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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

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

We have had a large number of queries about COVID-19 and medicines use. There are also a large number of resources published nationally to support and advise on issues around prescribing. This page aims to bring all these resources together. Where available we will link to national guidance and websites so that it reflects the most up to date information, if and when things change.

Practices are reminded to follow guidance which has been sent out regarding issue of prescription quantity and duration. Stockpiling will exacerbate pressures on prescribed medicine stocks and may create shortages. The current advice is for patients to continue ordering prescriptions as usual (via phone or on-line), maintaining current prescription length.

NHS England coronavirus advice page is available here

NHSE are hosting speciality guides - available here

NICE rapid guidelines and evidence reviews are hosted here

PressPortal - See Covid-19 information on the PressPortal here

RCGP Guidance on workload prioritisation during COVID-19 can be found here (For further information on the warfarin to DOACs switch see under 'Cardiovascular System' also see ‘Nutrition & Blood ‘section for advice on Vitamin B12 below)

Some general evidence reviews available here, these are not national recommendations but may help in the management of individual patients https://www.cebm.net/oxford-covid-19/

RCGP's COVID-19 e-learning resource hub

SPS COVID-19 resources here. They have produced a general principles document around blood monitoring and a number of individuals ones for high risk medicines.

Community pharmacy

If needed, the following pharmacies have been commissioned to hold stocks of palliative care medicines - Palliative Care Pharmacies

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;

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.

NHSE/NHSI/DHSC - Coronavirus (COVID-19) - Re-use of medicines in a care home or hospice: This is a national SOP to support the re-use of medicines during the COVID-19 pandemic, in the event of a medicines shortage please contact the Medicines Optimisation Team if you are considering the re-use of medicines.

Cardiovascular System

ACEi / ARBs – Position statements have been released from the European Society of Cardiology, British Cardiovascular Society, British Society for Heart Failure and the Renal Association highlighting that there is no evidence to support an increased risk to patients taking ACEi or ARB. It is strongly recommended that all patients on these medications for systemic hypertension, heart failure, post-myocardial infarction or for those with diabetes and diabetic nephropathy should continue on their therapy.

Anticoagulation
- NHS England/Improvement Clinical guide for the management of anticoagulant services during the coronavirus pandemic 31 March 2020 Version 1; updated February 2021
- **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)

Respiratory

*COVID-19 and respiratory illness (asthma and COPD) - current knowledge and advice as at 7 May 2020 here

*Advice on shielding for respiratory Patients during COVID-19 outbreak - advice as at 23 April 2020 here

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

Community sexual & reproductive health services - Sexual Health Sheffield are scaling back the community sexual & reproductive health services they provide in order to protect those aspects of the service considered critical, such as emergency contraception. Please see their webpage for up-to-date details.

Sexual health bulletin: COVID edition: PCS has compiled a newsletter of resources to support clinicians managing sexual and reproductive health during COVID-19. The current edition (07/05/20) is here. These resources have not been through the APG approval process and where treatments are recommended, prescribers are requested to prescribe in line with Sheffield Formulary, wherever possible.

Corticosteroids, replacement therapy The Society for Endocrinology have developed a template letter for patients who are on long term steroids and includes advice about steroid management during a coronavirus infection.
See: Pituitary and Adrenal Insufficiency/ Letter Template updated advice for AI patients.
Denosumab - The Royal Osteoporosis Society have developed practical advice around administration and monitoring of denosumab.

Diabetes - The Primary Care Diabetes Society have published an at-a-glance fact sheet for primary care with some important and useful information for primary care HCPs – including information around prescribing. Please balance the recommendation that people have adequate supplies of medication with the risk of putting pressure on supply chains.
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.
LARCs - The Faculty of Sexual and Reproductive Healthcare (FSRH) have developed a webpage where they aim to share the most up to date information to help with questions about SRH delivery during the Covid-19 outbreak.

National Diabetes Prevention Programme – Covid-19 Update here

Testosterone injection - guidance for the administration and monitoring of testosterone injections during COVID-19 for androgen deficiency in adults

Musculoskeletal & Joint Diseases

SPS provides a useful resource to aid assessment if considering a delay in blood monitoring of DMARDS in stable patients– see link

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

Denosumab - The Royal Osteoporosis Society have developed practical advice around administration and monitoring of denosumab.

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

Dermatology

SPS provides a useful resource to aid assessment if considering a delay in blood monitoring of DMARDs in stable patients– see link

To determine the level of risk to dermatology patients of COVID-19 and advice on what precautions to take - see link

Nutrition

See the British Dietetic Association's advice re: COVID-19 and diet here
Vitamin B12: The British Society of Haematology have produced advice around vitamin B12 supplements during the COVID pandemic here (updated 06.05.20)

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)