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Back To Vidyya Information From The UK:

NICE Guidance On The Use Of Zanamivir (Relenza): Implementation Guidance For NHS


Introduction

1. This guidance has been prepared by the UK Department of Health and the National Assembly for Wales in conjunction with NICE. It is being issued along with NICE's guidance on the use of zanamivir (Relenza) for the treatment of influenza to provide the NHS in England and Wales (particularly PCG/Ts & LHGs and their related GP practices) with supplementary advice on implementation.

2. NICE recommends zanamivir for the treatment of at-risk adults who present within 36 hours of the onset of influenza like illness (ILI) when influenza is circulating within the community and who are able to commence treatment within 48 hours of the onset of these symptoms. Other patients should continue to be advised that the best way to treat flu is to stay at home, rest, take symptomatic treatment if necessary and drink plenty of non-alcoholic fluids.

3. At-risk groups are recommended to be immunized against influenza before every winter. This should be the first line of defence against influenza for at-risk patients. Improvements in the delivery of the immunization program for the 2000/01 influenza season are expected to achieve a target uptake of at least 60% in the 65 and over age group.


Potential impact on primary health care services

4. The accompanying guidance from NICE properly acknowledges that the guidance is likely to have an impact on primary health care services - principally, increased activity, but also some additional drug costs. Their guidance sets out an assessment of the potential impact.

5. NICE recommends that the NHS develops plans to implement their guidance as part of integrated winter planning arrangements. The remainder of this document explains the arrangements being made nationally and sets out what might be done locally. Arrangements for notifying when influenza is circulating are explained. It is suggested that separate arrangements should be developed to deal with the at-risk groups and those not falling within the recommendations from NICE.

National Action


Information for the public

6. The leaflets What should I do about flu? (England) and All you need to know about Flu (Wales) are available from the Department of Health, PO Box 777, London SE1 6XH and Public Health Division, National Assembly for Wales, (029) 20823336. They give important advice to patients on how to judge whether they have flu, and what they should do, depending on their age and underlying health.

Glaxo Wellcome also have available posters and leaflets on flu and colds. These can be obtained from the Glaxo Wellcome Customer Service Department - Telephone 0800 221 441.

NHS Direct will advise callers on what to do if they have an influenza like illness.

Guidance on "when influenza is circulating"

7. NICE's guidance does not apply until influenza is known to be circulating in the community. This will be triggered across England and Wales when PHLS advises the Administrations that they have identified the circulation of influenza viruses and when the RCGP Weekly Returns Service monitoring data indicates that new GP consultations for ILI have risen above the baseline level of 50 consultations per 100,000 population per week. This information will be cascaded through Regional Epidemiologists and flu coordinators each Thursday. The information is available on the web at www.doh.gov.uk/flu/

Resources

Local Action

Managing at-risk patients

8. HAs with their LHGs, PCGs and PCTs will need to put in place suitable arrangements for managing the supply of zanamivir to high risk patients as part of their winter planning. Ensuring that there is timely, adequate and appropriate information available to health professionals locally and patients will be an important part of this.

9. Zanamivir, a prescription-only medicine (POM), is available only on prescription from a doctor or supply by health professionals (including pharmacists and nurses) on the direction of a doctor. Depending upon local circumstances local arrangements may need to incorporate a mixture of the following elements:

  • Telephone triaging by practice nurse or other health professional working to a protocol and standard diagnostic questions
  • Patient group directions for direct supply by nurses and community pharmacists, including those working from NHS Walk-in Centres (England only)
  • NHS prescriptions issued by GPs in the normal way following consultation or home visit

10. As with all prescribing the final decision will fall to GPs in the exercise of their clinical discretion.

Telephone triaging

11. It is likely that most patients developing flu symptoms will contact the GP surgery or out of hours services by telephone in the first instance. Health professionals working under a well drafted protocol with standard diagnostic questions could recommend whether a prescription is appropriate and advise on arrangements for collection. As an aid to this and for more general planning purposes GP practices may wish to identify in advance their at risk population for whom zanamivir might be appropriate from existing influenza immunization registers. Local pharmacies may be prepared to offer a local delivery service for dispensed prescriptions. A sample document, which has been trialled by a PCT, is available here on the Vidyya site.

12. Glaxo Wellcome can supply additional Patient Information Leaflets on zanamivir which may be helpful, including in introducing Patient Group Directions. These can be obtained from the Glaxo Wellcome Customer Service Department - Telephone 0800 221 441. For further information on zanamivir you should contact the Glaxo Wellcome Medical Information Department - Telephone 0800 371 891.

NHS prescriptions issued by GPs following consultation

13. Some at-risk patients will present at the surgery or will be seen at home within 36 hours of the onset of symptoms. Arrangements should be in place for these patients to receive NHS prescriptions from the GP in the usual way. GPs may wish to carry a small stock of zanamivir (so-called "black bag") for immediate supply during OOH.


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Editor: Susan K. Boyer, RN
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