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.

BNF Chapter Appendices

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
Polypharmacy guidance - Further resources to support deprescribing

Renal Resources

CKD detailing aid
Think Kidneys Resources for Primary Care
Medicines and Your Kidneys Patient Information Leaflet - follow the link to the Patient Information section

Prescribing medicines in renal impairment (MHRA October 2019)

For most drugs and for most adult patients of average build and height, estimated Glomerular Filtration Rate (eGFR) should be used to determine dosage adjustments

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)

Resources for medicine queries

Over the counter, Opiate based medication and Benzodiazepine position statement - Derbyshire Recovery Partnership
Resources to support answering medicines-related questions in primary care - NHS Specialist Pharmacy Service
MIMS drug shortages tracker
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