unit 1 - patient group direction Flashcards
What is a Patient Group Direction?
A written instruction for the sale, supply and/or administration of medicines to groups of patients who may not be individually identified before presentation for treatment
What does a Patient Group Direction allow?
Patient Group Directions allow healthcare professionals to supply and administer specified medicines to pre-defined groups of patients, without a prescription
What is the purpose of a Patient Group Direction?
Aims to ensure that patient group directions are used in line with legislation, so that patients have safe and speedy access to the medicines they need
Who can supply under a PGD?
Chiropodists and podiatrists Dental hygienists Dental therapists Dieticians Midwives Nurses Occupational therapists Optometrists Orthoptists Orthotists and prosthetics Paramedics Pharmacists Physiotherapists Radiographers Speech and language therapists
Why is a PGD needed?
To improve patient care but doesn’t compromise on safety
PGDs can improve access to medicine
Improved access to treatment
Maximise the skills of many healthcare practitioners
PGDs will often be developed in response to a pharmaceutical needs assessment.
The service is designed to improve delivery of care to an identified population e.g. the flu vaccination service aims to increase the percentage of the population vaccinated by making the vaccine more accessible to at-risk patients
How is a PGD produced?
Multidisciplinary team including:
Lead doctor/dentist
Pharmacist
Representative of any professional expected to use the PGD (e.g. a paramedic)
Who authorises a PGD?
The organisation who will be using it e.g. NHS or Primary Care team
What must a PGD have in order to be valid?
Signed by the Lead doctor/dentist and the Senior Pharmacist involved in writing the PGD
Signed by the organisation using it
How often are PGDs reviewed?
Normally every 2 years
Flu PGDs are reviewed every year
What does a PGD need to contain?
Name of the business to which the direction applies
Date when the direction comes into force and expires
What medicines the direction applies to
Class of Healthcare Professional it applies to
Signature of the Doctor (or dentist) and Pharmacist writing it
Signature by the Appropriate organisation
The Clinical Situation to which it applies
Description of patients included and excluded from treatment
Descriptions of situation that need to be referred or extra treatment sought
Details of appropriate dosage and max dosage of medication
Quantity, form, strength, route and frequency of administration
Relevant warnings and potential adverse reactions
Details of follow up actions
What record keeping is needed
What is the inclusion criteria for a PGD?
Specifies which group of patients can access the PGD
What is the exclusion criteria for a PGD?
This lists patietns who CANNOT access the PGD. If a patient is excluded, they may not be supplied with, or administered, the medication. They should be signposted to a more appropriate service. Some of these may be temporary exclusions (e.g. the patient has a temperature so they must wait until they are better) or it could be a permanent exclusion (e.g. past history of anaphalaxis to egg products (albumin))
Does a medicine involved in a PGD need to be labelled?
It depends if it is written in the PGD
Which medicines generally do NOT need to be labelled in a PGD?
Injectable or single dose medicines supplied for immediate administration
Which medicines do need to be labelled in a PGD?
Medicines taken away by the patient for administration later
A PIL should also be included and they should be asked to read it
Give examples of PGDs
Influenza vaccine Travel vaccines Meningococcal vaccine Welsh Common Ailments Scheme Champix Azithromycin Sildenafil Finasteride Emergency Hormonal Contraception
What is the Service Aim of an EHC PGD?
To provide, where clinically indicated, a supply of EHC at no cost to the client, as specified within the nationally agreed PGD, and to provide sexual health advice
What conditions apply to the pharmacist running an EHC PGD?
They must be registered with the GPhC
They must pass the accredited training. They must also make a professional declaration to confirm they are competent to provide the service
They must complete Child Protection Level 2 (needs renewing every 3 years)
They must sign a copy of the PGD
They must successfully pass a DBS check
What conditions does the premises need to be able to deliver a PGD?
The premises must contain:
A clearly designated consultation room for confidential discussion
The pharmacist and patient need to be able to talk at normal volume without being overheard
Clinical governance must be adhered to at all times (improve quality of services, safeguard high standards of care, provide an environment in which excellence in clinical care should flourish)
What is the Service Outline for an EHC for a PGD?
Patient needs EHC for their own use
Clinically indicated according to the inclusion criteria
Aged 13 and over
Free to patients
Non-judgemental
Signposting services for patients needing extra support
What is the primary aim of the EHC services in a PGD?
To reduce unplanned pregnancies, of which unplanned teenage pregnancies are included
The service must be offered in accordance with FRASER guidance
What is the age of consent for sex?
16 years old
What is the purpose of the laws surrounding sexual consent?
To protect children from abuse or exploitation, rather than to prosecute under-16s who participate in mutually consenting sexual activity
What should always be seen as a possible indicator of child sexual exploitation?
Underage sexual activity
Under what age can children not legally give consent?
Under the age of 13 years old
Why can’t children under the age of 13 years not legally give consent?
To protect younger children. Anyone who engages in any sexual activity with a child who is 12 years or younger is breaking the law
What are the Fraser Guidelines?
The young person, although under 16, understand the advice from the healthcare professional
The young person cannot be persuaded to tell their parents they are seeking contraceptive advice
The young person is likely to have intercourse with or without contraceptive treatment
The young person’s physical or mental health is likely to suffer unless they receive contraceptive advice or treatment
It is in the young person’s best interest to give contraceptive advice or treatment
What are the inclusion criteria for EHC in a PGD?
Patient is aged over 13 years or over and presents in person at the community pharmacy
between 72 and 120 hours of unprotected sexual intercourse (UPSI) or failure of a contraceptive method
OR
between 0 and 72 hours of unprotected sexual intercourse (UPSI) or a failure of a contraceptive method AND the patient weighs more than 70kg or has a BMI > 26
OR
UPSI is likely to have taken place during the 5 days before the expected date of ovulation
OR
The patient weighs less than 70kg or has a BMI less than 26 and levonorgestrel is not suitable
What are the next steps for a patient within the exclusion criteria for EHC in a PGD?
Refer to Family Planning service or GP
Use different PGD
Refer to sexual health clinic
If patient is under 13 - refer to Child Protection Services
If more than 96 hours after Unprotected Sexual Intercourse (UPSI) Levonelle is not clinically appropriate
What is the treatment for an UPSI?
Levonelle (1500mg)
What class is levonelle?
POM
What is the dose of levonelle?
One or two tablets to be taken immediately
What paperwork needs to be complete for an EHC PGD?
EHC record form
All aspects need to be filled in
Helps us to determined whether a patient is to be included or excluded
Acts as a structure for the consultation
Helps us to remember all the information we need to elicit from and give to the patient
What is the Service Level Agreement?
An agreement between the pharmacy and the LHB / CCG
Sets out the minimum specifications in order to provide the service
Provides standards for premises and information on what the pharmacy and the pharmacist have to do in order to be accredited
Has information on the fees that the pharmacy can claim for providing the service
Works together with the PGD
