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  • CLINICAL GUIDELINE

    A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

    Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

    If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

    Version Number: 2.2 MHS Number: 30 Does this version include changes to clinical advice: Yes

    Date Approved: 24th October 2018

    Date of Next Review: 24th October 2019

    Lead Author: Andrew Walker

    Approval Group: Mental Health Prescribing Management Group

    Important Note:

    The Intranet version of this document is the only version that is maintained. Any printed copies should therefore be viewed as ‘Uncontrolled’ and as such, may not necessarily contain the latest updates and amendments.

    Use of DEPOT and Long Acting Antipsychotic Injections

  • Good Practice Statement for the Use of Depot & Long Acting Antipsychotic Injections

    Please record brief details of the changes made alongside the next version number. If the procedural document has been reviewed without change, this information will still need to be recorded although the version number will remain the same.

    Version Date Brief Summary of Changes Author(s)

    1.0 Mar 2013 New document MHS Safer Use of Medicines

    2.0

    Sep 2016

    Page 1 – key documents updated Page 3 – Introduction updated to reflect newer NICE guidance Page 3 – Definitions amended to include the term long acting injections Page 3 – Standard statement amended to reflect role of student nurses Page 3 Choice of drug.. Pipotiazine deleted as product discontinued. Aripiprazole added a new since first version. Page 4 – Pipotiazine deleted from table Page 4 – Sentence added regarding aripiprazole. Page 5 – first bullet point amended Page 5 – pipotiazine removed from table and aripiprazole added Page 5 – use of GASS added to sentence regarding side effect monitoring Page 5 last sentence amended to recommend prescriptions are reviewed every six months Page 7 - pipotiazine removed from table and aripiprazole added Page 8 – bullet points under Recording administration amended to include recording the preparation, strength and volume administered. Page 9 – under communication additional text added regarding transfer of depot prescriptions and maintaining electronic alerts Page 10 – side effect added under General Physical Monitoring Page 15 - pipotiazine removed from table and aripiprazole added Page 17 – point 9 in table aripiprazole added Page 18 – point 16 aripiprazole added

    A Walker

    2.1

    Oct 2017

    Pages 3, 4 & 5 - Note of the impending discontinuation of Fluphenazine in 2018 added

    Page 4 - Details of the amended contra-indications for haloperidol decanoate have been added. Page 7 - At the request of the Professional Nurse Advisors group, to ensure standardisation and improve safety, the list of information to be record in the chronological account of care when a depot is administered has been amended.

    A Walker

    2.2 Oct 2018 Information and link to GGC Consent policy added

    C Sellar

  • Consultation The document was sent to Community Mental Health teams, Pharmacy and the Psychiatric Advisory Committee for comments prior to completion.

    Key Documents

    When reading this policy please consult the NHS Consent Policy when considering any aspect of consent National Institute for Clinical Excellence CG178 (2014), Psychosis and schizophrenia in adults: prevention and management NHS Lothian (2011), Depot Antipsychotic Guidance,

    Maudsley (2015), Prescribing Guidelines in Psychiatry 12th edition.

    UKPPG (2009) Guidance on the Administration to Adults of Oil based Depot and other Long Acting Intramuscular Antipsychotic Injections

    Summary of Product Characteristics for:

    • Clopixol (Zuclopenthixol Decanoate) • Flupentixol Decanoate • Haldol (Haloperidol Decanoate) • Fluphenazine Decanoate • Risperdal Consta • Xeplion (Paliperidone Palmitate) • ZypAdhera (Olanzapine Embonate) • Abilify Maintena (Aripiprazole)

    http://www.staffnet.ggc.scot.nhs.uk/Partnerships/MHP/MHP%20Corporate%20Information/Policies/MHS%20Policies/GGC%2001%20Consent%20Policy%20Final%202017.pdf

  • Contents

    1. Introduction .......................................................................................................................... 2 2. Scope .................................................................................................................................. 2 3. Definitions ............................................................................................................................ 2 4. Standard Statement ............................................................................................................. 2 5. Choice of Drug and Dosage Selection ................................................................................. 2 6. Side effects .......................................................................................................................... 4 7. Prescribing........................................................................................................................... 4 8. Administration ...................................................................................................................... 5 9. Recording the Administration ............................................................................................... 6 10. Communication .................................................................................................................... 6 11. Medication Related Issues ................................................................................................... 7

    Preparation & Equipment ..................................................................................................... 8 Criteria for Selection of Injection Site .................................................................................... 9 Injection Techniques .......................................................................................................... 10

    Appendix 1 Dose Selection for Depot Antipsychotic Injections ....................................................... 11 Appendix 2 Equipment .................................................................................................................. 14 Appendix 3 Procedure – Preperation for Administration of Depot Antipsychotic Injections ............. 15 Appendix 4 Procedure – Administration of Depot Antipsychotic Injections ..................................... 17

    1

  • 1. Introduction Antipsychotic depot injections have been used in psychiatry for many years. Their use was endorsed by NICE in CG178 Psychosis and schizophrenia in adults: prevention and management

    ‘Consider offering depot/long-acting injectable antipsychotic medication to people with schizophrenia:

    • who would prefer such treatment after an acute episode

    • where avoiding covert non-adherence (either intentional or unintentional) to antipsychotic medication is a clinical priority within the treatment plan.’

    There are disadvantages to depot use namely managing side effects that may be prolonged and patient perception.

    The use of depots can be the subject of controversy, however in appropriate circumstances they are a very useful addition to the range of antipsychotic preparations available.

    The purpose of this good practice statement is to support the safe and effective use of depot antipsychotic injections.

    2. Scope These guidelines apply to all staff involved in the prescribing, administration and supply of depot antipsychotics in the Mental Health Services of NHS Greater Glasgow & Clyde. It is the responsibility of all appropriate senior managers to ensure that these guidelines are implemented.

    3. Definitions Depot or long acting antipsychotic injection – an antipsychotic drug formulated in such a way as to allow the steady gradual release of a drug over a defined time period. There are a variety of formulations and delivery vehicles but all are administered by deep intra-muscular injection.

    4. Standard Statement Only appropriately trained and competent staff may administer depot antipsychotics. Newly qualified staff must complete a competency framework and must undergo a period of supervised practice before they may administer depot antipsychotics. Student Nurses, once deemed competent are allowed under supervision to administer depot medication.

    5. Choice of Drug and Dosage Selection The antipsychotics currently available as depot preparations are:

    First generation • Fluphenazine decanoate (note: will be discontinued in 2018) • Flupentixol decanoate • Haloperidol decanoate • Zuclopenthixol decanoate

    Second generation

    • Aripiprazole • Risperidone • Paliperidone palmitate • Olanzapine embonate (note: Category 3 non formulary item)

    All of the currently available depots are indicated for

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