Open discussion on identifying and informed consent of the cascade use of medicines.

RE: Open discussion on identifying and informed consent of the cascade use of medicines.

jenni99 — Sat, 11 Mar 2023 19:55:16 GMT

Not legal but from PSS

"Assessors will wish to see evidence that Cascade medicines are clearly identified to owners who give informed consent for their use. Written forms for signature are expected"
It is not acceptable to use an all embracing “general” lifelong consent for any and all off-label products that might be given to any animal.

Specific consent needs to be obtained for each unauthorised medicine used, however it is acceptable where there is a specific ongoing condition requiring unauthorised medicine for a lifelong consent form to be used for that particular medicine in that particular animal".

Prescribers are required to discuss individual drugs with owners. :) Ultimately its the MRCVS' responsibility as only they can use cascade, but we found the whole red sticker, automatic consent form production etc has also really helped with the off license use as it is a reminder, even if using a dog licensed drug for a cat etc.

Practice standards looked at our signed off licence consent forms, and asked about prescription and supply of them with the staff involved.

RE: Open discussion on identifying and informed consent of the cascade use of medicines.

apache — Fri, 10 Mar 2023 00:14:34 GMT

[quote userid="30516" url="~/001/f/clinical-discussions/32404/open-discussion-on-identifying-and-informed-consent-of-the-cascade-use-of-medicines/178071#178071"]Our PMS highlights off license drugs when the V/S selects them,[/quote]

I assume what you mean are things like human medicines, where all usage is via the cascade? Let's not forget that we can, and frequently do, use licenced veterinary medicines off of the SPC - either different indications, different species, different duration of treatment, different dose, or potentially even combination use.

For those reasons, I don't believe that any system will ever be able to identify all cascade use.

Personally, I'm not convinced there is a real issue to solve here. There is no reason that a single off-licence form is not sufficient for the life of the animal, if it continues on such a medicine. I don't believe there is even a need for signed consent as long as it is noted in the record (although I accept it is good practice, and defensive medicine).

We put links to the data sheet on the labels. As a prescriber, I would explain specific risks and make the owner aware it was a human medicine. Our admit/op consent for includes a general statement that off-licence meds may be used in the best interests of the animal and to protect animal welfare.

RE: Open discussion on identifying and informed consent of the cascade use of medicines.

Jo Brett — Tue, 07 Mar 2023 21:23:16 GMT

That's really good that your PMS prompts for a reason why the V/s is prescribing the medicine under the cascade. Ultimately this is what the VMD would look for is the justification for the use of medicines under the cascade. I hope that more and more PMS will adopt this feature.

RE: Open discussion on identifying and informed consent of the cascade use of medicines.

jenni99 — Tue, 07 Mar 2023 20:35:15 GMT

Our PMS highlights off license drugs when the V/S selects them, then if the V/s actually clicks to "sell" them, the V/S has to type the reason for prescribing off license into a box, it them brings up a consent form to be completed by the V/S, which then prints & the client signs and get a copy. Red stickers manually on boxes to remind V/S for inpatients or if selecting drugs before pricing them. Its a bit of a to-do for animals who are on repeats, but their is the option to add a Y/N to has the client signed a form in the last 6 months, had meds before etc