Prescribing opioids in general practice

In this scenario you are working as a practice nurse in a large GP practice. Your local formulary recommends morphine as the first line strong opioid analgesic. Your practice pharmacist has analysed your prescribing data to check whether prescribing is in accordance with the formulary. The analysis reveals that the practice is prescribing a large proportion of non-formulary or second line strong opioids. In the average UK practice, morphine makes up 30% of all strong opioids prescribed. In your practice, it makes up just 20% of all strong opioids prescribed. Your pharmacist has identified a list of 50 patients on non-formulary or second line strong opioids, all for chronic pai

Over-use of short-acting inhalers for uncontrolled asthma

Why asthma still kills is the National Review of Asthma Deaths' first national investigation of asthma deaths in the UK and the largest study worldwide to date (Royal College of Physicians (RCP), 2015). The primary aim was to understand the circumstances surrounding asthma deaths to identify avoidable factors and make recommendations to improve care and reduce the number of deaths. Some of the recommendations involve prescribing and medicines use. One of these specifically states, ‘All asthma patients who have been prescribed more than 12 short-acting reliever inhalers in the previous 12 months should be invited for urgent review of their asthma control, with the aim of improving their asthma through education and change of treatment, if required’ (RCP, 2015). The reason for this is that over-use of short-acting relievers can be an indication of uncontrolled asthma. An additional concern due to over-use can be explained by the pharmacology of short-acting relievers. These medicines, such as salbutamol and terbutaline, are beta-2 receptor agonists, and their over-use can lead to the ‘down-regulation’ of receptors, which can result in an insufficient therapeutic effect in an emergency situation (Joint Formulary Committee, 2016). Furthermore, the over-use of medicines can lead to side effects (e.g. palpitations or anxiety), and is a waste of NHS resources

Prescribing emollients

It is important to encourage self care whenever possible (NHS England, 2018). Self care is recommended for mild dry skin and mild irritant dermatitis, however it is appropriate to prescribe emollients for long term conditions including eczema (National Insitute for Health and Care Excellence (NICE), 2013; National Eczema Society, 2018). The British National Formulary (BNF) (2020) suggests suitable quantities of dermatological preparations to be prescribed for specifi c areas of the body (Table 1)