Clinical Guidelines

Prescribing guidelines and recommendations are approved and ratified by the Joint Area Prescribing Committee.

Members include primary and secondary care clinicians, representatives from commissioner and provider organisations and other stakeholders, working together to develop a consistent health community approach to medicines management.

This committee has a wide remit around formulary management and clinical guidelines, but also considers the implementation of NICE guidance and manages the introduction of medicines and some prescribable medical devices across a health economy.

The Derbyshire JAPC have developed an abridged version of the most commonly prescribed formulary medicines in primary care:

• Preferred Choices Formulary Joint Area Prescribing Committee

BNF Chapters & prescribing guidelines

In this section you will find the full formulary and prescribing guidelines relevant to the BNF Chapters.

End of Life Pathway - Derbyshire Alliance for End of Life Care

Deprescribing

SPS - Taking a person-centred approach to managing polypharmacy

Improving Medicines & Polypharmacy Appropriateness Clinical Tool (IMPACT) - PrescQipp

Medication and falls - PrescQIPP

Medicines and Falls - National Falls Prevention Coordination Group

Polypharmacy guidance - Further resources to support deprescribing

Resources for medicine queries

Over the counter, Opiate based medication and Benzodiazepine position statement - Derbyshire Recovery Partnership

SPS/UKMi Drug Monitoring in Adults in Primary Care (See shared care agreements or local guidance where relevant)

SPS Medicines Supply Tool (require sign in)

Self care / Items which should not be routinely prescribed across Derbyshire now has its own section under Clinical Guidelines 

• Creatinine clearance (CrCl) should be calculated using the Cockcroft-Gault formula (see below) to determine dosage adjustments for:
         - direct-acting oral anticoagulants (DOACs)
         - patients taking nephrotoxic drugs (e.g. vancomycin and amphotericin B)
         - elderly patients (ages 75 years and older)
         - patients at extremes of muscle mass (BMI <18kg/m2 or >40kg/m2)
         - patients taking medicines that are largely renally excreted and have a narrow therapeutic index e.g. digoxin and sotalol
• When dose adjustments based on CrCl is important and no advice is provided in the relevant BNF monograph, consult the Summary of Product Characteristics
• Reassess renal function and drug dosing in situations where eGFR and/or CrCL change rapidly e.g. acute kidney injury (AKI)