Antibiotic Oral (tablet/capsule/suspension) PATIENT GROUP DIRECTION (PGD) FOR YOU MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO IT Caution: This drug is also available in a different presentation or dose. Please ensure this is the correct PGD prior to administration Clinical Condition Indication Tonsillitis/Pharyngitis Inclusion criteria Age o Children aged from 1 year to 5 years 11 months Tonsillitis / Pharyngitis with 3 or 4 Centor Criteria features (see additional clinical information box) and with one or more of the following: o Marked systemic upset secondary to the acute sore throat o Unilateral peritonsillitis o A history of rheumatic fever o An increased risk for infection Exclusion criteria Previous hypersensitivity to penicillin antibiotics Child who is drooling, cannot swallow or with stridor Presence of a quinsy Known renal impairment Human/animal bites Known MRSA positive patients or contacts Facial cellulitis Recent penicillin treatment (within last 14 days) for same problem Porphyria Patients on methotrexate Cautions Generic Cautions with Antibiotic Use. Action if patient declines or is excluded Additional clinical information Patients on Warfarin (advise to see GP at end of course for INR/dose review) Patients with renal impairment Patients whom are pregnant Patients who are breastfeeding Patients who are immunocompromised Efficacy of oral contraceptives Refer to supervising doctor/receiving facility. Document findings and action taken in patient s record For all cases refer to GP/ED as necessary Centor criteria to aid diagnosis of Group A beta-haemolytic streptococcus (GABHS)as a caus of presentation with a sore throat: o o o tonsillar exudate tender anterior cervical lymph nodes absence of cough Ref : PHP_susp_PO_v1.0 Page 1 of 9
o history of fever presence of three or four of these clinical signs suggests that the chance of the patient having GABHS is between 40% and 60%, so the patient may benefit from antibiotic treatment absence of three or four of the signs suggests that there is an 80% chance that the patient doesn't have the infection, and antibiotics are unlikely to be necessary in patients with tonsillitis who are unwell, and have three out of four of these criteria, the risk of quinsy is 1:60 compared with 1:400 in those who are not unwell centor criteria is not ideal, and will lead to some patients with bacterial pharyngitis not being treated and result in unnecessary antibiotic treatment for others Ref : PHP_susp_PO_v1.0 Page 2 of 9
Drug Details Name, form & strength of medicine Route/Method Dosage Frequency Duration of treatment Maximum or minimum treatment period Quantity to supply/administer Phenoxymethylpenicillin (Penicillin V) 125mg/5ml Oral 1-5 years and 11 months 1 x 5ml spoonful of 125mg/5ml suspension It is preferable to administer measured dose via a medicine syringe. FOUR times a day (QDS) 5 days** **IMPORTANT: The indicated course of treatment is 10 days but, because of the limited shelf life of reconstituted Pen V, only 100mls can be issued. The patient therefore MUST see their GP before day 5 to review the medication. 5 days** 1 x 100ml bottle Side effects` The most common reactions are nausea, vomiting, epigastric distress, diarrhoea Hypersensitivity reactions including urticaria, fever, joint pains, rashes, angiodema, anaphylaxis. (Anaphylactic reactions occur occasionally with a reported incidence of about 0.05% of patients) Infrequently haemolytic anaemia, interstitial nephritis, neutropenia, thrombocytopenia, neuropathy and nephropathy Advice to patient/carer Doses should be taken 1 hour before food or on an empty stomach and at regular intervals It is important to finish the course even if the symptoms have resolved If any side effects occur such as nausea and vomiting or severe diarrhoea advise patient to see GP for further advice If rash develops discontinue treatment and see GP Advise patient to shake the bottle before use and to store syrup preparations in fridge discarding any contents more than 7 days old Advise that any oral solution or tablets remaining after proper completion of the course should be safely discarded Product information leaflet should be given to the patient Follow up Advise patient (or parent guardian) to return or see GP if they become more unwell or symptoms do not resolve Ref : PHP_susp_PO_v1.0 Page 3 of 9
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Staff Characteristics Professional qualifications Ambulance Paramedic with Paramedic Practitioner Qualification (must have passed minor injury, minor illness and applied pharmacology module or equivalent qualification). Specialist competencies or qualifications Continuing education & training Registered Nurse with current Nursing and Midwifery Council (NMC) registration and on SECAmb paramedic practitioner pathway (must have passed minor injury, minor illness and applied pharmacology module). Has undertaken appropriate training and successfully completed the competencies to undertake the clinical assessment of patient leading to diagnosis that requires treatment according to the indications listed in this PGD. Has undertaken appropriate training for working under PGDs for the supply and administration of medicines. Demonstrates ongoing competency for treating condition indicated for use of each PGD. 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 of practice. Consider discussing with your PP CEM or GP mentor if you have concerns over your ongoing competency. Ref : PHP_susp_PO_v1.0 Page 5 of 9
Referral Arrangements and Audit Trail Referral arrangements Instruct patient and/or carer to seek advice in the event of condition worsening. Records/audit trail Patient s name, address, date of birth and consent given Contact details of GP (if registered) Diagnosis or working diagnosis Dose and form supplied Batch and expiry details Duration of antibiotic treatment given Advice given to patient (including side effects) Signature/name of staff who administered or supplied the medication Details of any adverse drug reaction and actions taken including documentation in the patient s medical record Referral arrangements (including self-care) Document that patient has received the patient advice leaflet with the medication (where applicable) References/Resources and comments British National Formulary 57 National Electronic Library for Medicines http://www.nelm.nhs.uk/en/originalsearch/?parent=11968&query=penicillin+v Clinical Knowledge Summaries http://www.cks.nhs.uk/sore_throat_acute#-326936 GP Notebook Centor criteria to aid diagnosis of Group A beta-haemolytic streptococcus http://www.gpnotebook.co.uk/simplepage.cfm?id=x2006121 3134544295600 Ref : PHP_susp_PO_v1.0 Page 6 of 9
This patient group direction must be agreed to and signed by all health care professionals involved in its use. The NHS Trust should hold the original signed copy. The PGD must be easily accessible in the clinical setting Organisation South East Coast Ambulance Service NHS Trust Ambulance Headquarters The Horseshoe Banstead, Surrey, SM7 2AS Authorisation Organisational authorisation by Name: Position: Paul Sutton Chief Executive Signature: Lead Doctor Name: Dr Jane Pateman Position: Medical Director Date: Lead Allied Health Professional Signature: Date: 25/3/2010 Name: Andy Newton Position: Clinical Director & Consultant Paramedic Signature: Date: 29/3/2010 Lead Pharmacist Name: Ian Bourns Position: Pharmacy Advisor Clinical Governance Lead Signature: Date: 29/3/2010 Name: Nicola Brooks Position: Assistant Clinical Director (Governance) Signature: Date: 25/3/2010 PGD Authored by Name: Andy Collen Position: Head of Programmes & Planning Signature: Date: 25/3/2010 Ref : PHP_susp_PO_v1.0 Page 7 of 9
Patient Group Direction Peer Reviewed by Name Position Date Andy Collen Head of Programmes and Planning August 2009 Andy Newton Clinical Director August 2009 Jane Pateman Medical Director August 2009 Nicola Brookes Assistant Clinical Director August 2009 Ref : PHP_susp_PO_v1.0 Page 8 of 9
Individual Authorisation PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. It is the responsibility of each professional to practice only within the bounds of their own scope of practice and in accordance with their own Code of Professional Standards and Conduct. Note to Authorising Managers: authorised staff should be provided with an individual copy of the clinical content of the PGD and a photocopy of the document showing their authorisation. I have read and understood the Patient Group Direction and agree to supply/administer this medicine only in accordance with this PGD. Name of Professional Signature Authorising Manager Date Ref : PHP_susp_PO_v1.0 Page 9 of 9