Intravenous Immunoglobulin (IVIG)
LOCAL GUIDANCE AND REQUEST FORMS
NHS E commissions use of Immunoglobulin products to ensure use is evidence based and treatment is available for urgent clinical use.
Treatment must follow National guidelines with approved commissioning criteria.
NHS E have set up regional panels of experts to review use of Immunoglobulin locally and to review requests in conditions where there is a lack of published evidence (grey indications)
The Kent and Medway Sub-Regional Immunoglobulin Assessment Panel is hosted by MTW.
Prescribing for new patients
An immunoglobulin request form must be completed for all new Immunoglobulin prescriptions. When completing the form, check the diagnosis on the new NHS E diagnosis list if the diagnosis is not on the list then refer to the old diagnosis list
"No panel required" (new guidelines) and Red/Blue indications (old guidelines) can be dispensed by pharmacy after the immunoglobulin request form has been completed and sent to the HCD team for processing.
Email the request form to (MTW Requests Only): email@example.com
Panel prior approval (new guidelines) or Grey (old grey) indications need ‘Panel Approval’ before treatment can be dispensed by Pharmacy. In addition to the form above, complete a separate panel form electronically with as much clinical detail as possible. All yellow boxes on the form must be completed, incomplete forms will be returned as the panel will not have the correct information to make a decision. The panel reviews the request virtually within 24 hours of receipt (Monday-Friday).
Out of hours, contact the on call Pharmacist for advice via switchboard.
Email the panel form to your local pharmacy for processing. Once reviewed your pharmacy will send to the KMSRIAP:
For MTW: firstname.lastname@example.org
Both forms must include patient height and weight and doses must be calculated using the Ontario dose calculator
Prescribing for patients previously approved for Immunoglobulin use
Contact the pharmacy team to confirm that the approval for immunoglobulin use is still valid
Pharmacy must be sent details of follow up/ outcome for all patients