COVID-19 Updates

For the latest updates and advice on coronavirus (COVID-19), please visit the NHS website.

This page provides a summary of Formulary updates specific to the COVID-19 pandemic.

For Clinical Referral Guideline (CRG) updates specific to the COVID-19 pandemic, please click here. The NHS Devon CCG Medicines Optimisation Team have produced a COVID-19 Information and Guidance page, which features a frequently asked questions section, please click here.

Shared Care / SMS drug safety monitoring during the COVID-19 pandemic

In order to minimise the need for patients to attend NHS facilities for face-to-face contact, the frequency of drug safety monitoring has been temporarily extended in certain clinical circumstances. Thresholds for action remain unchanged.

The guidelines for each drug have been amended, showing clearly in a blue font in the monitoring section of each guideline the changes introduced to apply during the COVID-19 pandemic.

A very brief summary of changes can be found by clicking here. Prescribers should refer to the relevant individual guidelines for details, these can be found on the NHS Devon CCG website and via the relevant drug entries in the formulary.

Template letters are available to support practices in writing to their patients who are affected by these temporary changes to advise them of the revised monitoring arrangements and what this means for them. These can be found by clicking here.

Please note: These recommendations only apply to patients being treated in accordance with the Devon Specialised Medicines Service/ shared care guidelines; they do not apply to other clinical situations e.g. transplant patients or ad hoc individual arrangements between GPs and specialists – Prescribers should seek specialist advice for these patients.

***UPDATE 29/05/2020*** The incidence of patients in Devon infected with COVID-19 in the first surge has been much less than was initially feared. Given the current relatively low prevalence of COVID-19 in Devon and the uncertainty about how the situation will change over the next few months, practices may wish to consider conducting some of the deferred monitoring tests now. It is recognised that practices will have responded to the original guidance differently and that individual circumstances vary. Not all practices will be in a position to undertake additional monitoring at this time. Further information and a template patient letter can be found by clicking here.

End of life symptom control for patients dying of COVID-19

National guidance: Guidance has been issued for end of life symptom control for when a patient is dying of infection with COVID-19, please see here.

Prescribing for end of life symptom control: Local prescribing guidance and prescribing and medication administration records (PMAR) have been developed to support patients with COVID-19 infection who require end of life symptom control, please see here.

Prescribing information for symptom management via syringe driver: Local concise prescribing guidance has been produced to support practitioners in the care of patients in the community who require medicines for symptom management of COVID-19 via syringe drivers as they approach the end of life. Please see here.

End of life care resource for GPs: A resource page for GPs providing guidance for end of life care of patients with COVID-19 is available here. The page includes symptom management and links to the formulary palliative care section 16.17 End of life symptom control for patients dying of COVID-19 where the national and local guidance shown above is also available. Other topics covered include: the conversation, treatment escalation plans/do not resuscitate orders, care at the time of death, bereavement advice and support, care for carers and care for yourself.

Supply of medication for palliative care: please see here for a list of community pharmacies in Devon which maintain a minimum level of stock of more specialised medicines, including injectable medicines most likely to be used in the management of patients with COVID-19.

Managing pneumonia in the community during the COVID-19 pandemic

NICE has issued a COVID-19 rapid guideline (NG165): managing suspected or confirmed pneumonia in adults in the community (03 April 2020). The previous recommendations for severity assessment and management of community-acquired pneumonia have been revised for use during the COVID-19 pandemic. The antibiotics recommended in this guideline differ from the previous recommendations for treatment of community-acquired pneumonia. This decision was taken for clinical reasons and to support the supply chain. Points covered by the new guideline include:

  • Diagnosis and assessment
  • Differentiating viral COVID-19 pneumonia from bacterial pneumonia
  • Deciding about hospital admission
  • New antibiotic recommendations – doxycycline has become the first line agent (see full guideline for details)

NICE will review and update their guidance as knowledge and practice develops. Please remember to ensure you are using the current guidance.

Antibiotic treatment of pneumonia for adults in hospital during the COVID-19 pandemic

NICE has issued a COVID-19 rapid guideline (NG173): antibiotics for pneumonia for adults in hospital (01 May 2020). The guideline includes patients presenting to hospital with community-acquired pneumonia and patients who develop pneumonia in hospital. Please also refer to your local acute trust's antibiotic guidelines.

Management of anticoagulation during the COVID-19 pandemic

Guidance has been issued from NHS England regarding the management of anticoagulant services during the COVID-19 pandemic, please see here.

Treatment of patients requiring Vitamin B12 during the COVID-19 pandemic

The British Society of Haematology (BSH) has issued advice on the management of patients requiring vitamin B12 supplements during the COVID-19 pandemic. This guidance covers patients who receive vitamin B12 for diet-related conditions and for conditions which are not thought to be diet-related (e.g. pernicious anaemia, history of total/partial gastrectomy or achlorhydria, inflammatory bowel diseases).

In patients who have vitamin B12 deficiency which is not thought to be diet-related and who have received regular maintenance parenteral vitamin B12, liver stores of vitamin B12 will be adequate to allow for the omission of one or two three monthly injections to minimise the risk of transmission of COVID-19 from face to face interaction with a healthcare professional. See the guidance for advice for managing patients with symptoms in the weeks preceding the injection.

If a patient is intending to attend a healthcare facility for a vitamin B12 injection, they should be informed of the increase in risk of transmission of COVID-19.

Contraception guidance during the COVID-19 pandemic

Guidance has been issued from the Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists regarding contraception during the COVID-19 pandemic, please see here.

Rheumatological autoimmune, inflammatory and metabolic bone disorders during the COVID-19 pandemic

NICE has issued a COVID-19 rapid guideline (NG167): rheumatological autoimmune, inflammatory and metabolic bone disorders (03 April 2020). The following has been highlighted in the formulary to aid prescribers with patients having treatment with denosumab and zoledronic acid:

  • Do not postpone treatment with denosumab
  • Treatment with zoledronic acid can be postponed for up to 6 months

Advice for GPs regarding patients presenting in alcohol or opiate withdrawal to general practice during the COVID-19 pandemic

Issued by the Together Drugs and Alcohol Service: Exeter, East and Mid Devon, North Devon and South Devon ( not Torbay)

The Together Drugs and Alcohol Service has issued advice for GPs who may be contacted by patients presenting in opiate or alcohol withdrawal during the COVID-19 pandemic. This advice can be found here. The prescribers at Together are continuing to assess and start new patients onto opioid substitution therapy; referral is via phone, email or letter (see contact details). Guidance is provided on adjunctive treatment and symptomatic relief for patients withdrawing from opiates.

GPs should not initiate a medically assisted withdrawal from alcohol. Guidance is provided for GPs who are contacted by patients for advice regarding alcohol detoxification. For urgent medical advice, see contact details.

Valproate Pregnancy Prevention Programme: temporary advice for management during the COVID-19 pandemic

The MHRA has issued temporary guidance for specialists for initiation of valproate in female patients, and for annual review and pregnancy testing to support adherence to pregnancy prevention requirements during the pandemic. Annual reviews should not be delayed. Please see here

Advice regarding the prevention and treatment of skin damage beneath personal protective equipment (PPE) during the COVID-19 pandemic

Specific information regarding the Prevention and Treatment Protocol for Mask Associated Dermatitis (MAD) and Skin Damage beneath PPE (from Royal Devon and Exeter NHS Foundation Trust) during the Coronavirus (COVID-19) pandemic can be found here (RD&E Intranet)

For further support or advice please contact:

  • Royal Devon and Exeter NHS Foundation Trust
    • Infection Prevention and Control – 01392 402355

Routine immunisation programmes during the COVID-19 pandemic

Specific information regarding maintaining immunisation programmes (from NHS England (NHSE)) during the Coronavirus (COVID-19) pandemic can be found here.

Where possible, the routine immunisation programmes should be maintained and offered in a timely manner and non-scheduled vaccinations should still be given. Anyone with an appointment cancelled as part of COVID-19 response should be invited for vaccination as soon as possible.

Information contained in the document includes:

  • What personal protective equipment (PPE) should be worn when administering vaccines
  • Ordering vaccines during the COVID-19 pandemic
  • NHS Immunisations FAQs (for the public)

Routine access to remdesivir in the treatment of COVID-19

From 3rd July 2020, an interim clinical commissioning policy has been put in place to define routine access to remdesivir in the treatment of COVID-19 across the UK.

Remdesivir is recommended to be available as a treatment option for patients hospitalised with COVID-19 (adults and children aged 12 years and older) in accordance with the criteria set out in the policy document (July 2020) (see interim clinical commissioning policy for more details)

Updated guidance for the management of musculoskeletal and rheumatic conditions with corticosteroids during the COVID-19 pandemic

For guidance which covers the management of patients with musculoskeletal and rheumatic conditions who are receiving corticosteroids, or require initiation of oral or intravenous corticosteroids, or require a corticosteroid injection during the pandemic, please click here.

The guidance is supported by the British Society of Rheumatology, the Royal College of General Practitioners and other professional bodies. It supersedes guidance issued by NHS England at an earlier stage in the pandemic. The guidance covers:

  • Maximum daily doses of prednisolone for a range of indications
  • Intramuscular injections, intra-articular injections for inflammation, and injections for musculoskeletal pain
  • Factors to consider in deciding whether to use an injectable corticosteroid during the pandemic
Last updated: 20-07-2020


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