PGDs Flashcards
Herd immunity
vaccination of a significant proportion of a population results in less risk to individuals who have not developed immunity. Chain of infection is disrupted. Greater the proportion of individuals who are resistant the smaller the probability that a susceptible individual will come into contact with an infectious individual. Depending on disease herd immunity threshold 80-95%
active immunisation
stimulating the immune system like an infection
passive immunisation
introducing antibodies, protection until lost from circulation
natural passive immunity
eg trans-placental spread, breast feeding
acquired passive immunity
eg serum from individuals, pooled antibody fraction eg immunoglobulin
“live” attenuated vaccines
the vaccine is live but weakened eg MMR
“killed” vaccines
inactivated and non-infectious eg typhoid and influenza
subunit vaccines
subunit vaccines contain fragments of protein and/or polysaccharide from the pathogen eg mono-component hepatitis B
Toxoid
bacterial toxin that is no longer active but retains the property of combining with or stimulating the formation of antibodies eg tetanus, diphtheria
adjuvants
added to help immunogen generate an adequate and protective response
how do adjuvants increase immune response
prolonging retention of immunogen at site, increasing effective size of immunogen, stimulating local influx or immune cells
where do adjuvants come from
derived from bacteria eg HPV, immune cell signals or stimulating T helper cells, from inert material eg alum salts
Definition of PGD
“PGDs provide a legal framework that allows some registered health professionals to supply and/ or administer a specified medicine to a pre-defined group of patients, without them having to see a prescriber” Nice
when are PGDs administered
“supplying or administering medicines under PGDs should be reserved for situations in which this offers an advantage for patient care, without compromising patient safety. For example, a PGD may be appropriate for supplying a medicine to a patient seeking treatment for a minor ailment in a community pharmacy or walk in centre”
is a PGD a form of prescribing
no
do patients need to fit every bit of criteria in the PGD
yes
can supply or administration of the medicine be delegated when working under PGD
no
intention of PGD use
should be provided on an individual, patient-specific basis, use must be consistent with appropriate professional relationships and accountability
the MHRA states…
PGDs are an important mechanism in delivering the required capacity and enabling the effective service delivery in the NHS
what are the 3 classes of drugs
GSL, P and POM
what is the medicines act 1968
“authorisation of medicinal products for human use”
what do they oversee
manufacture, import, distribution, sale supply and administration, labelling and advertising, pharmacovigilance
which of those groups do PGDs come under
sale and administration
PGD definition
a specific written instruction for the supply and administration or administration of a named medicine in an identified clinical situation. it applies to groups of patients who may not be individually identified before presenting for treatment
in what situations are PGDs a good fit
when medicine use follows a predictable pattern and is less individualised, used mainly to manage specific episodes where supply or administration is necessary. they are best used in first contact services eg A and E, ambulance service, occupational health
how a PGD is implemented
identify need for PGD, prepare template for organisation eg Health Board, Training and competency assessment, review timelines (usually 2 years)
what information must a PGD contain
clinical, medicine specific, organisation, named staff
authorising a PGD
produced by a multidisciplinary group: senior doctor (or dentist), senior pharmacist, a representative of any professional group expected to operate under the PGD. Must be authorised by the organisation, signatures
organisational requirements
a senior person in each profession should be designated with the responsibility to ensure only fully competent, qualified and trained professionals operate within direction. NHS organisations should maintain a record of the designated senior person for each professional group. All professions must act within their appropriate code of professional conduct. a direction should be reviewed every 2 years
training required for PGD
individuals operating under a PGD should receive appropriate training relevant to the clinical condition and the medicines used, a competency assessment should be completed
PGD records
healthcare may only operate under PGF as named individuals, a record of the named individual must be maintained, all PGDs documentation must be kept for 8 years (for children until child is 25 years)
medicines that can be included in a PGD
medicine must have a UK marketing authorisation, black triangle drugs can be included, medicines can be included for off-label use, antimicrobials (use should be supported by evidence of best practice), certain controlled drugs can be included
PGD in practice
sexual health- EHC, antibiotics. Vaccines- childhood immunisation. Minor ailments- sore throat test and treat. emergency planning- potassium iodide
