RESPONSIBILITIES and ROLES. Specialist responsibilities
RESPONSIBILITIES and ROLES. Specialist responsibilities Diagnosis and initiation of azathioprine treatment, ensuring that there are no interactions with current therapy or disease states. Discuss the benefits and side effects of treatment with the patient/carer, including providing the patient with information leaflets and a monitoring record book if required. If appropriate, patients should be advised about the impact of treatment on fertility, pregnancy and breastfeeding. Men planning to conceive should also receive appropriate counselling. Undertake baseline tests including weight, blood pressure, ALT (or AST), eGFR, CRP, chest X-ray and TMPT levels) prior to starting therapy. Advise patient to be vaccinated against pneumococcus and influenza infection (via GP). Notify the patients GP that treatment has started and inform results of baseline tests. Prescribe azathioprine until a stable dose is reached and blood tests are stable for three months. Contact the GP to ask whether he or she is willing to participate in shared care (once the patient is stable). Shared care can only commence when GP written consent has been received Discuss the shared care arrangement with the patient so that the patient/carer is clear what needs to be monitored and when. Where applicable advise patient treatment is off-label Dose stabilisation: initial dosage adjustment until stable. Thereafter, during maintenance treatment, advice to the GP on any further dose adjustments required. If dose and bloods are stable for 3 months the GP, if agreeable, can monitor the patient as below Periodically review the patient’s condition and communicate promptly with the GP when treatment is changed. Have a mechanism in place to receive rapid referral of a patient from the GP in the event of deteriorating clinical condition. Advise the GP on stopping treatment (if appropriate). Report serious adverse events to the MHRA and GP Ensure that clear backup arrangements exist for GPs to obtain advice and support. General Practitioner responsibilities Reply to the request for shared care as soon as practicable. File copy in patient’s record and add shared care – specialist/GP read code 66S2 or XaK6z depending on GP clinical system. Ensure compatibility with other concomitant medication and prescribe azathioprine at the dose recommended. Once patient is stable and shared care has been agreed, monitor patient as below. Adjust the dose as advised by the specialist. Report to and seek advice from the specialist on any aspect of pat...
RESPONSIBILITIES and ROLES. A. Roles of NRCS
RESPONSIBILITIES and ROLES. Consultant / Specialist responsibilities
RESPONSIBILITIES and ROLES. Pharmacy undertakes to:
RESPONSIBILITIES and ROLES. 1 Initially prescribe and stabilise the patient on the treatment regimen and monitor transplant graft function.
RESPONSIBILITIES and ROLES. Specialist responsibilities 1 Discuss and supply appropriate information on Lithium treatment with the patient and carer for informed medication choice. 2 Arrange for baseline monitoring including weight, BP, renal and thyroid function, calcium levels and an ECG, where clinically indicated. 3 Treatment is then initiated with monitoring for side effects. Arrangement is made to issue a lithium booklet. Adverse events or side effects must be managed as per North Staffordshire Combined Healthcare’s protocol and report all adverse effects to MHRA. 4 Obtain consent with patient and/or carer for shared care arrangements with own GP, subject to patients own GP’s agreement. 5 Review dose titration, monitoring lithium levels (sample taken 12 hours post dose) at every dose change and at a minimum of three monthly intervals if there is no change in dose. 6 Continue with lithium prescribing responsibilities for a minimum of two weeks to overlap transfer arrangement. 7 Monitor plasma lithium level in accordance with the range agreed (sample taken 12hours post dose) at maximum of three monthly intervals if there is no change in dose or when doses change. Communicate results to GP promptly. 8 Arrange as a minimum for six monthly renal and thyroid function as suggested by NICE guidelines and annually check calcium levels. Communicate results to GP. 9 Agree on the frequency of medication reviews with the GP based on treatment plan and CPA strategy developed for individual service user. 10 Communicate promptly on all results, any treatment events including all risk assessments to the GP. GPs can access results via pathology system Written by (clinician): Written by (pharmacist): Date of issue: Approved by North Staffordshire Area Prescribing Committee (date): Review Date: Version number: General Practitioner responsibilities 1 Reply to the request for shared care as soon as practicable. 2 Maintain lithium prescribing as agreed with specialist team. 3 Ensure patients are aware of their blood testing requirements and results are communicated to the patient verbally and through the lithium booklet. 4 Communicate results to dispensing pharmacist to enable prompt lithium dispensing either via medication monitoring clinic letter or the lithium booklet. 5 Ensure results are checked and any abnormalities acted upon in liaison with the specialist team. 6 Consult for advice and report any concern that may affect treatment to the specialist team promptly. 7 Refer patient to the special...
RESPONSIBILITIES and ROLES. Specialist responsibilities Initiation 1 Perform initial baseline tests. These include FBC, LFT’s, U&E’s, creatinine clearance, lipids and BP.
RESPONSIBILITIES and ROLES. A. UHB Consultant/Specialist (Secondary Care Specialist) To confirm the diagnosis of osteoporosis. To assess the suitability of the patient for denosumab injection. To discuss the benefits and side effects of treatment with the patient including the risk of osteonecrosis of the jaw, cellulitis and atypical femoral fracture. To assess the patient to ensure that he/she has a good oral hygiene and advice patient of the need for dental examination prior to initiating therapy and the importance of undergoing regular dental check-up. Urgent treatment should not be delayed, however, a dental check-up should be advised and carried out as soon as possible (MHRA, 2014) To advise the clinical nurse specialist (CNS) of patient requiring denosumab treatment as per the Trust guidelines. To prescribe and administer the first two doses of denosumab if CNS is not a qualified prescriber. Issue to the patient “My Bone Passport”, ensure it is updated and explain the purpose of the passport. To ensure that patient is supplemented with Calcium and/or Vitamin D if required. To advise patient to stop other osteoporosis treatment (e.g. alendronate, risedronate, ibandronate, strontium) except Calcium and/or Vitamin D supplements (if indicated). To send GP a summary of out-patient review or in-patient stay within 10 days, and instructions provided to the patient. To review patient as agreed and whenever required as requested by the primary care physician. To ensure that arrangements are in place for GPs to obtain advice and support where needed. To report any adverse events to the MHRA.
RESPONSIBILITIES and ROLES. Specialist responsibilities 1 The Specialist (e.g. Rheumatologist, Care of the Elderly Physician or Osteoporosis Nurse) will discuss the benefits and side effects of treatment with the patient/carer/guardian and provide written information e.g.product information leaflet for Prolia®, ensure appropriate investigations have been obtained and agree that denosumab is the appropriate therapy for the patients’ condition.
