MEDUSA NHS Injectable Medicines Guide

The Injectable Medicines Guide (IMG), also known as Medusa, is an NHS multidisciplinary project.

The IMG aims to:

• provide guidance on the preparation and administration of injectable medicines in adult and paediatric clinical areas
• be a reference source for organisations preparing an injectable medicines administration policy for local use

The IMG is an on-line resource accessed via the internet or downloaded and made available through an organisation's intranet. It contains over 400 monographs for medicines given by the intravenous (IV) route (excluding cytotoxic agents). Both licensed and unlicensed medicines are included. As far as is achievable, information is relevant to all generic IV medicines currently on contract to the NHS in the UK. The IMG also contains monographs on medicines commonly administered by intramuscular (IM) injection in mental health practice (other IM monographs are currently in development) and on medicines given by the intraocular route. Monograph content is based on information from the published literature and pharmaceutical companies, and also draws on clinical experience and current practice.

The monographs contain a number of different sections detailing how the medicine is presented, how it should be reconstituted and/or diluted, how it should be administered, information on adverse effects, required monitoring, technical details (pH, osmolarity, sodium content and latex status) and risk assessments. Each monograph links to the British National Formulary (BNF), BNF for Children (BNFC), Summary of Product Characteristics (SmPCs), package insert/Patient Information Leaflet (PL), risk minimisation materials and other relevant publications.

Monographs are supported by Help Text designed to assist with interpreting information contained in each monograph heading. The Help Text is accessed by selecting the information  icon in each heading or by clicking on the heading itself.

The IMG website can be adapted for local use. Organisations can link locally produced guidelines to individual monographs. For organisations that produce their own monographs, these can be added to the website in such a way they will be viewed preferentially to IMG versions but a link to the IMG monograph is maintained.

Organisations with electronic prescribing systems are able to add a link to the IMG to their local system. The website is dm&d coded making it compatible with electronic prescribing systems.

Most organisations with access to the IMG customise the website to some extent, making the monographs more acceptable across the range of NHS clinical practice.

IMG monographs are written and updated by NHS hospital pharmacists. Organisations using the IMG can gain access either by paying a subscription or by writing and updating a set number of monographs (subscription rates and the number of monographs varies depending on the size of the organisation). All the money received from subscriptions is used to cover the running costs of the service.