Drugs used in megaloblastic anaemias (Formulary) | Right Decisions

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Anaemias and some other blood disorders
Drugs used in megaloblastic anaemias (Formulary)

Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26^th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

2.National IV fluid prescribing calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

HYDROXOCOBALAMIN

Important: Therapy notes

MHRA advice: Vitamin B12 (hydroxocobalamin, cyanocobalamin): advise patients with known cobalt allergy to be vigilant for sensitivity reactions (December 2023) (www.gov.uk).

Important: Formulation and dosage details

Formulation:

Injection 1mg/mL

Dosage:

By intramuscular injection: pernicious anaemia and other irreversible causes of B₁₂ deficiency, initially 1mg, up to 3 times a week for 2 weeks then 1mg every 2 to 3 months for life.

FOLIC ACID

Important: Therapy notes

Folic acid 5mg daily is used in folate-deficient megaloblastic anaemia.
Most megaloblastic anaemias result from a lack of either vitamin B₁₂or folate. It is essential to establish in every case which deficiency is present and the underlying cause before initiating treatment.
For prophylaxis in chronic haemolytic states it is sufficient to give folic acid 5mg daily or even weekly, depending on the diet and the rate of haemolysis.
Never give folic acid alone in the treatment of pernicious anaemia and other vitamin B₁₂ deficiency states because it may precipitate the onset of subacute combined degeneration of the spinal cord. If in doubt discuss with haematologist.
Folic acid is also given at a dose of 400 micrograms daily to prevent the first occurrence of neural tube defects. It should be started as soon as pregnancy is planned or confirmed and continued until week 12 of pregnancy.
To prevent the recurrence of neural tube defects give one 5mg tablet daily up to week 12 of pregnancy.
Women wishing to become pregnant, with coeliac disease or diabetes or if taking antiepileptic medicines should be advised to take 5mg folic acid supplementation daily, starting at least one month before conception and continuing up to week 12 of pregnancy.
For more information on nutrition in pregnancy see local Maternal and Child Nutrition Best Practice Guidance and Pre-pregnancy, antenatal and postnatal care guidance for women with obesity.
For advice on use of folic acid with methotrexate in inflammatory bowel disease see Chronic bowel disorders, in rheumatic disease see Drugs used in rheumatic diseases and gout and in dermatological conditions see Preparations for eczema and psoriasis.

Important: Formulation and dosage details

Formulation:

Tablets 400 micrograms^OTC, 5mg

Important: Formulation and dosage details

Formulation:

Syrup 2·5mg/5mL