Safety

The NHS campaign to improve the care of people at risk of, or with, acute kidney injury.

Advice for healthcare professionals:

• Ensure the patient or carer, or both are trained and understand optimal use of their adrenaline auto injector device.
• Advise the patient or carer or both to carry two adrenaline auto injectors at all times.
• Select a device that has a needle size appropriate to the individual patient.

Codeine is contraindicated in all children aged 0-18 years who undergo tonsillectomy or adenoidectomy (or both) for obstructive sleep apnoea. Codeine is restricted to children over 12 years of age and only if the benefit outweighs the risks.

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Domperidone is restricted to short term use in the relief of nausea and vomiting. The maximum recommended dose is 30 milligrams daily for one week. Contraindications include cardiac disorders, hepatic impairment, and concomitant QT prolonging or CYP3A4 inhibiting drugs.

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The Pan Mersey Safety subgroup recommends that all patients using a high dose Inhaled Corticosteroid (ICS) should be made aware of the risks of harm and be given an ICS or Steroid Treatment Card

The Pan Mersey Area Prescribing Committee recommends:

• All specialities, including haematology, should prescribe the methotrexate dose in multiples of 2.5mg tablets and the total dose in milligrams must also be included. For example, “Three 2.5mg tablets (7.5 milligrams)”;
• Methotrexate 10mg tablets MUST NOT be prescribed or supplied;
• Prescription and the dispensing label must clearly show the dose in milligram and the number of tablets to be taken and the frequency as “ONCE a week on the same day each week”;
• prescribing of methotrexate with co-trimoxazole or trimethoprim is an ABSOLUTE CONTRAINDICATION and MUST NOT occur under any circumstances*. This contraindication applies to people that have recently taken methotrexate.

ENSURING SAFETY WHEN USING FENTANYL AND BUPRENORPHINE PATCHES

Valproate treatment must be started and supervised by a specialist. Do not prescribe valproate medicines for women and girls of childbearing potential unless other treatments are ineffective, not tolerated, or a specialist has otherwise indicated there is a clinical need. Rationale for prescribing, patient or carer understanding, and consent must be clearly documented.