How Specials Can Deliver Value to the NHS | Seite 22

CASE STUDY 8
An elderly patient with arrhythmia,
unable to swallow tablets or capsules

Background
An 83-year-old woman had been discharged from hospital to a care
home following a chest infection. The patient had difficulty swallowing
food and after a few days the doctor noted that her condition was
deteriorating and was concerned that she may need to be re-hospitalised.
On discussion with the nursing sister and care assistants, it was discovered that
the patient was unable to swallow tablets or capsules and although they had tried
opening the capsule, the patient refused to take them as tablets.
The doctor noted that the anti-arrhythmia drug was a slow release formulation and was a
critical drug so could not be withheld. An unlicensed special liquid preparation was ordered
and prepared so that the medication would need to be given via a nasogastric tube. No licensed
preparation was available in this situation.

Patient unable to swallow tablets or capsules
LOWEST RISK/PREFERRED CHOICE
UK-licensed medicine

Treatment available in capsule form

Off-label use of UK-licensed medicine
Imported product licensed in (approved) country of origin

UK-manufactured Special
in MHRA-licensed facilities

Liquid formulation prepared for
delivery via a nasogastric tube (NGT).
Patient’s condition was stabilised.

An extemporaneously dispensed medicine
An imported product not licensed in the country of origin

Crushing or splitting licensed
tablets or capsules
A non-UK-made unlicensed medicine or food supplement

HIGHEST RISK/LAST CHOICE
22

Adapted from RPS practical guidelines on supplying Specials
Hierarchy may alter in particular patient groups; for example, neonates

Incorrect opening of a slow release
formulation did not provide control
of condition. Potential cost of stay in
cardiac unit £1,094.