nhs forth valley formulary 11 - Community Pharmacy

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Forth Valley Formulary Eleventh Edition 2012/13Appendix 2NHS FORTH VALLEY PRESCRIBING OF NEW MEDICINEFLOWCHARTThis flowchart outlines the NHS Forth Valley process for the prescribing of newmedicines. This follows guidance from the Scottish Government for the managedintroduction and availability of newly licensed medicines in NHS ScotlandIs this medicine licensed for theindication?YesIs the medicine approved bySMC?NoNoUse Unlicensed Medicine Form(acute services)In Primary Care the use will be atthe discretion of the GP anddocumented in the patient’s notesRefer to IPTR (Individual PatientTreatment Request) policyYesIs the medicine on the localformulary?PrescribeYESNOIs the prescription for a ‘one-off’ use or do you requireto use this medication on a regular basis?‘one-off’regular basisRefer to nonformulary processNew Medicine proforma to becompleted for medicines to beadded to formularyAuthor: Katrina Kilpatrick / Christine RussellPage 50
Forth Valley Formulary Eleventh Edition 2012/13Appendix 2FORTH VALLEY ACUTE HOSPITALSPHARMACY SERVICESREQUEST FOR A NON-FORMULARY DRUGWS-S-712IssueDate:May11ReviewDate:May 2013This form should be completed by the PRESCRIBER for initiation of a non-formulary drug if the drugis prescribed for this patient for the first time in this hospital.The form should then be forwarded to the responsible CONSULTANT for counter signature.The completed form should then be returned to the clinical ward pharmacist who will retain thedocument in the pharmacy department.These forms will be monitored and audited on a regular basis.Part A: Patient DetailsPatient Name/Details:Reason for admission:Consultant:Ward:Clinical pharmacist:Name(generic and proprietary):Part B : Drug DetailsForm: Strength: Dose:Indication:No equivalent Drug:Part C : Reason Formulary Product is not suitableNo equivalent Form of Administration:MoreEffective:Less Side Effects, Specifically………………….Other:Prescriber (printed):………………………………….Signature:………………………………Date:………………….Consultant (printed):………………………………….Signature:………………………………Date:………………….Part D: Pharmacy UsePrice (include VAT) - per packsize:- per daily doseComment:Clinical Pharmacist (printed):Signature:Page 51
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