ASPIRIN v01 1/8 ASPIRIN PGD Details Version 1.0 Legal category P Staff grades Approved by 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 his/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.
ASPIRIN v01 2/8 Clinical Situation Clinical situation Inclusion criteria Exclusion criteria Immediate management of Transient Ischaemic Attack (TIA) to reduce the risk of a subsequent stroke in patients 16 years and over who have been assessed using the ABCD 2 scoring tool as part of the Trust s TIA pathway (Clinical Guideline CG20 - Stroke and Transient Ischaemic Attacks) Adults 16 years and over presenting with a possible Transient Ischaemic Attack, who are being referred to a TIA Clinic. Patients who do not fulfil the TIA pathway criteria: Patients with an ABCD 2 score higher than the limit agreed by the Trust with local TIA services (See Clinical Guideline CG20). Previous potential TIAs within the past 7 days. Atrial Fibrillation Patients taking warfarin or other anticoagulants (including dabigatran, rivaroxaban, apixaban, edoxaban) Patients with haemophilia or other coagulation defects (decreases platelet aggregation and increases bleeding time). Previous or active peptic ulceration Children <16yrs Evidence of hypersensitivity to aspirin or other NSAIDS (those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated) Pregnancy Breastfeeding Severe hepatic impairment (increased risk of GI bleeding) Severe renal impairment (increased risk of GI bleeding, sodium and water retention, deterioration in renal function) Patients already taking anti-platelet drugs e.g 300mg aspirin or clopidogrel (See advice below under action if excluded)
ASPIRIN v01 3/8 Cautions Side effects Action if excluded Action if patient declines Patients already taking: NSAIDs (check OTC use) Lithium Corticosteroids Ciclosporin Methotrexate Tacrolimus SSRIs (citalopram, sertraline, escitalopram, venlafaxine) Uncontrolled hypertension G6PD deficiency (an inherited condition in which the body doesn t have enough of the enzyme G6PD, which helps red blood cells function normally. Asthma (patient may be sensitive to NSAIDS) Excessive alcohol consumption. Hypersensitivity reactions including skin rashes (common), angioedema and bronchospasm. Gastro-intestinal discomfort, nausea, diarrhoea and occasionally bleeding and ulceration. Systemic as well as local effects contribute to GI damage. Haemorrhage If patient meets exclusion criteria: Explain reason to patient/carer Record reason in patient s clinical record (PCR) Admit patient to hospital. If patient declines treatment or advice ensure the patient clinical record details: The advice given by the clinician, including that they must be admitted to hospital. If patient refuses admission explain implications of decision and complete a refusal form The intended actions of the patient (including parent or guardian)
ASPIRIN v01 4/8 Description of Treatment Generic name Presentation Route Aspirin 300mg tablets Oral Method Administration Supply Dosage Frequency Duration of treatment Quantity to supply 300mg (one tablet) One tablet to be taken at the time of assessment and each following morning with breakfast. Seven days (unless stopped following review at TIA clinic) 1 x 7 tablets Follow Up Advice to patients For people who are already prescribed daily lowdose aspirin, advise patient to cease taking the 75mg tablets, and replace with the 300mg daily dose until review at the TIA clinic. Swallow tablets whole and take with or after food. Taking aspirin with food can reduce symptoms such as dyspepsia. Do not take other painkillers or medicines containing aspirin at the same time as taking this medicine, without asking your doctor or pharmacist for advice. If rash, bronchospasm or other signs of hypersensitivity occur, stop taking the medicine and contact your doctor for advice, otherwise do not stop taking this medicine until you have been seen at the TIA clinic. If you experience any of the symptoms again or are worried about your condition, dial 999 immediately. It is against the law for you to drive a motor vehicle until you have been assessed at the TIA clinic.
ASPIRIN v01 5/8 Interactions Referral and Safety netting Records References Aspirin antagonises the diuretic effect of spironolactone. Ensure history includes other medication taken as risk of a GI event is increased if patient is taking another drug that can cause an increased GI risk in their own right i.e. anticoagulants, clopidogrel, low dose aspirin, SSRI, methotrexate or corticosteroids. Aspirin reduces excretion of methotrexate, increasing the risk of toxicity. Metoclopramide increases the rate of absorption of aspirin and increases its effect. Patient must be referred according to Clinical Guideline CG20 - Stroke and Transient Ischaemic Attack. Supply patient with TIA information leaflet and ensure that they are aware of the telephone number of the TIA clinic should they not receive a telephone call from the hospital to book their appointment, or have any other issues with the appointment. Inform patient s GP using local mechanisms. Complete patient clinical record (PCR) SWASFT Clinical Guideline CG20 - Stroke and Transient Ischaemic Attack British National Formulary 64 September 2012 (BNF) Clinical Knowledge Summaries http://www.cks.library. nhs.uk National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 68 TIA pathway Stroke: Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) [Accessed 29-10-2012]
ASPIRIN v01 6/8 Authorisation Chief Executive Officer Medical Director Pharmaceutical Advisor Name Ken Wenman Signature Date 01/02/2013 Name Dr Andy Smith Signature Date 01/02/2013 Name 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.
ASPIRIN v01 7/8 Individual Authorisation (Staff Copy) Individual Authorising officer Name Signature Date / / Name Signature Date / / I have read and understood the Patient Group Direction and agree to supply 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.
ASPIRIN v01 8/8 Individual Authorisation (Trust Copy) Individual Authorising officer Name Signature Date / / Name Signature Date / / I have read and understood the Patient Group Direction and agree to supply 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.