GROUP PROTOCOL FOR THE MANAGEMENT OF SIMPLE INDIGESTION Version 5 December 2017 RATIFYING COMMITTEE Drugs and Therapeutics Group DATE RATIFIED MAUP EXPIRES December 2020 EXECUTIVE SPONSOR Chief Nurse MAUP ORIGINAL AUTHOR Louise Noble - Pharmacist REVIEWED BY Tracey Tugwell Pharmacy Technician KEY POLICY ISSUES: Key indication for the use of Magnesium Trisilicate Mixture Staff eligible to work under the protocol If you require this document in an alternative format, ie easy read, large text, audio, Braille or a community language please contact the Pharmacy Team on 01243 623349.
GROUP PROTOCOL FOR THE MANAGEMENT OF SIMPLE INDIGESTION (Magnesium Trisilicate Mixture) Version: 5 December 2017 Group Protocol drawn up by: Name Louise Noble Title Pharmacist Group Protocol authorised by: (on behalf of the Trust). Chief Medical Officer Chief Nurse Chief Pharmacist Rick Fraser Diane Hull Ray Lyon Appointed Practitioner in Charge (on behalf of the ward) Date Protocol agreed December 2017 Proposed review date December 2020 Date Protocol expires December 2020 Ward Protocol relates to
GROUP PROTOCOL FOR THE MANAGEMENT OF INDIGESTION 1. CLINICAL CONDITION 1.1 Clinical condition Symptoms of SIMPLE INDIGESTION (i.e. discomfort or pain in stomach and/or upper abdomen). 1.2 Inclusion Criteria Patients with the above symptoms who are otherwise well. Patients who usually self-administer at home for prophylactic symptomatic treatment of above symptoms. 1.3 Exclusion Criteria Patients under 18 years of age. Known sensitivity to magnesium trisilicate mixture. Patients with abnormally alkaline blood. Patients with low blood phosphate or calcium levels. Patients with insufficient stomach acid. Patients with severe renal failure. Patients on a low sodium diet. Patients with cirrhosis of the liver. 1.4 Action to be taken if patient is excluded from treatment under protocol Consult with ward Medical Officer 9.00 am 5.00 pm Monday to Friday. Contact duty Medical Officer out of hours if persistent or acute discomfort warrants. 1.5 Action to be taken if patient refuses treatment under protocol Discuss with ward Medical Officer if problem continues and nursing staff have significant concerns. 2. STAFF AND LOCATION 2.1 Location Inpatient units Trustwide.
2.2 Staff Qualified nursing staff that have been signed off as competent by the Appointed Practitioner in Charge of the ward following training and successful completion of the 'Key Aspects of Pharmacy' questionnaire for magnesium trisilicate mixture. 2.3 Continued Training Requirements. Not required unless changes to protocol 3 TREATMENT 3.1 Name of medicine Magnesium Trisilicate Mixture. 3.2 Legal status (POM, P or GSL) GSL (General sales list) 3.3 Dose or dose range and criteria for determining dose 10-20ml in a little water. 3.4 Method of route of administration Oral. 3.5 Frequency of administration Up to three times a day. Maximum period of continuous treatment must not exceed 48 hours without a medical review of the underlying symptoms. Caution If the client gets no symptomatic relief or an increase in severity, particularly if the client has a history of an MI or angina, then refer to the Medical Officer. 3.6 Follow up treatment Documented review by ward Medical Officer if needed. 3.7 Side effects and possible drug interactions Diarrhoea and burping due to release of carbon dioxide. Avoid administering at the same time as other drugs as may impair the absorption of some drugs.
3.8 Instruction on identifying and managing possible adverse outcomes Normal ward observations. If there is a decline in the patient s physical condition or the nurse suspects an adverse reaction, contact the ward Medical Officer or duty Medical Officer. Document concerns in patient s notes. 3.9 Arrangement for referral to medical advice Contact ward Medical Officer in normal working hours. Contact duty Medical Officer outside working hours. 4. INFORMATION AND DOCUMENTATION 4.1 Advice (including written advice) to be given to patient or carer before or after treatment. Verbal instruction on drug being administered. Provide advice to patient on a more appropriate diet. Consider raising the bed. Advise the patient or carer to inform nursing staff if symptoms persist. Offer leaflet indigestion, if appropriate. See appendix. 4.2 Details of treatment records required Completion of MAUP section of patient s drug chart. Record entry in Carenotes. This should record the presence of indigestion, and that administration of magnesium trisilicate mixture occurred in line with MAUP (or equivalent statement). 5. MANAGEMENT AND MONITORING 5.1 Advisory group approving the protocol Drugs and Therapeutics Group. 5.2 Lines of accountability Clinical Service Managers Appointed practitioner in charge
5.3 Method to report any adverse drug reactions to the doctor Normal ward policy for communicating with the Medical Officer. 5.4 Audit Arrangements Pharmacy supervision. Clinical audit. 5.5 Review Date and by Whom Every three years by the Drugs and Therapeutics Group or earlier if significant new evidence or manufacturers advice on Magnesium Trisilicate Mixture use is made available.
6. Staff authorized to work under the Group Protocol I have read the group protocol and agree to use it: - Nurses agreeing to and authorized to work under the protocol Appointed Practitioner in Charge assessing competence Name Signature Name Signature Date
KEY ASPECTS OF PHARMACY QUESTIONNAIRE (To be completed without access to the Protocol or drug text books, e.g. BNF.) Key aspects of pharmacy for Magnesium Trisilicate Mixture Professional's name: Grade: 1. Symptoms/criteria under which the patient will be eligible for treatment under the Protocol 2. Forms and strengths available 3. Mode of action 4. Exclusion criteria 5. Dose 6. Route of administration 7. What potentially significant side effects and drug interactions are there? 8. What written/verbal advice must be given to the patient/carer on the identification and management of significant potential side effects? I confirm that at the time of completion the answers provided showed an acceptable level knowledge. Name: Designation: Signature: Date:
Patient Information on Indigestion Indigestion (or dyspepsia) is discomfort or pain caused by excess stomach acid. Symptoms The discomfort or pain from indigestion is usually felt in the upper stomach or chest. Heartburn is a specific symptom of indigestion and is a burning pain caused by stomach acid flowing back into the gullet (oeophagus). Causes Your stomach produces acid that helps digest food. A layer of mucus lines the stomach, oesophagus and intestines to act as a barrier against this acid. If the mucus layer is damaged, the acid can irritate the tissues underneath. This then causes the discomfort or pain. Some of the following things can make the symptoms worse: Eating a heavy meal. Drinking excess alcohol. Pregnancy. Smoking. Drugs such as aspirin and ibuprofen. Stress and anxiety. Treatment and prevention If you smoke, try to stop. If you are over weight, try to lose weight. Avoid eating just before bed and if taking any tablets wash them down with a glass of water to avoid them sticking in your oesophagus and slowly dissolving there. Consider raising the head of your bed (one tends to slip down off extra pillows and so blocks or bricks under the head end of the bed may be better). Small meals regularly are better than large meals infrequently. Avoid tight clothing around the waist. Avoid aspirin and other anti-inflammatory medications (NSAIDs) eg ibuprofen, except after consultation with your doctor. Antacids such as Magnesium Trisilicate Mixture neutralise the acid in the stomach. Some antacids such as Gaviscon Advance Liquid contain an ingredient called an alginate which forms a barrier on the top of the stomach contents to prevent the stomach acid flowing back into the oesophagus. Various medications cause reduced acid secretion. Some of these are available over the counter and others only on prescription. If you require this document in an alternative format, ie easy read, large text, audio, Braille or a community language please contact the Pharmacy Team on 01243 623349. Reviewed unchanged 2017