Prescribing Glycopyrronium for anticipatory / palliative care
The Urgent Palliative Care Medicines Service commissioned for NHS Eastern Cheshire CCG, NHS South Cheshire and NHS Vale Royal CCG includes Glycopyrronium bromide 200micrograms/1ml solution for injection ampoules on the formulary, and pharmacies providing this service are expected to maintain 1 pack of 10 ampoules in stock at all times (for details of the pharmacies providing the service see http://www.cpcw.org.uk/wp-content/uploads/sites/19/2018/06/Think-Pharmacy-Urgent-Palliative-Care-Medicine-Service-24052018-1.pdf)
A local community pharmacist has informed us that there are stock shortages of the product at present. Pharmacists who are unable to sources supplies of the Glycopyrronium bromide 200microgams/1ml ampoules have been advised to obtain the Glycopyrronium bromide 600micrograms/3ml solution for injection ampoules as an alternative (and keep a pack of 10 in stock).
Prescribers are therefore advised to:
• Ensure that patients / representatives are aware of whether the script is immediately necessary or anticipatory prescribing.
• If the script is immediately necessary it is important that the prescriber (or a colleague) phones ahead to the pharmacy of the patient’s choice to check what stock is available, and write a prescription for the item in stock. This will save the patient / representative having to visit numerous pharmacies and/or return to the surgery to have a script for one strength of the medicine to be cancelled and another script issued.
• If the script is for anticipatory prescribing, it is important to counsel patients that a pharmacy may need to order in the items, and that it would be acceptable to wait a couple of days for this.
• Write each medicine on a different script / token as this enables the patient / representative get individual items at different pharmacies in the unlikely event that this is necessary.