STANDARD OPERATING PROCEDURE Chlamydia screening and treatment for year olds

Transcription

1 STANDARD OPERATING PROCEDURE Chlamydia screening and treatment for year olds Service Commencement Date: 1 st October 2014 Contract Term: 17 months to 31 st March 2016 Produced by: Leicestershire Independent Pharmacy Co Ltd (LIPCO) 18/20 High View Close Vantage Park Hamilton Leicester LE4 9LJ LIPCO Chlamydia SoP 1

2 PURPOSE 1. To ensure a safe and efficient Chlamydia screening and treatment service for year olds is maintained in accordance with local and guidelines. 2. To promote and offer an opportunistic screening kit 3. To follow the Chlamydia screening pathway detailed in Appendix B 4. To provide treatment in accordance with the protocol detailed in appendix C 5. To ensure all members of the Pharmacy Provider team who have had the appropriate training provided by the LIPCO in collaboration with the ISHS, have a clear understanding of the Chlamydia testing service 6. To provide a user- friendly, non- judgmental, client- centred and confidential service in line with the You re Welcome criteria which can be found at: /dh_ pdf SCOPE The provision of a free Chlamydia screening and treatment service for year olds (in accordance with the Chlamydia SoP) and treatment from community based settings situated within the Local Authority boundaries of the County of Leicestershire and the County of Rutland, in accordance with the Agreement between the Leicestershire Independent Pharmacy Company Ltd (LIPCO) and the Provider Pharmacy Appropriately accredited clinical practitioners who are registered with the General Pharmaceutical Council of Great Britain and who practice with the designated Pharmacy Provider must deliver these services. The name and registration number of all accredited clinical practitioners must be given to LIPCO HEALTHCARE, as requested by the Local Authority. PROCEDURE 1. The Pharmacy Provider will ensure all pharmacists/locums providing the treatment service attend the LIPCO training workshop delivered by the Integrated Sexual Health Service before providing this service Delivery of Chlamydia Screening. The workshop covers: ü Working with young people ü Local safeguarding ü Local services and referral routes 2. PRIOR to commencing the service a) Advise LIPCO of the name(s) of the designated lead that will liaise with the Leicestershire Integrated Sexual Health Service for the treatment of positive patients b) Immediately notify the LIPCO of any changes in the designated lead c) Conduct a risk assessment for the use of onsite toilet facilities and ensure your insurance covers public use of staff areas if applicable. LIPCO Chlamydia SoP 2

3 3. PRIOR to commencing the service, the appropriate pharmacy staff should: ü be familiar with the storage location of the testing kits within the pharmacy ü know from where to order chlamydia testing kits ü be familiar with the laboratory service being used 4. Patients may access the service either by: request for self- testing when receiving pharmacy EHC services 5. If the patient requests a kit or the pharmacist/locum/appropriate pharmacy staff member deems it appropriate to provide the test kit in accordance with other services, the patient must be shown to a confidential consultation room and follow the procedure indicated below: confirm the patient is willing to undertake the test and ask their age (must be between 15 and 24 years) 6. Ask if the patient is experiencing any of the symptoms indicated below (indicating a greater risk of Chlamydia or another STI): Genital itching Pain on passing urine Unusual vaginal/penile discharge Pain during sexual intercourse Abnormal spots or lumps Fever Abnormal bleeding Pain in lower abdomen 7. Provide the patient with a postal chlamydia screening kit and ensure that patient is aware of the importance to return the sample taken within 24 hours Explain fully how the kit should be used Ensure the name and unique reference number (URN) are written on the sample bottle The test request form included with each kit should be completed by the patient with at least their first name, family name, address, postcode, contact number, DOB and gender The patient should clearly indicate how they wish to receive their results The urine sample should ideally be the first pass sample of the day, the bottle to be just over half full is sufficient Blood stained samples will not be processed and females maybe given the option of a vaginal swab or urine sample The patient should keep the patient tear off slip from the request form as it contains the URN The sample should be posted with 24 hours and it complies with Royal Mail requirements Encourage all patients to return to the pharmacy, even if a negative result so that any issues can be discussed LIPCO Chlamydia SoP 3

4 8. Encourage all patients to use on site or nearby toilets and return samples back to the pharmacy for return to the laboratory by post (rather than relying on the patients to post) 9. If no onsite facilities are available, the community provider will encourage patients to return postal screening kits to the Pharmacy Provider for sending to the lab and ensure patients are aware that samples must be returned within 24 hours 10. If the patient is under 16 years: refer to Safeguarding guidelines Check the symptoms that they are experiencing Advise of the importance of seeing their GP or sexual health clinic advise the patient of the increased risk of Sexually Transmitted Infections (STIs) Explain Chlamydia to the patient outline the lack of symptoms and possible long term complications 11. If the patient is NOT willing to be tested: provide a Patient Information Leaflet (National Chlamydia Screening programme) Advise the patient that should they change their mind, they may return to the pharmacy (age dependant) or access the test through their GP or local Sexual Health Services 12. If the patient presents with a partner notification slip (issued because one of their sexual partners has tested positive for Chlamydia) national guidelines state that treatment should be indicated. 13. If the patient is over 16 years and has no symptoms and no positive partner result, the testing kit may still be given. Explain fully how the kit should be used Ensure the name and unique reference number (URN) are written on the sample bottle The test request form included with each kit should be completed by the patient with at least their first name, family name, address, postcode, contact number, DOB and gender The patient should clearly indicate how they wish to receive their results The urine sample should ideally be the first pass sample of the day, the bottle to be just over half full is sufficient Blood stained samples will not be processed and females maybe given the option of a vaginal swab or urine sample The patient should keep the patient tear off slip from the request form as it contains the URN The sample should be posted as indicated as soon as possible and it complies with Royal Mail requirements. Advise the patient not to post at weekends or Bank holidays Encourage all patients to return to the pharmacy, even if a negative result so that any issues can be discussed LIPCO Chlamydia SoP 4

5 14. If the patient tests positive, the pharmacist/locum should, in a confidential consultation area, provide the patient with the following advice/information: Confirm patient details Explain the meaning of a positive result i.e. the patient has Chlamydia at the time the sample was tested and will need to be treated with a short course of antibiotics If the patient may suspect she is pregnant she must visit her GP or Sexual Health Service as soon as possible Advise the patient to contact any sexual partners within the past six months Sexual health information and advice including the risk of other STIs Abstention from sexual contact for at least seven days after completion of antibiotics in order to prevent re- infection Use of condoms for future prevention of STIs 15. Provide an OTC supply of Clamelle under the product license and following the Clamelle national eligibility protocol, as detailed in appendix B of this SoP. The Clamelle treatment will be made at Local Authority expense and free of charge to the client 16. Complete and return to LIPCO the paperwork as required by the ISHS to confirm treatment has taken place 17. Very occasionally the patient may receive an ambiguous result. In this case, a repeat test maybe given. This may be hormonal or cause by the use of lubricants. 18. In the event of a negative result, the pharmacist/locum should speak to the patient in a confidential consultation area, to: Confirm patient details Explain that a negative result means that the patient did not have Chlamydia at the time the sample was tested Give advice on protection against STIs and advise that it can take up to two weeks for an infection to appear after having unprotected sex Recommend a re- test after two weeks of unprotected sex if the patient has any concerns REVIEW This SoP will be reviewed in the event of changes in Regulations, changes in the Law affecting the supply of emergency contraception or in the event of Commissioning changes or in the event of clinical or governance incidents. Otherwise this SoP it will be reviewed on or before the date shown below. KNOWN RISKS Distractions or interruptions Working long hours without a break Patient has not been explained the service fully by the appropriate Pharmacy staff Illness/ lack of focus/ personal problems LIPCO Chlamydia SoP 5

6 Poor communication by pharmacy Locums or new members of staff that maybe unfamiliar with this SOP Young clients under 16 years Clients 16 years who are not considered to be Fraser competent Known hypersensitivity, contraindications or interactions with Clamelle or any excipient of the preparation Possible pregnancy Established pregnancy Breastfeeding Recent treatment No valid consent obtained from client LIPCO Chlamydia SoP 6

7 STANDARD OPERATING PROCEDURE Chlamydia screening and treatment for year olds Service Commencement Date: 1 st October 2014 Contract Term: 17 months to 31 st March 2016 PREPARED BY: SIGNATURE: DATE: DATE EFFECTIVE: 1 st October 2014 VERSION NUMBER: v DATE OF REVIEW: 1 st October 2015 LIPCO Chlamydia SoP 7

8 APPENDIX A INDIVIDUAL AUTHORISATION PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. It is the responsibility of each professional to practice only within the bounds of his/her own competence and in accordance with his/her own Code of Professional Conduct. For Authorising Managers: 1. 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. 2. Pharmacists should initial appropriate PGDs individually and then sign beneath the list of PGDs on the signature sheet below. 3. Each pharmacist should have their own copy of this document. I have read and understood the Patient Group Direction and agree to supply/administer this medicine only in accordance with this PGD. Name of Professional Signature Authorising Manager Date LIPCO Chlamydia SoP 8

9 CHLAMYDIA SCREENING PATHWAY Leicestershire & Rutland Community Pharmacy APPENDIX B Opportunistic offer of chlamydia screen one of the pharmacy team approach client in target age group (15-25 yrs) Client asks member of pharmacy team about chlamydia screening Pharmacist/Locum provides advice and information about: Chlamydia Chlamydia screening process The test kit, sample collection, test request form PREFERRED ROUTE 4. Client uses onsite of nearby toilets to collect urine sample 5. Pharmacy checks that test request form and label on sample container are correctly completed 6. Pharmacy posts sample to laboratory 1. Client takes test kit home to collect urine sample 2. Test request form and label on container are completed 3. Client posts sample to laboratory Laboratory processes sample and sends results to LLR Integrated Sexual Health Service (ISHS) Chlamydia Screening Office NEGATIVE RESULT Client is informed by ISHS using txt message, phone call or letter (as requested by client) POSITIVE RESULT Client is informed by ISHS using text message, phone call or letter (as requested by client) TREATMENT PATHWAY COMMENCES (see Appendix C) LIPCO Chlamydia SoP 9

10 APPENDIX C CHLAMYDIA TREATMENT PATHWAY (LLR) Community Services POSITIVE RESULT Client informed by LLR ISHS Client: contacts ISHS within 7 days advises ISHS of their choice of pharmacy advises ISHS is partner will present to pharmacy ISHS asks client: to inform partner/s or provide partner details for tracing process for traced partners same as index patient ISHS 3 attempts to contact client If no response, GP is informed ISHS Phones pharmacy Provides patient details Advised whether partner will also attend Client presents at pharmacy for treatment Pharmacist/Locum verifies details (UPN* if known) Clamelle Treatment protocol is used to check patient suitability Importance of partner notification explained Offer test kits (also for partner even if not attending) *unique patient number Client presents at different pharmacy for treatment Pharmacist/Locum contacts CSO to confirm details Provide treatment as indicated in previous box Pregnant Breastfeeding Symptoms Contraindications Interactions Recent treatment DO NOT TREAT Possible pregnancy Advise client : Why they re not suitable for treatment They will be contacted by ISHS to be treated by a specialist LIPCO Chlamydia SoP Absence of: Pregnant Breastfeeding Symptoms Contraindications Interactions Recent treatment SUPPLY CLAMELLE (otc) Provide sexual health information & advice Complete treatment form (test positive of partner treatment) Send form to CSO 10

11 Patient Information Leaflet APPENDIX D You may not know you have it! Choose chlamydia testing What is chlamydia? Chlamydia is the most commonly diagnosed sexually transmitted infection (STI) in the UK. It s most common in men and women under 25 years old. The bacteria that cause chlamydia are found in the semen, vaginal fluids and saliva of people who have the infection. Chlamydia is easily passed from one person to another through unprotected sex (e.g. not using a condom). Why is chlamydia a problem? If chlamydia is not treated it can cause pain in the pelvis, ectopic pregnancy (a pregnancy in the fallopian tubes) and infertility (being unable to have children). This risk is increased if you get the infection again and again. Most people with chlamydia don t get any symptoms. If you do get symptoms you might notice: Unusual vaginal discharge Pain when peeing or having sex Bleeding after sex or between periods Pelvic pain (pain in the lower part of the stomach) or painful testicles If you have any of these symptoms you should see a health professional, even if you have tested negative for chlamydia as you may have a different infection. How regularly should I get a chlamydia test? If you are under 25 years old and sexually active, you should get tested for chlamydia annually or when you change your sexual partner. Where can I get a free chlamydia test? GP surgeries Community pharmacies Sexual health clinics Home sampling kits via the internet/texting services LIPCO Chlamydia SoP 11

12 What is the chlamydia test? The test is free and simple. All you need to do is give a urine sample or a self taken vaginal swab. You do not need to be examined. You may be asked to fill in a form ask for help if you want. We will also need a way of contacting you with your results. This can be your address, mobile number or e- mail. It is important to understand that no medical test is 100 per cent accurate. However, it is rare for the chlamydia test result to be wrong. If you are concerned discuss this when you get your results. The test is confidential. Even if you are under 16 you still have the same rights to confidentiality as anyone else. In exceptional circumstances, like when a doctor or health worker thinks you might be in serious danger, they might feel there is a need to pass information on but they must talk to you first before they tell anyone else. This applies to everyone, no matter what age you are. An organisation called Public Health England counts how many people in England have chlamydia and other STIs. We will send them details of your test results, but not your name or contact details. What if I have chlamydia? If you have chlamydia you will be given antibiotics to treat the infection (do tell us if you could be pregnant, as you may need different antibiotics). Some people experience side effects on antibiotic treatment, the most common of which is an upset stomach. The people you have had sex with recently should also be tested. It is a good idea to get tested again about 3 months after you finish your treatment. This is because it s been shown people who have chlamydia once are more likely to get it again, and that repeat infections increase the risk of developing serious health consequences. You may be contacted again about the option of getting re- tested. It s also important you follow the safer sex advice below. How do I protect myself from chlamydia and other STIs? You can reduce your risk of getting or passing on chlamydia, or other STIs, by: Always using a condom when having sex with casual and new partners Reducing your number of sexual partners and avoiding overlapping sexual relationships Getting screened for chlamydia every year, and on change of sexual partner. For more information and to find out where you can get a test locally: Visit Call the Sexual Health Help Line: Text Phone: Contact your local chlamydia screening office Speak to your local pharmacy LIPCO Chlamydia SoP 12

13 Fraser Competence Clients Under 16 Years APPENDIX E The Gillick ruling in 1985 established the current legal position in England and Wales, which states that people under the age of sixteen are legally able to consent on their own behalf to medical or dental procedures or treatment. In considering the provision of advice or treatment on contraception, doctors and other professional staff need to take special care not to undermine parental responsibility and family stability. The doctor or health professional should therefore, always seek to persuade the young person to tell their parents or guardian (or other person in loco parentis) or to let the doctor inform them, that contraceptive advice is being sought and the nature of any advice or treatment that is given. Exceptionally there will be cases where it is not possible to persuade the young person either to inform the parents or to allow the health professional to do so. In such cases, a doctor or other health professional would be justified in giving advice and treatment without parental knowledge or consent provided that the doctor or other health professional was satisfied that the Fraser Guidelines (often referred to as Gillick Competence) were met: The Fraser Guidelines 1. The young person can understand the advice and has sufficient maturity to understand what is involved in terms of moral, social and emotional implications. 2. The young person cannot be persuaded to involve the parents, nor will they allow notification to the parent that contraceptive advice was being sought. 3. The young person will be very likely to begin or continue to have sexual intercourse with or without contraceptive treatment. 4. Without contraceptive advice or treatment the young person s physical and/or emotional health will be likely to suffer. 5. The young person s best interests require the health professional to give contraceptive advice and/or treatment without parental consent Source: The Fraser Ruling: Gillick v West Norfolk and Wisbech Area Health Authority (1985) The Fraser guidelines in practice If a client is believed to be under the age of sixteen, the pharmacist should: 1. Assess the maturity of the client in terms of understanding any advice given. 2. Encourage the client to involve her parents. 3. Consider the effect on the physical or mental health of the client if advice or treatment is withheld. 4. Make a decision as to whether the client's best interests require the provision of contraceptive advice or supplies or both without parental consent Where the pharmacist does not consider a young person meets the Fraser guidelines, the pharmacist should recommend (and assist where necessary) the client to attend their GP or Integrated Sexual Health Service clinic. LIPCO Chlamydia SoP 13