Patient Group Direction for SALBUTAMOL INHALER (Version 02) Valid From 1 October September 2019

Transcription

1 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 31/07/17 V02 Review. No changes needed. 28/08/17 V02 Review. Minor editing changes. 28/08/2017 Page 1 of 7

2 CLINICAL CONTENT OF PATIENT GROUP DIRECTION Staff Characteristics Qualifications Specialist competencies or qualifications Continuing training and education 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. Clinical Details Indication 28/08/2017 Page 2 of 7 Emergency treatment of patients presenting with acute asthma or shortness of breath secondary to bronchospasm or other respiratory disorders, e.g. COPD. Inclusion criteria Patients with the above indications. Exclusion criteria Hypersensitivity to salbutamol, beta-adrenoceptor agonists or any constituent of the product. Children aged under 2 years. Pregnancy and breast feeding unless no prescribing clinician on site and able to manage the patient, when use can proceed only if benefits outweigh risks. Patients with severe acute or life-threatening asthma (or equivalent severity of other presentations): nebulised salbutamol is preferable. Refer to charts in BTS/SIGN guideline for criteria / physiological parameters indicating level of severity of acute asthma. PGDs should be used only where appropriate, suitable and legal. PGDs should not be routinely used when an independent prescriber is available. Precautions For use only via a nebulizer. In children under 18 months there is less certainty of the efficacy of salbutamol. Consider use of alternative bronchodilators if lack of effect. Serious cardiac disorders, including recent myocardial infarction, coronary heart disease, cardiomyopathies, tachyarrhythmias, severe / uncontrolled hypertension, aneurysm, hyperthyroidism, uncontrolled diabetes, pheochromocytoma: use with caution. Hypokalaemia. Patients taking other sympathomimetic drugs, tricyclic antidepressants,

3 Management of excluded patients Action for patients not wishing / unable to receive care under this PGD corticosteroids. Bronchodilation should not be the only or main treatment in patients with severe or unstable asthma. Severe asthma requires medical assessment prior to discharge as the need for beta-2 agonist indicates deterioration of asthma control. Consider the need for supplemental oxygen if saturations <94%. Consider if any indication for hospital referral: o See BTS/SIGN guideline for more information all patients with severe or life-threatening asthma. o See NICE/GOLD COPD guideline. Discuss with GP or Clinical Lead or refer. Make patient aware of risks and potential consequences of not taking medicine. Discuss any alternatives if available. Discuss alternative options with GP or Clinical Lead. Document discussion with patient. Description of Treatment Name of medicine Salbutamol Formulation and route CFC-free pressurised metered dose inhaler Strength 100 micrograms per dose Dosage Administer via an appropriate spacer Children may require the use of a face mask in association with the spacer Administer a single dose at a time, inhaled via 5 tidal-breaths on the spacer Repeat as needed up to 10 doses per cycle If not improving repeat cycles as needed while awaiting emergency transfer to hospital If retaining the inhaler 1-2 doses can be used when required for symptoms but patients should seek early advice if needing regularly or symptoms are deteriorating, especially in the days following an exacerbation Repeated dose instructions Duration of treatment Quantity to supply 28/08/2017 Page 3 of 7 Use in children under 4 years may be outside of the manufacturer s marketing authorisation (product license) but is consistent with advice in the BTS/SIGN asthma guideline. See above As needed for management of acute episode One inhaler (where appropriate patient can retain the inhaler used for treatment of the acute episode)

4 Legal status Special precautions Adverse effects POM Explain indications, contraindications and cautions (refer to BNF) Fine tremor of skeletal muscle may occur however the effect is usually dose related and common to all B adrenergic stimulants. Headache, tachycardia. Rarely Hypokalaemia, Peripheral vasodilatation. Very Rarely Hypersensitivity reactions, Paradoxical Bronchospasm indicated by an increase in wheezing (discontinue immediately and instigate alternative), electrolyte disturbances, Hyperactivity, Arrhythmias including AF, SVT, extrasystole. Uncommon Palpitations, Mouth and throat irritation, Muscle cramps. 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. 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. Advise regular appointments with practice respiratory nurse. Advise to carry reliever with them at all times. Ensure patient has supply of inhaled beta-2 agonist, any preventative therapies and that inhaler technique is correct. Patients with asthma requiring nebulisation have had an exacerbation: o This normally mandates preventative therapy (e.g. with an inhaled corticosteroid) for a minimum of the next two years. o Refer back to own surgery for follow up management. Consider the need for an appropriate oral steroid course (for all patients with acute asthma). 28/08/2017 Page 4 of 7 Use as an opportunity to educate regarding correct asthma care. Communicate the event promptly to the patient s own surgery so that they can take appropriate follow up steps. Prescribing guidance Doncaster, East Lancashire, Fylde and Wyre and North Lancashire CCG local guidelines.

5 Relevant NICE guidelines and advice from Clinical Knowledge Summaries. Public Health England guidance on primary care 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. 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 5 of 7

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 Dr Jonathan Bundy Magnus Hird Lead Paramedic 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 6 of 7

7 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 7 of 7