Non Prescription Supply of Medicines - PGDs Flashcards

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1
Q

What is a patient group direction?

A
  • Written instructions for the supply or administration of med to patients usually in planned circumstances
  • By named, authorised, registered health professionals
  • Using PGD is not a form of prescribing
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2
Q

What does the PGD guide register pharmacists to do?

A
  • PGD guide register health professionals in assessing the patients suitability for a specific drug without reference to an independent prescriber
  • Pharmacist can only supply medicines on a PGD if there is an advantage for the pt.
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3
Q

When are PGDs useful?

A
  • supplying medicine for treatment of episode
  • medicines use follows discrete pattern
  • homogenous patient group
  • unscheduled care
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4
Q

Who can use a PGD?

A

nurses, midwives, optometrists, pharmacists, radiographers, dieticians etc.

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5
Q

Legal Framework for PGDs

A

Legislation for PGDs included in HMR 2012
States requirements for:
- Developing/ authorising PGDs
- Information to be included in a PGD
- Reviewing and updating PGD
- Using PGD
- Labelling PGDs (normal legislation applies)
- PIL must be provided with PGDs (not required by legislation)

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6
Q

PGD and NHS charge

A

NHS exemptions/charges also apply PGDs
Prescription charges do not apply when meds are administered under a PGD

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7
Q

Setting up a PGD in your pharmacy

A
  • 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
  • construct the proposal document for seeking agreement, and ensure it has all the info necessary
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8
Q

Authorising bodies who can sign PGD include

A
  • NHS bodies: CCG, hospital trust and funds, local authorities
  • Non NHS bodies: independent medical agencies, independent hospitals
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9
Q

Legal requirements of a PGD

A
  • Name of business who owns the direction
  • Start and end date of PGD
  • Description of medicines
  • Class of HCP who can supply or administer
    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
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10
Q

Legal MEDICINES requirements of a PGD

A
  • Clinical conditions to which the direction applies
  • Exclusion criteria
  • Referral criteria
  • Details of appropriate dose, max total dose, qty, form, strength, route, frequency
  • Max/min period to administer meds
  • Relevant warnings
  • Details of any necessary follow up actions
  • Statement of records to be kept for audit
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11
Q

Exclusion from PGDs

A
  • Supply or administration of abortifacients
  • As part of training
  • Care homes and independent schools providing healthcare entirely outside the NHS
  • Certain controlled drugs (see Part 2 lecture)
  • Meds needing frequent dose adjustments or monitoring (anticoagulants and insulin)
  • Dressings or medical devices (they don’t have a MA)
  • Mixing of medicines (it produces an unlicensed medicine)
  • Radiopharmaceuticals
  • Unlicensed medicines
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12
Q

Medicines included with caution in PGD

A

Abx:
- Only when their inclusion is necessary and won’t interfere with strategies to combat AMR.
- Will need to involve microbiologist.
e.g. 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
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13
Q

CD included with PGD

A

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)
- Ketamine

Schedule 3:
- midazlolam

Schedule 4:
- except anabolic steroids and injectables used for treating addiction

Schedule 5:
- all including codeine

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14
Q

Which CDs cannot be supplied and administered under a PGD

A

Sch 3:
Tramadol
Gabapentin
Pregabalin

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15
Q

Before working under a PGD, healthcare professional must ensure:

A
  • 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
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16
Q

Practising Under a PGD

A

HCPs cannot delegate their responsibility

They must:
- Determine that patient meets inclusion criteria/no exclusion criteria apply.
- Assess each individuals circumstances and preferences.
- Understand relevant information about the medicines in the PGD – e.g. dosage, interactions, etc.
- Be able to advise patient/carer about the medicine.
- Document the supply or administration.

Where appropriate they should also:
- Be able to discuss alternative options for treating the patient.
- Recognise when you need to signpost or refer to another HCP as defined in the PGD.

17
Q

Documentation

A

Most PGD require a record of supply or administration but not always specified in a PGD

18
Q

What is good practice for documentation in PGD?

A
  • Date and time of supply/administration
  • Patient details and how the patient met the criteria of the PGD
  • Details of medicine
  • Statement that supply/administration 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 kept for eight years and for children it is until they are 25 or eight years after a child’s death
19
Q

Reviewing and updating PGDs

A
  • Usually done close to expiry date of PGD (max 3 years) OR when there are changes in legislation e.g. NICE guidance/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
20
Q

Types of PGD

A

NHS: all of previous information applies

Private

21
Q

Private PGD

A
  • Healthcare providers registered with the Care Quality Commission as ‘independent medical agencies’
  • 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
22
Q

Examples of Private PGDs

A
  • Antimalarials (Malarone, doxycycline, Lariam)
  • Cystitis treatment (trimethoprim)
  • Erectile dysfunction (Viagra, Cialis, Levitra)
  • Emergency contraception (Levonelle and ellaOne)
  • Hair loss (Propecia)
  • Stop smoking (Champix)
  • Salbutamol inhalers (for repeat supply)
  • Vaccines (rabies, yellow fever
23
Q

Examples of NHS PGD

A
  • nappy rash
  • impetigo (fusidic acid)
  • Oral thrush (nystatin suspension)
  • Emergency contraception
24
Q

PGD - Off label

A
  • Clearly state the product is being used outside the terms of it’s MA
  • Why this is recommended
  • Reference to supporting evidence/guidance.
  • Inform pt when use is off-label
25
Q

Pandemic Treatment PGD

A
  • Supply of a POM for the prevention or treatment of a disease that is, or is anticipated to be, pandemic.
  • Must be done in accordance with a Pandemic Treatment Protocol (PTP) or Pandemic Treatment Patient Group Direction (PTPGD), if and when one is issued.
26
Q

Authorising PGD

A