patient group directions jane swan senior medicines management advisor nursing and governance health...
TRANSCRIPT
Patient Group Directions
Jane SwanSenior Medicines Management Advisor
Nursing and GovernanceHealth Partnerships
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Aims & Learning Outcomes of the Session
Aims
Develop an understanding of PGDs
Discuss how to use PGDs safely
Learning outcomes
Describe the background to Patient Group Directions (PGDs)
Learn about some of the legal aspects of PGDs and how this impacts on your practice
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What is a PGD?
A specific written instruction
for the supply and/or the administration
of named medicines
in an identified clinical situation.
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Who do PGDS apply to?
To groups of patients
or other service users,
who may not be individually identified
before presentation for treatment.
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Legislation
1968 Medicines Act and the Human Medicine Regulations 2012 regulate the use of medicines in the UK.
There are 3 subsequent classifications of drugs once they have marketing authorisation.
o GSLo Po POM
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Drug Classifications
GSL – (general sales list)
Medicines sold in general shops as well as pharmacies
P – (pharmacy medicine)
Medicines sold in pharmacies by or under the
supervision of a pharmacist
POM – (prescription only medicine) Medicines only obtained on a prescription through a
pharmacy
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Restrictions on classes of drugs on PGD
Controlled drugs○ Some can be used – see later – but we do not
encourage it
Unlicensed medicines [unlicensed] ○ e.g. Mantoux test
Off-label drugs [unlicensed] ○ If in line with current clinical practice e.g. NICE PGD
must state product is outside licence and reasons for using.
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Restrictions on classes of drugs on PGD
Black Triangle drugs○ Can be used in exceptional circumstances
e.g. national guidelines. Yellow card reports for all side effects/adverse reactions
Antibiotics○ Can be used as long as measures to combat
resistance are not compromised. A microbiologist should be involved in the construction of the PGD
Appliances/dressings ○ Not licensed medicines
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Who can work under a PGD? Pharmacists Registered dietitians Registered midwives Registered health visitors Registered nurses Registered occupational therapists Registered ophthalmic opticians Registered orthotists and prosthetists Registered speech and language therapists Registered chiropodists Registered orthoptists Registered physiotherapists Registered radiographers Registered paramedics
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Which organisations can use PGDs?
Special Health Authorities NHS Trusts A GP or dental practice, (providing NHS services) Non-NHS organisation providing treatment made under an
arrangement with NHS trust/PCT Services funded by the NHS but provided by private,
voluntary or charitable sector Independent hospitals, agencies or clinics registered under
Care Standards Act 2000 Health care services provided by prison service Health care services provided by police service Health care services provided by armed forces
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What information must a PGD contain?
Clinical
Indication Inclusion criteria Exclusion criteria Cautions/ need for further
advice Action if patient declines or
is excluded Advice to patient/carer Follow up/referral
Drug Details Generic name, form and
strength of medicine Route or method of
administration Dosage Frequency Duration of treatment Maximum or minimum
treatment period Quantity to supply or
administer
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What information must a PGD contain?
Organisation The name of the organisation to
which the direction applies (e.g. CHP, CityCare)
The date the PGD comes into force and when it expires
Signatures:o Pharmacisto Doctoro Organisation (Governance)
Statement of the records to be kept for audit
Staff Characteristics Each PGD will specify the
professional group that is allowed to work under it
Qualifications Specialist competencies and or
qualifications Continuing training and
education The professional who is to work
with the PGD must sign the documentation before using the PGD
You should tell your indemnity insurer you are using PGDs
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Your responsibility
Accountable○ Required to answer for one’s conduct
Responsible ○ Dependable, trustworthy, morally accountable
Individuals using PGDs are accountable and responsible for their actions to:
○ The law○ The patient/public○ Their employer○ Their professional body
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To prescribe or to PGD?
Prescribers see a patient after assessment and diagnosis, the need for a medicine is established as part of the treatment plan. A prescription is issued and dispensed.
This is still the preferred route for patients to receive their medication and the only way to manage chronic disease.
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To prescribe or to PGD?
A PGD allows a range of healthcare
professionals to supply and/or administer to a
patient if they fit within an identified clinical
criteria given in the PGD.
The patient does not have to see a prescriber.
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Process for Production and Implementation
Identify a need for a PGD
Complete proposal form and submit to the HCW PGD Group
Once approved, the professional will devise and prepare PGD using the organisations template with assistance from a Pharmacist
Submit draft PGD to HCW PGD Group for approval and Medicines Management Group informed
Authorised for the organisation
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Process for Production and Implementation
Approved PGD signed, added to database, PDF’d and put on intranet. Author notified.
Training and Competency assessment initiated for relevant staff
Implement, monitor and audit.
Review every two years or sooner if there are any evidence based changes to clinical practice which affect the PGD
Medicines Management Group informed of any changes to PGD
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Frequently Asked Questions
Are PGDs appropriate for managing chronic disease? No.
If a patient falls out of the inclusion criteria, can professional judgement be used to supply or administer a medicine?
No. They must fall exactly into the criteria or be referred as per PGD guidelines.
How long is PGD documentation kept for? Adults is eight years, Children until they are 25 or for eight
years after their death.
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Frequently Asked Questions Should patients receive patient information leaflets with any medicine
supplied? Yes
Can controlled drugs be supplied under the PGD framework? Some can: All drugs in schedule 4 except anabolic steroids. Recent
changes authorise the supply of morphine and diamorphine by registered nurses and pharmacists under PGDs in any setting
Can unlicensed medication be used under the PGD framework? No. Unlicensed medicines cannot be used. However an unlicensed
indication of a licensed medicine can be used.
Are prescription charges payable? Yes, unless usual exemption
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THE CONSULTATION• Clinical and pharmaceutical knowledge• Establishing options• Communicating with patients
EFFECTIVE SUPPLY AND ADMINISTRATION WITHIN A PGD•Safe PGD use•Professional standards•Practice development
PGDs IN CONTEXT•Information in context•The NHS in context•The team and individual context
Competency Framework
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Intranet
All HP & NottsHealthcare NHS Trust PGDs are posted on the intranet
See Handout-
http://inottshc/sitefiles/data/getmaindata.asp?cat=Patient Group Directions (PGDs)&id=4400&desc=PGDs that have been approved for use within Nottinghamshire Healthcare Trust&department=Pharmacy - Forensic Division
If a service wants to start using them they must contact the Senior Medicines Management Advisor