COVID-19 Clinical Update

Updated: 16/4/2020

Disclaimer: The information contained on this page is provided for reference only and should not be used as a substitute or replacement for diagnosis or treatment recommendations or other clinical decisions or judgment.

COVID-19 Related Drug Information for FDB Multilex Customers

Drug Information:
The Multilex drug database has included for the first time a trial medication being used in the treatment of COVID-19. The information pertaining to remdesivir will be available in the data upload due in early April. There is limited clinical information available at this time and will appear where a Multilex picklist is used. Other products that are being used test and trialled for the treatment of COVID-19 are being reviewed to ensure that the most relevant Clinical Decision Support is available. If there are specific preparations in use to treat COVID-19 patients at your site that are not currently listed, please contact Customer Services as soon as possible and our team will do all they can to help.

Devices:

The Multilex drug database does routinely not contain information pertaining to hospital type medical devices e.g. masks, gloves, tubing unless listing within the assorted primary care drug tariffs of the United Kingdom. Normally in NHS systems these are not part of the medication prescribing process, however, if a Trust feels that being available in this form would assist then requests for such additions of this type will now be considered. Note: This does not extend to devices such as ventilators, continuous positive airway pressure machines. 
Products added in this manner will only be available in systems that allow selection of the individual product (not via groupers such as OrderableMedicine), and when using a Multilex picklist.

SNOMED:

To support the effective management of COVID-19 cases in the UK, FDB has incorporated the recently published new SNOMED concepts into Multilex. This will enable FDB to best support its customers at this critical time, providing up to date information to clinical users in line with the latest international SNOMED updates. The updated standardised dataset will enable accurate recording of the condition within patients’ medical records helping to inform prescribing and patient care during this pandemic.

COVID-19 Related Information for FDB OptimiseRx Customers

OptimiseRx continues to provide your prescribers with trusted content led by national guidance that is up to date, timely and specific to the patient. We believe at this time more than ever, the best practice, safety and quality messages can be a great support to all those working with patients in primary care.

We are constantly reviewing the latest national guidance around COVID-19 and assessing its suitability for OptimiseRx messages.  We are aware of the increased pressure everybody is under and that local processes are being developed or are already in place to support your prescribers and patients.
 
New Best Practice Messages
 
We have authored the national messages below using advice from the Royal College of General Practitioners (RCGP) as a reference source which you can enable if you feel they would be useful in your local area. You can add your own local text and URLs to the messages as required to support workflows you may already have in place locally.

25015—Warfarin preparations: consider prescribing a Direct-acting Oral Anticoagulant (DOAC) for suitable patients (COVID-19 pandemic workload prioritisation) 

The RCGP (March 2020) recommends that consideration should be given to changing suitable patients taking warfarin onto a DOAC as part of workload prioritisation during the COVID-19 pandemic, removing the need for regular INR monitoring.
 
25009—Progestogen-only intrauterine contraceptive devices: consider prescribing a progestogen-only oral contraceptive for suitable patients (COVID-19 pandemic workload prioritisation) 

25010—Progestogen-only contraceptive implants: consider prescribing a progestogen-only oral contraceptive for suitable patients (COVID-19 pandemic workload prioritisation)

25011—Progestogen-only contraceptive depot injections: consider prescribing a progestogen-only oral contraceptive for suitable patients (COVID-19 pandemic workload prioritisation)

The RCGP (March 2020) recommends that consideration should be given to prescribing a progestogen-only oral contraceptive as an interim measure to mitigate the need for checking and changing coils as part of workload prioritisation during the COVID-19 pandemic. Refer to the Faculty of Sexual and Reproductive Healthcare (FSRH) guidance for further information.

Best Practice Message Amendments

We have amended some of our existing messages after the recent publication of NICE COVID-19 rapid guidelines and the new recommendations from the Specialist Pharmacy Service (SPS) on drug monitoring in primary care during COVID-19 pandemic.

Antimicrobial Resistance and Stewardship

5434 - Antibiotics: doxycycline (or amoxicillin if doxycycline unsuitable) recommended for the first-line treatment of community acquired pneumonia in non-pregnant patients aged 18 years and over (COVID-19 rapid guideline)

NICE (NG165, Apr 2020) recommend a 5-day course of doxycycline (or amoxicillin, if doxycycline unsuitable) for the first-line treatment of community acquired pneumonia.
NG165 COVID-19 rapid guideline now supersedes previous NICE pneumonia guidelines during the COVID pandemic recommending doxycycline over amoxicillin.

Monitoring Messages

5282 - Methotrexate: monitor and record full blood counts at least every 3 months (reduce frequency during COVID-19 pandemic workload prioritisation)

5290 - Methotrexate: monitor and record liver function tests at least every 3 months (reduce frequency during COVID-19 pandemic workload prioritisation)


The Specialist Pharmacy Service (SPS, April 2020) recommends that monitoring intervals can be extended by up to every 6 months in stable patients as part of workload prioritisation during the COVID-19 pandemic; patients at higher risk of toxicity are not suitable for blood monitoring extension.

5287 - Lithium: monitor and record lithium levels at least every 6 months (reduce frequency during COVID-19 pandemic workload prioritisation)

9327 - Lithium: monitor and record thyroid function (no evidence of measurement within the previous 6 months) (reduce frequency during COVID-19 pandemic workload prioritisation)

9328 - Lithium: monitor and record serum calcium levels (no evidence of measurement within the previous 6 months) (reduce frequency during COVID-19 pandemic workload prioritisation)

9574 - Lithium: monitor and record lithium levels (no evidence of measurement of lithium levels within the previous 3 months) (reduce frequency during COVID-19 pandemic workload prioritisation)

The Specialist Pharmacy Service (SPS, April 2020) recommends that monitoring intervals can be extended by up to 3 months in stable patients as part of workload prioritisation during the COVID-19 pandemic. Monitoring intervals of patients at higher risk should not be extended and should be continued as per their normal monitoring interval.

5294 - Warfarin: monitor and record INR at least every 3 months (unless self-monitoring) (reduce frequency during COVID-19 pandemic workload prioritisation)

The Specialist Pharmacy Service (SPS, April 2020) recommends that monitoring intervals can be extended by up to 3 months in stable patients as part of workload prioritisation during the COVID-19 pandemic. Monitoring intervals of patients at higher risk should not be extended and should be continued as per their normal monitoring interval.

19466- Sodium valproate and valproic acid preparations: compliance with pregnancy prevention programme required for female patients of childbearing potential (further advice during COVID-19 pandemic)

MHRA guidance (May 2020) on PPP management during the COVID-19 pandemic advises that valproate initiation should take place via face-to face consultations with social distancing, or remote consultation for patients shielding due to health conditions. Annual review should take place via virtual or telephone consultation.