Consultation Group: See relevant page in the PGD. Review Date: October 2016

Transcription

1 Patient Group Direction For The Administration Of Adrenaline (Epinephrine) By Trained Nurses In The Management Of Cardiac Arrest In The Medical High Dependency Unit/Coronary Care Unit (MHDU/CCU) Working Within NHS Grampian Co-ordinators: Senior Charge Nurse, Medical High Dependency Unit/Coronary Care Unit, ARI Consultation Group: See relevant page in the PGD Approver: Medicine Guidelines and Policies Group Signature: Signature: Identifier: NHSG/PGD/AdrMHDU/CCU/ MGPG671 Review Date: October 2016 Date Approved: October 2014 A Patient Group Direction is a specific written instruction for the supply or administration of named medicines in an identified clinical situation. It is drawn up locally by Doctors, Pharmacists and other appropriate professionals, approved by the Employer and advised by the relevant professional advisory committees. In most cases, appropriate clinical care is provided on an individual basis by a specific prescriber to a specific individual patient. Patient Group Directions should only be considered where they offer a benefit to patient care without compromising patient safety in any way. Uncontrolled when printed Version 5

2 Title: Identifier: Replaces: Patient Group Direction for the administration of adrenaline (epinephrine) by trained nurses in the management of cardiac arrest in The Medical High Dependency Unit/Coronary Care Unit (MHDU/CCU) working within NHS Grampian. NHSG/PGD/AdrMHDU/CCU/MGPG671 NHSG/PGD/AdrCCU/MGPG431 Across NHS Boards Organisation Wide Directorate Clinical Service Sub Department Area Yes This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative. Author: Subject Key word(s): Policy application: Purpose: Senior Charge Nurse, MHDU/CCU, ARI Patient Group Direction PGD patient group direction adrenaline cardiac arrest nurse MHDU Medical High Dependency Unit CCU Coronary Care Unit NHS Grampian This Patient Group Direction (PGD) authorises appropriately qualified and trained nurses to administer adrenaline (epinephrine) to individuals without the requirement for a patient specific prescription written by a medical practitioner. Responsibilities for implementation: Organisational: Corporate: Departmental: Area: Hospital/Interface services: Operational Management Unit: Policy statement: Review: Chief Executive and Management Teams Senior Managers Heads of Service/Clinical Leads Line Managers Assistant General Managers and Group Clinical Directors Unit Operational Managers It is the responsibility of individual nurses and their line managers to ensure that they work within the terms laid down in this PGD and to ensure that staff are working to the most up to date PGD. By doing so, the quality of the services offered will be maintained, and the chances of staff making erroneous decisions which may affect patient, staff or visitor safety and comfort will be reduced. Supervisory staff at all levels must ensure that staff using this PGD act within their own level of competence. This policy will be reviewed at least every two years or sooner if current treatment recommendations change. UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG671 - i -

3 This document is also available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on (01224) or (01224) Responsible for review of this document: Responsible for ensuring Registration of this document on the NHS Grampian Information/ Document Silo: Physical location of the original of this document: Job/group title of those who have control over this document: Responsible for disseminating document as per distribution list: Senior Charge Nurse, MHDU/CCU, ARI Medicines Management Pharmacist, Pharmacy and Medicines Directorate Protocol Folder, Nurses Stations in Medical High Dependency Unit and the Coronary Care Unit, ARI Coordinators and Consultation Group Senior Charge Nurse, MHDU/CCU, ARI Revision History: Date of Approval change date of PGD that is being superseded Summary of Changes Section heading July 2014 January 2011 Update into new template July 2014 July 2014 January 2011 Change of Unit s formal name to combine Medical High Dependency Unit and Coronary Care Unit Throughout July 2014 January2011 Change to Description of Treatment Available Under This Direction P3 Sections July 2014 January 2011 Addition made to Consent P6 Section 5.3 July 2014 January 2011 Consultation group updated P8 Section 9.1 Sep 2014 January 2011 Change to patients who may receive administration of adrenaline P2 Section 2.2 Sep 2014 January 2011 Change of wording to dose route frequency P3 section3.2 (v) Sep 2014 January 2011 Authorising Manager changed P8 9.3 Sep 2014 January 2011 Change to references P8 section10 Oct 2014 January 2011 Trained added to nurses Throughout Oct 2014 January 2011 Addition of using a central line if available 3.2 (i) UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG671 - ii -

4 Patient Group Direction For The Administration Of Adrenaline (Epinephrine) By Trained Nurses In The Management Of Cardiac Arrest In The Medical High Dependency Unit/Coronary Care Unit (MHDU/CCU) Working Within NHS Grampian Contents Part A Specific Drug Information Page No 1 Introduction 2 2 Clinical Decision Making Patients who may be considered for the administration of adrenaline 2 (epinephrine) 2.2 Patients who may receive the administration of adrenaline 2 (epinephrine) 2.3 Contraindications Precautions Action to be taken when a patient is excluded from treatment under 3 this PGD 2.6 Action to be taken when a patient does not wish to receive treatment 3 under this PGD 3 Description Of Treatment Available Under This PGD Drug details Dose, route and frequency Concurrent medication Adverse effects Advice to patient Follow up treatment 4 Part B PGD General Information 4 Designated Staff Authorised To Administer Under This PGD 5 5 Documentation Authorisation of administration Record of administration Consent 6 6 Further Points 7 7 Facilities And Supplies To Be Available At Sites For The 7 Administration Of The Drug Specified In The PGD 8 Audit 7 Part C PGD Specific Information 9 Management And Monitoring Of Patient Group Direction Consultative group Professional advisory group approving PGD Authorising managers 8 10 References 8 Appendix 1 - Health Care Professional Agreement To Administer 9 Medicines Under Patient Group Direction Appendix 2 - Certificate Of Authorisation To Administer Medicines 10 Under Patient Group Direction Appendix 3 - Record Of Administration Of Adrenaline (Epinephrine) Under Patient Group Direction 11 UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

5 Patient Group Direction For The Administration Of Adrenaline (Epinephrine) By Trained Nurses In The Management Of Cardiac Arrest In The Medical High Dependency Unit/Coronary Care Unit (MHDU/CCU) Working Within NHS Grampian. Part A 1. Introduction This patient group direction (PGD) will authorise trained nurses working within the MHDU/CCU (see part B) to administer adrenaline (epinephrine) to individuals in cardiac arrest situation. 2. Clinical Decision Making 2.1. Patients who may be considered for the administration of adrenaline (epinephrine) Patients > 16 years of age Patients in cardiac arrest and where there is no doctor immediately available in the Medical High Dependency Unit/Coronary Care Unit. Cardiac arrest is diagnosed when the patient: (i) Is in asystole (defined as the absence of electrical activity from the ECG); pulseless electrical activity, pulseless ventricular tachycardia or ventricular fibrillation. (ii) Has no palpable pulse or heartbeat Patients who may receive the administration of adrenaline (epinephrine) All patients in 2.1 above who have not written a living will (advance directive) refusing resuscitation or do not have a Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) in place Contraindications Contraindications are relative as this product is intended for use in life-threatening emergencies Precautions Nil. UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

6 2.5. Action to be taken when a patient is excluded from treatment under this PGD Not applicable Action to be taken when a patient does not wish to receive treatment under this PGD Not applicable. 3. Description Of Treatment Available Under This Direction 3.1. Adrenaline 1mg/10mL (1:10,000) Preparation: Pre-filled syringe containing adrenaline (epinephrine) 1mg/10mL (1:10,000). Store below +25 C, protected from light. Adrenaline (epinephrine) is a Prescription-only Medicine (PoM) but when administered for the purpose of saving life in an emergency, it is exempt from certain administration regulations Dose, route and frequency (i) 1mg (i.e. 10mL of 1:10,000) adrenaline (epinephrine) is given as intravenous bolus using a central line if available. (ii) Flush with 10mL (20mL if peripheral line) 0.9% sodium chloride injection following each administration (refer to the Patient Group Direction for the administration of sodium chloride 0.9% injection for flushing intravenous catheters/cannulae). (iii) Give as soon as possible having determined asystole or pulseless electrical activity. Repeat, if necessary, every 3 to 5 minutes having assessed rhythm before administration (as per current UK Resuscitation Council Guidelines 2010, Advanced Adult Life Support). (iv) Give after the third shock when treating ventricular fibrillation or pulseless ventricular tachycardia. Repeat, if necessary (after alternate shocks), every 3 to 5 minutes having assessed rhythm before administration (as per current UK Resuscitation Council Guidelines 2010, Adult Advanced Life Support). Contact Medical Staff for assistance immediately; continue as per current Resuscitation Council Guidelines (UK) until they arrive Concurrent medication Not Applicable. UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

7 3.4. Adverse effects Anxiety, tremor, tachycardia, arrhythmia, headache, cold extremities; also severe hypertension (risk of cerebral haemorrhage) and pulmonary oedema (on excessive dosage or extreme sensitivity); nausea, vomiting, sweating, weakness, dyspnoea, restlessness, angina, dizziness and hyperglycaemia also reported. Medical advice in cases of anaphylaxis Not applicable. Treatment of overdose Not applicable Advice to patient It is not possible to offer patient advice as this drug will be administered during a clinical emergency Follow up treatment Urgently refer to a member of the medical staff for further management. UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

8 4. Designated Staff Authorised To Administer Under This PGD Part B The following staff are authorised to administer the drug specified in this PGD without an individual medical prescription providing the patient falls into one of the categories listed in 2.2 of this PGD. Staff must be employed either directly by NHS Grampian, or contracted to provide NHS services, or providing services in partnership with NHS Grampian under the direction of this authorised PGD. (i) Registered Nurse as recognised by the NMC with the following qualifications: Nurse at Band 5 or above with a minimum of 12 months experience in the MHDU/CCU. IV Drug Administration Certificate. Current ACLS AND ILS certificate. In addition the following requirements are necessary. Staff must: (i) Agree to be professionally accountable for their work (Appendix 1). (ii) Be competent to assess the patient s capacity to understand the nature and purpose of the administration in order for the patient to give or refuse consent. (iii) Be aware of current treatment recommendations and be competent to discuss issues about the drug with the patient. (iv) Have been trained and assessed as being competent in the administration of the drug. All staff will have access to the current PGD. (v) Have undertaken an NHS e-anaphylaxis training session which covers all aspects of the identification and management of anaphylaxis. This can be accessed via eksf or the AT Learning tool. (vi) Be competent in basic life support which is required to be updated annually. (vii) Have immediate access to the appropriate equipment and drugs to treat anaphylaxis and have access to the current PGD for the management and treatment of anaphylaxis should this occur. (viii) Maintain their skills, knowledge and their own professional level of competence in this area according to their individual Code of Professional Conduct. (ix) Agree to work within the terms of the NHS Grampian PGD. Professional Managers/Nurse managers/lead nurses will be responsible for: (i) Ensuring that the current PGD is available to staff providing care under this direction. (ii) Ensuring that the staff have access to all relevant Scottish Government Health Directorate advice, including any relevant CMO letter(s). UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

9 (iii) Ensuring that staff have received adequate training in all areas relevant to this PGD and meet the requirements above. (iv) Maintaining a current record of all staff authorised to administer the drug specified in this PGD. 5. Documentation 5.1. Authorisation of administration Staff Nurses working within the MHDU/CCU within NHS Grampian can be authorised to administer the drug specified in this PGD by their nurse manager. A certificate of authorisation (Appendix 2) signed by the authorising doctor/manager should be supplied. This should be held in the individual staff records or as agreed locally Record of administration An electronic or paper record for recording the screening of patients and the subsequent administration of the drug specified in this PGD must be completed in order to allow audit of practice. Record of Administration Form in Appendix 3 To be filed in patient s drug kardex on completion. The nurse administering the drug must document that they have done so in the patient s medical notes. Record the administration in the once only section of the drug kardex. Nurses should sign the entry and annotate PGD. These records should be retained as per Hospital Policy Consent Prior to the administration of the drug specified in this PGD, consent should ideally be obtained from the patient, parent, guardian or person with parental responsibility. Verbal consent is acceptable in the emergency scenario. This should be documented in the patient s notes/case records once their condition is stable (see section 5.2). Consent must be in line with current NHSG Staff Policy for Obtaining Consent for Clinical Procedures and Healthcare Interventions. See link below. However, if the patient is unable to give consent due to a life-threatening situation, or if parents or guardians are not present, adrenaline (epinephrine) should be administered where treatment is judged to be in the best interests of the patient. Verbal information should ideally be available in a form that can be easily understood by the person who will be giving the consent, but in an emergency situation, this should not delay treatment. Where English is not easily understood, translations and properly recognised interpreters should be used. UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

10 6. Further Points The manufacturers leaflet inside boxes of drug should be read and advice from them taken into consideration. 7. Facilities And Supplies To Be Available At Sites For The Administration Of The Drug Specified In The PGD The following should be available at sites where the drug is to be administered: (i) Resuscitation equipment. (ii) Access to medical support (this may be via telephone). (iii) Safe storage areas for medicines and equipment. (iv) Approved equipment for the disposal of used materials. (v) Clean and tidy work areas. (vi) Copies of the current PGD for the drug specified in the PGD (vii) PGD for the administration of adrenaline (epinephrine) in cases of suspected anaphylactic reactions by qualified health professionals. 8. Audit All records of administration of the drug specified in this PGD will be filed with the normal records of medicines administration in each practice/service. A designated person within MHDU/CCU will be responsible for auditing completion of drug forms and collation of data. UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

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12 Appendix 1 Health Care Professional Agreement To Administer Medicines Under Patient Group Direction I: (Insert name) Working within the Medical High Dependency Unit/Coronary Care Unit, NHS Grampian Agree to administer medicines under the direction contained within the following Patient Group Direction Patient Group Direction for the administration of adrenaline (epinephrine) by trained nurses in the management of cardiac arrest in The Medical High Dependency Unit/Coronary Care Unit (MHDU/CCU) working within NHS Grampian. I have completed the appropriate training to my professional standards enabling me to administer medicines under the above Patient Group Direction. I agree not to act beyond my professional competence nor outwith the recommendations of the Patient Group Direction. Signed: Print Name: Date: NMC Registration No: UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

13 Appendix 2 Certificate Of Authorisation To Administer Medicines Under Patient Group Direction This authorises: Working within the Medical High Dependency Unit/Coronary Care Unit, NHS Grampian To administer medicines under the following Patient Group Direction Patient Group Direction for the administration of adrenaline (epinephrine) by trained nurses in the management of cardiac arrest in The Medical High Dependency Unit/Coronary Care Unit (MHDU/CCU) working within NHS Grampian. The above named person has satisfied the training requirements and is competent to administer medicines under the above Patient Group Direction. The above named person has agreed not to act beyond their professional competence nor outwith the recommendations of the Patient Group Direction Signed: Authorising Manager/Doctor Print Name: Date: UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG

14 Appendix 3 Record Of Administration Of Adrenaline (Epinephrine) Under Patient Group Direction Patient Name Patient Address Chi No Date Of Birth Consultant/General Practitioner Details Risk Group (If Appropriate) Physical Examination Required (If Appropriate) Exclusion Criteria, Record Why Drug Not Administered Reason For Giving Consent To The Administration (If Applicable) Drug Manufacturer, Batch Number, Expiry Date Site, Dose And Route Of Administration Signature And Name In Capital Letters Of Practitioner Who Administered The Drug Date Drug Given Record Of Adverse Effects UNCONTROLLED WHEN PRINTED Review Date: October 2016 Identifier: NHSG/PGD/AdrMHDU/CCU/MGPG