URGENT (Scotland): adrenaline auto-injectors 150mcg protocol to be implemented immediately

The Scottish Government and NHS Scotland has issued an interim protocol for dispensing all brands of AAIs 150mcg, due to the unusual circumstance with current AAI shortage to ensure patient safety is not compromised.

Following the recent Department of Health and Social Care (DHSC) Supply Disruption Alert on Epipen® and EpiPen® Junior adrenaline auto-injectors (AAIs), the Scottish Government and NHS Scotland has now issued an interim protocol for dispensing all brands of AAIs 150mcg, due to the unusual circumstance with the current AAI shortage to ensure patient safety is not compromised. A letter accompanies the interim protocol from the Scottish Government Chief Medical Officer:

• “Interim Protocol on Dispensing of Adrenaline Auto-injectors, 150mcg” – the flowchart within this document must be followed whilst undertaking the dispensing validation protocol
• “Adrenaline for anaphylaxis kits – a reminder to Healthcare Professionals” – this letter provides further information regarding the interim protocol, including the template letters GPs will provide to patients regarding the shortage

From immediate effect – pharmacies/dispensing doctors receiving any prescription (NHS and private) for 150mcg AAIs (all brands) must follow a 2-step validation process until further notice. See the interim protocol for full details.

For partially fulfilled prescriptions, pharmacy contractors are required to endorse clearly the quantity supplied and submit it to NHS National Services Scotland with the submission bundles of prescriptions.

 The Medicines & Healthcare products Regulatory Agency (MHRA) has approved specified lot number of EpiPen® 300mcg, and specified lot number of Jext 150mcg and 300mcg to be used past their expiry date during this critical period of shortage.

Patients can sign up to the Expiry Alert Service for both EpiPen® and Jext – this is free to use. Patients/parents/carers should regularly check the viewing window of their adrenaline device to make sure the liquid inside is clear and colourless.

Key steps to take for pharmacists and pharmacy team:

1. Ensure that the pharmacists and members of the dispensing team in particular read and understand the full contents of the DHSC Supply Disruption Alert, CMO letter and

PCA (P)(2018)14 protocol and familiarise themselves with them fully

2. Print off the flowchart and ensure that it is readily available in the dispensary
3. Ensure that the whole pharmacy team is aware of this matter and refer all patients/parents/carers with queries about adrenaline to the pharmacist
4. If a supply of adrenaline is not made after following the protocol:
   • The pharmacist must explain to the patient/parent/carer that the prescription will be dispensed at a later date when a supply is available
   • A letter is available for pharmacist/dispensing doctor to supply to the patient/parent/carer within the aforementioned letter from the Scottish Government
   • Explain that if the situation changes and they use one of their devices, they must return to the pharmacy for supply
   • The pharmacists/dispensing doctor practice should speak to/contact the prescriber if there is any uncertainty about the best course of action for the patient, and to assess any risks to the patient
5. The wholesaler may have their own validation process which pharmacies are required to follow – these should be checked and a note made and kept for reference
6. If in doubt or to check anything, call the NPA Pharmacy team on 01727 891800 — we are available to advise and support you Monday-Friday 9am-6pm and Saturday 9am-1pm

The NPA has dedicated a webpage for all adrenaline-related news; this includes the latest adrenaline auto-injector stock update.

For further information please contact the NPA Pharmacy team on 01727 891800 or email at pharmacyservices@npa.co.uk.