implementation and maintenance.
The following documentation has been produced in order to provide clarity and consistency in relation to shared care across Wales.
Definition of Shared Care
Criteria for Shared Care
Generic Shared Care Template
Shared Care - Establishing an All Wales Core Amber List (Rheumatology)
Shared Care Template – Amiodarone (2016)
Shared Care Template – Subcutaneous Methotrexate
Information Note: Cystic Fibrosis Drugs – Interface Issues: Use of Tobramycin and Dornase Alfa for Adults with Cystic Fibrosis
Proposal to Update Near Patient Testing Enhanced Service
National Prescribing Indicators are developed annually to promote rational prescribing, balancing both quality and cost. The indicators are evidence-based and are designed to be clear and applicable at practice level.
National Prescribing Indicators 2017–2018
National Prescribing Indicators 2016–2017
National Prescribing Indicators 2015–2016
National Prescribing Indicators 2014–2015
National Prescribing Indicators 2013–2014
National Prescribing Indicators 2012–2013
National Prescribing Indicators 2011–2012
The Supporting Information for Prescribers summarises the AWMSG NPIs and provides points for consideration and links to supporting materials.
National Prescribing Indicators 2017–2018: Supporting Information for Prescribers
National Prescribing Indicators 2016–2017: Supporting Information for Prescribers
National Prescribing Indicators 2015–2016: Supporting Information for Prescribers
National Prescribing Indicators 2014–2015: Supporting Information for Prescribers
National Prescribing Indicators 2013–2014: Supporting Information for Prescribers
A slide set has been produced to support the National Prescribing Indicators 2015-2016, and is available here as a PowerPoint presentation for local adaption.
Secondary Care National Prescribing Indicators have been developed to highlight therapeutic priorities for
NHS Wales in secondary care.
Secondary Care National Prescribing Indicators 2016–2017
For each National Prescribing Indicator the threshold is set at the 25th percentile (i.e. reducing or increasing prescribing rates in line with the best performing 25% of practices). All practices within Health Boards are encouraged to achieve or move towards these thresholds. The following analyses of prescribing data are available:
National Prescribing Indicators: Analysis of Antibacterial Prescribing Data to March 2014
National Prescribing Indicators: Analysis of Yellow Card Reporting Data to December 2013
National Prescribing Indicators: Analysis of Morphine and Tramadol Data to June 2013
National Prescribing Indicators: Analysis of Antidepressant and Dosulepin Prescribing Data to December 2012
National Prescribing Indicators 2013-2014: Analysis of Prescribing Data to March 2014
National Prescribing Indicators 2013-2014: Analysis of Prescribing Data to December 2013
National Prescribing Indicators 2013-2014: Analysis of Prescribing Data to September 2013
National Prescribing Indicators 2013-2014: Analysis of Prescribing Data to June 2013
National Prescribing Indicators 2012-2013: Analysis of Prescribing Data to March 2013
National Prescribing Indicators 2012-2013: Analysis of Prescribing Data to December 2012
National Prescribing Indicators 2012-2013: Analysis of Prescribing Data to September 2012
The following National Prescribing Audits have been developed to highlight prescribing, safety and cost-effectiveness issues. The audits are intended to support the AWMSG National Prescribing Indicators.
Repeat Prescribing (June 2012)
Patient Safety: Lithium Prescribing (March 2012)
Towards More Appropriate Management of Depression in a Primary Care Setting (March 2012)
Reducing the Use of High Acquisition Cost (HAC) Proton Pump Inhibitors (PPIs) 2011-2013 (March 2011)
Community Pharmacy Contract All Wales Multi-Disciplinary Audit Proton Pump Inhibitors (PPIs) (March 2011)
This document summarises the AWMSG therapeutic priorities for the financial year. It also outlines the recommended structure of CEPP and elements within the General Medical Services (GMS) through which prescribing initiatives can be progressed.
This paper is intended to inform AWMSG of progress made in monitoring the usage of medicines appraised by AWMSG and the National Institute for Health and Care Excellence (NICE).
Monitoring Usage in Wales of Medicines Appraised by NICE and AWMSG - Data to March 2016
Monitoring Usage in Wales of Medicines Appraised by NICE and AWMSG - Data to March 2015
Monitoring Usage in Wales of Medicines Appraised by NICE and AWMSG - Data to March 2014
Monitoring of Medicines Appraised by NICE and AWMSG: Summary - Data to March 2013
Monitoring of Medicines Appraised by NICE and AWMSG - Data to September 2012
This document has been prepared by the Welsh Analytical Prescribing Support Unit (WAPSU) to provide a detailed analysis of diabetes therapeutic area prescribing at national, health board and GP cluster level. The report also incorporates GP cluster level comparators, a novel way of presenting prescribing data, which allows prescribing leads in GP clusters and health boards to benchmark prescribing data against the most similar GP clusters in terms of specific disease prevalence and socio-economic factors.
Primary Care Prescribing Analysis - Medicines Used in Diabetes (September 2015)
This paper provides an analysis of primary care prescribing in Wales and England for
medicines and preparations within the respiratory therapeutic area for the period July
2013–June 2014. The report contains information specific to Wales and its health
boards, and also data for England and North East (NE) England for comparative
Respiratory Prescribing Analysis with Cluster Level Comparators (2015)
This report outlines a proposed method for the development of cluster group
comparators, based on socio-economic similarity and disease prevalence, to enable
benchmarking of prescribing. The respiratory therapeutic area is used here to illustrate
the method, due to the impact of respiratory illness on the population, the high cost of
prescribing respiratory items, recent changes in the evidence base and the potential for
GP Cluster Level Comparators (2014)
This document reviews the prescribing of gluten-free products in Wales, with reference to the All Wales Guide to Prescribing Gluten-Free Products.
Primary Care Prescribing Analysis 2012-2013 Gluten-free Products (2013)
As part of the NHS Wales Clinical Effectiveness Prescribing Programme, local comparators are produced to allow benchmarking across a range of prescribing indicators and are available for both local and national comparative measurement as necessary in accordance with local prioritisation. Prescribing of tramadol and tramadol-containing combination products as a percentage of all opioid prescribing has been a local comparator since April 2011.
The following documents have been produced by the All Wales Drug Chart Review Subgroup of the Welsh Chief Pharmacists Committee, with endorsement from AWMSG.
In-patient Medication Administration Record
In-patient Medication Administration Record (discharge version)
Paediatric In-patient Medication Administration Record
Long Stay In-patient Medication Administration Record
Long Stay In-patient Medication Administration Record (discharge version)
Student In-patient Medication Administration Record
Continuous Subcutaneous Infusion Medication Administration Record (slides)
Continuous Subcutaneous Infusion Medication Administration Record
Guidelines for Completing Continuous Subcutaneous Infusion Medication Administration Record
Patients should be able to easily access information to enable them to make informed decisions about their health. This leaflet provides written information on the use of proton pump inhibitors for the treatment of indigestion. It is available as a Word template in English and Welsh, to allow local adaptation.
Patient Information - Proton Pump Inhibitors for the Treatment of Indigestion
Patient Information - Proton Pump Inhibitors for the Treatment of Indigestion (MS Word)
Opioids are offered frequently in palliative care to help reduce pain and breathlessness. The initiation and titration happens in wards, clinics and in outpatient settings. As their prescription sometimes forms part of a much wider consultation on disease status and other important matters in the palliative care context, it can be difficult for a patient (and their carer) to take in all the relevant information with regard to taking these strong medicines. Information tends to be verbal and is not always backed up by written guidance. Yet these are complicated medicines to take with varying dosing regimens and they can carry a lot of stigma and even fear for some people. Patients (and carers) can be left concerned or frightened about possible side-effects, addiction potential, or even feel that taking these drugs implies they are reaching the end of their lives and this can adversely affect compliance. NICE have recommended that strong opioid prescribing in palliative care should be backed up with written guidance. See also: http://publications.nice.org.uk/opioids-in-palliative-care-safe-and-effective-prescribing-of-strong-opioids-for-pain-in-palliative-cg140/recommendations
The following patient manuals on taking opioids in palliative care settings represent a useful take-home supplement to consultations where opioids have been discussed, considered and/or prescribed. It uses a ‘Frequently Asked Questions’ model, which patients and carers can dip in and out of at a time that suits them. There is a diary at the end that they can fill in and bring to the prescribers attention, for instance to show how many doses of fast-acting breakthrough opioid they have taken in the last few days.
The different opioid manuals on the AWMSG website give the prescriber a choice: There is a version that uses MST as an example of a sustained-release opioid, and one that uses Morphgesic SR as an example; this is because different health boards recommend different forms of oral sustained-release morphine as a first-line option. Please also consider visiting the following link to the NICE website to access these manuals, including different language versions (English, Welsh and Polish) within a downloadable Zip Folder (subsection 'Supporting Material’).
Patients should be able to easily access information to enable them to make informed decisions about their health. This leaflet provides written information on the medicines that are available for mild to moderate pain relief, both over the counter and on prescription.
Patient Information - Medicines for mild to moderate pain relief
Patients should be able to easily access information to enable them to make informed decisions about their health. This leaflet provides written information relating to the use of tramadol. The resource can be adapted locally and Word (or PowerPoint) versions of the document can be requested from AWTTC