Resources Update September 2013

Dave Abbott Medicines Information Pharmacist

Aims

• Refresher on core resources • how to access • coverage • pros and cons • Update on more specialist resources • How to assess the quality of resources • Useful newsletters and newsfeeds

Core Resources – BNF / BNFc

www.bnf.org

• Paper copies published twice a year • Electronic versions (internet / apps) updated monthly –

electronic is more up to date

• App available for free on android and iPhone. Need your Athens password to download updates • Internet version freely available from NHS computers

Core Resources – BNF / BNFc

Pros • Readily available • Up to date (electronic versions more so) • Guidance updated in light of MHRA updates / NICE etc • Well respected resource Cons • Little coverage of unlicensed medicines / indications • Space requirements mean not comprehensive - not all ADRs / interactions listed, advice on e.g. dose adjustment in renal impairment limited

Core Resources – EMC

www.medicines.org.uk

• Information provided by the manufacturers of products • Contains SPCs (aimed at HCPs) and PILs (aimed at patients) • Only holds information from manufacturers who are members of the ABPI who choose to participate – other manufacturers publish their information elsewhere

Core Resources - EMC

Pros • Gives a lot of information on the licensed uses of medicines • Additional information on pharmacology and the evidence supporting its use Cons • Not all products are listed • Only gives information on licensed indications • Can be cautious, so will tend to say ‘no’ if limited data – e.g. renal impairment / pregnancy

Core Resources – NHS Evidence

www.evidence.nhs.uk

• Resource provided by NICE • Searches resources from reputable providers only • Need to use filters – searching ‘methotrexate’ returns >7,000 results. Can filter by information type (guidelines / pathways / trials etc) or provider (NICE / Cochrane / UKMI etc)

Core Resources – NHS Evidence

Pros • ‘NICE approved Google’ • Fairly comprehensive with a lot of different types of available information • Useful first step to search the literature Cons • Can be difficult to find the things you want (but practice makes it easier)

Core Resources - Leeds Health Pathways

nww.lhp.leedsth.nhs.uk

• Local repository for guidelines and pathways • Used by LTHT and all Leeds CCGs • All content approved by relevant groups before publishing

Core Resources – Leeds Health Pathways

Pros • Reflects local practice, with guidelines to be followed within LTHT • Shared resource • Robust review processes Cons • Older guidelines may not reflect current practices – check review dates

Core Resources - Medusa IV guide

http://lthweb/sites/medicines-management-and pharmacy/information-on-medicines/iv-monographs • National collaborative intravenous administration guide, with local customisation • National monographs written by pharmacists in participating hospitals, local customisation added by Leeds Medicines Information Service • Available within LTHT without a password

Core Resources - Medusa IV guide

Pros • Tailored to local Cons practice • Reasonably comprehensive • Some monographs more up to date than others • Sometimes too much detail in national monographs • Paediatric guide in development • IV guide, not IM or SC • Intermittent access problems (use back-up site)

Core Resources – Leeds Formulary

www.leedsformulary.nhs.uk

• The medicines formulary followed by all NHS organisations in Leeds • Lists the medicines supported for use within Leeds, along with links to further information (guidelines, NICE, information updates etc) • Managed by the Leeds Medicines Information Service at LTHT

Core Resources – Leeds Formulary

Pros • Reflects local practice, and links to assessed resources (does your filtering for you) • Hosts a newsfeed for information on medicines • Acts as a hub for other sources of information – all core resources linked • Updated continually Cons • Work in progress, so some chapters are not yet complete • Some links will only work within LTHT or the NHS

Specialist Resources Update

For quality assured resources, see: • Pharmacy Quicklinks http://pharminfo01/mi_intranet/index.asp

• UKMI free to access resources http://www.ukmi.nhs.uk/filestore/ukmiacg/ResourceswithFreeAccess_Jul13_f inal.doc

Changes and updates:

Pregnancy and Lactation: • Schaeffer is now quite old so after Toxbase, Briggs is the preferred resource for pregnancy queries. The web version may not work with your version of Internet Explorer – use Firefox if this is a problem (on MI computers) • UKMI Trent and West Midlands now jointly run the lactation advisory service – DILAS. Their information is now at www.midlandsmedicines.nhs.uk

Specialist Resources Update

Antimicrobials: • We now have access to the Sanford and John Hopkins guides. Contact MI for access Drug compatibility / stability: • Stabilis ( www.stabilis.org

) free to access – second line resource after Medusa, Trissell etc. French site, so take care – some symbols don’t mean what you think they might Other people’s formularies: • There has been a push to make information more available, so some other specialist hospitals are publishing their formularies online, including http://www.moorfields.nhs.uk/Publicationsandresources/Medicines and http://www.guysandstthomas.nhs.uk/resources/publications/formulary/paedia tric-formulary-9th-edition.pdf

Specialist Resources Update

General resources: • Clinical Knowledge Summaries (CKS – previously Prodigy) are back and being actively maintained. Primary care angle – available via www.evidence.nhs.uk

• Up To Date – www.uptodate.com

– is back. Log in using your Athens details. Will ask you to register again, but feel free to ignore this. Has a useful ‘What’s New’ section Literature searches: • All of Medline is now indexed in Embase – searching Embase using thesaurus will cover Medline content as well.

Resources which are no more: • Meyler’s Side Effects Of Drugs – no additional benefit over Martindale/AHFS

Assessing quality of new resources

Why?

• • • • If you are working as a specialist within an area, you may find your practice is not covered by ‘standard’ resources The problem used to be finding information. The problem now is finding reliable, useful information Any 15 year old can make a professional-looking website There is a huge amount of dubious information out there – search ‘George Eby’ (‘special’ zinc cures the common cold) or ‘Miracle Mineral Solution’ (drink bleach to cure AIDS) as extreme examples

•

Assessing quality of new resources

• • • Has someone else you trust done an assessment already? If not… Is it an appropriate person/organisation providing the information? Relevant qualifications / experience etc Is the information referenced to sensible resources? Is there a publication date and review date? Is the editorial policy clear?

Is the information relevant to your patient group? Does the cohort the resource covers match your patient? If a non-UK product, does their practice match ours, and are the products available in the UK?

We have a more comprehensive assessment tool in MI if required

Useful newsletters and newsfeeds MHRA Drug Safety Update

Important safety alerts on medicines – go to www.mhra.gov.uk

and search ‘drug safety update’ to subscribe

NICE Medicines Awareness

Daily or weekly options for digests of new information on medicines – search ‘NICE Medicines Awareness’ to subscribe

NICE ‘Eyes on Evidence’

Monthly update on new NICE products – subscribe from the same page above