Non-prescription supply of medicines 3 Flashcards
A community service is currently being reviewed to understand if a PGD is still the most appropriate method of medicines supply
1) What needs to be considered when undertaking this review?
2) Who should be involved?
1) Legislation (does it comply), NICE guideline (is it in line with guidelines), governance, review of the service (is it still necessary? Is it still the most appropriate method of supply? Any other options? How often is it used….?
2) Commissioner and provider, health professionals working in the service, relevant stakeholders
A nurse works in a clinic using PGDs to supply injections for self-administration by the patient. A patient attends and asks if the district nurse can administer the injection instead.
1) Can the district nurse make this supply?
Registered health professionals using PGDs can only do so as named, authorised individuals. They are not able to assign or delegate their responsibility to another person
The PGD inclusion criteria should clearly state that patients would only be included if they are competent to self-administer
Need to consider why patient wants the district nurse to administer the injection
A pharmacist working in an NHS Trust has been asked to be the pharmacist signatory on some PGDs which have already been developed by a PGD working group.
1) What does the pharmacist need to consider?
What are they signing for? Is there a PGD policy? Do they feel competent to undertake the role? If neither of these are in place or unclear then the pharmacist should not sign the PGD
Should the pharmacist signing the PGD have also been involved in developing the PGD?
This is not required by legislation
But the PGD should be drawn up by a multidisciplinary group involving a doctor, a pharmacist and a representative of any other professional group expected to supply medicines under the PGD
A PGD is being used to supply a medicine that is for children aged from 3 months to 12 years of age. A mother attends the clinic with her 2 month old child. All criteria included in the PGD are met, except for the child’s age.
1) Can the health professional make a clinical judgement to supply the medicine under a PGD?
No, this is not legal. The patient must meet the criteria exactly as stated in the PGD. The health professional cannot use their clinical judgement to determine that the medicine can be supplied
A PGD is being used to supply a medicine that is for children aged from 3 months to 12 years of age. A mother attends the clinic with her 2 month old child. All criteria included in the PGD are met, except for the child’s age.
2. What if the health professional working under the PGD was an independent prescriber? Can the medicine be supplied to the child in this case?
No, for the same reasons stated in question 1. The PGD must be followed exactly if the health professional is working under the PGD. If the health professional is an independent prescriber and competent to prescribe, they should not be working under a PGD
A PGD is being used to supply a medicine that is for children aged from 3 months to 12 years of age. A mother attends the clinic with her 2 month old child. All criteria included in the PGD are met, except for the child’s age.
- What options are available to the health professional?
- When reviewing your records, there seems to be a high proportion of patients being referred to an alternative provider, because they don’t meet the PGD criteria. What should you do?
1) Not supply the medicine, so refer to another health professional or provider (legal requirement that the referral information is included in the PGD)
2) Discuss this with whoever developed the PGD, check if the PGD service has been evaluated, or if it needs redesigning, is it still fit for purpose?
A PGD was authorised for use before April 2016 and it is close to its expiry date. The PGD will automatically be authorised for another year. What are the potential risks of doing this?
Important new evidence may not be identified
May be changes to indication of drug
Service delivery may not be identified
Therefore, PGD should be reviewed and updated. Remember to update all relevant documents and get new signatures for all those involved in the PGD
It is a legal requirement that Patient Group Directions must be signed by?
a) The medical director and the director of nursing
b) A senior doctor and a senior pharmacist
c) A senior pharmacist, a medical consultant and the ward sister
d) A representative of the Trust, a senior pharmacist and a senior doctor/dentist
d
Patient group directions may be used by?
a) Only those practitioners individually authorised and named on the PGD
b) Any registered health professional employed by a hospital trust
c) Any nurses/midwives on the NMC register
d) Any community pharmacist within the local area
a
Patient Group Directions cannot be used for?
a) Antibiotics
b) Unlicensed medicines
c) General Sales List Medicines
d) Newly licensed ‘black triangle’ drugs
b
Patient Group Directions should be reviewed at least?
(a) Every six months
(b) Every year
(c) At the discretion of the pharmacist
(d) Every two years
d
