Version Control This PGD has been agreed by the following organisations FCMS Doncaster CCG Lancashire CCGs including East Lancashire, Fylde and Wyre and North Lancashire CCGs Change history 31/07/17 V02 Review. Minor editing changes. 28/08/17 V02 Review. Adjustments to dose information. Minor editing changes. 28/08/2017 Page 1 of 6
CLINICAL CONTENT OF PATIENT GROUP DIRECTION Staff Characteristics Qualifications Specialist competencies or qualifications Continuing training and education Registered nurse, Paramedic practitioner, ECP (Paramedic) or Nurse practitioner Received training to undertake administration and supply of medicines under PGD. Has undertaken appropriate training to carry out clinical assessment of patient, leading to diagnosis. Also that such diagnosis requires treatment according to the indications listed in this PGD. 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 and to work within the limitations of individual scope or practice. Clinical Details Indication For emergency treatment of hypoglycaemia. Inclusion criteria Patients with hypoglycaemia (capillary blood glucose less than 3 mmols/litre as determined by glucose meter/strips) who are unable to take oral glucose (dextrose). A further medical consultation is required for all patients following severe hypoglycaemia. Hospital admission may be required and further monitoring is required following the event to detect any further episodes that occur as the effects of glucagon wear off. Exclusion criteria Known hypersensitivity to glucagon, latex or any of the excipients. Patients who are able to take glucose orally. Patients known to have phaeochromocytoma. PGDs should be used only where appropriate, suitable and legal. PGDs should not be routinely used when an independent prescriber is available. Precautions Patients taking indomethacin: glucagon may lose its ability to raise blood glucose or may even produce hypoglycaemia. Management of excluded patients Action for patients not wishing / unable to 28/08/2017 Page 2 of 6 Patients taking warfarin: glucagon may increase the anticoagulant effect. Patients taking beta-blockers: glucagon might be expected to have a greater increase in both pulse and blood pressure, an increase of which will be temporary because of glucagon's short half-life. The increase in blood pressure and pulse rate may require therapy in patients with coronary artery disease. Patients with adrenal insufficiency or insulinoma. Discuss with GP or Clinical Lead. Refer to supervising doctor/receiving facility as appropriate. Make patient aware of risks and potential consequences of not taking medicine.
receive care under this PGD Discuss any alternatives if available. Discuss alternative options with GP or Clinical Lead. Document discussion with patient. Description of Treatment Name of medicine Glucagon hydrochloride Formulation and route Powder and solvent for solution for intramuscular or subcutaneous injection Strength 1mg/mL Dosage Adults: 1mg Children over 6-8 years or over 25kg bodyweight: 1mg Children under 6-8 years or weight below 25kg: 500micrograms (0.5mg) 28/08/2017 Page 3 of 6 If patient responds (usually within 10 minutes of glucagon injection) give oral carbohydrate to prevent relapse and restore the liver s glycogen levels. Arrange follow up. If there is no response in that time, patient will require urgent medical attention and an emergency ambulance should be called Repeated dose Not applicable instructions Duration of treatment Once only Quantity to supply Administration only Legal status POM Special precautions Explain indications, contraindications and cautions Adverse effects Occasionally nausea, vomiting, abdominal pain, hypokalaemia, hypotension. Hypersensitivity reactions occur rarely. This is not a complete list. Refer to BNF or SPC (summary of product characteristics) for full information. Advice necessary Provide the patient with the manufacturer s Patient Information Leaflet. Advise on dose and administration with reference to the cautionary label information and give any further instructions to aid compliance. Give advice on practical self-care if appropriate, including management of likely symptoms (including fever management where appropriate). Make patient aware of potential adverse effects and the action to take if they occur. Provide appropriate worsening advice describing the range of signs and symptoms to monitor for and the action to take if they occur. Consider whether the provision of health promotion material is appropriate e.g. on smoking or lifestyle factors. Provide any advice relevant to the patient from the Precautions section
above. Advise patient not to drive or operate machinery for a least 1 hour post recovery as symptoms may recur. Discuss cause of hypoglycaemia with own GP. If treated with glucagon the hypoglycaemic event is considered severe and one that needed external assistance : this may have an impact on the patient s suitability for continuing to drive and they should discuss with the DVLA. Prescribing guidance Doncaster CCG local guidelines. Relevant NICE guidelines and advice from Clinical Knowledge Summaries. Records and Follow Up Referral arrangements Inform GP as soon as possible. Advise if worsening or no improvement to seek further medical advice. Records to be kept Patient s name, address, date of birth and consent given. Contact details of GP (if registered). Diagnosis. Dose and form administered. Batch and expiry details. Advice given to patient (including side effects). Signature / name of staff who administered or supplied the medication. If relevant, signature / name of staff who removed / discontinued the treatment. Details of any adverse drug reaction and actions taken, including documentation in the patient s medical record. Referral arrangements (including self-care). Any serious side effects attributable to drug should be recorded and medicine management advised via yellow card system found in BNF. Follow up Advise follow up with GP/ Practice nurse. Patient Group Direction, organisation and individual authorisation signatures can be found on the managerial content sheet along with other non-clinical details relating to this patient group direction. 28/08/2017 Page 4 of 6
Patient Group Direction Owner Details of PGD owner FCMS (NW) Ltd Newfield House Vicarage Lane Blackpool FY4 4EW Patient Group Direction Authorisation Lead Doctor MANAGERIAL CONTENT OF PATIENT GROUP DIRECTION Lead Pharmacist Lead Nurse Dr Jonathan Bundy Magnus Hird Alison O Connor Lead Paramedic Organisational Authorisation for FCMS Organisational Authorisation for East Lancashire CCG Gillian Gregory Patient Group Direction Peer Review Reviewed by Wendy Lambert, Nurse Practitioner 28/08/2017 Page 5 of 6
Individual Authorisation BY SIGNING THIS PATIENT GROUP DIRECTION YOU ARE INDICATING THAT YOU AGREE TO ITS CONTENTS AND THAT YOU WILL WORK WITHIN IT. PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. IF THIS IS AN UPDATED OR REPLACEMENT PGD ENSURE THAT ALL OLDER VERSIONS ARE WITHDRAWN FROM USE WITH IMMEDIATE EFFECT. IT IS YOUR RESPONSIBILITY TO MAKE SURE YOU ARE USING THE CURRENT VERSION. NOTE TO AUTORISING MANAGERS: AUTHORISED STAFF SHOULD BE PROVIDED WITH AN INDIVIDUAL COPY OF THE CLINICAL CONTENT OF THIS PGD AND A PHOTOCOPY OF THE AUTHORISATION SHEET SHOWING THEIR AUTHORISATION. Name of Professional Signature Authorising Manager Date 28/08/2017 Page 6 of 6