FULL shared care agreement - Leicestershire Medicines Strategy

Leicestershire
Medicines
Strategy Group
FULL SHARED CARE AGREEMENT FOR
Rivaroxaban
in the treatment of
Deep vein thrombosis and the prevention of
recurrent DVT and PE
Prepared by:
Dr Jane Strong
Consultant Haematologist, Acute DVT service lead
On behalf of:
NHS Leicester City
NHS Leicestershire County and Rutland
University Hospitals of Leicester NHS Trust
Leicestershire Partnership Trust
Date written/reviewed:
September 2012
Date of next review:
September 2014
Approved by LMSG:
October 2012
Version:
1.0
Additional medicines information is available from:
Trent Medicines Information Centre
Victoria Building, Leicester Royal Infirmary, LE1 5WW
Tel: 0116 255 5779 / 0116 258 6491
Fax: 0116 258 5680
e-mail: [email protected]
scaF-tmpl-v2
Full Shared Care Policy for the prescribing of Rivaroxaban in the treatment of
deep vein thrombosis and the prevention of recurrent DVT and pulmonary
embolus
Introduction and purpose
This shared care agreement has been produced following classification of
Rivaroxaban in the Leicestershire drug traffic light scheme. See website at
www.lmsg.nhs.uk
Shared care has been defined as the mechanism of sharing patient care between
primary and secondary care providers. This document sets out these responsibilities
from initial diagnosis to on going support.
Disease Background
Acute DVT is a common and potentially life threatening disorder. It has an incidence
of around 1:1000 patients per year, the incidence increasing with age (Winter et al,
2005)
Uncomplicated DVT is now widely managed on an outpatient basis and most patients
can be treated at home without problems (Winter et al, 2005)
This positively contributes to the drive to reduce pressure on acute hospital beds and
importantly reduce the time that patients have to spend waiting in A&E or MAU.
NICE CG144 and TA 261 contain evidence based guidance on the assessment,
diagnosis and treatment of suspected and proven DVT.
Drug covered by the agreement
Rivaroxaban (Xarelto®) is a specific inhibitor of activated factor Xa with excellent
oral bioavailability and a half life of approximately nine hours. NICE TA261 –
Rivaroxaban for the treatment of DVT and prevention of recurrent DVT and PE
recommends rivaroxaban as an option for treating deep vein thrombosis and
preventing recurrent deep vein thrombosis and pulmonary embolism after the
diagnosis of acute DVT in adults. It has potential advantages over warfarin of not
requiring INR blood monitoring, but other factors about rivaroxaban need to be taken
into consideration when deciding whether it is appropriate for an individual patient.
Secondary Care Clinician Responsibilities
•
Diagnosis of condition and ensuring other treatment options have been fully
explored
•
Ensuring patient selection criteria as stated in UHL DVT Process for supply
•
Completion of the Rivaroxaban in DVT New Patient Request Form available at
http://www.lmsg.nhs.uk/LMSGDocs/Guidelines/Rivaroxaban(DVT)-newpatient_request_form_Oct12_V1doc.doc
•
Discussion of risks/ benefits, initiation of treatment, referral to anticoagulation
specialist nurse for counselling*
•
Advising GP on monitoring adverse drug reactions ( ADRs)
•
Liaison with the general practitioner (GP) to share the patient’s care using the
Shared Care Agreement Form: Shared Care Agreement Form. Shared care
should not be assumed until a written agreement has been received from the GP.
•
Outlining to GP date when therapy should be reduced or stopped assuming no
relapse in patient’s condition. Review periods to be agreed.
•
Responding to issues raised by GP after care of patient has been transferred
•
Advising GP of information sources for further guidance on drug interactions,
adverse effects etc.
Page 2 of 3
*Anticoagulation specialist nurse will
• Counsel patient, providing information leaflet and anticoagulation card
• Telephone patient after approximately 7 working days to ascertain tolerability
• Feedback/liaise with appropriate secondary care consultant so shared care
request can be initiated if there are no problems or liaise to resolve any
problems identified.
GP Responsibilities
•
Confirm or decline request to share patient’s care as soon as possible, using
the shared care agreement form.
•
Monitoring the patient’s overall health and well being and observing patient
for evidence of ADRs/abnormalities and raising with secondary care clinician
if necessary.
•
Clinical surveillance in line with anticoagulation practice throughout the
treatment period
Assessment of renal function at least once a year, or more frequently as
clinical circumstances dictate when it is suspected that renal function could
decline or deteriorate.
Annual review as appropriate to include
o History of any venous thromboembolic event in last year
o Reassessment of bleeding risk
Prescription of drug after initiation by secondary care
Ensuring advice is sought from the secondary care clinician if there is any
significant change in the patient’s physical health status
Reducing/stopping treatment in line with secondary care clinician’s original
request
•
•
•
•
•
Patient Responsibilities
• Attendance at initial counselling session
• Report untoward effects to prescribing clinician
• Compliance with treatment
• Compliance with blood tests as detailed by prescribing clinician
• Informing other professionals as appropriate that they are receiving an
anticoagulant.
Prescribing & Clinical Information Summary
Summary of Product Characteristics (SPC) Xarelto (Rivaroxaban), Bayer. Available
from e-MC at http://emc.medicines.org.uk/
BNF prescribing information available at http://bnf.org/bnf/
Contact for support and advice
Consultant Haematologists (Dr J Strong, Dr S Pavord, Dr P Mensah, Dr R Gooding)
Haemophilia Centre, LRI
Fax 0116 258 5093
Stuart Brown, Lead Anticoagulation Nurse Practitioner
UHL-CAS LRI
Tel: 0116 2585096 1030-1530hrs Mon-Fri except BH and weekends
Fax: 0116 2587561 Email [email protected]
Page 3 of 3

Download Report