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Varenicline PGD flow chart Process for PGD accredited Pharmacists

Varenicline PGD flow chart Process for PGD accredited Pharmacists. How to choose between NRT and Varenicline (Varenicline)? Advice for PGD accredited Pharmacists. Yes. No. The patient needs to come back when ready. Consider NRT. Is the patient sufficiently motivated to quit?.

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Varenicline PGD flow chart Process for PGD accredited Pharmacists

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  1. Varenicline PGD flow chart Process for PGD accredited Pharmacists

  2. How to choose between NRT and Varenicline (Varenicline)?Advice for PGD accredited Pharmacists Yes No The patient needs to come back when ready Consider NRT Is the patient sufficiently motivated to quit? If not interested in NRT CONSIDER VARENICLINE (C H A M P I X) • Contraindications • Hypersensitivity to Varenicline or any of its excipients • End stage renal disease • Pregnancy or breastfeeding • Under 18 years of age • Cautions (see PGD for full list) • Renal disease • Psychiatric conditions • Epilepsy • History or risk of an MI Is the patient over 18 years old? Is the patient pregnant or breastfeeding? Yes No No Yes Yes No Consider NRT options Has the patient tried NRT previously Yes No Consider Varenicline (Champix) – course can be given once in a 12 month period No Has the patient signed form 4 and the standard monitoring form (please keep forms together) Consider NRT Record Client ID no. Yes No Is the patient suitable for Varenicline and agreed on a quit date in the next 2 weeks? Fill out form 5, sign and instruct patient to take form 5 to nominated PGD accredited Pharmacy A See next page… Advisor Process Yes Fill form 5 on subsequent sessions (offering 2 week maintenance pack supplies) – maximum of 12 weeks. Refer patient to the same Pharmacy only

  3. Pharmacist PGD Process Nominated PGD accredited pharmacist reviews completed letter of recommendation (form 5) once received from patient – Not a photocopy ! Nominated PGD pharmacist undertakes final review before providing Varenicline starter pack B Stop smoking advisor provides weekly behavioural support and signs off (form 5) additional 2 weeks of Varenicline (patient must be quit between day 8 & 14) Patient takes form 5 to the same nominated PGD accredited pharmacy for subsequent supply (maintenance pack) Nominated PGD accredited pharmacist reviews form 5 and undertakes final review before providing Varenicline maintenance pack patient continues course of Varenicline with on-going behavioural support C A

  4. Pharmacist PGD Process Patient confidentiality, Data governance, Indemnity insurance Record Client ID no. on all forms To be done on 1st supply of Varenicline only (FAX LETTER OF INITIATION TO GP & S4H– form 2) PGD accredited Pharmacist to fill assessment proforma (form 3) of PGD. This is filled out with the patient (refer to PGD document throughout). Patient consent needed on all supplies PGD accredited Pharmacist to supply clearly labelled Varenicline maintenance pack including full dosage. PIL given and patient counselling (adherence issues and side effects e.g. Nausea, abnormal dreams, headaches etc). Also discuss depression episodes of concern if they were to arise and discontinue treatment immediately (See latest version of Varenicline SPC www.medicines.org.uk) No prescription levy (FREE) PGD accredited Pharmacist to fill record of supply form (form 1) B

  5. Pharmacist PGD Process Patient confidentiality, Data governance, Indemnity Insurance Subsequent supplies only (and if patient has quit) - PGD accredited pharmacist issues Varenicline (maximum of 2 weeks at a time – 12 weeks total) – Contact S4H for exceptions e.g. going abroad Assessment proforma of PGD reviewed (form 3) with patient (refer to PGD document throughout) Discontinue use if concerned PGD accredited pharmacist to check if patient is suited to the treatment and if anything has changed that is of concern since they were last seen? (E.g. Allergy, Depressive episode(s)) Refer to GP and yellow card side effects www.yellowcard.gov.uk PGD accredited pharmacist to supply clearly labelled Varenicline maintenance pack including full dosage. PIL given and patient counselling (adherence issues and side effects e.g. Nausea, abnormal dreams, headaches etc). Also discuss depression episodes of concern if they were to arise and discontinue treatment immediately (See latest version of Varenicline SPC www.medicines.org.uk) No prescription levy (FREE) PGD accredited pharmacist to fill record of supply form (form 1) – patient signature required on all supplies Final record of supply form (form 1) send to S4H for payment GP & S4H (form 2) – fax to inform patient outcome (under additional notes) Pharmacy to retain copy of Assessment Proforma and a copy of form 1 (kept for 2 years) C

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