Non Prescription Supply of Medicines - PGDs Flashcards
What is a patient group direction?
- 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
What does the PGD guide register pharmacists to do?
- 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.
When are PGDs useful?
- supplying medicine for treatment of episode
- medicines use follows discrete pattern
- homogenous patient group
- unscheduled care
Who can use a PGD?
nurses, midwives, optometrists, pharmacists, radiographers, dieticians etc.
Legal Framework for PGDs
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)
PGD and NHS charge
NHS exemptions/charges also apply PGDs
Prescription charges do not apply when meds are administered under a PGD
Setting up a PGD in your pharmacy
- 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
Authorising bodies who can sign PGD include
- NHS bodies: CCG, hospital trust and funds, local authorities
- Non NHS bodies: independent medical agencies, independent hospitals
Legal requirements of a PGD
- 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
Legal MEDICINES requirements of a PGD
- 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
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
Medicines included with caution in PGD
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
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)
- Ketamine
Schedule 3:
- midazlolam
Schedule 4:
- except anabolic steroids and injectables used for treating addiction
Schedule 5:
- all including codeine
Which CDs cannot be supplied and administered under a PGD
Sch 3:
Tramadol
Gabapentin
Pregabalin
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
