patient group direction

Transcription

1 DIAZEPAM (RECTAL) v01 1/8 DIAZEPAM (RECTAL) PGD Details Version 1.0 Legal category Staff grades Approved by POM Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner (Nurse) Medicines Management Group Date issued 01/02/2013 Review date 31/01/2015 Clinical Publication Category Mandatory - No deviation from document permissible Clinical Requirements Competencies Continuing education Successful completion of a competency assessment in the use of this medicine for the indications stated. Completion of education in both the legal and professional aspects of PGD administration and the supply of medicines. The clinician is responsible for keeping him/herself aware of any changes 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 their own individual scope of practice.

2 DIAZEPAM (RECTAL) v01 2/8 Clinical Situation Clinical situation Inclusion criteria Exclusion criteria Cautions Seizures including those of epileptiform or eclamptic origin Symptomatic cocaine toxicity Adults or children experiencing any of the following: Seizures lasting longer than 5 minutes and still fitting Repeated seizures not secondary to uncorrected hypoxia or hypoglycaemia Status epilepticus Eclamptic fits if recurrent or lasting >2-3 minutes Cocaine toxicity associated with severe hypertension, chest pain or seizure Seizures which lasts more than 2-3 minutes or are recurrent and unlikely to be due to hypoxia, as part of the post-rosc care guidance within Clinical Guideline CG07 - Cardiac Arrest. Known hypersensitivity to diazepam Elderly or debilitated patients may require a reduced dose. Respiratory disease, muscle weakness and myasthenia gravis Recent doses of diazepam or midazolam by carers/ relatives should be taken into account when calculating the maximum cumulative dose. Valproate may increase the plasma level of diazepam. If a patient is supplied with diazepam avoid supplying opioid drugs concomitantly for analgesia.

3 DIAZEPAM (RECTAL) v01 3/8 Side effects Action if excluded Action if patient declines Confusion and ataxia (especially the elderly) Respiratory depression (especially in the presence of alcohol or opioids) Acute pulmonary insufficiency Paradoxical increase in aggression Muscle weakness Visual disturbance, vertigo and tremor Incontinence/urinary retention Skin reactions and jaundice Blood disorders Salivation changes Hypotension (may be significant if moved from the horizontal position). Drowsiness, light-headedness, confusion and ataxia Occasionally amnesia may occur. If patient meets exclusion criteria: If still experiencing the seizure transport under emergency conditions to an Emergency Department, placing an ATMIST pre-alert. Record specific exclusion on patient clinical record (PCR). This medicine will be used in a situation where the patient will be unable to make a competent refusal; act in the patient s best interests. Description of Treatment Generic name Presentation Route Method Diazepam Rectal tubes 2.5mg and 5mg Rectal Administration Supply In small children, the rectal route (PR) is the route of choice initially, with IV ccess sought subsequently. Insert rectal tube nozzle no more than 4-5cm in adults and 2.5cm in children (there is a marking on the nozzle).

4 DIAZEPAM (RECTAL) v01 4/8 Dose Age Initial Dose Maximum Total Dose Adult (over 12 years) 10mg 20mg 2-12 years 5-10mg 20mg Under 2 years 2.5-5mg 10mg Birth mg 5mg If the seizure continues, the initial dose can be repeated every 10 minutes, up to the maximum total dose. If a dose of diazepam has been given PR and IV access is subsequently available, administer Diazemuls. The combined dose of both preparations (PR/IV) must not exceed the maximum total dose stated above. Frequency Duration of treatment If the seizure continues, the initial dose can be repeated every 10 minutes, up to the maximum total dose. One episode of care Follow Up Referral arrangements and safety netting The senior clinician on-scene is responsible for deciding whether admission to an Emergency Department is required, with reference to Trust and JRCALC guidelines. Only patients with known epilepsy who make a full recovery and who can be adequately supervised should be considered to be left at home. If seizure is not terminated transport under emergency conditions to an Emergency Department, placing an ATMIST pre-alert. Where the patient is not admitted, their GP should be informed using local mechanisms.

5 DIAZEPAM (RECTAL) v01 5/8 Advice to patients Records References In recovery, stand up slowly as diazepam may cause hypotension. Diazepam interacts with most antihypertensive drugs to increase their hypotensive effect which may make you feel light-headed or dizzy. Diazepam is a muscle relaxant and anxiolytic. It may cause drowsiness which can persist until the following day. The sedative effect is increased if you take alcohol, opioid analgesics, antihistamines, antipsychotics, some antivirals, certain ulcer healing drugs (esomeprazole and omeprazole) and other muscle relaxants such as baclofen or tizanidine. Diazepam may either increase or decrease the blood level of phenytoin if you are prescribed this drug. Diazepam can cause amnesia. Ensure patient left at home receives a manufacturer s patient information leaflet and discuss where necessary Advise not to drive or operate machinery during treatment and for a full day after treatment; it is an offence to drive while under the influence of drink or drugs. Advise patient to seek further medical attention if their condition worsens or new symptoms develop. Patients left at home and their carers should be told to seek further medical advice if they become generally unwell or if there is a deterioration in their condition and call 999 if another seizure occurs. Complete a patient clinical record (PCR). Rectal diazepam is a controlled drug. Staff must carry out a stock check when issuing these preparations and ensure that the supply, and the remaining stock balance are recorded as necessary. Any discrepancy in the stock level that is discovered must be reported to your line manager and an investigation instigated as detailed in the Trust s Medicines Management Policy. British National Formulary 64 September 2012 (BNF) Electronic Medicines Compendium at medicines.org.uk/emc/medicine/24296/spc/ Stesolid+rectal+tubes+5+mg/ [Accessed ] JRCALC (2012) UK Ambulance Service Clinical Practice Guidelines

6 DIAZEPAM (RECTAL) v01 6/8 Authorisation Chief Executive Officer Ken Wenman Signature Date 01/02/2013 Medical Director Dr Andy Smith Signature Date 01/02/2013 Pharmaceutical Advisor Sue Oakley Signature Date 01/02/2013 This must be signed by the Chief Executive Officer, Medical Director and Pharmaceutical Advisor to be legally valid.

7 DIAZEPAM (RECTAL) v01 7/8 Individual Authorisation (Staff Copy) Individual Signature Date / / Authorising officer Signature Date / / I have read and understood the Patient Group Direction and agree to administer this medicine only in accordance with this document. 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. This signed page must be retained by the member of staff, together with the full PGD, which must be available in clinical practice.

8 DIAZEPAM (RECTAL) v01 8/8 Individual Authorisation (Trust Copy) Individual Signature Date / / Authorising officer Signature Date / / I have read and understood the Patient Group Direction and agree to administer this medicine only in accordance with this document. 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. This signed page copy of the PGD must be retained by the station Clinical Support Officer, Clinical Team Leader or Lead Paramedic in a station file which is available for inspection upon request.