Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose

Transcription

1 Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose Co-ordinators: Healthy Hoose Pharmacist Consultation Group: See relevant page in the PGD Approver: Medicine Guidelines and Policies Group Signature: Signature: Signature: Identifier: NHSG/PGD/HH_min_ill/ MGP782 Review Date: January 2018 Date Approved: January 2016 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 3

2 Title: Identifier: Replaces: Across NHS Boards Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose NHSG/PGD/HH_min_ill/MGP782 NHSG/PGD/HH_min_ill/MGP589 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: Healthy Hoose Pharmacist/Lead Pharmacist (Central Clusters) Aberdeen City Health And Social Care Partnership. Patient Group Direction PGD patient group direction Healthy Hoose medicines minor illness NHS Grampian This Patient Group Direction (PGD) authorises appropriately qualified and trained Nurse Practitioners or Pharmacists working in the Middlefield Healthy Hoose to supply medicines included in this PGD 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 Deputy General Managers and Clinical Leads Unit Operational Managers It is the responsibility of individual Nurse Practitioners or Pharmacists 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: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP782 - 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: Healthy Hoose Pharmacist Pharmacy and Medicines Directorate Healthy Hoose, Logie Place, Aberdeen Healthy Hoose Pharmacist Healthy Hoose Pharmacist Revision History: Date of change Approval date PGD being superseded Summary of Changes Nov 2015 July yearly update into new template Nov 2015 July 2013 Amended Dimeticone Lotion quantities to 50mL and 100mL Section heading Monograph Nov 2015 July 2013 Removal of Hydrocortisone 1% Ointment x 15g Monograph Feb 2016 July 2013 Removal of administration so PGD is for supply only as no longer administer on site Feb 2016 July 2013 Removal of Loratadine Monograph UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP782 - ii -

4 Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose Part A Introduction Clinical Decision Making Patients who may be considered for the supply of medicines listed in Appendix 3 of this PGD Patients who may receive the supply of medicines listed in Appendix 3 of this PGD Contraindications Precautions Action to be taken when a patient is excluded from treatment under this PGD Action to be taken when a patient/parent/guardian or person with parental responsibility does not wish the treatment to be received under this PGD Description Of Treatment Available Under This Direction Medicines Listed in Appendix 3 of this PGD Dose, route and frequency Concurrent medication Adverse effects Advice to patient Follow up treatment... 5 Part B Designated Staff Authorised To Supply Under This PGD Documentation Authorisation of supply Record of supply Further Points Facilities And Supplies To Be Available At Sites For The Supply Of The Drug Specified In The PGD Audit... 8 Part C Management And Monitoring Of Patient Group Direction Consultative group Professional advisory group approving PGD Authorising managers References... 9 Appendix Appendix UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

5 Appendix 3 - Medicine Monographs Beclometasone Dipropionate Cetirizine Chloramphenicol Chlorphenamine Clotrimazole Dimeticone 4% Lotion (Hedrin ) Fluconazole 150mg Capsule Hydrocortisone 1% Ibuprofen Malathion Mebendazole Omeprazole Paracetamol Permethrin 5% Salicylic Acid/Lactic Acid Sodium Cromoglicate UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

6 Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose Part A 1. Introduction This patient group direction (PGD) will authorise Nurse Practitioners or Pharmacists working in the Healthy Hoose to supply medicines listed in Appendix 3 to individuals who meet the criteria as described on each individual drug monograph, according to diagnosis, age, disease state and concurrent medicines. This PGD should be used in conjunction with the recommendations in the current British National Formulary and individual Summary of Product Characteristics. 2. Clinical Decision Making 2.1. Patients who may be considered for the supply of medicines listed in Appendix 3 of this PGD (i) Patients who attend the Healthy Hoose Patients who may receive the supply of medicines listed in Appendix 3 of this PGD All patients in 2.1 above, where they, their parent, guardian or person with parental responsibility does not want specifically to consult with a doctor and are happy for the supply to be given by the Nurse Practitioner or Pharmacist working at the Healthy Hoose Contraindications Patients may be supplied medicines listed in Appendix 3 under this PGD unless: (i) the patient has a known or suspected hypersensitivity to the medicine or any of its ingredients. (ii) the patient has previously experienced an adverse reaction to the medicine. (iii) the patient is already receiving therapy for the condition from a doctor. (iv) the patient meets any of the exclusion criteria listed in the individual monographs. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

7 2.4. Precautions The medicines included in this PGD should be used only for the specific indication(s) and age group listed in the individual drug monographs. (i) If there is any concern about the appropriate use of the medicine in the specific indications given within the PGD then medical advice should be sought. (ii) If there is any doubt about the correct diagnosis, medical advice should be sought. (iii) Precautions listed in the individual monographs should be taken into account. (iv) The medicine patient information leaflet should be consulted to ensure that the patient has not experienced a previous hypersensitivity reaction to any ingredients or excipients Action to be taken when a patient is excluded from treatment under this PGD If a patient is excluded from treatment under this PGD, medical advice should be sought refer to a doctor Action to be taken when a patient/parent/guardian or person with parental responsibility does not wish the treatment to be received under this PGD If a patient/parent/guardian/person with parental responsibility does not wish the treatment to be received under this PGD, medical advice should be sought refer to the patient s own GP. 3. Description Of Treatment Available Under This Direction 3.1. Medicines Listed in Appendix 3 of this PGD See individual monographs Dose, route and frequency See individual monographs. Duration of treatment Limited to short term use (generally one pack as specified in monograph). Patients advised to seek further advice if condition not resolved Concurrent medication See individual product monographs and refer to manufacturer s product information. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

8 3.4. Adverse effects In the event that the patient suffers an adverse reaction to the medicine supplied, the medicine should be stopped and the adverse event documented and treated if necessary. Medical advice in cases of anaphylaxis Injections of IM adrenaline/epinephrine 1:1000 must be available to treat an anaphylactic reaction should this occur. Medical advice must be sought as soon as possible from a doctor if any patient develops any signs of hypersensitivity. If there is a delay in medical support arriving and the condition of the patient is deteriorating then an emergency ambulance must be called on 999 or direct via ambulance control or dial 2222 (hospital internal) according to local procedure, or seek urgent medical advice. (Refer to Patient Group Direction for the administration of adrenaline (epinephrine) in cases of suspected anaphylactic reactions by qualified health professionals). Overdose Refer to manufacturer s product information. In case of significant overdose, refer to Accident and Emergency or dial 999 if appropriate Advice to patient (i) Advice should be given on what to expect and what to do for major and minor reactions. (ii) The patient information leaflet contained in the medicine(s) should be made accessible to the patient/parent/guardian or person with parental responsibility. Where this is unavailable, or unsuitable, sufficient information should be given to the patient/parent/guardian or person with parental responsibility in a language that they can understand Follow up treatment Patients should not leave if they are feeling at all unwell without speaking to the Nurse Practitioner or Pharmacist first. If necessary a doctor or the patient s GP should be contacted for advice. If symptoms do not resolve, patients should be advised to seek further advice. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

9 Part B 4. Designated Staff Authorised To Supply Under This PGD The following staff are authorised to supply 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 Practitioners working within Middlefield Healthy Hoose, as recognised by the Nursing and Midwifery Council (NMC). (ii) Pharmacists registered as Practising Pharmacists as recognised by the General Pharmaceutical Council (GPhC) working within Middlefield Healthy Hoose. 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 supply. (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 supply of the drug. All staff will have access to the current PGD. (v) have undertaken the 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: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

10 (iii) Ensuring that staff have received adequate training in all areas relevant to this PGD and meet the requirements above. (iv) PGD. Maintaining a current record of all staff authorised to supply the drug specified in this 5. Documentation 5.1. Authorisation of supply (i) Nurses working within Middlefield Healthy Hoose, NHS Grampian can be authorised to supply the drugs specified in this PGD by their nurse manager. (ii) Pharmacists working within Middlefield Healthy Hoose, NHS Grampian can be authorised to supply the drugs specified in this PGD by The Director of Pharmacy and Medicines Management. A certificate of authorisation (Appendix 2) signed by the authorising doctor/manager should be supplied. This should be held in the individual Nurse Practitioner or Pharmacist records or as agreed locally Record of supply An electronic or paper record for recording the screening of patients and the subsequent supply of the drug specified in this PGD must be completed in order to allow audit of practice. This should include: (i) Name and address of patient/parent/guardian or person with parental responsibility, patient CHI No (ii) Date of birth (iii) Consultant/General Practitioner details (iv) Risk group, if appropriate (v) Physical examination required, if appropriate (vi) Exclusion criteria, record why drug not supplied (vii) Reason for giving (viii) Signature and name in capital letters of practitioner who supplied the drug (ix) Date drug supplied (x) Record of adverse effects (advise patient s doctor). These records should be retained: For children and young people, retain until the patient's 25th birthday or 26th if the young person was 17 at the conclusion of treatment. For 17 years and over retain for 6 years after last date of entry. Or for 3 years after death, or in accordance with local policy, where this is greater than above. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

11 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 Supply Of The Drug Specified In The PGD The following should be available at sites where the drug is to be supplied: (i) Pharmaceutical refrigerator (or validated cool box for storing vaccine if mobile unit). (ii) Resuscitation equipment. (iii) Access to medical support (this may be via telephone). (iv) Safe storage areas for medicines and equipment. (v) Approved equipment for the disposal of used materials. (vi) Clean and tidy work areas. (vii) Copies of the current PGD for the drug specified in the PGD (viii) PGD for the administration of adrenaline (epinephrine) in cases of suspected anaphylactic reactions by qualified health professionals. 8. Audit All records of supply 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 each HSCP/practice/service will be responsible for auditing completion of drug forms and collation of data. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

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13 Appendix 1 Health Care Professional Agreement To Supply Medicines Under Patient Group Direction I: (Insert name) Working within: Agree to supply medicines under the direction contained within the following Patient Group Direction Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose I have completed the appropriate training to my professional standards enabling me to supply 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: Professional Registration No: UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

14 Appendix 2 Certificate Of Authorisation To Supply Medicines Under Patient Group Direction This authorises: Working within: e.g. HSCP, Practice To supply medicines under the following Patient Group Direction Patient Group Direction For The Supply Of Medicines For Minor Illness By Nurse Practitioners Or Pharmacists Working Within Middlefield Healthy Hoose The above named person has satisfied the training requirements and is authorised to supply 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: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

15 Appendix 3 - Medicine Monographs Beclometasone Dipropionate Cetirizine Chloramphenicol Chlorphenamine Clotrimazole Dimeticone 4% Lotion (Hedrin ) Fluconazole 150mg Capsule Hydrocortisone 1% Ibuprofen Malathion Mebendazole Omeprazole Paracetamol Permethrin 5% Salicylic Acid/Lactic Acid Sodium Cromoglicate UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

16 Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Beclometasone Dipropionate Drugs used in nasal allergy P 50mcg/spray [1 x OP] Intranasal Prevention and treatment of seasonal allergic rhinitis Adults aged 18 years and over Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other Dose: Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Informed non-consent Children and adolescents under 18 years of age Hypersensitivity to any constituents Recent injury or surgery to the nose Ulceration in the nose Pregnancy and breast-feeding Adult (over 18 years): 100micrograms (2 sprays) into each nostril morning and evening. When symptoms are controlled this can be reduced to 50 micrograms (1 spray) into each nostril morning and evening. Advise patient: (i) read manufacturer s patient information leaflet. (ii) no improvement in symptoms within 10 days seek further advice. (iii) should not be used continuously for longer than 3 months without review. Dryness and irritation of the nose and throat, and epistaxis. Raised intra-ocular pressure, glaucoma or cataract has been reported rarely. Headache, smell and taste disturbances. Hyperactivity, sleep disturbances, anxiety, depression and aggression. Hypersensitivity reactions including bronchospasm. Patient may also require additional therapy for eye symptoms. Storage: Store below 30 C Spray should be discarded 3 months after opening. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

17 Drug Group: Drug Legal Status: Cetirizine Non-sedating antihistamine P Presentation: 10mg tablets [1 x 30] 5mg/5mL solution [1 x 200mL] Route: Indication: Oral Relief of allergy such as hay fever, urticaria Antihistamine of choice where the side-effect of drowsiness is problematic for patient Inclusion Criteria: Adults and children over 2 years of age Exclusion Criteria: (a) consent (b) age (c) disease states Informed non-consent Children under 2 years of age Hypersensitivity to any constituents Renal impairment (d) other Dose: Pregnancy or breast-feeding Adults and children over 12 years: 10mg once daily Child 6-12 years: 5mg twice daily (half a tablet twice daily) Child 2-6 years: (solution only) 2.5mg twice daily Nursing/Patient Advice: (a) administration Advise patient: (i) that drowsiness can occur and may affect performance of skilled tasks, e.g. driving. (ii) that excess alcohol should be avoided. (iii) to read manufacturer s patient information leaflet. (b) side-effects/adverse reactions Storage: Headache, dry mouth, dizziness, agitation, GI upset. Refer to BNF for other side-effects. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

18 Drug Group: Drug Legal Status: Presentation: Route: Indication: Chloramphenicol Antibacterial eye drops/ointment P 0.5% eye drops [10mL]/1% eye ointment [4g] Topical Acute purulent conjunctivitis Refer to NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care (Updated March 2015) Inclusion Criteria: Adults and children over 2 years of age Exclusion Criteria: (a) consent (b) age (c) disease states (d) other Dose: Informed non-consent Child under 2 years of age Hypersensitivity to chloramphenicol Hypersensitivity to excipients of chloramphenicol preparation History of aplastic anaemia Disturbances in vision except those due to matter in eye Orbital cellulitis Moderate to severe pain within eyeball Pregnancy or breast-feeding Eye drops: Instil 1 drop to affected eye(s) every 2 hours for first 48 hours (waking hours only) then four times daily. Eye ointment: Apply 3-4 times daily to the inside of lower affected lid if used alone, or at night if eye drops are used during the day. Treatment is for 5 days. Nursing/Patient Advice: (a) administration Advise patient: (i) to follow the manufacturer s patient information leaflet. (ii) to use a separate dropper/tube for each eye. (iii) to contact the GP if symptoms worsen. (iv) that treatment should continue for 48 hours after eye has returned to normal. (v) not to wear contact lenses when using this product and for 24 hours after completion of treatment. (vi) to keep the ointment tube tightly closed. (vii) to return any unused ointment to the community pharmacy. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

19 (b) side-effects/adverse reactions (c) other Storage: Chloramphenicol May cause transient blurring of vision on administration. Warn patients not to drive or operate hazardous machinery unless vision is clear. Refer to BNF Chapter for information on excipients. Advise patient to seek medical advice if there is no improvement within 24 hours. Eye drops store in fridge between +2 to +8 C. Eye ointment - Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

20 Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Chlorphenamine Antihistamine P 4mg tablets [1 x 28/30], 2mg/5mL solution [1 x 150mL] Oral Relief of allergy, hay fever, vasomotor rhinitis, urticaria, insect bites, stings (where the side-effect of drowsiness is not a problem). Adults and children over 1 year of age Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other Informed non-consent Children under 1 year of age Benign prostatic hyperplasia Urinary retention Epilepsy Hypersensitivity to chlorphenamine or ingredients Glaucoma Renal and hepatic impairment Bronchiectasis or asthma Severe hypertension or cardiovascular disease Alcohol due to increased risk of sedation. A non-sedating antihistamine is preferable Patients treated with MAOIs within the last 14 days Phenytoin, carbamazepine Other medicines containing antihistamines Tricyclic antidepressants, anxiolytics and hypnotics due to increased risk of sedation. A non-sedating antihistamine is preferable Pregnancy or breast-feeding. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

21 Dose: Chlorphenamine By mouth Adult: 4mg every 4-6 hours maximum 24mg daily Child 6-12 years: 2mg every 4-6 hours, maximum 12mg daily Child 2-5 years: 1mg every 4-6 hours, maximum 6mg daily Child 1-2 years: 1mg twice daily Child under 1 year: not recommended Tablets are not licensed for children under 6 years, Solution to be given to children under 6 years of age. Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions Advise patient to avoid alcohol. Drowsiness and psychomotor impairment that can seriously affect the patient s ability to drive and use machinery. Sedating effects are enhanced by alcohol and other sedating medicines. (c) other Storage: Rarely paradoxical stimulation in children and elderly patients in high doses. Antimuscarinic side-effects urinary retention, dry mouth, blurred vision and GI disturbances. Refer to BNF for other rare side-effects. Patient should be advised not to drive or operate machinery. Store below 30 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

22 Drug Group: Drug Legal Status: Presentation: Route: Indication: Clotrimazole Antifungal P Cream 1% [20g] Vaginal Tablet [1 x 500g] Canesten Pessary Combi [2% cream x 10g, 1 x 500mg pessary] Topical Treatment of vaginal thrush Fungal skin infection (cream only) Refer to NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care (Updated March 2015) pdf Inclusion Criteria: Adults over 16 years of age (vaginal tablet and Canesten Pessary Combi) Exclusion Criteria: Adults, Children and Infants (1% Cream) (a) consent (b) age (c) disease state (d) other Dose: Informed non consent Children under 16 years of age (vaginal tablet (pessary) and Canesten Pessary Combi) Hypersensitivity to clotrimazole, cetostearyl alcohol or any excipients Pregnancy, breastfeeding Vaginal Thrush: One vaginal tablet should be inserted into the vagina at night. The cream should be thinly applied to the vulva and surrounding area, two or three times daily and rubbed in gently. Fungal skin infection: The cream should be applied thinly to the affected area 2 to 3 times daily. If the feet are affected before applying cream they should be washed and dried, in particular between the toes. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

23 Clotrimazole Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Storage: Advise patient: (i) that the vaginal tablet should be inserted as high as possible into the vagina using the applicator provided. (ii) to avoid treatment during the menstrual period due to the risk of the pessary being washed out by the menstrual flow. (iii) that treatment with the cream should be continued for 1-2 weeks after symptoms have resolved. (iv) that if symptoms do not resolve in 7 days, then medical advice should be sought. (v) that if the patient has experienced the symptoms of vaginal candidiasis for the second time in 6 months, then medical advice should be sought Provide appropriate patient information leaflet. Itching, rash, swelling, discomfort, burning, skin irritation. Pain in the abdomen or pelvic area (pessary). Male sexual partners do not need treatment unless they have symptoms of thrush on their penis. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

24 Dimeticone 4% Lotion (Hedrin ) Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Parasiticidal preparations P 1 x 100mL, 1 x 50mL External application Head lice Adults and children over 6 months of age Exclusion Criteria: (a) consent (b) age (c) disease state Instructions for Use: Informed non consent Children under 6 months of age Hypersensitivity to any constituents Adults/Children over 6 month: Apply lotion evenly over DRY hair ensuring scalp is fully covered. Work into hair spreading liquid from roots to tips. Allow hair to dry naturally. Leave on hair for at least 8 hours or overnight. Wash hair with normal shampoo, rinse thoroughly. REPEAT AFTER 7 DAYS (Refer to manufacturer s advice in pack) Nursing/Patient Advice: (a) administration Advise patient: (i) to read the manufacturer s patient information leaflet. (ii) that head lice infestation should only be treated if live lice are present. (iii) that all close contacts should be advised to check their hair but should not treat unless live lice are found. (iv) to avoid contact with eyes. Rinse eyes with cold water and seek medical advice if Hedrin accidently gets in eyes. (v) that detection combing two or three days after the final application of insecticide should be undertaken in order to check whether or not treatment was successful. (vi) to keep hair away from naked flames or lit cigarettes during treatment with Hedrin. (b) side effects/adverse reactions (c) other Storage: Slight skin irritation may occur, e.g. itching or flaking of the scalp. If signs of more severe irritation, e.g. rash or urticaria, pruritus or hypersensitivity, shampoo off and if symptoms do not resolve medical advice should be sought. For external use only Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

25 Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Fluconazole 150mg Capsule Triazole antifungal capsule P 1 x 150mg capsule Oral Vaginal Candidiasis Refer to NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care (Updated March 2015) pdf Adults and children over 16 years of age Exclusion Criteria: (a) consent (b) age (c) disease state (d) other Dose: Informed non consent Children under 16 years of age Acute porphyria Hypersensitivity to fluconazole or any constituents Pregnancy Adults and children over 16 years: A single dose of 150mg swallowed whole Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Storage: Advise patient to read the manufacturer s patient information leaflet. Nausea, abdominal discomfort, diarrhoea, flatulence, headache, rash. Hypersensitivity reactions. Advise patient that it is a single dose and if symptoms persist to seek further advice. Discuss treating partner if relevant. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

26 Hydrocortisone 1% Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Mild topical steroid P 1 x 15g cream Topical Allergic contact dermatitis, irritant dermatitis, insect bite reactions and mild to moderate eczema Adults and Children over 10 years of age Exclusion Criteria: (a) consent (b) age (c) disease state (d) other Instructions for Use: Informed non consent Children under 10 years of age Hypersensitivity to hydrocortisone or any of its constituents. Not to be used for application to the face, anogenital region, broken or infected skin (including cold sores, acne and athlete s foot). Pregnancy Adults and Children over 10 years: Apply thinly over the affected area once or twice daily for maximum 1 week. Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Storage: Advise patient: (i) to apply thinly to the affected area. (ii) that if the condition has not improved after 7 days, or worsens, to seek further advice. (iii) to read the manufacturer s patient information leaflet. Usually well tolerated rarely hypersensitivity reactions. For external use only. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

27 Drug Group: Drug Legal Status: Ibuprofen Non-steroidal anti-inflammatory drug (NSAID) P Presentation: 200mg, 400mg tablets [1 x 24] 100mg/5mL suspension [1 x 100mL/150mL] Route: Indication: Inclusion Criteria: Oral Adults over 18 years of age: Mild to moderate musculoskeletal pain and inflammation Children over 3 months of age: Mild to moderate pain, pyrexia Adults and children over 3 months of age with body weight over 5kg Caution in the elderly Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other Informed non consent Child under 3 months of age Active Peptic ulcer or history of peptic ulcer Current dyspepsia Hypersensitivity to the constituents and other NSAIDs including aspirin Asthma Severe renal and hepatic impairment Congestive cardiac failure Porphyria Patients with coagulation defects ACE-Inhibitors Anticoagulants Anti-platelets, e.g. clopidogrel and aspirin (above 75mg daily) Ciclosporin Corticosteroids Lithium Methotrexate Pentoxifylline Probenecid Quinolones Tacrolimus Other NSAIDs Sulphonylureas Pregnancy or breast-feeding Body weight under 5kg UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

28 Dose: Ibuprofen Adults: 400mg 3-4 times daily after food. Up to maximum of 2.4g daily Children: years: 200mg - 400mg 3-4 times daily after food years: 200mg - 300mg 3 times daily after food 7-10 years: 200mg 3 times daily after food Child 4-7 years: 150mg 3 times daily after food Child 1-4 years: 100mg 3 times daily after food Child 6 months to 1 year: 50mg 3-4 times daily after food Child 3-6 months: 50mg 3 times daily after food Caution: Elderly or frail are more susceptible to side-effects associated with NSAIDs and should be advised to take half the normal adult dose. Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Storage: Advise patient: (i) to take with or after food. (ii) to read manufacturer s patient information leaflet. GI discomfort occasionally with GI bleed or ulceration Nausea and diarrhoea Headache Dizziness/drowsiness Nervousness Insomnia Depression Vertigo Tinnitus Photosensitivity Hypersensitivity reactions including rashes and bronchospasm and angioedema. Refer to BNF for other side-effects. Issue a 5mL spoon or 2.5mL /5mL oral syringe with the suspension. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

29 Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Malathion Parasiticidal preparations P 0.5% aqueous liquid [1 x 50mL, 1 x 200mL] Topical external For the eradication of head lice Refer to NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care (updated March 2015) Adults and children over 6 months of age Exclusion Criteria: (a) consent (b) age (c) disease states Dose: Informed non consent Child under 6 months of age Hypersensitivity to any of the constituents Rub the liquid into the scalp until all the hair and scalp is thoroughly moistened. Leave the hair to dry naturally in a warm but well ventilated room. After 12 hours, or the next day if preferred, shampoo the hair in the normal way. Rinse the hair and comb whilst wet to remove the dead lice and eggs (nits) using a nit comb. Treatment should be repeated after 7 days. Nursing/Patient Advice: (a) administration Advise patient to apply as above and: (i) to avoid contact with eyes. (ii) not to apply to broken or infected skin. (iii) that head lice infestation should only be treated if live lice are present. (iv) that all close contacts should be advised to check their hair but should not be treated unless live lice are found. (v) that detection combing two or three days after the final application of insecticide should be undertaken in order to check whether or not treatment was successful. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

30 (b) side-effects/adverse reactions (c) other Storage: Malathion Skin irritation Hypersensitivity reactions (anaphylaxis, angioedema, and swollen eyes). Chemical burns have also been reported. For external use only If swallowed contact seek medical advice immediately Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

31 Drug Group: Drug Legal Status: Presentation: Route: Indication: Mebendazole Anthelmintics P Mebendazole 100mg tablets [1 x 1, 1 x 4 tablets] Oral Treatment of threadworm infestation Refer to NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care (updated March 2015) Inclusion Criteria: Adults and children over 2 years of age Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other Dose: Informed non consent Children under 2 years of age Hypersensitivity to any of the constituents Cimetidine Metronidazole Pregnancy, breastfeeding One tablet as a single dose. A second tablet may be taken after 2 weeks if re-infection is suspected. Nursing/Patient Advice: (a) administration Advise patient: (i) that tablets may be chewed or swallowed whole. (ii) to crush the tablet before giving it to a young child. (b) side-effects/adverse reactions Very rarely abdominal pain, diarrhoea, convulsions (in infants), allergic reactions. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

32 (c) other Storage: Mebendazole Care should be taken to avoid re-infection and it is strongly recommended that all members of the family are treated at the same time. General hygiene measures: (i) Keep nails short. (ii) Discourage nail biting or finger sucking. (iii) Wear pyjamas or underclothes in bed. (iv) In the mornings, wash thoroughly around the bottom. (v) Provide a towel for the exclusive use of each member of the household. (vi) Change clothes regularly. (vii) Regularly wash and iron bed linen. (viii) Thoroughly wash hands and nails after using the toilet and before each meal. No specific requirements stated by manufacturer. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

33 Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Omeprazole Proton pump inhibitor P 10mg tablets [1 x 28 tablets] Oral 2 nd line acid reflux following unsuccessful treatment with Gaviscon Advance, indigestion, dyspepsia. Adults over 18 years of age Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other Informed non-consent Children under 18 years of age Liver disease Warfarin Phenytoin Clozapine Cilostazol Patients with any alarm symptoms: (i) Those aged 45 years or over with new onset of symptoms within the last year which lasted for at least four weeks. (ii) Those aged 45 years or over whose symptoms have changed. (iii) People of any age with heartburn associated with the following symptoms: unintentional weight loss dysphagia pain on swallowing persistent vomiting or vomiting with blood previous gastric ulcer or surgery jaundice. (iv) Those who have taken an indigestion or heartburn remedy for two weeks with no relief of symptoms Pregnancy or Breast-feeding. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

34 Dose: Omeprazole Two 10mg tablets once daily initially. If symptoms improve, reduce dose to one tablet daily. Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions Storage: Advise patient: (i) to swallow tablets whole with water. (ii) seek further advice if continuous treatment is required for 4 weeks or symptoms do not improve within 2 weeks. (iii) read manufacturer s patient information leaflet GI disturbance Headache Dizziness Refer to BNF for other side-effects. Store below 30 C. Store in the original container. Keep container securely closed. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

35 Drug Group: Drug Legal Status: Presentation: Route: Indication: Paracetamol Non-opioid analgesic P 120mg/5mL suspension [1 x 200mL] 250mg/5mL suspension [1 x 200mL] 500mg tablets [1 x 32 tablets] Oral Treatment of mild to moderate pain and/or pyrexia in adults and children over 3 months of age Post immunisation pyrexia for babies 2-3 months of age. Inclusion Criteria: Adults and children over 3 months of age and children over 2 months of age if for post immunisation pyrexia Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs Informed non consent Children under 2 months of age (or under 3 months of age if not for post immunisation pyrexia) Alcohol dependence Hypersensitivity to any excipients Renal or hepatic impairment Other medicines containing paracetamol Oral anticoagulants (prolonged regular use may enhance the anticoagulant effect. INR should be checked if patient continues to take paracetamol for more than 5 days). Dose: Adults; 500mg 1g every 4-6 hours to a max of 8 tabs in 24 hours. Child years: 500mg 1g every 4-6 hours; max 4 doses in 24 hours. Child 12-16years: mg every 4-6 hours; max 4 doses in 24 hours. Child years: mg every 4-6 hours; max 4 doses in 24 hours. Child 8-10 years: mg every 4-6 hours; max 4 doses in 24 hours. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

36 Paracetamol Child 6-8 years: mg every 4-6 hours; max 4 doses in 24 hours. Child 4-6 years: 240mg every 4-6 hours; max 4 doses in 24 hours. Child 2-4 years: 180mg every 4-6 hours; max 4 doses in 24 hours. 6 months 24 months:120mg every 4-6 hours; max 4 doses in 24 hours 3 6 months: 60mg every 4-6 hours; max 4 doses in 24 hours Child 2-3 months: 60mg as a single dose for post immunisation pyrexia. May be repeated once after 6 hours if necessary. Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Storage: Advise patient: (i) not to exceed recommended dose. (ii) not to take other medicines containing paracetamol. (iii) to have INR checked if they continue to take paracetamol regularly for longer than 5 days if taking oral anticoagulants. (iv) not to take cholestyramine at the same time as paracetamol as cholestyramine decreases the absorption of paracetamol. (v) to massage sachets before use (vi) to shake bottle for at least 10 seconds before use. (vii) to read manufacturer s information leaflet. Rarely occur Skin rashes and blood disorders have been reported rarely. Please refer to current BNF and BNFC Do not take other medicines containing paracetamol. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

37 Permethrin 5% Drug Group: Drug Legal Status: Parasiticidal preparations P Presentation: Dermal Cream [1 x 30g] Route: Indication: Inclusion Criteria: Topical external Treatment of scabies and crab lice Adults and children over 2 months of age Refer to NHS Grampian Staff prescribing Guidance for the Empirical treatment of Infections in Primary Care (Updated March 2015) Exclusion Criteria: (a) consent (b) age (c) disease states (d) other Dose: Informed non-consent Children under 2 years of age Hypersensitivity to any of the constituents Treatment should only be considered in pregnancy if clearly needed. Consider avoiding in breast-feeding (or temporarily discontinue breast-feeding) Scabies: Adults and children over 2 years: Apply cream to clean dry cool skin over whole body, including palms and soles (but not head and face). The whole body should be washed thoroughly 8 to 12 hours after treatment. If hands are washed during this time, the cream should be re-applied. Repeat after 7 days Guide to quantities: Adults and children over 12 years: 1 x 30g tube 6-12 years: Up to ½ of a 30g tube 2-5 years: Up to ¼ of a 30g tube Crab Lice: Adults over 18 years: Apply to the affected area (excluding eyelashes). Leave cream on for 24 hours. All treated areas should then be thoroughly washed. 1 x 30g tube. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

38 Permethrin 5% Nursing/Patient Advice: (a) administration (b) sideeffects/adverse reactions (c) other Storage: Advise patient: (i) to read the manufacturer s patient information leaflet. (ii) that scabies will persist indefinitely if not treated. Treatment is needed for anybody who has scabies and all household members, close contacts, and sleeping / sexual partners of the affected person - even if they have no symptoms. It can take up to six weeks to develop symptoms after becoming infected. Close contacts may be infected, but have no symptoms, and may pass on the mite. (iii) that itching can continue for up to 4 weeks after treatment. This is a normal reaction to dead scabies mites. Occasional burning, stinging of the skin. For external use only Store below 25 C. Do not freeze. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

39 Drug Group: Drug Legal Status: Salicylic Acid/Lactic Acid Preparations for warts and calluses P Presentation: Collodion 16.7% / 16.7% [1 x 10mL] (Salactol ) Gel 12% / 4% [1 x 5g] (Bazuka ) Route: Indication: Inclusion Criteria: Exclusion Criteria: (a) consent (b) age (c) disease states (d) drugs (e) other Dose: Nursing/Patient Advice: (a) administration Topical For the treatment of warts, verrucas, corns and calluses. For adults and children over 3 years of age Informed non-consent Children under 3 years of age Diabetes Impaired peripheral blood circulation Sensitivity to any of the ingredients Not to be used on or near the face, intertriginous or anogenital regions. Not to be used on moles, birthmarks, hairy warts or on any other skin lesions for which the preparations are not indicated. Apply once daily usually at night Advise patient: (i) to soak the affected site in warm water and pat dry. (ii) to protect skin surrounding wart, verruca, corn or callus with soft paraffin or a specially designed plaster. (iii) to carefully apply the treatment to the lesion following the manufacturer s instructions, taking care to localise the application to the affected area. (iv) that plantar warts should be covered by a plaster if using the colloidal preparation. (v) to leave for 24 hours. (vi) to repeat the procedure daily. (When using the gel, patient should peel off the dried gel from the wart before applying fresh gel). (vii) to gently rub the surface of the wart, verruca, corn or callus once a week with a pumice stone or manicure emery board to remove any hard skin. (viii) that it can take up to twelve weeks for resistant lesions to disappear, and it is necessary to persevere with the treatment. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

40 (b) sideeffects/adverse reactions Storage: Salicylic Acid/Lactic Acid Mild, transient irritation. If severe or persistent pain/irritation, then treatment should be suspended or discontinued. Store below 25 C. Extremely flammable. Replace cap tightly after use. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP

41 Drug Group: Drug Legal Status: Presentation: Route: Indication: Inclusion Criteria: Sodium Cromoglicate Other anti-inflammatory preparations (ocular) P 2% eye drops [1 x OP] Topical For the relief and treatment of seasonal and perennial allergic conjunctivitis. Adults and children over 3 years of age Exclusion Criteria: (a) consent (b) age (c) disease states (d) other Dose: Informed non-consent Children under 3 years of age Hypersensitivity to any of the constituents. First trimester of pregnancy One or two drops in each eye four times a day Nursing/Patient Advice: (a) administration (b) side-effects/adverse reactions (c) other Storage: Advise patient: (i) to take care that the tip of the dropper bottle does not touch the eye or the skin around the eye. (ii) for administration to tilt head backwards while seated, or lie down. Place the tip of the bottle close to the eye. Gently pull the lower eyelid downwards and look up. Squeeze the bottle gently and let one drop fall in the space between the lower eyelid and the eye. Close the eye for a moment. (iii) that soft contact lenses should not be worn whilst using this product. Transient stinging, burning, blurred vision. Only use in pregnancy if there is a clear need. Do not use during the 1 st trimester. Store below 30 C and protect from direct sunlight. Should be discarded 4 weeks after opening. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/HH_min_ill/MGP