How Specials Can Deliver Value to the NHS | Page 23

The treatment of supraventricular arrhythmias is normally under specialist
supervision initially and the GP would be unlikely to feel confident switching
such a drug, which was probably initiated under a cardiologist. Whilst the
patient could not swallow the once-daily sustained released capsule, the
liquid formulation administered three times a day would need to be titrated
carefully to ensure the correct dose was given.
Please also refer to Assessing clinical need on page 6.

Cost-effectiveness and quality of life improvements
Supraventricular arrhythmias are normally diagnosed and treated initially
within a cardiology setting in secondary care by a specialist38. It is critical for
tachycardic patients to cut down on caffeine, smoking and alcohol as these
can all be trigger factors38 If this patient had not received the anti-arrhythmia
drug and complications had developed, this could have been an upsetting
and expensive episode. Typical costs would have included emergency
admission to an Accident & Emergency department and several days as an
in-patient, most likely to be a geriatric ward. However, the patient may have
required a spell on the cardiac unit which would have cost £1,09439 plus
further tests and in-patient costs. This spell could have cost several thousand
pounds in treatment costs, depending on the interventions required39. There
would be considerable stress in addition for relatives who would see their
already-ill relative admitted to an acute coronary unit or re-admitted to an
in-patient hospital bed.
In this case, although the unlicensed Special is a liquid formulation, at least
the anti-arrhythmia drug could be successfully administered to control the
arrhythmias and titrated to keep the patient out of hospital.

CASE STUDY 8

Assessing clinical need – additional advice

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

A recent report published in April 2012 found the most common causes of
medication administration errors were incorrect crushing of medication and
not supervising the intake of medicines40. Although this study was Dutch, it
provides more evidence that the risk-benefits of crushing oral medication
need to be considered very carefully, especially in the elderly with dementia41.

38. http://www.nhs.uk/conditions/Supraventricular-tachycardia/Pages/Introduction.aspx [date accessed May 2014]
39. 2013-14 tariff – Admitted patient care & outpatient procedures – EB07H, Arrhythmia or Conduction Disorders with CC [date accessed May 2014]
40. Managing and administering medication in care homes for older people – A report for the project: ‘Working together to develop practical
solutions: an integrated approach to medication in care homes’. Centre for Policy on Ageing October 2011 Revised April 2012
41. Van den Bemt, P. M., Idzinga, J. C., Robertz, H., Kormelink, D. G. and Pels, N. (2009) Medication administration errors in nursing homes using an
automated medication dispensing system, Journal of the American Medical Informatics Association 16 (4) : 486-492

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