Committees : Surrey Heartlands Medicines Safety Committee (MSC)

Three infographics have been produced to clarify in which situations review by two specialists may be required for patients who are prescribed valproate:
•    for female patients under 55 years old
•    for male patients under 55 years old
•    for male and female patients 55 years and older

An easy read leaflet has been produced in 30 different languages and is aimed at women and people who could become pregnant who are taking valproate. It is downloadable and printable. Valproate - Welcome

Three infographics have been produced to clarify in which situations review by two specialists may be required for patients who are prescribed valproate:
•    for female patients under 55 years old
•    for male patients under 55 years old
•    for male and female patients 55 years and older

An easy read leaflet has been produced in 30 different languages and is aimed at women and people who could become pregnant who are taking valproate. It is downloadable and printable. Valproate - Welcome

Three infographics have been produced to clarify in which situations review by two specialists may be required for patients who are prescribed valproate:
•    for female patients under 55 years old
•    for male patients under 55 years old
•    for male and female patients 55 years and older

The Surrey Heartlands Medicines Safety Committee have approved a number of resources aimed at supporting the reduction of medicines waste.

The suite of resources include a media release, newsletter articles, social medis posts, posters for public-facing areas and digital screen images.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

The Medicines safety Committee has approved the 'Getting the most from your SGLT2 inhibitor (‘gliflozin’) medicine' PIL which can be adapted for use by services.

Dementia - Understanding Behavioural and Psychological Symptoms in People Living With Dementia Resource Pack for Families and Carers can be found in the attachment below

Resources to support the safer administration of enteral calcium and phosphate supplements in neonates and children can be found within the position statement: Enteral Calcium and Phosphate Supplementaton in Neonates and Children – NPPG

The Medicine Safety Committee has updated the "Safer Prescribing aide-memoire" for primary care which provides guidance on safe prescribing of sodium valproate (for women of child bearing age) in line with the Medicines and Healthcare products Regulatory Agency (MHRA) recomendations. 
It includes a summary of how to manage these patients within primary care, links to clinical resources and searches/ templates available on clinical systems  (EMIS Web and SystmOne)

The Medicine Safety Committee has updated the "Safer Prescribing aide-memoire" for primary care which provides guidance on safe prescribing of sodium valproate (for women of child bearing age) in line with the Medicines and Healthcare products Regulatory Agency (MHRA) recomendations. 
It includes a summary of how to manage these patients within primary care, links to clinical resources and searches/ templates available on clinical systems  (EMIS Web and SystmOne)

The Surrey Medication Safety Committee have reviewed the guidance for the safe prescribing of biological medicines (biologics). See document below

GPs should ensure that patient's records include the use of biologic medicines even if the GP is not the prescriber - see guidance for recording non-GP prescribed medication: https://surreyccg.res-systems.net/PAD/Guidelines/Detail/5677

To support the safe use of testosterone in menopause please note the 'BMS Statement on Testosterone'

The Medicines Safety Committee recommend the MHRA 'Guidance on contraceptive methods and frequency of pregnancy testing to reduce inadvertent exposures during pregnancy in a woman taking a medicine of teratogenic potential' which can be found in the link below.

aide-memoire_table-2024.pdf (publishing.service.gov.uk)

The Medicines Safety Committee recommend the MHRA 'Guidance on contraceptive methods and frequency of pregnancy testing to reduce inadvertent exposures during pregnancy in a woman taking a medicine of teratogenic potential' which can be found in the link below.

aide-memoire_table-2024.pdf (publishing.service.gov.uk)

The Medicines Safety Committee recommend the MHRA 'Guidance on contraceptive methods and frequency of pregnancy testing to reduce inadvertent exposures during pregnancy in a woman taking a medicine of teratogenic potential' which can be found in the link below.

Duplicate prescribing of inhalers that contain the same medicine is a commonly reported medicines safety incident when a patient’s inhalers are changed.  The “Know your inhalers” diagram shows practice staff the class of medicine in commonly prescribed inhalers and will help to identify if there is potential for a duplicate inhaler prescribing error.

Duplicate prescribing of inhalers that contain the same medicine is a commonly reported medicines safety incident when a patient’s inhalers are changed.  The “Know your inhalers” diagram shows practice staff the class of medicine in commonly prescribed inhalers and will help to identify if there is potential for a duplicate inhaler prescribing error.

Duplicate prescribing of inhalers that contain the same medicine is a commonly reported medicines safety incident when a patient’s inhalers are changed.  The “Know your inhalers” diagram shows practice staff the class of medicine in commonly prescribed inhalers and will help to identify if there is potential for a duplicate inhaler prescribing error.

The ‘Process for reporting medicines safety events identified in a social care setting’has been updated to support the sharing of intelligence across the system and to support health and social care learn from safety events

The Medicine Safety Committee has developed "Pizotifen safety advice" for healthcare professionals to consider when prescribing and monitoring patients on pizotifen

March 2024 - local guidance for Improving the Reporting of Medication Incidents has been updated - see below

Patient safety events in health and social care, including general practice, should be reported via the LFPSE  eForm:

Learn from patient safety events (learn-from-patient-safety-events.nhs.uk)

If you have indicated that the event happened outside of your practice, please save a pdf copy of the LFPSE submission and email it to: syheartlandsicb.medicinesafetyincidents@nhs.net

Primary Care specific information can be found here: NHS England » Primary care information on the new national learn from patient safety events service

Further information and advice can also be found in our local Medicines Management Guide to Prescribing https://surreyccg.res-systems.net/pad/Guidelines/Detail/4401 "Section 9 Patient Safety Reporting".

Local guidance has been updated to support healthcare personnel when recording an incident via the LFPSE service.

See document called "What makes a good LFPSE report" 

Preparing for pregnancy posters:

• Advice for Healthcare Professionals (For displaying in clinical areas within practices where appropriate) - to support prescribers when prescribing to consider how medicines might affect a pregnancy should this be an issue in the future.            
• Know your medicines (For displaying in patient waiting areas) - Encouraging patients to ask questions about their medicnes allowing them to make informed decisions about their care.

Medicines and Falls - NFPCG information and guidance.  This document is intended to provide information and guidance on medication review for people at 
risk of falls: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Pharmacy%20guide%20docs/Medicines%20and%20falls%209%2023%20(RPSendorsed).pdf?ver=kHy696ZEbkwR7eopGgbkFw%3d%3d

All non-GP prescribed medicines (hospital only, RED drugs, specialist drugs) should be recorded in the patient's medication record to ensure that records are complete and accurate.

A local guide has been updated to support practice staff in adding non-Primary Care prescribed drugs to the patient's record on the clinical system.

Clinical system guides are included for EMIS Web, SystmOne and INPS Vision

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages. 

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages.  See resources titled "ADHD Medication Shortage"

Information on management of ADHD medication stock shortages

There are currently supply disruptions affecting various medications which are licensed for the treatment of attention deficit hyperactivity disorder (ADHD).

A national patient safety alert has been issued and we have been liaising with colleagues both regionally and nationally about the ongoing situation.  We have been advised that centrally they are looking at publishing further guidance but until this is published we have been working with colleagues from Surrey & Borders Partnership NHS Trust and the Local Pharmaceutical Committee to produce the pack below which provides useful information and clinical recommendations about how to manage these shortages. 

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Committee have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The MHRA published in the Drug Safety Update (Dec 2014, updated November 2020) an update on the safety of modafinil, in regard to its effect on unborn children. Modafinil potentially increases the risk of congenital malformations when used in pregnancy.

Modafinil should not be used during pregnancy and women of childbearing potential must use effective contraception during treatment and for 2 months after stopping modafinil.

Modafinil was added to the PAD for non-licensed indications in 2014, and the initial MHRA alert was taken into consideration when the decisions were made.  Feedback from specialists is to retain the option to use in the non-narcolepsy approved indications on PAD.  See link to the MHRA information for further information   https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936767/Nov-2020-DSU-PDF-1.pdf

The Centre for Perioperative Care position statement on Modified Release Opioids - was agreed for use within Surrey Heartlands to support the safe use of opioids after surgery. See link 

https://cpoc.org.uk/sites/cpoc/files/documents/2023-05/CPOC%20MR%20Opioid%20statement.pdf

High sodium content can make some medicines unsuitable for patients on a salt-restricted diet. Alternative products exist for a range of conditions. Futher information can be found here: https://www.sps.nhs.uk/articles/considering-sodium-content-of-medicines/

Although there may have been historic prescribing of metolazone for hypertension in parts of Surrey, metolazone has not been formally assessed for this indication in Surrey Heartlands.  Prescribing for hypertension should be in line with NICE NG136 whilst the local Surrey Heartlands hypertension guidelines are being updated (https://surreyccg.res-systems.net/PAD/Guidelines/Detail/4397)

Where metolozone is being prescribed, please take note of the important safety information below:

When initiating patients on metolazone the licensed, branded Xaqua preparation should be prescribed.

Any switch between products should take into account the difference in bioavailability between Xaqua and other available unlicensed products.

Switching from the unlicensed (imported) product to Xaqua may require a reduction in dose by half, or for the same dose to be used but adjust the frequency from daily to alternate days.

The tablets have a single score-line and can be divided into equal halves.

Update March 2023:

• Refer any patients who are taking unlicensed metolazone and have not been reviewed to the prescribing specialist for review and consideration for switching to the licensed product Xaqua

When initiating patients on metolazone the licensed, branded Xaqua preparation should be prescribed.

Any switch between products should take into account the difference in bioavailability between Xaqua and other available unlicensed products.

Switching from the unlicensed (imported) product to Xaqua may require a reduction in dose by half, or for the same dose to be used but adjust the frequency from daily to alternate days.

The tablets have a single score-line and can be divided into equal halves.

Update March 2023:

• Refer any patients who are taking unlicensed metolazone and have not been reviewed to the prescribing specialist for review and consideration for switching to the licensed product Xaqua

The unsafe use of emollients can result in serious or fatal injuries from fire. The Surrey Fire and Rescue service  provide ‘Safe and Well’ visits to residents across Surrey, providing them with fire safety advice, equipment and sign post those who require additional care and support to teams and services available to them within their boroughs. 
The form below can be used to refer patients to this service. A link is also provided along with a leaflet explaining the service.  

Prescribing weight-adjusted oral paracetamol in adults - British Hepatology Pharmacy Group Position Statement - was agreed for use within Surrey Heartlands to support the safe use of paracetamol. See link below.

The ‘Community Pharmacy Incident Reporting Communications Process ’ was agreed for use within Surrey Heartlands to aid the sharing of intelligence across organisations, to support healthcare to learn from mistakes and to take action to keep patients safe.

See document below

The ‘OPIOID PATCH INFORMATION TO KEEP PATIENTS SAFE' leaflet for patients and 'OPIOID PATCH SAFETY: COUNSELLING CHECKLIST’ for healthcare professionals were agreed for use within Surrey Heartlands to support the safe use of opioid patches. See documents below.

The Neonatal & Paediatric Pharmacist Group (NPPG) and the Royal College of Paediatrics and Child Health (RCPCH) have published recommendations for choosing unlicensed oral liquids for children.

The advice has been reviewed and agreed by the Medicines safety Group and a weblink has been provided below.

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

MHRA Safety Alert

Cutaneous amyloidosis can be considered as a differential diagnosis to lipodystrophy when a patient presents with subcutaneous lumps at an insulin injection site.  Healthcare professionals are advised to ensure that all people who inject insulin are taught to check for signs of developing cutaneous amyloidosis or lipohypertrophy and that they should report any abnormalities to their healthcare professional.

Refer to the Cutaneous amyloidosis Guidance for Healthcare Professionals below

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Group have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Group have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Group have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

The Surrey Heartlands CCG Medicines Safety Group have produced a two page summary information sheet on Assessing Renal Function for Drug Dose Adjustments in Primary  Care.  This is based on the information in the MHRA safety alert: Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions October 2019.

The Surrey Heartlands CCG Medicines Safety Group have produced a two page summary information sheet on Assessing Renal Function for Drug Dose Adjustments in Primary  Care.  This is based on the information in the MHRA safety alert: Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions October 2019.