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URGENT Levomepromazine 25mg/ml injection supply issue – information for Primary Care

Overview of Supply

• Sanofi informed NHS England and DHSC on 5th April 2019 that they are going out of stock this week of levomepromazine 25mg/ml injection and new stock is expected to be available from the end of April.
• The supply issue is due to a quality deviation experienced at their Italian factory and is not linked to EU exit.
• The only other UK supplier, Wockhardt, have informed us that due to the unexpected increase in demand, they will also go out of stock of levomepromazine injection and their next delivery has been delayed with further stock expected at the end of April.
• Wockhardt have confirmed the remaining levomepromazine 25mg/mL injection stock which is held at Alliance will be ring-fenced for primary care use only. Stock at Alliance is limited and will not last until the end of April.
• Existing stocks are likely to be exhausted by end of this week and no new supplies are expected until end of April.
• GPs, palliative care networks and community pharmacies should consider the following advice and work together during this period to ensure patients can be managed appropriately.

Alternative agents

• UK Medicines Information with support of national clinical specialists have developed the following clinical information to help support the management of patients  who may be affected by this issue.
• Please click here to view this guidance.
• All the suppliers of the following medicines have  been made aware of this supply issue and have confirmed they can support an increase in demand should this be required.

• Haloperidol 5mg/1ml solution for injection ampoules (DrugsRUs)
• Midazolam 10mg/2ml solution for injection ampoules (Hameln, Accord, Roche)
• Cyclizine 50mg/ml solution for injection ampoules (Advanz)
• Metoclopramide 10mg/2ml solution for injection ampoules (Hameln, Ennogen)

Management Plan – GPs, Palliative Care Networks and Community Pharmacies to review and action immediately

1. During the period of shortage, new patients should only be started on levomepromazine if other treatment options have been exhausted. This is to try to avoid disrupting existing treatment regimens where possible whilst acknowledging that for some new patients levomepromazine may be the only option available.
2. Community pharmacies who require stock for existing patients should order Wockhardt stock from Alliance.
3. Community pharmacies having difficulty obtaining stock should contact their local secondary care trusts as they have been asked to support primary care and hospices where possible, to understand if they have stock that can be made available to allow the continuation of treatment in existing patients.
4. Some specialist importers have identified stock they can bring into the UK. Lead times vary between 7-21 days. If community pharmacies are considering ordering unlicensed imports, the community pharmacist will need to inform the prescribing doctor the product being supplied to the patients is an unlicensed product. Please consider placing orders now for 1-2 weeks of stock based on forecasted demand. We are currently aware that Clinigen, Waymade, Alium and Mawdsleys have sourced unlicensed supplies from abroad.
5. Community pharmacies unable to obtain levomepromazine injection should liaise with the prescriber to discuss using an alternative product as outlined in the memo above.

British Liver Trust have a new publication called Thinking ahead: Planning for your future when you have advanced liver disease.

The aim of the publication, which was produced in collaboration with the UK’s leading experts in supportive and palliative care, is to raise awareness of the support services available to those living with advanced liver disease, and advise on how to access them.   There is a perception that palliative care particularly is available only in the last weeks or days of life, while in fact it may be accessed at any stage of a life-limiting illness to help with symptom management and / or the planning of future care.

The publication would be of interest to those living with advanced liver disease or caring for someone with advanced liver disease – click here for more information.

This year our Annual National Conference will be held at Kents Hill Park, Training and Conference Centre Milton Keynes on the 19-20 September 2019.

The title for this year’s conference is ‘Back to the Future: Respecting the Fundamentals’.  The focus will be on developing, benchmarking and sustaining hospice at home services into the future and promoting ways of managing staff and organisational resilience.  This should help us to further influence commissioning agendas.

We have an exciting conference programme planned and the call for posters.  When open please do submit an abstract and remember to secure your Early Bird Member rate at the conference.  This rate is an added benefit of your membership renewal and enables us to give you a highly competitive rate for a residential event.

HCA Workshop 2019 – Sharing Best Practice

The NAHH are delighted to be running the HCA Workshops in 2019.  The programme “Sharing Best Practice; Caring for People at Home who are approaching the End of their Lives” an Interactive study day for Health Care Assistants

Click here to find out more and to register

The NAHH have set up a New advertising page on the website.

Click here find out what is new and to see our advertising costs.

Together for Short Lives has launched a ground-breaking new funding programme to help address the cliff edge in care experienced by young adults in their transition from children’s to adult services. The programme is funding innovative projects that have the potential to transform the experience of young people with life-limiting conditions as they prepare for and move on to adult services.

Applications for Round Two of the Improving Transitions for Young People Fund will open in March 2018. The Together for Short Lives website will be updated with more details when they are available: http://www.togetherforshortlives.org.uk/transitionawards

The NAHH have sent a succinct report to NICE regarding End of Life Care services which includes citing several examples provided by member services in the last 12 months.

The report is available to download here

The NAHH thanks contributors and welcome any further responses and is aware that some member services will have submitted more detailed evidence on behalf of your Hospice at Home service through their organisation.

The NAHH Trustees are delighted to share the news that a recent article written by Kay Greene and Lesley Spencer, has been published in the European Journal of Palliative Care (EJPC). The article outlines the NAHH strategy and explains who the NAHH is and what our Association’s goals are.

The article can be downloaded here -> 

This document is held under copyright by Hayward Group Ltd, publisher of the European Journal of Palliative Care. It may be downloaded for single academic use only. Reproduction for any other purpose is not allowed. For further information, please contact the editorial team by clicking here.

A new role that will sit alongside existing nursing care support workers and fully-qualified registered nurses to deliver hands-on care moved a step closer today as Health Education England (HEE) published the response to its recent consultation on the Nursing Associate role.

The consultation attracted more than 1,000 responses from individuals including patients, members of the public and a wide range of organisations including professional bodies, trade unions, health care and social care providers and commissioners of healthcare. The role will be given the title Nursing Associate. In order to get the implementation of the Nursing Associate role right, HEE intends to appoint ‘test sites’. Five workshops will take place in England in July so that HEE can engage with stakeholders on the scope of practice of the new role. Early test sites will recruit 1,000 students to start training for the new role in 2017.

To view the response to the consultation, visit https://hee.nhs.uk/our-work/developing-our-workforce/nursing/new-support-role-nursing

Join Lisa Bayliss-Pratt, HEE’s Nursing Director, for a Twitter chat on the @WeNurses platform on Tuesday 7 June (8-9pm) to debate areas of the consultation and ask questions.

Barbara A. Jack, Tracy K. Mitchell, Louise C. Cope & Mary R. O’Brien have written this interesting article entitled:

“ Supporting older people with cancer and life-limiting conditions dying at home: a qualitative study of patient and family caregiver experiences of Hospice at Home care ”

Download the document below:

Jack et al 2016 – Journal of Advanced Nursing