1. Prison Pain Formulary
Background
Denise Farmer April 2016

2. 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

3. 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!

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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 Q consultation and feedback on medicines included and revision of evidence

11. 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