Essential Shared Care Agreement (South Staffordshire): Aciclovir Administration in the Community

Transcription

1 E088 Essential Shared Care Agreement (South Staffordshire): Aciclovir Administration in the Community Patient s name: DOB NHS Number Patient s address: Consultant Note: Shared care agreement sets out a statement of Specialist Unit /CCN responsibilities. The agreement ensures that CCN s have sufficient information to enable them to take responsibility for administration of medication to children in the Community who may otherwise be in hospital or under the care of an acute trust. ESCA should be available whenever higher than minimal level of risk is involved (agreed by the Trust s Medicines Optimisation Committee) All reasonable requests will be considered however any CCN who does not wish to undertake the clinical and legal responsibility for administering tobramycin is not obliged to do so. Acceptance of the Shared Care Guidelines should be endorsed by the medicines management team of the CCG/ Acute Trust concerned. The information contained in this guideline is issued on the understanding that it is the best available from the resources at our disposal at the time of issue. For further information please refer to the relevant Summary of Product Characteristics ( and NICE guidance or contact your local Specialist or Drug Information Centre. Produced: March 2018 Review date: March 2021 Replaces: - one copy to CCN team - one copy to the patient - one copy to specialist unit Page 1 of 5

2 SHARED CARE GUIDELINES FOR Aciclovir Administration in Children Referral criteria When initiation is by an acute Trust, the patient will receive supplies of Aciclovir medication on a hospital or community prescription form. The prescription chart shall remain with the patient. A faxed copy of the prescription will need to be sent to the CCN before the medication is due to be given so that it can be checked. The patient will have an individual prescription programme defined for them and the CCN will receive a copy of this. A named key worker will have been identified on the CCN team to coordinate the medication plan. Specialist service s responsibilities Establish a diagnosis. Assess the patients suitability for home care, determine a clinical management plan and obtain consent from parents / carers for home care after identifying any risk.. Prescribe patient medication dose and length of treatment. Hold medication protocol/guidelines which can be available to CCN team to include clear information in respect of monitoring requirements. Discuss the benefits and side effects of treatment with the patient. Ensure that the CCN team have agreed to administer the medication as prescribed; appropriate clinical guidelines and protocols should be provided by the prescribing specialist service. Inform GP that child will be receiving Teicoplanin at home. The patient will receive supplies of medication, diluents and disposable supplies (syringes, needles etc) from the hospital for the prescribed course of treatment. Prescription will include; Patient details;age; DOB; Weight; allergies; Dose; infusion rate; diluent ;treatment end date Prescribing clinician needs to clarify specific monitoring requirements, and identify responsible lead clinician (see Below) Alert CCN if monitoring requirements change Have a mechanism in place to receive rapid referral of a patient from the CCN in the event of concerns in patient s clinical condition, and to provide all other review and monitoring (other than that specifically clarified and agreed above). Report adverse events to the MHRA Page 2 of 5

3 Side effects CCN need to be aware of : Dosage in children: Neonates and infants up to 3 months of age: The dosage of Aciclovir 25 mg/ml Concentrate for Solution for Infusion in neonates and infants up to 3 months of age is calculated on the basis of bodyweight. The recommended regimen of Aciclovir 25mg/ml Concentrate for Solution for Infusion for known or suspected neonatal herpes infections is 20 mg/kg bodyweight every 8 hours for 21 days for disseminated and CNS disease, or for 14 days for disease limited to the skin and mucous membranes. Children aged between 3 months and 12 years: The dose of Aciclovir 25 mg/ml Concentrate for Solution for Infusion for children aged between 3 months and 12 years is calculated on the basis of body surface area. Children with Herpes simplex (except herpes encephalitis) or Varicella zoster infections (with normal immune response) should be given Aciclovir 25 mg/ml Concentrate for Solution for Infusion in doses of 250 mg/m 2 of body surface area every 8 hours if renal function is not impaired. In immunocompromised children with Varicella zoster infections or children with herpes encephalitis, Aciclovir 25 mg/ml Concentrate for Solution for Infusion should be given in doses of 500 mg per square metre body surface area every 8 hours if renal function is not impaired. Infants and children with impaired renal function: Infants and children with impaired renal function require an appropriately modified dose, according to the degree of impairment (see Dosage in renal impairment). Dosage in renal impairment: Caution is advised when administering Aciclovir 25 mg/ml Concentrate for Solution for Infusion to patients with impaired renal function since the drug is excreted through the kidneys. Adequate hydration should be maintained. Dosage adjustment for patients with renal impairment is based on creatinine clearance, in units of ml/min for adults and adolescents and in units of ml/min/1.73m2 for infants and children less than 13 years of age. The following adjustments in dosage are suggested: Dosage adjustments in adults and adolescents: Creatinine clearance Dosage 25 to 50 ml/min The dose recommended above (5 or 10 mg/kg bodyweight) should be given every 12 hours. 10 to 25 ml/min The dose recommended above (5 or 10 mg/kg bodyweight) should be given every 24 hours. 0 (anuric) to 10 ml/min In patients receiving continuous ambulatory peritoneal dialysis (CAPD) the dose recommended above (5 or 10 mg/kg bodyweight) should be halved and administered every 24 hours. In patients receiving haemodialysis the dose recommended above (5 or 10 mg/kg bodyweight) should be halved and administered every 24 hours and after dialysis. Page 3 of 5

4 Dosage adjustment in infants and children less than 13 years of age : Creatinine clearance Dosage 25 to 50 ml/min/1.73 m 2 The dose recommended above (250 or 500 mg/m 2 body surface area or 20 mg/kg body weight) should be given every 12 hours. 10 to 25 ml/min/1.73 m 2 The dose recommended above (250 or 500 mg/m2 body surface area or 20 mg/kg body weight) should be given every 24 hours. 0 (anuric) to 10 ml/min/1.73 m 2 In patients receiving continuous ambulatory peritoneal dialysis (CAPD) the dose recommended above (250 or 500 mg/m2 body surface area or 20 mg/kg body weight) should be halved and administered every 24 hours. In patients receiving haemodialysis the dose recommended above (250 or 500 mg/m2 body surface area or 20 mg/kg body weight) should be halved and administered every 24 hours and after dialysis. Method of administration The required dose of Aciclovir 25 mg/ml Concentrate for Solution for Infusion should be administered by slow intravenous infusion over a one-hour period and adequate hydration should be established. Aciclovir 25 mg/ml Concentrate for Solution for Infusion may be administered by a controlledrate infusion pump. CCN responsibilities If the CCN declines shared care he/she will notify the consultant without undue delay. When shared care is agreed: Monitor the patient s overall health and well-being. Date / time therapeutic levels to be checked recorded clearly in patient records. Care of IV access site. Report to and seek advice from the specialist on any aspect of patient care that is of concern and may affect treatment. Specific triggers for referral back are: Drug level results fall outside of therapeutic level. CAUTION: NOTE DOSE VARIATION IF RENAL IMPAIRMENT IS PRESENT Refer patient to the specialist if his or her condition deteriorates. Stop treatment on the advice of the specialist or immediately if an urgent need to stop treatment arises. Adverse drug reaction/interaction monitoring Report adverse events to the specialist and serious adverse events to the MHRA. Inform specialist of all relevant medical information regarding the patient. Supporting information on this medicine is available at the team base Page 4 of 5

5 MUST be completed by prescriber MONITORING REQUIRED DATE REQUIRED Therapeutic levels FBC LFT U&E OTHER (specify) Y BLOOD TESTS DATES MUST BE SPECIFIED ON PRESCRIPTION Prescriber Signature: Prescriber Name: Date: Expiry Date of Agreement: Contact Details for Community Childrens Nurses: Contact Name Available Community Childrens 9am-9pm Nurse Stafford everyday Fax Community Childrens Nurse Burton 9am-5pm everyday Ext 2303 / 2305 Fax Page 5 of 5