Non Prescription Supply of Medicines 2 Flashcards
What is a patient group direction?
- Written instructions for the supply or administration of med to pre-defined group of patients who may not be individually identified before presentation for treatment
- by named, authorised, register health professionals
- using PGD is not a form of prescribing
- PGD guide register health professionals in assessing the patients suitability for a specific drug without reference to an independent prescriber
- different o PSD eg in patient drug chart
When are PGDs useful?
- supplying medicine for treatment of episode
- medicines use follows discrete pattern
- homogenous patient grou
- unschedule care
Legal Framework for PGDs
-legislation for PGDs included in HMR 2012
States requirements for:
-developing PGDs
-Authorising PGDs
-Information to be included in a PGD
-Using PGD
-Reviewing and updating PGD
-legislation for labelling includes PGD
-PIL must be provided with PFS, not required by legislation
-legislation regarding prescription charges and exemptions also applied to patients receiving supply of med under a PGD
-Prescription charges do not apply when med are administered under a PGD
Setting up and authorising a PGD
- consider need for PGD
- obtain the agreement of the authorising body before proceeding to develop PGD
- identify appropriate person who can sign PGD on behalf of authorising body
- Authorising bodies include:
- CCG, hospital trust and funds, local authorities
- Non NHS bodies: independent medical agencies, independent hospitals
- construct the proposal document for seeking agreement, and ensure it has all the info necessary
- at an early stage, notify the appropriate senior doctor, or pharmacist who will sign /PFS or representative of the professional groups practising under PGD
- Ensure PGD consistent with the relevant summary of product characteristics
PGD requirements
- signed on behalf of authorising body
- signed by a doctor
- signed by a pharmacist
- both a pharmacist and doctor must have been involved in developing the PGD
- when acting as a signatory, establish clinical and pharmaceutical content is accurate and can be supported by evidence
Medicines included with caution in PGD
AB- only when their inclusion is necessary and won’t interfere wit strategies used to combat AMR. Will need to involve microbiologist. Example azithromycin available as PGD for chlamydia
Black triangle and off label use of drugs: only in exceptional circumstances and when justified by current best clinical practice
- PGD must Cleary indicate the status of these drugs and why such use is necessary
- NICE guidelines just be used to justify the use of these meds
CD included with PGD
Schedule 2: morphine and diamorphine (only registered nurses and pharmacists for immediate, necessary treatment of a sick or injured person- not for treatment of addiction)
Schedule 3: midazlolam
Schedule 4: except anabolic steroids and injectables used for treating addiction
Schedule 5: all including codeine
Exclusion from PGDs
- unlicensed meds (need to have MA)
- meds needing frequent dose adjustments or monitoring (anticoagulants and insulin)
- special manufactured meds
- dressing, appliances and devices
- radiopharmaceuticals
- PGDs are not used for managing long term conditions
Who can use a PGD?
nurses, midwives, optometrists, pharmacists, radiographers, dieticians etc.
Before working under a PGD, healthcare professional must ensure:
- They have undertaken appropriate training and CPD
- assessed as competent and authorised to practice by provider organisation
- have signed an appropriate documentation
- are using a copy of most recent and in date final signed version of the PGD
- have read and understood context and content of PGD
Practising Under a PGD
- healthcare professionals may not delegate their responsibility
- ensure that you can determine that the patient meets the inclusion criteria as set out in the PGD and that no exclusion criteria apply
- Be able to discuss alternative options for treating the patient if appropriate.
- Assess each individuals circumstances and preferences.
- Recognise when you need to signpost or refer to another HCP as defined in the PGD.
- Understand relevant information about the medicines in the PGD – e.g. dosage calculations, interactions, etc.
- Be able to advise patient/carer about the medicine.
- Document the supply or administration.
Documentation
Most PGD require a record of supply or administration but not always specified in a PGD
What is good practice for documentation in PGD?
- Date and time of supply and/or admin
- Patient details and how the patient met the criteria of the PGD
- Details of medicine
- Statement that supply or admin is by using a PGD
- Name and signature of HCP administering or supplying
- Relevant info provided to the patient
- If consent was obtained (when relevant)
- for adults all PG documents must be keptt for eight years and for children it is until they are 25 or eight years after a Childs death
Reviewing and updating PGDs
- usually done in response to approaching the expiry date of PGD (max 3 yearS) or when change in legislation, new nice guidance, changes in SPC
- When reviewing the PGD (at least every 2 years), conduct an appropriate literature search to identify new evidence
- Determine whether the PGD remains the most appropriate option to deliver service; is it still needed
- If updating PGD, it will need to be re-authorised as per normal requirements
Type of PGD
NHS: all of previous information applies
Private:
- Healthcare providers registered with the Care Quality Commission as ‘independent medical agencies’, have the authority to write PGDs (still need to follow the legislation)
- Use of private PGDs generally require pharmacists to undertake training
- Superintendent pharmacists / Pharmacist Owners oversee the use of the PGDs within their organisation, including insurance
- Pharmacies set their own prices for services and medication supplied through private PGDs. No NHS authorisation is required.
- Private PGD services are paid for directly by patients
