Version Control This PGD has been agreed by the following organisations FCMS PDS Medical Doncaster CCG Lancashire CCGs including East Lancashire, Fylde and Wyre and North Lancashire CCGs Change history 10/07/17 V02 Records to be kept: all staff to get batch number and expiry date checked and signed by a second member of staff 28/08/17 V02 Review and minor editing updates. 28/08/2017 Page 1 of 6
CLINICAL CONTENT OF PATIENT GROUP DIRECTION Staff Characteristics Qualifications Specialist competencies or qualifications Continuing training and education Clinical Details Indication Inclusion criteria Registered nurse, Paramedic practitioner, ECP (Paramedic) or Nurse practitioner Received training to undertake administration and supply of medicines under PGD. Has undertaken appropriate training to carry out clinical assessment of patient, leading to diagnosis. Also that such diagnosis requires treatment according to the indications listed in this PGD. The practitioner should be aware of any change to the recommendations for the medicine listed. It is the responsibility of the individual to keep up to date with continued professional development and to work within the limitations of individual scope or practice. Patients with chickenpox or shingles meeting the criteria below. Chickenpox: Consider aciclovir for an immunocompetent adult or adolescent (aged 14 years or older) with chickenpox who presents within 24 hours of rash onset, particularly for people with severe chickenpox or those at risk of complications, such as smokers or people using corticosteroids (see CKS advice). Adults 18 years and over with shingles: Start aciclovir within 72 hours of rash onset, to reduce pain and severity for: Anyone aged 50 years and over. People aged less than 50 years with any of the following criteria: Non-truncal involvement (such as shingles affecting the neck, limbs, or perineum). Moderate or severe pain. Moderate or severe rash. Exclusion criteria Patients with severe renal impairment, e.g. Chronic Kidney Disease stages 4 or 5, or where creatinine clearance is <25ml/minute. Pregnancy (urgently seek specialist advice regarding the need for diagnostic tests, counselling regarding the risk of fetal varicella syndrome, antiviral treatment, and follow up) and breast-feeding. Immunocompromised (consider treating in primary care if the rash is localized and they are not systemically unwell; seek immediate specialist advice or refer immediately if the rash is severe, widespread, or multiple dermatomes are involved, they are systemically unwell, or there is severe immunocompromise). 28/08/2017 Page 2 of 6
Ophthalmic involvement (seek immediate specialist advice, or refer immediately). Aciclovir tablets are contraindicated in patients known to be hypersensitive to aciclovir and valaciclovir or to any of the excipients. Patient also taking ciclosporin, mycophenolate, tacrolimus or theophyllines. PGDs should be used only where appropriate, suitable and legal. PGDs should not be routinely used when an independent prescriber is available. Precautions Hydration status: Care should be taken to maintain adequate hydration in patients receiving higher dose oral regimens, e.g. for the treatment of herpes zoster infection (4g daily), in order to avoid the risk of possible renal toxicity. Management of Discuss with GP or Clinical Lead or refer. excluded patients Action for patients not wishing / unable to Make patient aware of risks and potential consequences of not taking medicine. receive care under this Discuss any alternatives if available. PGD Discuss alternative options with GP or Clinical Lead. Document discussion with patient. Description of Treatment Name of medicine Formulation and route Strength Dosage Repeated dose instructions Duration of treatment Quantity to supply Legal status Special precautions Adverse effects Aciclovir Oral tablets 800mg 800mg five times a day for 7 days See above 7 days Pre-packed box of 35 tablets POM Explain indications, contraindications and cautions (refer to BNF) Common fatigue, nausea and vomiting, diarrhoea, abdominal pain, rash, urticaria, pruritus, photosensitivity, headache Very Rare hepatitis, jaundice, dyspnoea, neurological reactions, renal failure, renal pain, anaemia and blood disorders, agitation, tremor, fever, psychosis This is not a complete list. Refer to BNF or SPC (summary of product characteristics) for full information. Advice necessary Provide the patient with the manufacturer s Patient Information Leaflet. Advise on dose and administration with reference to the cautionary label information and give any further instructions to aid compliance. 28/08/2017 Page 3 of 6
Advise on storage or expiry details and to dispose of any unused medicines appropriately. Give advice on practical self-care if appropriate, including management of likely symptoms (including fever management where appropriate). Make patient aware of potential adverse effects and the action to take if they occur. Provide appropriate worsening advice describing the range of signs and symptoms to monitor for and the action to take if they occur. Consider whether the provision of health promotion material is appropriate e.g. on smoking or lifestyle factors. Provide any advice relevant to the patient from the Precautions section above. Prescribing guidance East Lancashire CCG Antibiotic formulary North Lancashire Clinical Knowledge Summaries Health protection agency primary care guidance for the management of infection Records and Follow Up Referral arrangements Inform GP as soon as possible Advise if worsening or no improvement to seek further medical advice Records to be kept Patient s name, address, date of birth and consent given Contact details of GP (if registered) Diagnosis Dose and form administered Batch and expiry details all staff to get batch number and expiry date checked and signed by a second member of staff. Advice given to patient (including side effects) Signature / name of staff who administered or supplied the medication If relevant, signature / name of staff who removed / discontinued the treatment Details of any adverse drug reaction and actions taken, including documentation in the patient s medical record Referral arrangements (including self-care) Any serious side effects attributable to drug should be recorded and medicine management advised via yellow card system found in BNF Follow up Advise follow up with GP / Practice Nurse Patient Group Direction, organisation and individual authorisation signatures can be found on the managerial content sheet along with other non-clinical details relating to this patient group direction. 28/08/2017 Page 4 of 6
Patient Group Direction Owner Details of PGD owner FCMS (NW) Ltd Newfield House Vicarage Lane Blackpool FY4 4EW Patient Group Direction Authorisation Lead Doctor MANAGERIAL CONTENT OF PATIENT GROUP DIRECTION Lead Pharmacist Lead Nurse Lead Paramedic Dr Jonathan Bundy Magnus Hird Alison o Connor Organisational Authorisation for FCMS Organisational Authorisation for East Lancashire CCG Gillian Gregory Patient Group Direction Peer Review Reviewed by Wendy Lambert, Nurse Practitioner 28/08/2017 Page 5 of 6
Individual Authorisation BY SIGNING THIS PATIENT GROUP DIRECTION YOU ARE INDICATING THAT YOU AGREE TO ITS CONTENTS AND THAT YOU WILL WORK WITHIN IT. PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. IF THIS IS AN UPDATED OR REPLACEMENT PGD ENSURE THAT ALL OLDER VERSIONS ARE WITHDRAWN FROM USE WITH IMMEDIATE EFFECT. IT IS YOUR RESPONSIBILITY TO MAKE SURE YOU ARE USING THE CURRENT VERSION. NOTE TO AUTORISING MANAGERS: AUTHORISED STAFF SHOULD BE PROVIDED WITH AN INDIVIDUAL COPY OF THE CLINICAL CONTENT OF THIS PGD AND A PHOTOCOPY OF THE AUTHORISATION SHEET SHOWING THEIR AUTHORISATION. Name of Professional Signature Authorising Manager Date 28/08/2017 Page 6 of 6