Patient Group Direction for the administration or supply of medicines for the treatment of minor injuries in NHS Grampian.

Transcription

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2 Title: Patient Group Direction for the administration or supply of medicines for the treatment of minor injuries in NHS Grampian. Identifier: NHSG/PGD/MinInj/MGPG779 Replaces: NHSG/PGD/MinInj/MGPG553, Version 4 Across NHS Boards 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: Pharmacist, Aberdeenshire HSCP Patient Group Direction Patient Group Direction PGD minor injuries casualty departments nurses NHS Grampian This Patient Group Direction (PGD) authorises appropriately qualified and trained nurses to administer or supply medicines for minor injuries 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: NHS Grampian, Acute, Aberdeenshire and Moray HSCPs Senior Managers Heads of Service/Clinical Leads Line Managers Deputy General Managers and Clinical Leads Unit Operational Managers It is the responsibility of individual nurses 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/MinInj/MGPG779 - 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: Pharmacist, Aberdeenshire HSCP Pharmacy and Medicines Directorate Pharmacy and Medicines Directorate Pharmacist, Aberdeenshire Pharmacist, Aberdeenshire HSCP Revision History: Date of change Approval date of PGD that is being superseded November January November January November January November January November January 2015 November January 2013 Summary of Changes Updated into new template. Updated to include nurses in Acute Services. Addition of Co-Dydramol 10/500 tablets Removal of amoxicillin Monograph Update in line with antibiotic guidelines Monographs updated in line with changes in BNF /SPC Section heading Monographs Monographs Monographs Monographs UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG779 - ii -

4 Patient Group Direction For The Administration Or Supply Of Medicines For The Treatment Of Minor Injuries In NHS Grampian Part A Introduction Clinical Decision Making 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/person with parental responsibility does not wish the treatment to be received under this PGD Description Of Treatment Available Under This Direction Medicine Dose, route and frequency Concurrent medication Adverse effects Advice to patient Follow up treatment... 4 Part B Designated Staff Authorised To Administer Or Supply Under This PGD Documentation Authorisation of administration/supply Record of administration or supply Consent Further Points Facilities And Supplies To Be Available At Sites For The Administration Or Supply Of The Drug Specified In The PGD Audit... 7 Part C Management And Monitoring Of Patient Group Direction Consultative group Professional advisory group approving PGD Authorising managers References... 8 Appendix Appendix Appendix UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

5 Patient Group Direction For The Administration Or Supply Of Medicines For The Treatment Of Minor Injuries In NHS Grampian 1. Introduction Part A This Patient Group Direction (PGD) includes a list of those medicines which need not be prescribed by a doctor but which nurses registered with the Nursing and Midwifery Council (NMC) may administer or supply for the care of patients when being treated for minor injuries. It enables nurses registered with the NMC to become familiar with a limited range of products that can be used effectively and with confidence. A number of the medicines may be administered and others will be supplied for the patients to take away. A Monograph is included for each medicine containing information that can be used in conjunction with the core section of the PGD. 2. Clinical Decision Making 2.1. Patients who may be considered for the administration or supply of medicines listed in the Monographs Adults and children aged two years and over who present at NHS Grampian Minor Injury Units or Accident and Emergency Departments with a minor injury where nurses are on duty who are registered with the NMC and are trained in the treatment of minor injuries Patients who may receive the administration or supply of medicines listed in the Monographs 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 administration or supply to be given by the nurse 2.3. Contraindications No medicinal product should be used without consideration of the possible consequences for the patient. Medicinal products should not be used: (i) if the patient has previously experienced a reaction to the medicine/product or any of its ingredients. In the event that the patient suffers an adverse reaction, administration or use of the medicine should be stopped and medical help sought immediately. (ii) if the patient is already receiving therapy for the condition from a doctor. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

6 (iii) if the patient has any of the contraindications listed in the individual Monographs. In these cases the patient should be referred to the doctor Precautions The medicines listed in this PGD should be used only for the specific condition(s) and the age group specified in the Monographs. Patients of a different age group, or who are suffering from a condition other than that specified in the Monograph, should be referred to the doctor. (i) If there is any concern about the appropriate use of the medicine in the specific indications given within the direction then medical advice should be sought. (ii) If there is any doubt about correct identification of the condition, 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/person with parental responsibility does not wish the treatment to be received under this PGD Advice should be given concerning the risks of not receiving the administration/supply and medical advice should be sought refer to a doctor. 3. Description Of Treatment Available Under This Direction 3.1. Medicine See individual product Monographs and refer to manufacturer s product information Dose, route and frequency See individual product Monographs and manufacturer s product information Concurrent medication See individual product Monographs and manufacturer s product information. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

7 3.4. Adverse effects See individual product Monographs and manufacturer s product information. 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). Treatment of overdose See individual product Monographs and manufacturer s product information 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 first. If necessary a doctor or the patient s GP should be contacted for advice. On supply of the medicine, patients should be given advice about: (i) (ii) Self-management of minor injury. Effects on ability to drive or operate machinery. See individual product Monographs and manufacturer s product information. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

8 Part B 4. Designated Staff Authorised To Administer Or Supply Under This PGD The following staff are authorised to administer or supply the drugs specified in the Monographs 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 as recognised by the NMC. 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 administration/supply in order for the patient to give or refuse consent. (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 administration/supply of the drug. All staff will have access to the current PGD. (v) have undertaken the NHS e-anaphylaxis training session (and annual updates) which covers all aspects of the identification and management of anaphylaxis. This can be accessed via eksf or the AT Learning tool. (vi) 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. (vii) have undertaken approved NHS Grampian Minor Injuries training and be competent in all required aspects of clinical diagnosis, drug administration/supply, and be familiar with the medicinal products in the Monographs and aware of the contraindications to their use. (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/MinInj/MGPG

9 (iii) Ensuring that staff have received adequate training in all areas relevant to this PGD and meet the requirements above. (iv) Maintaining a current record of all staff authorised to administer or supply the drug specified in this PGD. 5. Documentation 5.1. Authorisation of administration/supply UK registered nurses, as recognised by the NMC, working within NHS Grampian, can be authorised to administer or supply minor injury medicines by their nurse manager. A certificate of competence (Appendix 2) signed by the authorising doctor/manager should be supplied. This should be held in the individual nurse records or as agreed locally Record of administration or supply An electronic or paper record for recording the screening of patients and the subsequent administration 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 administered or supplied (vii) Reason for giving (viii) Consent to the administration or supply (if not obtained elsewhere) (ix) Drug manufacturer, batch number, expiry date (x) Site where drug administered, dose and route of administration (xi) Signature and name in capital letters of practitioner who administered or supplied the drug (xii) Date drug given (xiii) 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/MinInj/MGPG

10 5.3. Consent Prior to the administration or supply of the drug, consent must be obtained, preferably written, either from the patient, parent, guardian or person with parental responsibility and documented either in the patient s medical records/notes or on an administration form (see section 5.2). Consent must be in line with current NHSG Staff Policy for Obtaining Consent for Clinical Procedures and Healthcare Interventions. See link below Further Points (i) Medicines are supplied as patient labelled packs the patient s name and date of supply must be added to the labelled pack. Dose and frequency should also be added if necessary. (ii) The recommendations for storage and handling of any product in the Monographs must be followed. (iii) 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 Administration Or Supply Of The Drug Specified In The PGD The following should be available at sites where the drug is to be administered or supplied: (i) Resuscitation equipment. (ii) Access to medical support (this may be via telephone). (iii) Safe storage areas (locked cupboards) for medicines and equipment. See individual product Monographs for details of storage requirements. (iv) Use of appropriate documentation to record administration or supply. (v) Approved equipment for the disposal of pharmaceutical waste. (vi) Clean and tidy work areas. (vii) Copies of the current PGD for the administration or supply of medicines for the treatment of minor injuries. (viii) PGD for the administration of adrenaline (epinephrine) in cases of suspected anaphylactic reactions by qualified health professionals. 8. Audit All records of administration or supply of the drug specified in this PGD will be filed with the normal records of medicines administration or supply 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/MinInj/MGPG

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12 4. Scottish Intercollegiate Guidelines Network (SIGN) Quality Improvement Scotland. Best Practice Statements on Patient Group Directions. March Summary of Product Characteristics. Document: Drafted: March 2002 Completed: April 2002, Approved: April 2002, December 2007, May 2010, June 2013, January 2016 (published February 2016) Review date: At least every 2 years or sooner if current treatment recommendations change. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

13 Appendix 1 Health Care Professional Agreement To Administer Or Supply Medicines Under Patient Group Direction I: (Insert name) Working within: e.g. HSCP, Practice Agree to administer or supply medicines under the direction contained within the following Patient Group Direction Patient Group Direction for the administration or supply of medicines for the treatment of minor injuries in NHS Grampian I have completed the appropriate training to my professional standards enabling me to administer or 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: NMC Registration No: UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

14 Appendix 2 Certificate Of Authorisation To Administer Or Supply Medicines Under Patient Group Direction This authorises: Working within: e.g. HSCP, Practice To administer or supply medicines under the following Patient Group Direction Patient Group Direction for the administration or supply of medicines for the treatment of minor injuries in NHS Grampian The above named person has satisfied the training requirements and is authorised to administer or 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/MinInj/MGPG

15 Appendix 3 Minor Injuries PGD Medicine Monographs DRUG NAME PAGE CHLORAMPHENICOL (SUPPLY) 13 CHLORPHENAMINE (SUPPLY) 14 CLARITHROMYCIN (SUPPLY) 16 CO-AMOXICLAV (SUPPLY) 18 CO-DYDRAMOL 10/500 TABLETS(SUPPLY) 20 CO-TRIMOXAZOLE (SUPPLY) 22 DOXYCYCLINE (SUPPLY) 24 ERYTHROMYCIN (SUPPLY) 26 FLUCLOXACILLIN (SUPPLY) 28 FLUORESCEIN SODIUM (ADMINISTRATION) 30 FUSIDIC ACID (SUPPLY) 31 IBUPROFEN (SUPPLY) 32 LIDOCAINE 1% INJECTION (ADMINISTRATION) 34 METRONIDAZOLE (SUPPLY) 35 OXYBUPROCAINE 37 PARACETAMOL (SUPPLY) 38 SODIUM CHLORIDE 0.9% (ADMINISTRATION) 40 UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

16 Drug Group: Drug Class: CHLORAMPHENICOL (SUPPLY) Antibacterial eye ointment PoM Presentation: 1% eye ointment [1 x 4g] Indication: Adults and children aged 2 years and over. Patients presenting with suspected corneal abrasion or welding flash eye injuries. Contra-indication to supply: (a) age (b) disease states Dose: Children under 2 years of age. Hypersensitivity to chloramphenicol or eye ointment ingredients. Pregnancy and breast-feeding. History of aplastic anaemia. Disturbances in vision except those due to matter in eye. Moderate to severe pain within eyeball. Eye surgery or laser treatment in the last 6 months. Apply 4 times daily to the inside of lower affected lid. Continue to apply for 2 days after healing. Not to be used for longer than 7 days without review. Nursing/Patient Advice: (a) administration (b) side-effects (c) other Storage: Advise the patient to follow the manufacturer s patient information leaflet. Treatment should continue for 48 hours after eye has returned to normal. Do not wear contact lenses when using this product and for 24 hours after completion of treatment. Use a separate tube for each eye. Keep tube tightly closed. Advise patient to return any unused ointment to the community pharmacy. May cause transient stinging and blurring of vision on administration. Warn patients not to drive or operate hazardous machinery unless vision is clear. Refer to BNF for other side-effects. Advise patient to seek medical advice if there is no improvement within 24 hours or if symptoms worsen at any time. The patient should be advised the ointment is being given for prophylaxis which is outwith product licence but is accepted clinical practice. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

17 Drug Group: Drug Class: Presentation: Indication: CHLORPHENAMINE (SUPPLY) Antihistamine P 4mg tablets [1 x 28/30], 2mg/5mL oral liquid [1 x 150mL] Adults and children aged 2 years and over. Relief of insect bites and stings. (Where the side-effect of drowsiness is not a problem). Contra-indication to supply: (a) age (b) disease states (c) drugs Dose: Children under 2 years. Benign prostatic hyperplasia. Urinary retention. Pyloroduodenal obstruction. Epilepsy. Hypersensitivity to chlorphenamine or ingredients. Pregnancy and breast-feeding. Glaucoma. Renal and hepatic impairment. Respiratory disease including asthma. Severe hypertension or cardiovascular disease. Alcohol due to increased risk of sedation. A non-sedating antihistamine is preferable. Anti-histamines MAOIs - Patients treated with MAOIs within the last 14 days. Phenytoin. Tricyclic antidepressants, anxiolytics and hypnotics and medicines causing sedation due to increased risk of sedation. A nonsedating antihistamine is preferable. For full list refer to current edition of BNF. By mouth Adult and child aged 12 years and over: 4mg every 4-6 hours, max 24mg daily. The elderly are more likely to experience neurological anticholinergic effects. Consideration should be given to using a lower daily dose (e.g. a maximum of 12 mg in any 24 hours). Child 6 - <12 years: 2mg every 4-6 hours, max 12mg daily. Child 2 - <6 years: 1mg every 4-6 hours, max 6mg daily. Tablets are not licensed for children under 6 years. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

18 CHLORPHENAMINE (SUPPLY) Nursing/Patient Advice: (a) administration (b) side-effects (c) other Storage: Advise the patient to read the manufacturer s information leaflet. Drowsiness and psychomotor impairment, which can seriously hamper the patient's ability to drive and use machinery. Sedating effects are enhanced by alcohol and other sedating medicines. Refer to BNF for other side-effects. Rarely paradoxical stimulation in children and elderly patients on high doses. Antimuscarinic side-effects - urinary retention, dry mouth, blurred vision and GI disturbances. Please refer to BNF for other rare side-effects. Patient should be advised not to drive or operate machinery. Piriton syrup contains 6.3% alcohol. Store below 30 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

19 Drug Group: Drug Class: Presentation: Indication: CLARITHROMYCIN (SUPPLY) Macrolide antibiotic PoM 250mg tabs [1 x 14], 125mg/5mL and 250mg/5mL oral liquid for reconstitution [1 x 70mL] Second line treatment of HUMAN BITES in adults and children 12 years and over where first line option (doxycycline) is contraindicated. Second line treatment of HUMAN BITES in children aged 2 years and over and under 12 years of age who weigh more than 12Kg where first line option (co-amoxiclav) is contra-indicated. (For a severe human bite metronidazole may also be indicated refer to a doctor). Contra-indication to supply: (a) age (b) disease states (c) drugs Children under 2 years or less than 12Kg. Hypersensitivity to clarithromycin or macrolide antibiotics or any ingredients. Impaired hepatic or renal function. Pregnancy and breastfeeding. Porphyria. Cardiac arrhythmias. Myasthenia gravis. Macrolide antibiotics have an extensive list of medicine interactions. You must refer to latest edition of the BNF to check all medicines the patient takes to check for an interaction. Antiarrhythmics Antibacterials Anticoagulants Antidepressants Antiepileptics Antifungals Antihistamine Antimalarials Antipsychotics Antivirals Anxiolytics and Hypnotics Calcium Channel Blockers Statins There are also a significant number of medicines out with these classes. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

20 Dose: CLARITHROMYCIN (SUPPLY) By mouth Adults: 500mg twice daily for 7 days. Child years: 250mg twice daily for 7 days. Child 30-40kg 250mg twice daily for 7 days. Child 20-29kg 187.5mg twice daily for 7 days. Child 12-19kg 125mg twice daily for 7 days. Nursing/Patient Advice: (a) administration (b) side-effects (c) other Storage: Take at regular intervals. Advise patient to complete the course unless otherwise directed by a doctor. Advise patient to read the manufacturer s patient information leaflet. Oral liquids must be reconstituted with fresh tap water in accordance with the manufacturer instructions before being issued to patients. Advise to shake well before administration. Issue with a 5mL spoon or 5mL oral syringe. Nausea, vomiting, abdominal discomfort, diarrhoea, dyspepsia, headache, smell and taste disturbance, tooth and tongue discolouration. Refer to BNF for further side-effects. Patients taking combined oral contraceptives should be advised to take additional contraceptive precautions if they experience diarrhoea or vomiting while taking clarithromycin and for 7 days after stopping the antibiotic. If these days run beyond the end of a packet of combined oral contraceptive, the next packet should be started immediately without a break. (In the case of every day (ED) tablets, the inactive ones should be omitted). Store below 25 C. Protect from light. Store in a dry place. Reconstituted oral liquids should be stored in accordance with the manufacturer s advice and used within the time specified. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

21 Drug Group: Drug Class: CO-AMOXICLAV (SUPPLY) Penicillin antibiotic PoM Presentation: 625mg tablets [1 x 21] 125/31 and 250/62 oral liquid for reconstitution [1x 100mL] 400/57 oral liquid for reconstitution [1 x 35mL and 1 x 70mL] Indication: First-line treatment of HUMAN and ANIMAL BITES in children aged 2 years and over and under 12 years. First-line treatment of ANIMAL BITES in adults and children 12 years and over. Contra-indication to supply: (a) age (b) disease states (c) drugs Dose: Children under 2 years of age. Hypersensitivity to amoxicillin, clavulanic acid or any of the ingredients Hypersensitivity to penicillins, cephalosporins or other beta-lactam agents. Previous penicillin-induced cholestatic jaundice or hepatitis. Pregnancy and breast-feeding. Renal impairment. Hepatic impairment Glandular fever Allopurinol; methotrexate; anticoagulants; antibiotics; probenecid. For full list refer to current edition of BNF. By mouth Adult and child over 40Kg: Co-amoxiclav 625mg three times daily. Child 6-11 years: Co-amoxiclav (250/62) 5mL three times daily for 7 days. Child 2 - <6 years: Co-amoxiclav (125/31) 5mL three times daily for 7 days. Or Child 6-11 years: Augmentin Duo (400/57) 5mL twice daily for 7 days. Child 2 - <6 years: Augmentin Duo (400/57) 2.5mL twice daily for 7 days. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

22 CO-AMOXICLAV (SUPPLY) Nursing/Patient Advice: (a) administration (b) side-effects (c) other Storage: To minimise potential gastrointestinal intolerance, administer at the start of a meal. Take at regular intervals. Complete the course unless otherwise directed by a doctor. Read the manufacturer s patient information leaflet. Oral liquids must be reconstituted with fresh tap water in accordance with the manufacturer s instructions before being issued to patients. Advise to shake well before administration. Oral liquids issue with a 5mL spoon or 2.5mL/5mL oral syringe. Hypersensitivity reaction. Nausea, vomiting, diarrhoea, dizziness, rashes - seek medical advice. Rarely: Cholestatic jaundice, antibiotic-associated colitis, superficial tooth discolouration occurs mainly with oral liquid, removed by brushing. Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, vasculitis discontinue if any of these conditions present. Refer to BNF for other side-effects. Patients taking combined oral contraceptives should be advised to take additional contraceptive precautions if they experience diarrhoea or vomiting while taking co-amoxiclav and for 7 days after stopping the antibiotic. If these days run beyond the end of a packet of combined oral contraceptive, the next packet should be started immediately without a break. (In the case of every day (ED) tablets, the inactive ones should be omitted). Store below 25 C. Store in a dry place. Reconstituted oral liquids should be stored in accordance with the manufacturer s advice and used within the time specified. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

23 Drug Group: Drug Class: CO-DYDRAMOL 10/500 TABLETS (SUPPLY) Analgesic for relief of mild to moderate pain PoM Presentation: Paracetamol 500mg/Dihydrocodeine 10mg Tablets x 30 Indication: Adults (16 years and over): Treatment of moderate pain due to a minor injury. Contra-indication to supply: (a) Age (b) disease states (c) drugs Dose: Children under 16 years. Alcohol dependence or substance misuse Hypersensitivity to paracetamol, dihydrocodeine, other opioids or any ingredients. Renal or hepatic impairment. Respiratory depression or Obstructive airway disease. Inflammatory bowel disease or recent GI surgery. Head injuries. Myasthenia gravis. Other medicines containing paracetamol or opioids. Patients who have taken paracetamol in the previous 4 hours or who have taken the maximum paracetamol dose in the previous 24 hours. 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). MAOIs-Patients treated with MAOIs within the last 14 days. For full list refer to current edition of BNF. By mouth Adults 1-2 tablets every 4-6 hours to a max of 8 tablets in 24 hours. Nursing/Patient Advice: (a) administration (b) side-effects Contains paracetamol, do not exceed recommended dose. Advise the patient to read the manufacturers information leaflet or instructions on the container. Advise patients taking oral anticoagulants to have INR checked if they continue to take paracetamol regularly for longer than 5 days. Nausea, constipation and drowsiness make occur. Skin rashes and blood disorders have been reported rarely. Refer to BNF for other side effects. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

24 (c) other Storage: CO-DYDRAMOL 10/500 TABLETS (SUPPLY) Do not take other medicines containing paracetamol. Make cause drowsiness, patient should be advised not to drive or operate machinery. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

25 Drug Group: Drug Class: Presentation: Indication: CO-TRIMOXAZOLE 40/200 (SUPPLY) Antibiotic PoM 240mg/5mL oral suspension [1x 100mL] Second-line treatment of ANIMAL BITES in children aged 2 years and over and under 12 years. To be taken along with metronidazole. Contra-indication to supply: (a) age (b) disease states (c) drugs Dose: Children under 2 years. Porphyria Blood disorders Asthma G6PD deficiency Hepatic Impairment Renal impairment Hypersensitivity to any constituents Antibiotics Anticoagulants Amiodarone Azathioprine Ciclosporin Cytotoxics Phenytoin For full list refer to the current edition of the BNF. Child 6-<12 years: 480mg (10mL) twice daily PLUS metronidazole three times daily for 7 days. Child 2-5 years: 240mg (5mL) twice daily PLUS metronidazole three times daily for 7 days. Nursing/Patient Advice: (a) administration Advice to patient: Shake suspension well before administration. Supply with a 5mL spoon 5mL/10mL oral syringe. Take at regular intervals. Complete the course unless otherwise directed by a doctor. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

26 CO-TRIMOXAZOLE 40/200 (SUPPLY) Read the manufacturers patient leaflet. Provide 2 x 100mL bottles for patients requiring 480mg dose. (b) side-effects Storage: Hypersensitivity reactions including rash seek medical advice. Nausea, diarrhoea, headache. Refer to BNF for other side-effects. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

27 Drug Group: Drug Class: DOXYCYCLINE (SUPPLY) Tetracycline antibiotic PoM Presentation: 100mg capsules [1 x 14] Indication: First line treatment of HUMAN BITES IN ADULTS AND CHILDREN 12 YEARS AND OVER. (For a severe human bite metronidazole may also be indicated refer to a doctor). Second line treatments of ANIMAL BITES IN ADULTS AND CHILDREN 12 YEARS AND OLDER where first line option (coamoxiclav) is contra-indicated. For animal bites metronidazole must also be supplied. Contra-indication to supply: (a) age (b) disease states (c) drugs Dose: Children under 12 years. Hepatic impairment. Myasthenia gravis. Systemic lupus erythematosus. Porphyria. Hypersensitivity to doxycycline or other tetracyclines. Sucrose intolerance. Pregnancy or breast-feeding. Antibiotics, anticoagulants, anti-epileptics, ciclosporin, methotrexate, retinoids. For full list refer to current edition of BNF. By mouth Adults and children 12 years and over: 100mg twice daily for 7 days. Metronidazole also to be supplied when appropriate. Nursing/Patient Advice (a) administration Advice to patient: Swallow capsules whole with water while sitting or standing. Take at regular intervals. Complete the course unless otherwise directed by a doctor. Do not take indigestion remedies or medicines containing iron or zinc at the same time of day as doxycycline. Read the manufacturer s information sheet. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

28 (b) side-effects (c) other DOXYCYCLINE (SUPPLY) Photosensitivity avoid exposure of skin to direct sunlight or sun lamps. May cause nausea, vomiting, diarrhoea, dysphagia, oesophageal irritation, flushing, tinnitus. Hypersensitivity reactions, headache and blurred vision - seek medical advice. Refer to BNF for other side-effects. Patients taking combined oral contraceptives should be advised to take additional contraceptive precautions if they experience diarrhoea or vomiting while taking doxycycline and for 7 days after stopping the antibiotic. If these days run beyond the end of a packet of combined oral contraceptive, the next packet should be started immediately without a break. (In the case of every day (ED) tablets, the inactive ones should be omitted). Patient taking anticoagulants should be advised to attend GP for INR monitoring. Storage: Store below 25 C. Protect from light. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

29 Drug Group: Drug Class: ERYTHROMYCIN (SUPPLY) Macrolide antibiotic PoM Presentation: 250mg tablets [1 x 28], [1 x 56] 250mg/5mL oral liquid for reconstitution [1x 100mL] Indication: First line for penicillin allergic patients and those for whom flucloxacillin is contraindicated: adults and children aged 2 years and over. Infected burns or wounds. Puncture wounds. Pulp injuries crush injury to distal end of the finger. (For a contaminated wound metronidazole may also be indicated - refer to a doctor). Contra-indication to supply: (a) age (b) disease states (c) drugs Children under 2 years. Hypersensitivity to erythromycin or macrolide antibiotics or any constituents. Impaired hepatic or renal function. Myasthenia gravis. Porphyria. Pseudomembranous colitis. Cardiac arrhythmias. Macrolide antibiotics have an extensive list of medicine interactions. You must refer to latest edition of the BNF to check all medicines the patient takes to check for an interaction. Antiarrhythmics Antibacterials Anticoagulants Antidepressants Antiepileptics Antifungals Antihistamine Antimalarials Antipsychotics Antivirals Anxiolytics and Hypnotics Calcium Channel Blockers Statins There are also a significant number of medicines out with these classes. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

30 Dose: Nursing/Patient Advice (a) administration (b) side-effects (c) other Storage: ERYTHROMYCIN (SUPPLY) By mouth Adults and children 8 years and over: 500mg four times daily for 7 days. Children: 2-7 years: 250mg four times daily for 7 days. Advice to patient: Take at regular intervals. Complete the course unless otherwise directed by a doctor. Read the manufacturer s patient information leaflet. Oral liquids must be reconstituted with fresh tap water in accordance with the manufacturer s instructions before being issued to patients. Advise to shake well before administration. Issue with a 5mL spoon or 5mL oral syringe. Nausea, vomiting, abdominal discomfort, diarrhoea, dyspepsia, headache, smell and taste disturbance, tooth and tongue discolouration, allergic reactions, skin reactions. Refer to BNF for other side-effects. Patients taking combined oral contraceptives should be advised to take additional contraceptive precautions if they experience diarrhoea or vomiting while taking erythromycin and for 7 days after stopping the antibiotic. If these days run beyond the end of a packet of combined oral contraceptive, the next packet should be started immediately without a break. (In the case of every day (ED) tablets, the inactive ones should be omitted). Patient taking anticoagulants should be advised to attend GP for INR monitoring. Advise to shake well before administration. Issue with a 5mL spoon or 5mL oral syringe. Read the manufacturer s patient information sheet. Store below 25 C. Protect from light. Reconstituted oral liquids should be stored in accordance with the manufacturer s recommendations and used within the time specified. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

31 Drug Group: Drug Class: FLUCLOXACILLIN (SUPPLY) Penicillin antibiotic PoM Presentation: 250mg, 500mg capsules [1 x 28] 125mg/5mL, 250mg/5mL oral liquid for reconstitution [1 x 100mL] Indication: Adults and children aged 2 years and over. First line for: Infected burns or wounds. Puncture wounds. Pulp injuries - crush injury to distal end of the finger. (For a contaminated wound metronidazole may also be indicated - refer to a doctor). Contra-indication to supply: (a) age (b) disease states (c) drugs Dose: Children under 2 years. Hypersensitivity to penicillins, cephalosporins or other beta-lactam agents. Hepatic impairment. Renal impairment. Pregnancy or breast-feeding. Antibiotics Methotrexate Warfarin For full list refer to current edition of BNF. By mouth Adults: 500mg four times daily for 7 days. Child over 10 years - 18 years: 250mg four times daily for 7 days. Child 2-10 years: 125mg four times daily for 7 days. Oral liquid pack size is 100mL. Two 100mL bottles should be supplied to provide a sufficient quantity for 7 days. Advise patient/parent/carer to return surplus liquid to a community pharmacist. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

32 FLUCLOXACILLIN (SUPPLY) Nursing/Patient Advice (a) administration (b) side-effects (c) other Storage: Advice to patient: Swallow capsules whole with water. Take half to one hour before food or on an empty stomach. Take at regular intervals. Complete the course unless otherwise directed by a doctor. Oral liquids must be reconstituted with fresh tap water in accordance with the manufacturer s instructions before being issued to patients. Advise to shake well before administration. Issue with a 5mL spoon or 5mL oral syringe. Read the manufacturer s information sheet. May cause nausea, diarrhoea, indigestion. Hypersensitivity reactions, rash - seek medical advice. Rarely: cholestatic jaundice - CSM has advised that this may occur up to several weeks after treatment with flucloxacillin has been stopped. Antibiotic-associated colitis. Refer to BNF for other side-effects. Patients taking combined oral contraceptives should be advised to take additional contraceptive precautions if they experience diarrhoea or vomiting while taking flucloxacillin and for 7 days after stopping the antibiotic. If these days run beyond the end of a packet of combined oral contraceptive, the next packet should be started immediately without a break. (In the case of every day (ED) tablets, the inactive ones should be omitted). Store below 25 C. Protect from light. Reconstituted oral liquids should be stored in accordance with the manufacturer s advice and used within the time specified. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

33 Drug Group: Drug Class: Presentation: Indication: FLUORESCEIN SODIUM (ADMINISTRATION) Ocular diagnostic agent P 2% eye drops single use Minims fluorescein For identification of corneal abrasions of the eye in adults and children aged 2 years and over. Contra-indication to supply: (a) age (b) disease states (c) other Dose: Children under 2 years. Pregnancy and breast-feeding. Hypersensitivity to fluorescein. Patients with soft contact lenses unless removed. Single application of 1-2 drops should be instilled drop wise into affected eye to stain lesion. Nursing/Patient Advice: (a) administration (b) Side-effects (c) other Storage: Should not be used if soft contact lenses are being worn. Excess may be washed away with sterile saline solution. Abrasions of the conjunctiva stain yellow or orange. Abrasions or ulcers of the cornea stain bright green. Foreign bodies are surrounded by a green ring. May cause transient stinging and blurring of vision on administration. May stain skin or clothing. Warn patient not to drive or operate machinery until vision is clear. Allergic-type reactions and hypersensitivity have been reported following administration of fluorescein eye drops. Be alert to symptoms of anaphylaxis, allergic conjunctivitis, periorbital oedema, urticaria or skin rash. Refer to BNF for other side-effects. Each Minims unit should be discarded after use in a pharmaceutical waste container. Advise patient any yellow stain in discharge will disappear within the hour. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

34 Drug Group: Drug Class: FUSIDIC ACID (SUPPLY) Antibiotic eye drops PoM Presentation: 1% viscous eye drops [1 x 5g] Indication: Adults presenting with suspected corneal abrasion or welding flash eye injuries with an allergy to chloramphenicol. Children aged 2 years and over presenting with suspected corneal abrasion or welding flash eye injuries with an allergy to chloramphenicol or where twice daily dose is preferred. Contra-indication to supply: (a) age (b) disease states Dose: Children under 2 years. Hypersensitivity to any constituents. Adults and children: One drop into the affected eye twice daily. Nursing/Patient Advice: (a) administration (b) side-effects Advise the patient to follow the manufacturer s patient information leaflet. Treatment should continue for 48 hours after eye has returned to normal. Do not wear contact lenses when using this product and for 24 hours after completion of treatment. Use a separate tube for each eye. Keep tube tightly closed. Advise patient to return any unused ointment to the community pharmacy. Transient stinging may occur after application. Hypersensitivity may occur. The drop becomes liquid in the eye so visibility should not be impaired. Refer to BNF for other side-effects. (c) other Storage: The patient should be advised the ointment is being given for prophylaxis which is outwith product licence but is accepted clinical practice. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

35 Drug Group: Drug Class: IBUPROFEN (SUPPLY) Non-steroidal anti-inflammatory drug (NSAID) P Presentation: 200mg tablets [1 x 12] 100mg/5mL oral liquid [1 x 100mL] Indication: Adults: Mild to moderate pain due to minor injury. Children aged 2 years and over: Mild to moderate pain due to a minor injury. Contra-indication to supply: (a) age (b) disease states (c) drugs Child under 2 years Active peptic ulcer or history of peptic ulcer Active GI Bleeding or history of bleeding or perforation due to NSAIDs or other causes Asthma Cardiac impairment Current or previous history of dyspepsia Heart failure Hypersensitivity to the constituents and other NSAIDs including aspirin Patients with coagulation defects Porphyria Pregnancy and breast-feeding Severe renal and hepatic impairment Anticoagulants Anti-platelets, e.g. clopidogrel and aspirin Antivirals Ciclosporin Corticosteroids Diuretics Erlotinib Lithium Methotrexate NSAIDs Pentoxyfylline Probenicid Quinolones Tacrolimus SSRIs and venlafaxine Sulphonylureas For full list refer to current edition of BNF. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

36 Dose: IBUPROFEN (SUPPLY) By mouth Adults: 400mg 3-4 times daily after food Child: years: mg 3-4 times daily after food. Children under 12 years should have a maximum of 30mg / Kg per day Child 10 - <12 years: 300mg 3 times daily after food Child 7 - <10 years: 200mg 3 times daily after food Child 4 - <7 years: 150mg 3 times daily after food Child 2 - <4 years: 100mg 3 times daily after food Caution: Elderly or frail are more susceptible to the side-effects associated with NSAIDs and should be advised to take half the normal adult dose. Nursing/Patient Advice: (a) administration (b) side-effects (c) other Storage: Take with or after food. Read manufacturer s patient information leaflet. Hypersensitivity reactions including rashes, bronchospasm and angiodema. GI discomfort occasionally with GI bleed or ulceration Nausea and diarrhoea Headache Dizziness/drowsiness Nervousness Insomnia Depression Vertigo Tinnitus Photosensitivity Refer to BNF for other side-effects. Issue a 5mL spoon with the oral liquid. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

37 Drug Group: Drug Class: Presentation: Indication: LIDOCAINE 1% INJECTION (ADMINISTRATION) Local anaesthetic PoM Lidocaine 1% injection [1 x 10 ampoules] Adults and children aged 6 years and over. To provide local anaesthesia prior to suturing minor injuries or removal of a barbed foreign body. Contra-indication to supply: (a) age (b) disease states Children under 6 years Hypersensitivity to lidocaine or other local anaesthetics Pregnancy Site of injection is inflamed or infected Bradycardia Epilepsy Debilitated patients Hypovolaemia Impaired cardiac conduction Impaired hepatic function Impaired respiratory function Myasthenia gravis Porphyria Shock Dose: Infiltrate each wound site with up to 5mL lidocaine 1%. Adults and children 12 years and over - maximum 10mLs Child 6 - <12 years - maximum 0.3mL/kg Nursing/Patient Advice: (a) side-effects Storage: Side effects are rare and are usually as a result of excessively high blood concentrations due to inadvertent intravascular injection or excessive dosage. Hypersensitivity reactions- urticaria, oedema and anaphylactic reactions. Refer to BNF for other side-effects. Store below 25 C. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG

38 Drug Group: Drug Class: Presentation: Indication: METRONIDAZOLE (SUPPLY) Antibiotic PoM 400mg tablets [1 x 21]; 200mg/5mL suspension [1 x 100mL] Second-line treatment of ANIMAL bites in adults and children aged over 2 years. In adults to be taken along with DOXYCYCLINE. In children under 12 years to be taken along with CO- TRIMOXAZOLE. Contra-indication to supply: (a) age (b) disease states (c) drugs Dose: Children under 2 years Hypersensitivity to metronidazole or any constituents Porphyria Hepatic Impairment Pregnancy and breast-feeding Alcohol - Metronidazole causes disulfiram-like reaction with alcohol Antibiotics Disulfiram Lithium Cimetidine Cytotoxics busulfan, fluorouracil Mycophenolate Warfarin For full list refer to current edition of BNF. Adults: 400mg three times a day PLUS doxycycline for 7 days. Child 2-11 years: 7.5mg/kg (max 400mg) three times daily PLUS co-trimoxazole for 7 days. Nursing/Patient Advice: (a) administration Shake suspension well before administration. Supply with a 5mL spoon or 2.5mL/5mL oral syringe. Take at regular intervals. Complete the course unless otherwise directed by a doctor. Read the manufacturers patient leaflet. Take with or after food. Avoid alcohol for duration of course and 48 hours after course of antibiotics completed. UNCONTROLLED WHEN PRINTED Review Date: January 2018 Identifier: NHSG/PGD/MinInj/MGPG