SHARED CARE GUIDELINE FOR LITHIUM. 1. Aim/Purpose of this Guideline. 2. The Guidance
|
|
- Lynne Bell
- 7 years ago
- Views:
Transcription
1 SHARED CARE GUIDELINE FOR LITHIUM 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical, nursing and pharmacy staff in the safe and appropriate prescription and administration of lithium. 2. The Guidance 2.1. See below for the Shared Care Guideline. Riluzole SCG Page 1 of 10
2 CORNWALL & IoS HEALTH COMMUNITY SHARED CARE GUIDELINE LITHIUM This shared care guideline (SCG) sets out details for the sharing of care of patients prescribed lithium. Lithium has been managed in primary care for many years and this SCG aims to support the safe and effective use of lithium as recommended by Safer Lithium Therapy NPSA/2009/PSA005. SCGs highlight some relevant prescribing issues but should be used in conjunction with relevant guidance (eg NICE, NPSA, BNF, ABPI summary of product characteristics), and do not replace them. INDICATIONS Lithium is licensed for the treatment of acute manic or hyomanic episodes, recurrent depression where other antidepressants have failed, in the prophylaxis of bipolar disorder, and control of aggressive behaviour or intentional self harm. PREPARATIONS AND DOSAGE Lithium should be prescribed by brand name, because of its narrow therapeutic range and differences in product bioavailability. te that not all lithium products are modified release (MR) The Priadel brand is recommended within Cornwall & IoS. This is available as Priadel MR 200mg and Priadel MR 400mg tablets; both contain lithium carbonate and both are scored tablets and can be halved. Particular care is needed with Priadel 520mg/5ml SF liquid, which actually contains lithium citrate where 5ml = 200mg lithium carbonate (= 5.4mmol Li+). Using a single brand (Priadel) throughout Cornwall healthcare community should help to reduce medication errors. CONTRAINDICATIONS AND PRECAUTIONS include: Hypersensitivity to lithium or any excipients Clinically significant renal disease Untreated hypothyroidism or Addison s Cardiac disease Low sodium (eg dehydration, low sodium diet) Women of childbearing potential discuss risks of teratogenicity (cardiac, Ebstein s anomaly) Pregnancy or breastfeeding seek specialist advice first to review risks and benefits t recommended for children, adolescents Initiation of lithium Initiation will be on the advice of a specialist, who will give the diagnosis and target lithium level for each patient, with ongoing guidance as necessary. The specialist will discuss potential risks and benefits of lithium with the patient and give written information (eg NPSA lithium folder). Baseline and ongoing blood results are more easily checked in primary care; any abnormal results should be discussed with the specialist before proceeding. Lithium should be started at low dose, (eg 400mg at night in healthy adults, 200mg at night in elderly), titrating up to the target therapeutic level as indicated by weekly serum lithium levels. The recommended therapeutic range in bipolar disorder is usually mmol/L in healthy adults, but lower (eg 0.4mmol/L) in elderly or frail patients. MONITORING The safe and effective use of lithium requires regular monitoring of lithium level, renal and thyroid function. Baseline monitoring Renal - Urea, electrolytes, creatinine, e-gfr Thyroid function TSH, T4 Full blood count Calcium ECG if existing cardiac disease or risk factors BMI Exclude pregnancy, consider contraception as appropriate, as risk of teratogenicity with lithium. Serum Lithium monitoring : 5-7 days after initiation, then weekly after each dose change until the level is stable within the therapeutic range for that patient, then after one month, then if stable every 3 months for the first year. After the first year, measure plasma lithium levels every 6 months, or every 3 months for people in any of the following groups: older people (65 years and over); people taking drugs that interact with lithium; people who are at risk of impaired renal or thyroid function, raised calcium levels or other complications; people who have poor symptom control; people with poor adherence; people whose last plasma lithium level was 0.8 mmol per litre or higher. Lithium samples should be taken 12 hrs post-dose, so a once-daily dose at night of Priadel tablets is recommended for simplicity of blood sampling. Patients taking lithium twice daily (eg Priadel liquid is licensed for twice daily dosage), should delay the morning dose until after the blood sample has been taken, again 12 hrs after the dose the preceding night. Ongoing monitoring of other parameters: Every 6 months renal function (Including e-gfr: potential for lithium toxicity if renal dysfunction; lithium can cause diabetes insipidus or more rarely reduce egfr). The decision whether to continue lithium depends on clinical efficacy, and degree of renal impairment; prescribers should consider Page 2 of 10
3 CORNWALL & IoS HEALTH COMMUNITY SHARED CARE GUIDELINE seeking advice from a renal specialist and psychiatrist. TFT (potential hypothyroidism, which can be treated as usual with thyroxine) BMI (potential weight gain) Annually corrected calcium (potential for increased calcium, hyperparathyroidism). ECG if cardiac disease or risk factors (potential for arrhythmias, bradycardia though these are not common). More frequent monitoring may be indicated in those with or at risk of, cardiac, renal or thyroid disease. SIDE EFECTS SEE SUMMARY OF PRODUCT CHARACTERISTICS Weight gain (avoid sugary drinks), oedema, mild GI disturbances e.g. mild nausea, diarrhoea (but see acute toxicity below), fine tremor, dry mouth, metallic taste, polydipsia, polyuria, exacerbation of psoriasis or acne. Longer term - hypothyroidism, hypercalcaemia & hyperparathyroidism, renal impairment & diabetes insipidus, bradycardia, arrhythmias Signs of Lithium Toxicity may be present even at a therapeutic lithium level. Raised lithium levels or signs of toxicity require lithium to be reduced or stopped, at least until blood levels fall to therapeutic range and the cause of lithium toxicity has been investigated. Because Priadel tablets are modified release, do repeat lithium levels. Risk factors for toxicity often involve change in sodium levels or how the body handles sodium. COMMON / SIGNIFICANT DRUG INTERACTIONS Lithium levels may be increased by:- Diuretics avoid diuretics, particularly thiazides. NSAIDs caution with when needed or OTC NSAIDs. Avoid NSAIDs or monitor lithium levels closely. ACE inhibitors and Angiotensin II antagonists Dehydration, sweating, low salt intake Stopping concurrent theophylline Lithium levels can be decreased by excessive fluid intake, acetazolamide, or adding theophylline. Risk of serotonin syndrome with other serotonergics eg SSRIs (although this can be a therapeutic combination in resistant depression), triptans, certain opioids e.g. tramadol, pethidine. Serotonin syndrome (restlessness, sweating, shivering, tremor, myoclonus, confusion) can be mild or potentially fatal, and resolves rapidly on stopping serotonergic drugs. Risk of neurotoxicity with concurrent diltiazem, verapamil, methyldopa, carbamazepine, phenytoin, antipsychotics or SSRIs. Again, lithium + antidepressant or lithium + antipsychotic is usually a synergistic therapeutic combination, but problems can occur rarely. REFERENCES Summary of Product Characteristics. NICE Clinical Guideline 185: Bipolar disorder: assessment and management (Sept 2014). Maudsley Prescribing Guidelines 12 th Ed. As a general guide :- Serum level 1.3mmol/l or above : blurred vision, muscle weakness, ataxia, increasing GI disturbances (anorexia, nausea, diarrhoea), drowsiness, confusion, coarse tremor, dysarthria, poor co-ordination, muscle twitching. Fine tremor is a normal side effect, but a coarse tremor may indicate toxicity. Action: Withhold lithium, advise patient to drink water, seek specialist advice, daily lithium level. Serum level 2.0mmol/l or above (severe lithium toxicity). hyperreflexia or hyperextension of limbs, convulsions, disorientation, syncope, renal failure, circulatory failure, coma. Action: Stop lithium immediately and seek urgent acute medical care Request for other formats Please ask if you would like to receive this leaflet in large print, braille, on CD or in any other languages. If you would like the leaflet in an alternative format please contact the NHS Kernow Communications Team at communications@kernowccg.nhs.uk or call For a planned withdrawal of lithium when not due to an urgent medical situation, withdraw gradually over at least one month, preferably longer. Stopping lithium suddenly can significantly increase the risk of relapse. Page 3 of 10
4 AREAS OF RESPONSIBILITY FOR THE SHARING OF CARE These are suggested ways in which the responsibilities for the management of patients prescribed lithium can be shared between the specialist and the general practitioners. The expectation is that these guidelines should provide sufficient information to enable GPs to be confident to take clinical and legal responsibility for prescribing these drugs. If a specialist asks the GP to prescribe this drug the GP should reply to this request as soon as practical. Sharing of care assumes communication between the specialist, GP and patient. The intention to share care should be explained to the patient and be accepted by them. In its guidelines on responsibility for prescribing (circular EL(91)127) between hospitals and GPs, the DH has advised that legal responsibility for prescribing lies with the doctor who signs the prescription. In line with the NPSA alert Safer Lithium Therapy, all health professionals involved with patients taking lithium should assist in educating those patients and support them in assuming some responsibility for their safe treatment. Specialist: Provide diagnosis, rationale for lithium therapy and advise on target lithium level for each patient. Advise GP on baseline tests and request notification of any abnormal results before proceeding with lithium. Discuss lithium treatment with the patient in advance, including potential benefits and side-effects, warning signs of lithium toxicity, the requirement for regular blood tests, likely duration of treatment. Provide patient with written information and patient lithium record card (eg NPSA folder of lithium information and record card). Encourage patient to be actively involved in monitoring lithium levels and to show lithium record to doctors, pharmacists and others involved in monitoring lithium. For women of childbearing potential, discuss the risk of teratogenicity and risk in breastfeeding where appropriate. Refer to GP and/or other sources for advice on contraception as appropriate. Ask GP and patient for a full list of prescribed and non-prescribed medicines and consider potential drug interactions with lithium. Risk assess patient and determine appropriate quantity of supply, eg weekly or monthly supplies. See patient again at one month, review current blood level and advise on any side-effects Check that patient understands the need for adherence and regular blood tests, and signs of lithium toxicity and what action to take. Encourage the patient to be actively involved in maintaining and monitoring the safe and effective use of lithium. Evaluate and advise on adverse events noted by GP or patient. Promptly communicate to GP any necessary changes to treatment. Advise GP on when and how to discontinue. Specialist reassessment should occur after 5 years to review need for treatment. General Practitioner: Reply to request for shared care as soon as practical. The general practitioner will prescribe the medicine in consultation with, and receiving advice from, the specialist service. To provide the patient with monthly repeat prescriptions, or smaller quantities if necessary. Specify the brand (Priadel) on the prescription; incorrect dosing can occur if the patient changes preparations To monitor for side-effects and drug interactions, seeking specialist advice as necessary. To discuss with specialist if a patient needs a drug which is likely to affect lithium levels. Undertake baseline tests and notify the specialist of any abnormalities before proceeding to prescribe. To check serum lithium levels according to recommendations on page 2. To monitor lithium levels closely and to reduce the dose or discontinue treatment as appropriate in serious diarrhoea, vomiting or intercurrent infection (especially if sweating profusely). To check patients for side effects and signs of lithium toxicity at each appointment. Toxicity can occur without apparent increase in serum level, and it is important to treat the patient not the level. Signs of neurotoxicity which can occur at therapeutic levels include paraesthesia, ataxia, tremor and cognitive impairment. To undertake continuation monitoring as set out above, take appropriate action if these tests are abnormal and to communicate all abnormal test results to specialist and seek advice as necessary. To stop lithium if signs of toxicity occur and contact the consultant psychiatrist for advice. Refer back to secondary care for specialist advice if the treatment is ineffective or the patient is non-compliant or if the patient develops unacceptable side effects (this is particularly important where patients develop signs of renal impairment.) To continue patient education and encourage the patient to take responsibility for maintaining their treatment safely. Page 4 of 10
5 To oversee the appropriate completion of the NPSA lithium therapy record book. To review the patient in accordance with the patient s care plan, if appropriate. To make a clear statement in the primary care notes showing where monitoring is being carried out. To inform care team if patient is non-adherent with treatment plan. Patient / carer: Attend appointments and have recommended tests at recommended Intervals. Carry the lithium alert card in case urgent medical treatment is needed. Keep the lithium record book up-to-date and show it to healthcare professionals as required, eg prescribers, pharmacists. Wherever possible, to be aware of due dates for regular monitoring, and utilise the lithium record book (or equivalent) Be aware of possible side-effects, especially signs of high lithium level and report these promptly to professional(s) involved with their care. Share any other concerns about lithium (e.g. incomplete understanding of treatment) with professional involved with their care. Maintain their usual adequate diet and fluid intake. Seek advice before self-medicating with over the counter medicines, eg check with a pharmacist. Seek advice and support from GP or specialist immediately if pregnant or planning a pregnancy Store medicines safely at home. BACK-UP ADVICE AND SUPPORT IS AVAILABLE FROM THE RELEVANT CLINICAL TEAM Page 5 of 10
6 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Compliance with prescribing and administration in accordance with this guideline (or other safe practice) Head of Prescribing Support Unit specific tool As required according to clinical incident reports Via Medicines Practice Committee Relevant Clinical Staff Relevant Clinical Staff 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 6 of 10
7 Appendix 1. Governance Information Document Title Lithium Shared Care Guideline Date Issued/Approved: May 2016 Date Valid From: June 2016 Date Valid To: June 2019 Directorate / Department responsible (author/owner): M Wilcock, Head of Prescribing Support Unit, Pharmacy Department, RCHT Contact details: Brief summary of contents Some clinical issues and details of prescribing responsibilities for GP and specialists Suggested Keywords: Target Audience Executive Director responsible for Policy: Shared care RCHT CCG CFT Medical Director Date revised: May 2016 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: v2.0 Cornwall Area Prescribing Committee Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Training Need Identified? Karen Jarvill, Associate Director CSCS t Required {Original Copy Signed} Internet & Intranet Intranet Only Clinical / Pharmacy ne ne Page 7 of 10
8 Version Control Table Date Version May 13 V2.0 Minor updating May 16 V3.0 Minor updating Summary of Changes Changes Made by (Name and Job Title) M Wilcock, Head of Prescribing Support Unit B Luft, Deputy chief Pharmacist, CFT All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 8 of 10
9 Appendix 2.Initial Equality Impact Assessment Screening Form Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: Lithium Shared Care Guideline Directorate and service area: Pharmacy Is this a new or existing Procedure? Existing Name of individual completing assessment: Dan Thomas, Pharmaceutical Services Contracting Team, NHS Kernow 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Telephone: To provide information on prescribing of lithium to enable General Practitioners to take over prescribing responsibility from secondary care. 2. Policy Objectives* To promote a consistent level of shared care between primary and secondary care (in relation to CPFT catchment area) 3. Policy intended Confident and competent prescribers, enabling medicines to be Outcomes* access in a primary care setting. 4. *How will you measure If the guideline is not well received, publicised and adopted, then the outcome? some GPs may not enter into shared care arrangements. 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? General practitioners, hospital specialists and community pharmacists from understanding local guidance around use of these medicines. Patients/carers, from being able to access medicines from their GP. C). Please list any groups who have been consulted about this procedure. Cornwall & IoS Area Prescribing Committee 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Page 9 of 10
10 Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity no no no no Sexual Orientation, no Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. Dan Thomas 2. Mike Wilcock Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 10 of 10
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME 1. Aim/Purpose of this Guideline This guideline is for the management of Adult patients with Diabetes Mellitus
More informationSEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline
SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline is for the management of sepsis in Infants and children. For full guidance please see the Surviving
More information2.1 When a breastfeeding woman is admitted to hospital, the support she needs depends on the nature of her illness and the treatment needed
CARE OF BREASTFEEDING WOMEN ADMITTED TO HOSPITAL, CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 Breastfeeding is known to be one of the most powerful health protective influences and as such,
More informationCLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline This guideline is for the management of for the management of Adult patients with Diabetes
More informationOccupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0
Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0 January 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Ownership
More informationThis guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital
CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS USING INSULIN PUMP THERAPY (Continuous Subcutaneous Insulin Infusion (CSII)), DURING ADMISSION TO HOSPITAL 1. Aim/Purpose of this
More informationProcedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging Examinations under IR(ME)R
Procedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging V3.0 December 2013 Page 1 of 11 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope...
More informationCLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline 1.1. Venesection is a clinical procedure commonly performed in the Haematology
More informationCLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR INJURY UNITS IN CORNWALL
CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR 1. Aim/Purpose of this Guideline This Protocol applies to Registered Healthcare Practitioners in the Minor
More informationLithium initiated by Secondary Care (Mental Health) Prescribe by Brand Name (usually Priadel)
Nottinghamshire Health Community Algorithm for Prescribing and Monitoring Lithium within Primary and Secondary Care (Mental Health) Traffic Light Classification - Amber 2 Information sheet for Primary
More informationSHARED CARE GUIDELINE FOR TREATMENT OF DEMENTIA 1. Aim/Purpose of this Guideline
SHARED CARE GUIDELINE FOR TREATMENT OF DEMENTIA 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical, nursing and pharmacy staff in the safe and appropriate prescription and administration
More informationLithium Therapy. Important information for patients COLLEGE CENTRE FOR QUALITY IMPROVEMENT
Lithium Therapy Important information for patients COLLEGE CENTRE FOR QUALITY IMPROVEMENT National Patient Safety Agency National Patient Safety Agency Your information Your name: Address: Postcode: Home
More information2.1. Applicable areas: Royal Cornwall Hospitals Trust; Neonatal Unit and Delivery Suite
ADVANCED NEONATAL NURSE PRACTITIONERS (ANNPs) BLOOD COMPONENT AND BLOOD PRODUCT REQUESTING PROTOCOL NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 The purpose of this protocol is to guide
More informationCLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline:
CLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline: 1.1. This protocol applies to Advanced Nurse Practitioners (Hepatology) employed by RCHT
More informationCLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start
CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start 1. Assemble all your equipment before you start. 2. Explain and discuss the procedure with
More informationClinical Guideline For The Use of Rectus Sheath Catheters For The Management of Pain Following Laparotomy. 1. Aim/Purpose of this Guideline
Clinical Guideline For The Use of Rectus Sheath Catheters For The Management of Pain Following Laparotomy. 1. Aim/Purpose of this Guideline 1.1. Nursing guidelines for the use of rectus sheath catheters
More informationAccounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0
Accounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0 June 2015 Table of Contents Accounts Receivable - Guidance to staff responsible
More informationCLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline 1.1. Systemic cancer treatments and immunological therapies can suppress the ability of the bone
More informationPREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline
PREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline All clinical staff working in the Division of women, children & sexual health to provide evidence based guidance
More informationGuidance on Leases and other Agreements V4.0
Guidance on Leases and other Agreements V4.0 August 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities...
More informationMANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE
MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. To provide monitoring and treatment guidance for medical and nursing staff
More informationOXYGEN THERAPY AND SATURATION MONITORING OF THE NEONATE - CLINICAL GUIDELINE
OYGEN THERAPY AND SATURATION MONITORING OF THE NEONATE - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 To provide guidance on the assessment and management of infants requiring oxygen therapy
More informationGMMMG Interface Prescribing Subgroup. Shared Care Template
GMMMG Interface Prescribing Subgroup Shared Care Template Shared Care Guideline for Selective Serotonin Reuptake Inhibitors (SSRIs) for the treatment of Obsessive Compulsive Disorder (OCD) and Body Dysmorphic
More informationDonepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa )
Donepezil (Aricept ), Galantamine (Reminyl XL ), Rivastigmine (Exelon ) and Memantine (Ebixa ) ESCA: For the treatment of Alzheimer s disease. SECONDARY CARE SECTION TO BE COMPLETED BY INITIATING DOCTOR
More informationAdjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.
Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,
More informationMaintenance of abstinence in alcohol dependence
Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly
More informationThe Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0
The Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0 January 2013 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3.
More information**Form 1: - Consultant Copy** Telephone Number: Fax Number: Email: Author: Dr Bernard Udeze Pharmacist: Claire Ault Date of issue July 2011
Effective Shared Care Agreement for the treatment of Dementia in Alzheimer s Disease Donepezil tablets / orodispersible tablets (Aricept / Aricept Evess ) These forms (1 and 2) are to be completed by both
More informationPHARMACISTS AMENDMENTS TO PRESCRIPTIONS
PHARMACISTS AMENDMENTS TO PRESCRIPTIONS May 2016 Version 2.3 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3. Scope... 3 4. Definitions/Glossary... 3 5. Ownership and Responsibilities...
More informationSTROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing)
STROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing) 1. Aim/Purpose of this Guideline The aim of this document to inform clinicians
More informationCLINICAL GUIDELINE FOR
CLINICAL GUIDELINE FOR the investigation and management of inpatients with discitis (vertebral osteomyelitis) 1. Aim/Purpose of this Guideline 1.1.This guideline applies to clinical staff managing patients
More information3. Prophylactic treatment of recurrent affective disorders.
PRIADEL Lithium carbonate Presentation Controlled release lithium carbonate tablets. White circular, bi-convex tablets engraved PRIADEL on one side, scored on the other side. Each tablet contains 400 mg
More informationCLINICAL GUIDELINE FOR THE MANAGEMENT OF OPIATE DEPENDENT PATIENTS AT RCHT 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR THE MANAGEMENT OF OPIATE DEPENDENT PATIENTS AT RCHT 1. Aim/Purpose of this Guideline 1.1. These guidelines are aimed at Medical Staff at RCHT treating patients admitted that are
More informationAccess Control Policy V1.0
V1.0 January 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 4 5. Ownership and Responsibilities... 4 5.1. Role of the Chief
More informationDiagnostic Testing Procedures for Ophthalmic Science
V3.0 09/06/15 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities... 3 5.2. Role of the Managers... 3 5.3.
More informationCLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to assist decision making of whether anticoagulants
More informationLEFLUNOMIDE (Adults)
Shared Care Guideline DRUG: Introduction: LEFLUNOMIDE (Adults) Indication: Disease modifying drug for rheumatoid arthritis and psoriatic arthritis Licensing Information: Disease modifying drug for active
More informationNaltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance
Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within
More informationAcetylcholinesterase Inhibitors and Memantine Clinical Indication: Treatment of Dementia in Alzheimer s Disease (AD)
SHARED CARE PROTOCOL AND INFORMATION FOR GPS Acetylcholinesterase Inhibitors and Memantine Clinical Indication: Treatment of Dementia in Alzheimer s Disease (AD) Version: 3 Date Approved: June 2011 Review
More informationShared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia
Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Version: 3.0 Ratified by: Medicines Committee Date ratified: 16 th November 2011 Name of originator/author: James
More informationDabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
More informationA Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood.
Bipolar disorder Bipolar (manic-depressive illness) is a recurrent mode disorder. The patient may feel stable at baseline level but experience recurrent shifts to an emotional high (mania or hypomania)
More informationMEDICATION GUIDE. TRINTELLIX [trin -tel-ix] (vortioxetine) Tablets
MEDICATION GUIDE TRINTELLIX [trin -tel-ix] (vortioxetine) Tablets Read this Medication Guide before you start taking TRINTELLIX and each time you get a refill. There may be new information. This information
More informationCLINICAL GUIDELINE FOR THE EMERGENCY DEFILL OF AN ADJUSTABLE GASTRIC BAND
CLINICAL GUIDELINE FOR THE EMERGENCY DEFILL OF AN ADJUSTABLE GASTRIC BAND 1. Aim/Purpose of this Guideline The aim of this guideline to enable the effective care of patients needing emergency defill of
More informationHow To Pay A Bill At The Trust
Guidance to Staff responsible for the Ordering, Authorising and Payment of goods and services received V3.0 June 2015 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3.
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) SHARED CARE AGREEMENT FRAMEWORK ACAMPROSATE CALCIUM (Campral EC) for alcohol abstinence ESCA: Adjunct in the treatment of chronic alcohol dependence (under
More informationCLINICAL GUIDELINE FOR THE MANAGEMENT OF HIGH BLOOD GLUCOSE LEVELS AND SICK DAYS ON AN INSULIN PUMP. 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR THE MANAGEMENT OF HIGH BLOOD GLUCOSE LEVELS AND SICK DAYS ON AN INSULIN PUMP. 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to give clear information and
More informationPOAC CLINICAL GUIDELINE
POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal
More informationPaxil/Paxil-CR (paroxetine)
Generic name: Paroxetine Available strengths: 10 mg, 20 mg, 30 mg, 40 mg tablets; 10 mg/5 ml oral suspension; 12.5 mg, 25 mg, 37.5 mg controlled-release tablets (Paxil-CR) Available in generic: Yes, except
More informationPrescribing Framework for Donepezil in the Treatment and Management of Dementia
Hull & East Riding Prescribing Committee Prescribing Framework for Donepezil in the Treatment and Management of Dementia Patients Name:.. NHS Number: Patients Address:... (Use addressograph sticker) GP
More informationRivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
More informationEssential Shared Care Agreement Drugs for Dementia
Ref No. E040 Essential Shared Care Agreement Drugs for Dementia Please complete the following details: Patient s name, address, date of birth Consultant s contact details (p.3) And send One copy to: 1.
More informationUnder Review. Policy for Self Administration of medicines (SAM) by Competent Patients. Document Title. Date Issued/Approved: 18 th October 2013
POLICY UNDER REVIEW Please note that this policy is under review. It does, however, remain current Trust policy subject to any recent legislative changes, national policy instruction (NHS or Department
More informationPatient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust.
Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust. This Patient Group Direction (PGD) has been written
More informationSummary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole)
EMA/303592/2015 Summary of the risk management plan (RMP) for Aripiprazole Pharmathen (aripiprazole) This is a summary of the risk management plan (RMP) for Aripiprazole Pharmathen, which details the measures
More informationGUIDELINES FOR THE USE OF PALIPERIDONE PALMITATE (Xeplion ) Version: 2
SH CP 29 GUIDELINES FOR THE USE OF PALIPERIDONE PALMITATE (Xeplion ) Summary: Guidelines for the use of paliperidone palmitate (Xeplion ) Keywords (minimum of 5): (To assist policy search engine) Target
More informationTrileptal (Oxcarbazepine)
Brand and Generic Names: Trileptal Tablets: 150mg, 300mg, 600mg Liquid Suspension: 300mg/5mL Generic name: oxcarbazepine What is Trileptal and what does it treat? Trileptal (Oxcarbazepine) Oxcarbazepine
More informationSHARED CARE GUIDELINE FOR MIDODRINE IN POSTURAL HYPOTENSION 1. Aim/Purpose of this Guideline
SHARED CARE GUIDELINE FOR MIDODRINE IN POSTURAL HYPOTENSION 1. Aim/Purpose of this Guideline 1.1. This guideline applies to medical, nursing and pharmacy staff in the safe and appropriate prescription
More informationMELATONIN FOR SLEEP DISORDERS IN CHILDREN AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDERS SHARED CARE GUIDELINES
MELATONIN FOR SLEEP DISORDERS IN CHILDREN AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDERS SHARED CARE GUIDELINES Version control: Version Date Main changes/comments V1 4 June 2013 First draft circulated
More informationGrievance and Disputes Policy and Procedure. Document Title. Date Issued/Approved: 10 August 2010. Date Valid From: 21 December 2015
POLICY UNDER REVIEW Please note that this policy is under review. It does, however, remain current Trust policy subject to any recent legislative changes, national policy instruction (NHS or Department
More informationA Policy for the Trial and Evaluation of Medical Devices
29/05/2014 V2.1 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3. Scope... 3 4. Definitions... 3 5. Ownership and Responsibilities... 4 5.1. Role of the Trust Board and Medical Director...
More informationThe reaction is termed anaphylaxis if there are life-threatening features such as respiratory difficulties and/or hypotension.
HYPERSENSITIVITY AND ANAPHYLACTIC REACTIONS DURING AND AFTER TREATMENT WITH CHEMOTHERAPY- CLINICAL GUIDELINE FOR RECOGNITION AND TREATMENT. 1. Aim/Purpose of this Guideline 1.1. The aim of this document
More informationRemeron (mirtazapine)
Remeron (mirtazapine) FDA ALERT [07/2005] Suicidal Thoughts or Actions in Children and Adults Patients with depression or other mental illnesses often think about or attempt suicide. Closely watch anyone
More informationNorth of Tyne Area Prescribing Committee
North of Tyne Area Prescribing Committee ANTIPSYCHOTICS IN PSYCHOSIS, BIPOLAR DISORDER AND AUGMENTATION THERAPY IN TREATMENT RESISTANT DEPRESSION Information for Primary Care Updated November 2013 This
More informationRivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)
Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep
More informationBerkshire West CCGs Alcohol Treatment Pathway for Nalmefene (Selincro) Primary Care Guidance
Berkshire West CCGs Alcohol Treatment Pathway for Nalmefene (Selincro) Primary Care Guidance Nalmefene (trade name Selincro) was given approval by NICE in November 2014 and should be available to use with
More informationAmitriptyline. Drug information Amitriptyline
Drug information Amitriptyline Amitriptyline This leaflet provides information on amitriptyline and will answer any questions you have about the treatment. Arthritis Research UK produce and print our booklets
More information2. Characteristics of staff Qualifications required. Additional requirements. Continued education & training requirements
Patient Group Direction The supply of Azithromycin 1g as a single dose by accredited Community Pharmacists to patients in receipt of a positive test result to Chlamydia trachomatis, and treatment of their
More informationCLINICAL GUIDELINE FOR THE NEONATAL MANAGEMENT OF INFANTS BORN TO MOTHERS WITH THYROID DISEASE 1. Aim/Purpose of this Guideline
CLINICAL GUIDELINE FOR THE NEONATAL MANAGEMENT OF INFANTS BORN TO MOTHERS WITH THYROID DISEASE 1. Aim/Purpose of this Guideline 1.1. This guideline applies to Neonatal/Paediatric and Midwifery/Obstetric
More informationAseptic Non Touch Technique (ANTT) Policy
Aseptic Non Touch Technique (ANTT) Policy V3 12 th May 2015 Page 1 of 19 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 4 5.
More informationPsychiatry: three favourite OSCE stations
Psychiatry: three favourite OSCE stations OSCE stations in psychiatry tend to fill medical students with dread. Psychiatric patients aren t as forthcoming when it comes to providing the interviewer with
More informationpatient group direction
DICLOFENAC v01 1/8 DICLOFENAC PGD Details Version 1.0 Legal category Staff grades Approved by POM Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner
More informationSafety Alerts Management Policy
Safety Alerts Management Policy Version Number 1.1 Version Date February 2014 Policy Owner Author First approval or date last reviewed Staff/Groups Consulted Director of Nursing and Clinical Governance
More informationSummary of the risk management plan (RMP) for Rasagiline ratiopharm (rasagiline)
EMA/744222/2014 Summary of the risk management plan (RMP) for Rasagiline ratiopharm (rasagiline) This is a summary of the risk management plan (RMP) for Rasagiline ratiopharm, which details the measures
More informationLithium. Generic name = lithium carbonate (tablets and capsules), or lithium citrate (liquid)
Lithium Brand and Generic Names Eskalith - Capsules: 300 mg Eskalith CR slow release - Tablets: 450 mg Lithobid slow release - Tablets: 300 mg Generic name = lithium carbonate (tablets and capsules), or
More informationThese guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes.
This is a new guideline. These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes. It incorporates NICE clinical
More informationConjoint Professor Brian Draper
Chronic Serious Mental Illness and Dementia Optimising Quality Care Psychiatry Conjoint Professor Brian Draper Academic Dept. for Old Age Psychiatry, Prince of Wales Hospital, Randwick Cognitive Course
More informationThe Pharmacological Management of Cancer Pain in Adults. Clinical Audit Tool
The Pharmacological Management of Cancer Pain in Adults Clinical Audit Tool 2015 This clinical audit tool accompanies the Pharmacological Management of Cancer Pain in Adults NCEC National Clinical Guideline
More informationMEDGUIDE SECTION. What is the most important information I should know about SEROQUEL? SEROQUEL may cause serious side effects, including:
MEDGUIDE SECTION Medication Guide SEROQUEL (SER-oh-kwell) (quetiapine fumarate) Tablets Read this Medication Guide before you start taking SEROQUEL and each time you get a refill. There may be new information.
More informationWellbutrin (bupropion)
Wellbutrin (bupropion) FDA ALERT [09/2007] - Suicidality and Antidepressant Drugs Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents,
More informationThe management of bipolar disorder in adults, children and adolescents, in primary and secondary care
Quick reference guide Issue date: July 2006 Bipolar disorder The management of bipolar disorder in adults, children and adolescents, in primary and secondary care Developed by the National Collaborating
More informationShared Care Agreement Insulin Degludec (Tresiba )
Licensed Indication Shared Care Agreement Insulin Degludec (Tresiba ) Insulin Degludec is licensed for the treatment of diabetes mellitus in adults. Countess of Chester prescribing guidelines Restricting
More informationShared Care Protocol for Atypical Antipsychotics
Shared Care Protocol for Atypical Antipsychotics Version Number: 2 Name of originator/author: Chief Pharmacist, 07813 783165 (with thanks to GMW) Name of responsible committee: Clinical Governance Committee
More informationBipolar disorder. Understanding NICE guidance
Understanding NICE guidance Information for people who use NHS services Bipolar disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments
More informationDEMENTIA EDUCATION & TRAINING PROGRAM
The pharmacological management of aggression in the nursing home requires careful assessment and methodical treatment to assure maximum safety for patients, nursing home residents and staff. Aggressive
More informationClinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012. Reference : NHSCB/D4/c/1
Clinical Commissioning Policy: Disease Modifying Therapies For patients With Multiple Sclerosis (MS) December 2012 Reference : NHSCB/D4/c/1 NHS Commissioning Board Clinical Commissioning Policy: Disease
More informationVersion 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal
More informationTHE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011
RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for
More informationDorset Cardiac Centre
P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February
More informationTreatments for Major Depression. Drug Treatments The two (2) classes of drugs that are typical antidepressants are:
Treatments for Major Depression Drug Treatments The two (2) classes of drugs that are typical antidepressants are: 1. 2. These 2 classes of drugs increase the amount of monoamine neurotransmitters through
More informationMEDICATION GUIDE Savella (Sa-vel-la) (milnacipran HCl) Tablets
MEDICATION GUIDE Savella (Sa-vel-la) (milnacipran HCl) Tablets Savella is not used to treat depression, but it acts like medicines that are used to treat depression (antidepressants) and other psychiatric
More informationAlways take this medicine exactly as described in this leaflet or as your doctor, pharmacist or nurse have told you.
leaflet: Information for the user Macrogol 4000 10 g powder for oral solution in sachet Macrogol 4000
More informationCLINICAL PROCEDURE FOR THE SAFE REMOVAL OF FEMORAL ARTERIAL SHEATHS USING A DIGITAL APPROACH 1. Aim/Purpose of this Guideline
CLINICAL PROCEDURE FOR THE SAFE REMOVAL OF FEMORAL ARTERIAL SHEATHS USING A DIGITAL APPROACH 1. Aim/Purpose of this Guideline 1.1. To aide registered nurses in the safe removal of arterial femoral sheaths
More informationNICE Clinical guideline 23
NICE Clinical guideline 23 Depression Management of depression in primary and secondary care Consultation on amendments to recommendations concerning venlafaxine On 31 May 2006 the MHRA issued revised
More informationHow To Use Novel Anticoagulants In Cornwall
PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline The aim of this document to guide clinicians on use of novel anticoagulants for stroke
More informationAbstral Prescriber and Pharmacist Guide
Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of
More informationADMINISTRATION OF VITAMIN K NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline
ADMINISTRATION OF VITAMIN K NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline applies to all staff responsible for the administration of Vitamin K (Phytomenodium) to newborn
More informationoptimal use of thyroid function tests (TFTs) to diagnose and monitor thyroid disease.
Guidance for Thyroid Function Testing in Primary Care in Lothian In July 2006 following a lengthy consultation process, a joint working group comprising representatives from the Association of Clinical
More informationClinical Audit: Prescribing antipsychotic medication for people with dementia
Clinical Audit: Prescribing antipsychotic medication for people with dementia Trust, team and patient information Q1. Patient's DIS number... Q2. Patient s residence: Home Residential Home Nursing Home
More informationPreconception Clinical Care for Women Medical Conditions
Preconception Clinical Care for Women All women of reproductive age are candidates for preconception care; however, preconception care must be tailored to meet the needs of the individual. Given that preconception
More information