Expiry Date: September 2009 Template Version: Page 1 of 7

Transcription

1 GG&C PGD ref 2007/467 YOU MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO IT Clinical Condition Indication: Inclusion criteria: Exclusion criteria: Cautions/Need for further advice/ Circumstances when further advice should be sought from the doctor: Action if patient declines or is excluded: Referral arrangements for further advice / cautions Treatment of asymptomatic genital Chlamydia trachomatis infection. Clients with asymptomatic, confirmed genital Chlamydia trachomatis infection or asymptomatic contacts of known chlamydia positive individuals. Age <14 years Symptoms suggestive of complicated genital Chlamydia trachomatis infection Currently taking any medication (other than contraceptives) Known or suspected pregnancy Breast feeding Known sensitivity to tetracycline Known alcohol dependence Known hepatic impairment Known Myasthenia gravis Known Systemic Lupus Erythematosis Known Porphyria Unavoidable imminent sun exposure Client requests to see doctor If any of the above exclusions apply Antacids decrease the absorption of Doxycycline Refer for medical review As per local arrangements/national guidelines. Review April 2009 Expiry September 2009 Page 1 of 7

2 Drug Details Name, form & strength of medicine: Route/Method of administration: Dosage (include maximum dose if appropriate): Doxycycline capsules 100mg Oral 100mg twice daily Frequency: Duration of treatment: Maximum or minimum treatment period: Quantity to supply/administer: Black Triangle Drug:* Legal Category: Is the use outwith the SPC:** Storage requirements: 7 days One pre packed out patient pack No POM No Locked cupboard * The black triangle symbol ( ) identifies newly licensed medicines that are monitored intensively by the MHRA/CSM **Summary of Product Characteristics Review April 2009 Expiry September 2009 Page 2 of 7

3 Warnings including possible adverse reactions and management of these: Advice to patient/carer including written information provided: Monitoring (if applicable): Follow up: Please refer to current BNF or SPC for full details. Use the Yellow Card System to report adverse drug reactions directly to the CSM. Yellow Cards and guidance on its use are available at the back of the BNF. If there is sexual activity during or within 7 days after completion of the course of treatment contact sexual health adviser. Explain treatment and course of action Explain potential side effects There should be no sexual activity during and for 7 days after completion of the course of treatment. Possible interaction with oral combined hormonal contraception. Clients should be advised to use an additional barrier method of contraception if intercourse is to take place. Male condoms offered and explain the need to abstain from sex as directed. Should not be taken at the same time as antacids, Advise to avoid sun lamps or sun exposure Give client a copy of any relevant patient information leaflet Ensure partner notification has been discussed and referral to sexual health advisor offered If symptoms develop then seek further medical advice Review as arranged two weeks post treatment Review April 2009 Expiry September 2009 Page 3 of 7

4 Staff Characteristics Professional qualifications: Specialist competencies or qualifications: Continuing education & training: Registered Nurse or Midwife with current NMC registration Has undertaken appropriate training to carry out 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 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. Referral Arrangements and Audit Trail Referral arrangements Records/audit trail: As per local arrangements / national guidelines Client s name, address, date of birth and consent given Contact details of GP (if registered) Diagnosis Dose and form administered (batch details if locally required) Advice given to client (including side effects) Signature/name of staff who administered or supplied the medication, and also, if relevant, signature/name of staff who removed/discontinued the treatment Details of any adverse drug reaction and actions taken including documentation in the client s medical record Referral arrangements (including self-care) References/Resources and comments: Notes: SPC Summary of Product Characteristics BNF British National Formulary Review April 2009 Expiry September 2009 Page 4 of 7

5 This patient group direction must be agreed to and signed by all health care professionals involved in its use. The original signed copy will be held at Queens Park House, Victoria Infirmary. The PGD must be easily accessible in the clinical setting Organisation: NHS Greater Glasgow & Clyde * Lorraine Forster Urszula Bankowska Kay McAllister Jeff Roberts * = lead Author Professionals drawing up PGD / Authors Designation and Contact Details Clinical Governance Coordinator Sandyford Consultant Sexual & Reproductive Health, Sandyford Consultant Sexual & Reproductive Health, Sandyford Clinical Director Leverndale Pharmacy Designation : address : Antimicrobial use If the PGD relates to an antimicrobial agent, the use must be support by an Antimicrobial Pharmacist. Antimicrobial Pharmacist: Review April 2009 Expiry September 2009 Page 5 of 7

6 AUTHORISATION: 1. NHSGG&C PGD & Non-Medical Prescribing Sub-Committee of ADTC Chairman Name in BLOCK CAPITALS Dr M Walters 2. Lead of the professional group to which this PGD refers: Name in BLOCK CAPITALS Jane Camp 3. Pharmacist representative of PGD & Non-Medical Sub-Committee of ADTC Name in BLOCK CAPITALS Review April 2009 Expiry September 2009 Page 6 of 7

7 Local Authorisation: Service Area for which PGD is applicable: Description of Audit arrangements: Frequency of checks: (Generally annually) Names of auditor(s): Lorraine Forster Nominated individual who agrees to keep staff training and list of practitioners operating under the PGD current and up to date (Lead professional) Designation: Lorraine Forster contact address : Lorraine.forster@ggc.scot.nhs.uk 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 competence and in accordance with their own Code of Professional 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. I acknowledge that it is a legal document and agree to supply/administer this medicine only in accordance with this PGD. Name of Professional Signature Date I agree that the professionals listed above are authorised to supply / administer medicines in accordance with this PDG to patients cared for in this service area. Lead Clinician for the service area (Doctor) contact address : Urszula.bankowska@ggc.scot.nhs.uk Review April 2009 Expiry September 2009 Page 7 of 7