COVID-19

COVID-19 virus and medicines

COVID-19 vaccination

• Model NHS COVID-19 Primary Care vaccine handling and management policy 2020-21 - Review December 2021 

Information on COVID-19 vaccines is changing as the vaccination programme develops. Please use the links below to ensure the most up-to-date guidance is accessed and followed.

NHS England NHS Improvement Covid-19 vaccination programme

• Primary care guidance

NHS England NHS Improvement Legal mechanisms

• Summaries of the legal mechanisms for administering the COVID-19 vaccines
• National Protocols for COVID-19 vaccines
• Accountability and delegation under the national protocols for COVID-19 vaccines
• Patient Group Directions (PGDs) for COVID-19 vaccines

Specialist Pharmacy Services (SPS) COVID-19 vaccines

SPS has produced information and guidance on pharmaceutical aspects of COVID-19 vaccines use, including standard operating procedures (SOPs).

• General information and guidance common to all vaccines
• Information and guidance specific to COVID-19 vaccine Pfizer-BioNTech
• Information and guidance specific to COVID-19 vaccine AstraZeneca
• Information and guidance specific to COVID-19 vaccine Moderna

Training

eLearning can be accessed from your ESR or via e-Learning for Health (e-LfH);

Resources to support medicines optimisation during COVID-19 

This section is under review

NHS England coronavirus advice page is available here

NICE guidelines and evidence reviews are hosted here

RCGP's COVID-19 e-learning resource hub​

eRD

Please see link for some hints and tips on EPS & RD produced by Sheffield CCG. This provides some suggestions on patients who may be suitable for RD. 

How to guides;

• ​​Setting up eRD using maximum issues - SystmOne
• Setting up eRD using review dates - SystmOne 

Drug/condition specific national/local advice;

*Due to the speed of trying to get advice to local clinicians, these documents have not been through APG, but all are based on local expertise / national advice.

Those annotated with ** have been approved during the COVID-19 pandemic under delegated authority and when the pandemic is over they will be reviewed and potentially stood down.

Acute Kidney Injury (AKI)

• Primary care resources on AKI are on the ‘Think Kidneys’ website. Links to key documents regarding medications:
  • Sick day guidance: position statement (Jan 2020) 
  • Quick guide to problematic drugs and actions to take (Note also see below for sick day rules around diabetes)
  • ACEI/ARB use and COVID-19 (includes algorithm of suggested management of patients)

Palliative Care

See link for End of Life Care resources to support practices

General principles:

For all patients who are dying in the community;

• Continue with usual palliative care practice including advanced care planning
• Use the Sheffield palliative care formulary.  
• Complete the pink card as usual. Community nurses can now take verbal instructions to amend (SOP in place)
• Saf-T-Intima Lines can now be used for PRN sub cut meds

For those at end of life with COVID-19 (suspected or confirmed)

For symptoms caused by COVID or suspected COVID, national guidance is available here:

• Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic (RCGP) includes symptom management flow charts for the relief of  common symptoms that may arise because of an infection with COVID-19, including how they should be managed if the patient is dying. The RCGP guidance is a live document and will be updated with relevant information on the RCGP COVID resource hub.  

• NICE NG191 Covid-19 rapid guideline: managing COVID-19

Prescribing smaller quantities of anticipatory medicines

When prescribing anticipatory medicines at the end of life, take into account any medicines shortages or lack of administration equipment/staffing, prescribing of smaller quantities may be appropriate. 

If your local pharmacy does not have EOL medicines in stock the following pharmacies have been commissioned to keep the following medicines in stock.

Cardiovascular System

• Anticoagulation
  
  • **Self-testing of INR during COVID-19 Pandemic 2020
  • MHRA - Warfarin and other anticoagulants: monitoring of patients during the COVID-19 pandemic (Drug Safety Update 22/10/20)
    

Central Nervous System

• Substance Misuse - SHSC have just agreed the Interim guidelines for managing continuity of care for patients in Sheffield Treatment & Recovery Team (START) & Community Pharmacists.  This includes details of managing patients who are self-isolating. 

• Mental Health - monitoring lithium during the COVID-19 pandemic

Infections

Refer to NICE NG191 COVID-19 rapid guideline: managing COVID-19

 Endocrine

• The London Clinical Networks have produced crib sheets around sick days rules​, see links;

  • Sick day rules crib sheet – Type 1 MDI   Updated 06.04.20
  • Sick day rules crib sheet – Type 1 Pump  Updated 06.04.20
  • Sick day rules crib sheet  – Type 2  Updated 06.04.20

• Primary Care Diabetes Society (PCDS) Quick Guide: Undertaking a remote diabetes review.  This quick reference guide provides the essential information and resources on conducting a safe and effective remote diabetes review; helping healthcare professionals to continue provide high quality care during coronovirus restrictions.

• National Diabetes Prevention Programme – Covid-19 Update here

Musculoskeletal & Joint Diseases

• NSAIDS - see link to CAS alert here - (advice around the use of NSAIDs updated 15.04.20)

• The British Society for Rheumatology and other partners have published Management of patients with musculoskeletal and rheumatic conditions who are on corticosteroids, require initiation of oral/IV corticosteroids or a corticosteroid injection

 Nutrition

• Vitamin D:
  • NICE COVID-19 rapid guideline: vitamin D (NG187) (17.12.20)
  • SACN Update of rapid review: Vitamin D and acute respiratory tract infections (December 2020) 
  • DHSC Vitamin D guidance for clinically extremely vulnerable adults (15.01.21) 
  • DHSC Vitamin D guidance for care homes (15.01.21) 

 

Medicines for use in the treatment or prevention of COVID-19

NICE NG191 Covid-19 rapid guideline: managing COVID-19                                                                                        NICE are monitoring the evidence and updating the guideline as new information emerges

     Covid-19 primary care prescribing briefing: NICE NG191 Covid-19 rapid guideline: managing COVID-19

For all NICE products on Covid-19, including guidance and advice see  here.

NHSE COVID-19 community-based treatments (nMABs and antivirals)

CAS alert Neutralising monoclonal antibodies (nMABs) or antiviralsfor non-hospitalised patients with COVID-19      (updated 27 Jan 2022)