Summary: Patients diagnosed with or at high risk of B12 deficiency will require supplementation and ongoing treatment for life. Some bariatric surgery patients also need this (see BOMSS guidelines)
Who’s it for: Pharmacists & Prescribers
Diagnosis
B12 blood tests are commonly requested during patient investigations for those reporting tiredness, anaemia symptoms, palpitations, or feeling faint.
Patients may be diagnosed by the hospital, or from GP blood tests.
Initiation
- The primary replacement course will need to take place if it hasn’t already
- If the primary course is not required, then task reception to arrange a routine telephone call with the patient to discuss the need for 3 monthly injections, and provide the date for when the next injection is due
- Advise the patient they will be responsible for arranging this appointment, ordering the B12 injections and bringing with them to their appointment
- The initiation letter, found on EMIS, should be sent to the patient
- Medication is to be added patient’s repeat prescription and issued
- Give diet advice – eggs, meat, dairy products, salmon and cod
Safety Netting Advice
- 🚩 : An alert should also be added when loading the patient to remind the user about the need for 3 monthly B12 injections
- A diary entry for the next dose due should be entered into EMIS by the clinician administering the injection
- Use the AccuRX template to remind the patient - please ensure there is the text in 10-weeks time (the 10-week text will show up when you choose the B12 template)
Primary Replacement Course
Please always check the BNF before prescribing B12 therapy. Non-Prescribers must use the B12 PSD on EMIS.
- Patient will need replacement of Hydroxocobalamin 1mg, IM injection, three times per week, for 2 weeks
- The pharmacist will task reception to contact the prescription, and arrange appointments
- Patient to be advised to collect injections and bring to their arranged appointment
Maintenance Doses
1mg, IM injection every 3 months lifelong
- Advise patient they will need to call the surgery to arrange this appointment when it is due
- Advise them to order medication before their appointment and bring to their appointment
- Please follow safety netting advice - there is a range of ways to ensure the patient will attend. Please use judgement as to the best methods for our patient
Patients who have demonstrated competence in self-injecting to a nurse may self-administer - see here for instructions, or see Intramuscular Injections for more information.