How Specials Can Deliver Value to the NHS | Página 24

CASE STUDY 9
Management of blood pressure in
a patient in a care home

Background
An elderly patient was admitted to a local hospital due to increased
blood pressure and blockage of their nasogastric tube. The patient had
been transferred from a nursing home where their tablets had been crushed
since their recent discharge from hospital a few weeks ago. The patient also had
dementia which meant they were aggressive and not able to interact with their
carer or relatives. Sometimes the nursing home had ordered the liquid formulation
of their blood pressure treatment as an unlicensed Special, as there is no licensed liquid
formulation available. Recently the patient had been reviewed and due to the acquisition
cost, the formulation had been switched back to tablets. The tablets had then been crushed
instead by the nursing home staff. Whilst in hospital, the patient was reviewed by a Consultant and
the multi-disciplinary team. The team prescribed the blood pressure treatment as a liquid which was
supplied as an unlicensed Special when discharged. The nasogastric tube was replaced and is now clear.

Dementia patient with high blood pressure
LOWEST RISK/PREFERRED CHOICE
UK-licensed medicine
Off-label use of UK-licensed medicine
Imported product licensed in (approved) country of origin

UK-manufactured Special
in MHRA-licensed facilities

Blood pressure treatment prepared
as a liquid for nasogastric tube.
Patient is 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
Adapted from RPS practical guidelines on supplying Specials
Hierarchy may alter in particular patient groups; for example, neonates

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Care home staff ordered to crush
licensed tablets to achieve cost savings.
Tube became blocked and patient was
admitted to hospital with high blood
pressure. Cost of stay £3,292.