Document Details Title Patient Group Direction (PGD) Administration of sodium chloride 0.9% injection by registered professionals Trust Ref No 1987-38096 Local Ref (optional) Main points the document As a solvent and diluent for injectable medicines covers As a saline irrigant To flush peripheral intravenous cannula to maintain patency: 1. Following the insertion of intravenous cannula 2. Before and after intravenous drug administration 3. When a cannula in situ is not in use Who is the document Staff administering injections aimed at? Owner Rita O Brien Approval process Approved by Quality and Safety Delivery Group (Committee/Director) Approval Date 12/09/2017 Initial Equality Impact yes Screening Full Equality Impact Not required Assessment Lead Director Director of Nursing and Operations Category Policy Sub Category Patient Group Direction Review date 30/09/2019 Distribution Who the policy (PGD) will Available to community practitioners be distributed to Method Email notification of entry onto webpage Document Links Required by CQC S4 Required by NHLSA yes Other Amendments History No Date Amendment 1 V1 Shropshire Community Health NHS Trust 2 September 2017 No material changes, minor spelling changes 3 4 Page 1 of 7
PATIENT GROUP DIRECTION Administration of sodium chloride 0.9% injection by registered pofessionals PGD prepared by: (author / owner) Rita O Brien If any signatures are missing below, then the PGD is not valid APPROVED FOR USE BY: Medicines Management Group Doctor Dr Emily Peer Associate Medical Director 8/9/2017 Pharmacist Rita O Brien Chief Pharmacist 8/9/2017 RATIFIED BY: Quality & Safety Operational Group Governance Lead Alison Trumper Associate Director Quality 12/9/2017 Page 2 of 7
STAFF CHARACTERISTICS Employed by Shropshire Community Health NHS Trust Eligible professional with current registration Specialist competencies or qualifications: The clinical manager has evidence that the health care professional has undertaken training to carry out clinical assessment of patient leading to diagnosis that requires treatment according to the indications listed in the PGD. Provide evidence of training, annual updates and Continuing Professional Development undertaken The clinical manager has proof of training by the health care professional on the legal aspects of supply or administration of medicines under a Patient Group Direction The clinical manager has assessed the competency (against the national framework) of the healthcare professional to work to a Patient Group Direction at least every 2 years Has undertaken training and annual updates in the recognition and treatment of anaphylaxis, including practical in Basic Life Support and has immediate access to an in-date supply of adrenaline 1mg in 1ml (1:1000) at the time of the consultation Must have access to all relevant sources of information e.g. information issued by the Department of Health (DH), British National Formulary (BNF), Summary of Product Characteristics (SPC), and the clinical guideline concerning medicine(s) within this Patient Group Direction (PGD) The practitioner needs to reinforce and update their knowledge and skills in this area of practice with particular reference to changes and national directives The registered health care practitioner is professionally accountable for supply or administration under the PGD as defined in their own profession s Code of Professional Conduct and Ethics. YOU MUST BE AUTHORISED BY NAME BY YOUR MANAGER UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO IT Page 3 of 7
CLINICAL CONDITION Clinical need addressed Inclusion criteria Exclusion criteria (for full details of interacting medicines refer to current Summary of Product Characteristics (SPC) & BNF As a solvent and diluent for injectable medicines As a saline irrigation To flush peripheral intravenous cannula to maintain patency: o 1. Following the insertion of intravenous cannula o 2. Before and after intravenous drug administration o 3. When a cannula in situ is not in use Dissolving or diluting an injectable medicine with sodium chloride 0.9% as indicated in the Summary of Product Characteristics prior to administration. Patients who require saline irrigation. Patients who require insertion or re-siting of a peripheral intravenous cannula or who have a peripheral cannula in situ For flush : incompatibility with the prescribed drug. Exclusion under this Patient Group Direction does not necessarily mean contraindicated but it would be outside its remit and another form of authorisation will be required Caution / need for further advice Management of excluded patients Action for patients not wishing to receive care under this PGD None known. Refer to manufacturer s information leaflet for appropriate flushing. Document action Consider reasons for declining Referral to appropriate medical practitioner Record in patient record Page 4 of 7
DRUG DETAILS Name form and strength of medicine Sodium Chloride Injection BP 0.9% w/v Legal classification Prescription only medicine (POM) Route / method For dissolution or dilution: parentally as indicated by the medicines to be injected o For irrigation: topically o For flush: intravenously Dose / Frequency For dissolution or dilution: as required by the injectable medicine to be administered For irrigation: volume as required to provide sufficient irrigation For flush: volume as required up to 10ml Number of times treatment may be administered For dissolution or dilution: as required by the injectable medicine to be administered For Irrigation: volume as required to provide sufficient irrigation For flush: o 1. A single dose to be administered at the time of cannulation o 2. As a single dose before and after the administration of each intravenous medication Side effects Full details of side effects are available in the SPC. Suspected adverse reactions to drugs including vaccines should be reported on the yellow card available at the back of the BNF. Also at www.yellowcard.gov.uk Additional Information o 3. Up to twice a day to maintain cannula patency None known Storage area should not exceed 25 0 C Stock must be locked in approved medicines cabinets with access restricted by nurse in charge Advice to patient / carer Patient to receive appropriate advice in accordance with the medicine prescribed or procedure/condition treated. When administering a flush: inform the patient of the reason for the flush and obtain consent. Follow up Referral to doctor or independent prescriber if necessary Error reporting Any incidents or near miss issues must be reported via the organisation s internal reporting system (Datix) RECORD KEEPING Documentation needed / treatment records to be kept for audit purposes A computer or manual record of all individuals receiving treatment under this Patient Group Direction should also be kept for audit purposes. Patient s name, address, date of birth and GP Manufacturer / brand of product, batch number, expiry date Dose Date of administration, route Advice given to patient / carer Details of staff who administered (sign and print name) Details of any adverse drug reactions, and action taken including informing GP Reconciliation stock balances should be reconcilable with receipts, administration, records and disposal on a patient by patient basis. A register of all individuals receiving treatment under this Patient Group Direction should also be kept for audit purposes within each service Page 5 of 7
REFERENCES British National Formulary 72 Last accessed: 7/9/2017 Summary of Product Characteristics http://www.medicines.org.uk Last accessed: 7/9/2017 Royal Marsden Manual of Clinical Nursing Procedures Last accessed 7/9/2017 http://www.shropscommunityhealth.nhs.uk/rte.asp?id=11040 Page 6 of 7
Register of practitioners qualified to administer and / or supply sodium chloride 0.9% injection Name of clinical team manager under this Patient Group Direction Signature of clinical team manager Date: All PGD documentation must be kept for 8 years and for children until the child is 25 years old A copy of this page should be retained by the authorising manager for audit purposes. Please state clinical area where this PGD is in use Healthcare professional individual declaration: I have read and understood the Patient Group Direction and agree to supply this medicine only in accordance with this PGD PGDs DO NOT REMOVE INHERANT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. It is the responsibility of each professional to practice only within the bounds of their own competence. All practitioners operating in accordance with this PGD should have a current, signed copy of it readily available for reference. If a practitioner is asked to supply, or administer a medicine not covered by this or any other PGD then a patient specific direction is required from a doctor, dentist or independent prescriber. Name of professional Signature (please print) Authorising Manager (Must sign against each entry) Date of authorisation Page 7 of 7