Salbutamol nebules YOU MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO IT NPGD2007/355 (supersedes 2004/177) Clinical Condition Indication: Inclusion criteria: Exclusion criteria: PGD To allow named individual(s) to administer salbutamol (5mg nebules) for the relief of bronchospasm in an on call or emergency situation where absence of medical staff may delay appropriate physiotherapeutic intervention; relief of bronchospasm caused by diagnostic procedure sputum induction; as part of hypertonic saline challenge for dose response supervision. Administered via jet nebuliser Patients judged, following assessment, to fall into one of the above categories, i.e. bronchospasm where delay in medical attendance may lead to unnecessary distress/discomfort. Patients aged 13 and over. Patients under the age of 13. Patients with a history of hypersensitivity to any of the components of the medicine. Known hypersensitivity to any of the components of the medicine. The nebules should be used for inhalation only. Cautions/Need for further advice/ Circumstances when further advice should be sought from the doctor: Action if patient declines or is excluded: Use with caution in patients who have received large doses of other sympathomimetic drugs. Use with caution in diabetic patients who are receiving corticosteriods as there is potential for blood glucose to become elevated. CSM adivses that potentially serious hypokalaemia may result from B2 agonist therapy. Caution must be exercised in severe asthma as this effect maybe potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids and diuretics and by hypoxia. Steps should be taken to ensure Serum potassium levels are being monitored Refer to supervising doctor/ medical facility. Document findings and actions in patients records. Date approved: July 07 Version: 2 Review Date: January 09 Expiry Date: July 2009 Page 1 of 7
Drug Details Name, form & strength of medicine: Route/Method of administration: 5mg salbutamol nebules for inhaltion via a nebuliser. Nebules for inhalational use only, to be breathed in through the mouth via jet nebuliser via air compressor or oxygen. COPD patients should have this administered via air compressor with supplemental oxygen as required via nasal cannulae to maintain oxygen saturations greater than 92% or with oxygen as driving gas should patient require high flow oxygen to maintain acceptable saturations. Dosage (include maximum dose if appropriate): Frequency: Duration of treatment: Maximum or minimum treatment period: Quantity to supply/administer: Black Triangle Drug:* Legal Category: Is the use outwith the SPC:** Storage requirements: 5mg Once only Once only Once only administration of 5mg on one occasion 5mg as 2.5ml of a sterile 0.2% w/v solution of salbutamol No POM No Locked ward drug trolley, drug cupboard. Locked cupboard in physiotherapy department * The black triangle symbol ( ) identifies newly licensed medicines that are monitored intensively by the MHRA/CSM **Summary of Product Characteristics Page 2 of 7
Warnings including possible adverse reactions and management of these: Please refer to current BNF or SPC for full details. Use the Yellow Card System to report adverse drug reactions directly to the CSM. Yellow Cards and guidance on its use are available at the back of the BNF. Common adverse reactions include: fine tremor, headache, muscle cramps and palpitations. Refer to previous section on cautions/need for further advice. Advice to patient/carer including written information provided: Monitoring (if applicable): Follow up: Explain treatment and course of action May experience fine tremor (particularly in hands), nervous tension, headaches, peripheral dilation and palpitations. May experience tachycardia and arrhythmias. Muscle cramps, hypersensitivity reactions including paradoxical bronchospasm, urticaria and angioedema have been reported. Assess patient during and after administration of drug and report to medical staff any adverse reactions. Document findings and any actions in patient s records. Monitor patient s response as per local protocols for condition being treated, document findings in patient records. Therapist administering drug reports any adverse events via clinical incident reporting policy and Pharmacy. Request for medical advice, if necessary, made by therapist administering drug, documentation of this made in patient s notes. Page 3 of 7
Staff Characteristics Professional qualifications: Specialist competencies or qualifications: BSc degree in physiotherapy or equivalent. Member of the Chartered Society of Physiotherapy. HPC registration (registration must be current) Minimum 5 years post graduate experience. Employed at clinical specialist level. Initial assessment and annual peer review by respiratory medicine doctor (Dr CE Bucknall or nominated alternate) and pharmacy demonstrating understanding of mechanics of bronchospasm and mode of action of salbutamol. Has undertaken appropriate training to carry out clinical assessment of patient leading to diagnosis that requires treatment according to the indications listed in this PGD. Undertaken appropriate training to carry out clinical assessment of patient leading to diagnosis that requires treatment according to indications listed in this PGD. Review and training supervised by Dr CE Bucknall. Currently involved in on call or emergency rota. Been named in the salbutamol for bronchospasm PGD. Has undertaken appropriate training for working under PGDs for the supply and administration of medicines Continuing education & training: All named persons under this direction will be expected to maintain their competence as specified in hospital policies and as directed by the CSP. Annual review and competency assessment by Dr CE Bucknall or her nominated alternate. Practitioner should be aware of any change to the recommendations for the medicine listed. It is the responsibility of the named individual to keep up to date with continued professional development. Page 4 of 7
Referral Arrangements and Audit Trail Referral arrangements: Records/audit trail: As per local arrangements/national guidelines. Patient s name, address, date of birth and consent given Contact details of GP (if registered) Diagnosis Dose and form administered (batch details if locally required) Advice given to patient (including side effects) Signature/name of staff who administered or supplied the medication, and also, 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) References/Resources and comments: Notes: SPC Summary of Product Characteristics BNF British National Formulary Page 5 of 7
This patient group direction must be agreed to and signed by all health care professionals involved in its use. The original signed copy will be held at PPSU, Queen s Park House, Victoria Infirmary. The PGD must be easily accessible in the clinical setting Organisation: NHS Greater Glasgow & Clyde Antimicrobial use If the PGD relates to an antimicrobial agent, the use must be support by a consultant microbiologist with authority to the area in which the PGD is intended to be used. Cons Microbiologist: (Relevant to area where PGD is to be used) Name: Signature: Date: Page 6 of 7
Local Authorisation Service Area for which PGD is applicable: Description of Audit arrangements: Frequency of checks: (Generally annually) Annually Names of auditor(s): Nominated individual who agrees to keep staff training and list of practitioners operating under the PGD current and up to date (Lead professional) Name: Signature: Designation: Date: Name of person checking any medicines Act issues on arrangements for keeping and retention of records and medicine stock security and storage (Pharmacist) Name: Signature: Designation: Date: 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. Note to Authorising Managers: 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. I have read and understood the Patient Group Direction. I acknowledge that it is a legal document and agree to supply/administer this medicine only in accordance with this PGD. Name of Professional Signature Date I agree that the professionals listed above are authorised to provide/administer medicines in accordance with this PDG to patients under my care. Lead Clinician for the service area (Doctor) Name: Signature: Date: Page 7 of 7