Prison Pain Formulary Background Denise Farmer April 2016

Issues with pain medicines in prisons Risk of trading, diversion, misuse and harm Co-morbidities make risk of dependence higher Challenges when continuing care Demand versus clinical need: Complex factors to assess pain (functional, mental health + physical) Time issues for consultation Specific communication skills needed for effective outcomes for consultation and patient Operational and clinical safety issues for non-IP and IP pain medicines

Prescription opioid misuse: What is being done Pain Management in Secure Settings- 2013 Gabapentin/Pregabalin briefing- 2014 NICE Guideline: Safe use and management of controlled drugs- just published!

Why a Prison Pain Formulary Main Aim: Optimise medicines use and pain relief for patients by: Enabling more consistent access and safety of access Improving pain care on transfer of care Measuring outcomes or markers of quality prescribing and access Focussing clinicians to evidenced clinical effective care and improved clinical continuity inside and outside custody Still retaining freedom for individualised care Integrating medicines better into pain care Reducing the potential for misuse and abuse of pain medicines

Scope considers: Pain Formulary Assessment and Diagnosis of pain Short vs long term pain: continuity of care Safer prescribing and review Self-care and support

How we developed it Working Group H&J CRG subgroup Ratification by CRG and then Prison Health Board and then H&J Oversight Group (NHS England) Follows NICE! Just like CCGs

Publications: Formulary Published a list of medicines & supporting information for different types of pain namely Acute pain and chronic persistent pain Neuropathic pain X Not palliative/cancer care! X Not pain for specific diagnoses- e.g. migraine, arthritis- but can still use formulary

Publications: Implementation Guide Fitting medicines into pain pathways: Background to the formulary Patient experience Non-pharmacological management Medicines pathway for pain medicines Risk, use of IT and governance Workforce skills

Monitoring, Evaluation & Review Agree how to monitor and evaluate formulary use Prescribing data Patient experience Supported by healthcare teams- with you not to you! Review of formulary from Q3 2016- consultation and feedback on medicines included and revision of evidence

Sharing Practice Collation of resources and examples from you! How prisoners access OTCs and self-care Gym access including remedial gym Medicines use Compacts Pain information leaflets Audit tools Models of pain management care Adherence checking processes