patient group directions for the supply and administration ...€¦ · 2. supplying and...

DOCUMENT CONTROL:

Version: 7

Ratified by: Quality Assurance Sub-Committee

Date ratified: 2 February 2018

Name of originator/author: Trust Pharmacist

Name of responsible committee/individual:

Trust Medicines Management Committee

Date issued: 23 March 2018

Review date: January 2021

Target Audience Clinical Staff within inpatient services

Patient Group Directions for

The Supply and Administration of Medicines for Minor Ailments by Registered Nurses

Within Inpatient Services

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CONTENTS

SECTION PAGE NO

1. INTRODUCTION 4

2. PUPROSE 4

3. SCOPE 4 3.1 Characteristics’ of staff 4 3.2 Medical Support 5

4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES 5 4.1 Trusts Medicines Management Committee 5 4.2 Area Managers for the Relevant Service 5 4.3 Registered Authorised Staff acting to the Patient Group Direction 5

5. PROCEDURE/IMPLEMENTATION 6 5.1 General Guidance for the Supply of the medications 6 5.2 Competence in the supply and administration of the medications 6 5.3 Storage of Drugs 7

6. TRAINING IMPLICATIONS 7

7. MONITORING ARRANGEMENTS 7

8. EQUALITY IMPACT ASSESSMENT SCREENING 7 8.1 Privacy, Dignity and Respect 7 8.2 Mental Capacity Act 8 9. LINKS TO ANY ASSOCIATED DOCUMENTS 8 10. REFERENCES 8

11. APPENDICES 9

Appendix 1 – Authorisation Form 9 Appendix 2 – Patient Group Directions for:

i. Paracetamol (pain) 11 ii. Senna (constipation) 13 iii. Simple Linctus (dry cough) 15 iv. Maalox suspension (dyspepsia) 16 v. Peptac (dyspepsia) 18 vi. Bonjela (mouth ulcers) 20 vii. Drapolene 22 viii. E45 cream 24 ix. Uvistat 25

Appendix 3 - Prescription Record for administration of medicines 27 under the PGD

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MANAGEMENT AND AUTHORISATION

PATIENT GROUP DIRECTIONS FOR MEDICATIONS FOR MINOR AILMENTS

Approved for use by RDASH NHS Foundation Trust:

Original Authors:

NAME TITLE

Andrew Houston Senior Pharmacist

Dr S Omkar Senior House Officer

Anne Barber Sister

Rachel Lumby Pharmacist

Reviewed by:

Committee Approval

COMMITTEE DATE

Medicines Management Committee 19th January 2018

Quality Assurance Sub Committee 2nd February 2018

Date of Implementation: October 2017

Date of Review: January 2021

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1. INTRODUCTION This Patient Group Direction (PGD) is in place to enable specifically authorised staff who have received specified, appropriate training and have been assessed as competent to supply and administer the specified medicines for minor ailments in accordance with the following protocol, recommendations issued by the Department of Health 1998 and guidance from the Nursing and Midwifery council (NMC)

2. PURPOSE This Patient Group Direction authorises those employees of Rotherham Doncaster and South Humber NHS Foundation Trust specified below to:-

Authorise nurses to supply and administer medicines to a specified group of patients who have been admitted under the care of Rotherham Doncaster and South Humber NHS Foundation Trust in order to alleviate discomfort and/or pain while at the same time enhancing the quality of care for patients.

Give guidance to nurses authorised to supply and administer medicines from a limited list approved by the Trust.

Enable Registered Nurses (as defined below under characteristics of staff) to supply and administer medicines as a response to symptoms in an identified clinical situation where medical diagnosis is not required. If the nurse is unsure of the cause of symptoms, the patient must be referred to a doctor.

as detailed within this document.

3. SCOPE

The contents of this Patient Group Direction only apply to clinical staff working in the RDaSH service who meet the following characteristics.

3.1 Characteristics of Staff Qualifications Required Level 1 Registered General Nurse (RGN) Registered Nurse Learning Disabilities (RNLD) Registered Mental Nurse (RMN)

Additional Requirements

Those members of staff in a contracted relationship with the Trust, and registered with their respective registration body for more than 6 months Knowledge of drugs as specified in the patient group directions and drug information leaflets and British National Formulary (BNF).

Continuing Training Requirements

Authorised nurses will have undertaken an in-house or equivalent training course.

Continuing Training Requirements: Minimum three yearly update, or sooner if deemed necessary.

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Annual Personal Development Review (PDR).

Demonstration of up to date knowledge of the medicines included in the PGD to line managers at Professional and Development Reviews.

Additional requirements

Abide by the Trust standards for record keeping and will record that the patient group direction has been followed.

The clinician will acknowledge any limitation in his/her knowledge and competence and decline any duties and responsibilities unless able to perform them in a safe and skilled manner.

Each clinician is accountable for his/her own practice and for the education preparation of that practice including in-house training. When using this PGD there is a requirement to maintain and improve professional knowledge and competence.

The nurse has received training and is competent in, and the recognition and treatment of anaphylaxis.

3.2 Medical Support

It is important to stress that once authorised, the nurse will not be working in isolation. She should feel confident that, she can refer to a doctor at any time; this may be by telephone. The patient may then be advised to see a doctor at the next available session.

The patient should always be given the option of seeing a doctor.

4. RESPONSIBILITIES, ACCOUNTABILITIES AND DUTIES

4.1 Trusts Medicines Management Committee The Trust Medicine Management Committee is responsible for the review and updating of the Patient Group Direction.

4.2 Area Managers for the Relevant Service

The Area Managers within the Trust Services are responsible for:

Organising the provision of training to staff in relation to the supply and administration of the medicines for minor ailments within this Patient Group Direction (Characteristics of staff).

Monitoring staffs compliance with the contents of this Patient Group Direction as detailed in section 7.

Investigating any none compliance with the contents of this Patient Group Direction.

To hold an up to date register of all staff that is trained to supply and administer the medicine for minor ailments under this Patient Group Direction. (See appendix 1)

4.3 Registered Authorised Staff acting to the PGD

It is the responsibility of any member of staff who is authorised to supply and administer medicines for minor ailments under this Patient Group Direction to:

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Be familiar with and abide by the standards set out.

Report any non- compliance with the content of this Patient Group Direction.

Report any adverse effects reported by the patient following supply and administering of any of the specified medicines for minor ailments

Meet the continuing training requirements of the PGD, additionally to undertake annual update in the treatment of anaphylaxis and resuscitation.

5. PROCEDURE / IMPLEMENTATION

5.1 General Guidance for Supply and administration of medicines for minor

ailments This general guidance outlines good practice in the supply and administration of the specified medicines for minor ailments. The information provided should be used in conjunction with Product Characteristics or patient leaflet.

5.1.1 Consent Capacity and consent to treatment must be in line with the Trust Mental Capacity Act Policy In agreeing to supply and administer the medicines for minor ailments nurses assume professional accountability and should ensure that they keep up to date with all aspects of immunisation as outlined in the NMC “Code of Professional Conduct, 2015” which suggests that :- As a registered nurse, midwife, or health visitor, you are personally accountable for your practice. In caring for patients and clients, you must:

Respect the patient or client as an individual

Obtain consent before you give any treatment or care

Protect confidential information

Co-operate with others in the team

5.2 Competence in the supply and administration of the medicines for minor ailments

Before undertaking supplying any of the specified medicines for minor ailments, the nurse should ensure that they have achieved competence in the following areas of practice. This will be achieved either by peer observation or by self-directed learning, (as per the requirement Part 6. NMC Code of Professional Conduct, 2015) 1. Understanding the principles of the medicines for minor ailments under Patient

Group Direction. 2. Supplying and administering the medicines for minor ailments 3. Storage of the medicines for minor ailments 4. Understanding the principles of valid consent and implied consent 5. Taking a medical history to ascertain if client is able to have a certain medicine

for a minor ailments 6. General advice on the different medicines for minor ailments 7. Documentation

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8. Anaphylaxis and resuscitation 9. Safe disposal of clinical waste 10. Indications. Contraindications and adverse reactions of a specific medicine for

minor ailments. 11. Supplementary information

5.3 Storage of Drugs

All proprietary medication has a predetermined shelf life and an expiry date should be clearly marked on the outer packaging of the specified medicines for minor ailments.

Ensure that stock is properly rotated. 6. TRAINING IMPLICATIONS

Registered Nursing Staff on the inpatient wards will receive training in the contents of this Patient Group Directive as part of their local induction, from both the Ward Manager and Pharmacy staff.

7. MONITORING ARRANGEMENTS

Area for Monitoring How Who by Reported to

Frequency

Compliance with the prescribing and administration standards as stated in this Patient Group Direction

Audit of the prescribing and administration record chart

Pharmacy Staff

Modern Matron

Ongoing

8. EQUALITY IMPACT ASSESSMENT SCREENING

The completed Equality Impact Assessment for this Policy has been published on the Equality and Diversity webpage of the RDaSH website click here

8.1 Privacy, Dignity and Respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’. As a consequence the Trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

Indicate how this will be met

All clinical rooms have curtains around the couches which are drawn when clients are required to undress for examination. A dignity paper sheet is used for clients to cover the lower (below the waist) section of the body when required to undress for an examination. All clinical rooms have blinds at the windows

http://www.rdash.nhs.uk/information-for-the-public/equality-and-diversity/equality-impact-assessments/

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8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individuals informed consent, or the powers included in a legal framework, or by order of the Court

Therefore, the Trust is required to make sure that all staff working with individuals who use our service is familiar with the provisions within the Mental Capacity Act. For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act 2005 to ensure that the interests of an individual whose capacity is in question can continue to make as many decisions for themselves as possible.

Indicate How This Will Be Achieved.

All individuals involved in the implementation of this policy should do so in accordance with the Guiding Principles of the Mental Capacity Act 2005. (Section 1)

9. LINKS TO ANY ASSOCIATED DOCUMENTS

Policy for the Safe and Secure Handling of Medicines – Clinical policies, Medicines, RDaSH Intranet

10. REFERENCES

Crown Report on the Supply and Administration of Medicines under Group Protocols Policy (HSC 1998/051) Appendix A Nursing and Midwifery Council (NMC) Guidelines for the Administration of Medicines (2008) Nursing and Midwifery Council, Standards of proficiency for Nurse and Midwife Prescribers (2006) Nursing and Midwifery Council, The Code. Professional standards of practice and behaviour for nurses and midwives (2015)

11. APPENDICES

Appendix 1 – Name / signature sheet for staff authorised to act under this Patient Group Direction. Appendix 2 – Patient Group Direction for Supply and Administration of medicines for minor ailments Appendix 3 - Prescription Record for administration of medicines under the PGD

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APPENDIX 1

PATIENT GROUP DIRECTION FOR THE SUPPLY AND ADMINISTRATION OF MEDICINES FOR MINOR AILMENTS

AUTHORISATION AND AGREEMENT FOR APPROVED PRACTITIONER

Authorisation is given for ____________________________________________ to supply and administer the medicines for minor ailments to patients within the agreed patient group directions.

Description Tick to indicate appropriate for use

Date

Paracetamol 500mg tablets/ Paracetamol suspension 250mg/5ml

Senna Tablets/Liquid

Simple Linctus

Maalox Suspension

Peptac

Bonjela

Drapolene

E45/Hospital hand cream

Uvistat Sun block factor 50

I ……………………………………….. agree to act under the patient group directions for supply and administer the medicines for minor ailments. I have received, read and fully understand the following documents: The relevant patient group directions I have received the training which approved practitioners must undertake before being authorised to supply and administer the medicines for minor ailments under the relevant patient group directions. I agree to act as an approved practitioner within the terms of the Patient Group Directions to supply and / or administer accordingly. In return, the Trust accepts vicarious liability for the approved practitioner acting under the terms of the patient group directions. I understand that by agreeing to act as approved practitioner under the patient group directions I am adjusting my scope of professional practice and job description. I

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understand that my acceptance of the adjustment to my role and job description has not been a compulsory requirement of the Trust.

Approved Practitioner

Name: (block capitals): ……………………………………………..

Signature: ……………………………………………

Date: ……………..

Authorising Signature

Name: (block capitals) …………………………………………………….

Signed: ……………………………………………

Date: ……………….

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APPENDIX 2 i)

Paracetamol

Clinical condition

Pain

Inclusion criteria

Mild to Moderate pain

Exclusion criteria

Known sensitivity to Paracetamol

Paracetamol overdose

Hepatic Impairment

Chest Pain,

Pyrexia of unknown recent origin.

Known Pregnancy.

Alcohol dependence.

Patients under the age of 16.

Use in pregnancy or when the client is at risk of pregnancy

Not to be given if the patient is pregnant

Action if excluded

Explain and discuss reason for exclusion

Suggest and discuss alternative treatments

Document action taken in patient’s computer records

Refer to doctor

Action if patient declines

Refer to doctor

Document in computer record and refer to doctor

Description of Treatment

Name of Medicine

Paracetamol 500 mg tablet, Paracetamol suspension 250mg/5ml, soluble 500mg tablets

POM/P/GSL GSL/P (dependent on quantity)

Dose / procedure

For patient of body weight up to 50kg : 500mg (10mls) four to six hourly

up to maximum of 60mg/kg in 24 hours

For patients of body weight above 50kg : 500mg – 1gram (one or two

tablets or 10 or 20mls of liquid) four to six hourly up to 4 gram in 24

hours

Maximum treatment of up to 2 consecutive days within a 14 day period.

Route Oral

Storage There are no specified storage instructions

Adverse reaction / side effects

Side effects are rare

See BNF 4.7.1

Follow up Inform Doctor when next reviewed

Advice to patient carer

Seek medical advice if maximum dose administered within 24hrs and pain persists despite regular Paracetamol.

Seek medical advice If the patient is taking other products containing Paracetamol, combined total daily dose must not exceed 60mg/kg or 4g (dependent on body weight – see dose instructions above) within 24hrs of Paracetamol

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Seek advice at any stage if concerned.

Treatment and application instructions to be discussed with patient before leaving the clinic - advise patient to read instruction leaflet included in packaging before administration of capsules / tablets / liquid

Advise patient on drug reactions found in the SPC for Paracetamol

Inform of possible side effects and their management

Manufacturer’s Patient information Leaflet (PIL) to be given to the client

Record Medication name, dose, frequency, expiry date, batch number, name of health professional providing treatment to be recorded clearly in the patients notes.

Patient instructions should be also recorded clearly in patient notes

All adverse side effects to be reported in the patients notes and where appropriate, reported immediately to lead consultant

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APPENDIX 2 ii)

Senna

Clinical condition

Constipation

Inclusion criteria

Simple constipation

Exclusion criteria

Already on Laxative

Abdominal pain

Intestinal obstruction

Allergic reaction

Known Pregnancy

Breastfeeding




Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

Senna tablets/liquid

POM/P/GSL GSL/P

Dose / procedure

2 tablets, 10 mls syrup Single Dose at night. 2 tablets or 10 mls in 24hours, Maximum treatment of up to 3 days within 14 day period.

Route Oral



Side effects include

Abdominal cramps

diarrhoea

See BNF 1.6.2



Advise patient or carer that it may take 8 to 12 hours to take effect

Seek advice after three doses, if patient has excessive stomach pain/griping, or if obstruction is considered or severe diarrhoea.


Treatment and application instructions to be discussed with patient before leaving the clinic - advise patient to read instruction leaflet included in packaging before administration of tablet/ liquid

Advise patient on drug reactions found in the SPC for Senna


Manufacturer’s Patient information Leaflet (PIL) to be given to the

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client




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APPENDIX 2 iii)

Simple Linctus

Clinical condition

Dry Cough

Inclusion criteria

Dry Cough

Exclusion criteria

Sensitivity to Simple Linctus.




Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

Simple Linctus

POM/P/GSL GSL

Dose / procedure

5mls As required up to three times a day Maximum 15mls (three doses) over 24hrs within a 14 day period.

Route Oral




See BNF 3.9.2



Advise patients it is a cough linctus

Seek advice after three doses if symptoms persist, chest pain, persistent cough, high temperature, confusion, high pulse rate, noisy breathing.


Treatment and application instructions to be discussed with patient before leaving the clinic - advise patient to read instruction leaflet included in packaging before administration of liquid

Advise patient on drug reactions found in the SPC for Simple Linctus






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APPENDIX 2 iv)

Maalox

Clinical condition

Dyspepsia

Inclusion criteria

Dyspepsia (Antacid to relieve symptoms)

Exclusion criteria

Severe renal impairment,

if patient severely debilitated,

Severe abdominal pain, and/or possibility of bowel obstruction.

Known Pregnancy.

Sensitivity to Maalox.




Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

Maalox Suspension, sugar free (Co-magaldrox 195/220)

POM/P/GSL GSL

Dose / procedure

10-20 mls (two to four 5ml spoonfuls)

Four times daily (between meals and at bedtime) - 4 doses over

24hours. Maximum treatment up to 3 days in any 14 day period

Route Oral




Constipation

See BNF 1.1.1



Best not to be taken at the same time as enteric coated tablets, and other oral drugs.

Give 2-3 hours apart, 20 to 60 minutes after meals

Seek advice If there is a continuing need after maximum total dose given



Advise patient on drug reactions found in the SPC for Maalox



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client




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APPENDIX 2 v)

Peptac

Clinical condition

Dyspepsia

Inclusion criteria

Gastric reflux, reflux oesophagitis, heartburn, hiatus hernia, flatulence associated with gastric reflux.

Exclusion criteria

Very rarely allergic reactions to Peptac.

Known severe renal impairment.

Known angina and hypertension.

Patients already on antacid medication.

Known pregnancy.




Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

Peptac Liquid

POM/P/GSL P

Dose / procedure

10 ml –20 mls After meals and at bedtime 4 doses in 24hrs, maximum 3 days in any 14 day period

Route Oral




See BNF 1.1.2



Explain to patient to report any improvement or deterioration to the nursing staff.

Cardiac, hepatic and renal impairment and pregnancy due to high sodium content where excessive sodium intake is undesirable.

Best not to be given at the same time as enteric coated tablets and other oral drugs, but 2-3hrs hours apart.

Seek advice if the patient has severe chest pain. Seek medical advice if symptoms persist or allergic manifestations.



Advise patient on drug reactions found in the SPC for Peptac



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client




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APPENDIX 2 vi)

Bonjela

Clinical condition

Mouth Ulcers

Inclusion criteria

Mouth ulcers and denture sore spots

Exclusion criteria

Hypersensitivity to salicylates.

Peptic Ulcers.

Patients under the age of 16



Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

Bonjela (Choline Salicylate)

POM/P/GSL GSL

Dose / procedure

1 cm gel Not more than once in 3 hours Maximum of 8 doses (over 3 days)

Route Topical




Irritation to gum

See BNF 12.3.1



May precipitate bronchospasm and precipitate asthma attack in susceptible individuals eg asthmatics/Chronic Obstructive Pulmonary Disease.

Seek medical advice on earliest suspicion of bronchospasm and if no response to medication.

Seek medical advice if allergic reaction within the mouth.


Treatment and application instructions to be discussed with patient before leaving the clinic - advise patient to read instruction leaflet included in packaging before administration of gel

Advise patient on drug reactions found in the SPC for Bonjela



Record Medication name, dose, frequency, expiry date, batch number,

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name of health professional providing treatment to be recorded clearly in the patients notes.



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APPENDIX 2 vii)

Drapolene

Clinical condition

Rash

Inclusion criteria

Treatment & prevention of urinary rash

Exclusion criteria

Previous allergic reaction to Drapolene or any of its ingredients.




Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

Drapolene (Cetrimide 0.2% w/w Benzalkonium chloride 0.01% w/w)

POM/P/GSL GSL

Dose / procedure

Apply to skin Twice daily to affected area Maximum of two applications in 24 hours up to 3 days maximum within 14 day period

Route Topical




Irritation to skin

See BNF 13.2.2



Ensure area is dry and clean before applying cream

Seek medical advice if allergic reaction.

Seek medical advice if skin when reviewed appears sore or signs of infection, or broken skin.


Treatment and application instructions to be discussed with patient before leaving the clinic - advise patient to read instruction leaflet included in packaging before administration of cream

Advise patient on drug reactions found in the SPC for Drapolene



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APPENDIX 2 viii)

E45/Hospital Hand Cream

Clinical condition

Dry skin

Inclusion criteria

Emollient for dry skin

Exclusion criteria

Known eczema/psoriasis/other skin conditions.




Action if excluded




Refer to doctor


Refer to doctor



Name of Medicine

E45/Hospital Hand Cream

POM/P/GSL GSL

Dose / procedure

As Required, apply thin coat to affected area

.

Route Topical/External




See BNF 13.2.1




Seek medical advice if still required after 3 days.



Advise patient on drug reactions found in the SPC for E45






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APPENDIX 2 ix)

Uvistat factor 50 sun block

Clinical condition

Sun block

Inclusion criteria

Require skin protection from UV radiation/sunlight exposure

Exclusion criteria

Known sensitivity to Uvistat sun block.

Known eczema/psoriasis/other skin conditions.




Action if excluded




Refer to doctor



Limit patients exposure to the sun/UV radiation to a minimum. Description of Treatment

Name of Medicine

Uvistat Sun Block factor 50

POM/P/GSL GSL

Dose / procedure

As Required, apply thin coat to affected area Re-apply frequently especially if patient is excessively sweating or rinses the skin.

Route Topical/External






Ensure area is dry and clean before applying cream. Reapply frequently and stay out of direct sunlight using alternative

methods e.g. hats, long sleeves, sitting in the shade particularly between 11am and 3pm when the sun is at its strongest.


Seek medical advice if patient suffers from sunburn. Seek advice at any stage if concerned.


Advise patient on drug reactions found in the SPC for Uvistat



Record Medication name, dose, frequency, expiry date, batch number,

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name of health professional providing treatment to be recorded clearly in the patients notes.



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APPENDIX 3

ROTHERHAM DONCASTER AND SOUTH HUMBER NHS FOUNDATION TRUST

Prescription Record for administration of medicines under the PGD

Preparations which may be given at the discretion of a named Registered Nurse under PGD for minor ailments. (Form to be kept with patient’s medicine card )

Patient Name: ……………………………….Ward/area……………………...

Date of Birth: ………………Unit No. ……………………….……

MEDICATION Date &

Time

Dose Given

By

Date &

Time

Dose Given by

Date & time

Dose Given By

Paracetamol 500mg tablets*/ Paracetamol suspension 250mg/5ml* delete as

appropriate

Dose: 500mg if body weight up to 50kg (max 60mg/kg/24hours) or 1g if body weight above 50kg (max 4g/24hours) See appendix 2i

To be given at 4-6 hrly intervals if required

Senna Tablets*/Liquid*

Dose : 2 tablets or 10ml*

To be given once a day usually at bedtime * delete as appropriate

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Simple Linctus

Dose 5ml

To be given when required up to three times a day

Maalox Suspension

Dose:10-20ml

To be given when required up to four times a day

Peptac

10-20 mls

To be given as required after meals & at bedtime, no more than 4 doses in 24 hrs

Bonjela – 1cm gel

Every three hours if required

Drapolene

Apply twice daily

E45/Hospital Hand cream

As required

Uvists Sun block Factor 50

As required

patient group directions for the supply and administration ...€¦ · 2. supplying and...

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