EK039



Written by:Laraine ClarkSigned by:Senior Clinician:Senior Clinician NamePharmacist:Pharmacist NameNHS Authorising Body:see page 10 Date of Issue:28/11/2018Review Date:28/11/2021DOCUMENT HISTORYVersionAuthorDateMain Changes/CommentsNext Action Required1.0Laraine Clark18/05/2017Based on Feb 2014 version 1.5 (Kym Lowder)External reviewer1.1Laraine Clark 09/11/2017Added indication acute sinusitis. Change to use FeverPAIN score in acute sore throatExternal reviewer1.2Laraine Clark 18/11/2017Minor changes(rhinosinusitis, description of FeverPAIN)1.3Laraine Clark10/01/2018Minor change to wording on sidebar to dose section1.4Laraine Clark17/10/2018Addition of advice under ‘Cautions’ for patients taking MethotrexateDateINSTRUCTIONSStepDetails1Replace all the green text in this document with organisation specific data & dates as shown.2Read all of the draft content for the specified medication details. These have been provided based on previous PGD documentation (version shown above where available) and are there to assist the provider organisation. They should be confirmed and amended as required.3NHS Authorising Body. Check page and amend above as required.YOU MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO ITClinical ConditionIndicationTreatment of acute sore throat in line with locally adapted Public Health England guidance. Use Fever PAIN score to determine whether immediate antibiotic indicated. Treatment of acute rhinosinusitis in line with PHE and NICE guidance (July 2017), where immediate antibiotic indicated Inclusion CriteriaAcute sore throat : Children from 2 years of age and adults Only patients within the criteria determined by the FeverPAIN scoreFever?in last 24 hours;Purulence;Attend rapidly under three days;severely?Inflamed tonsils;No?cough or coryza.?Acute rhinosinusitis : Adults and children over 12y.Exclusion CriteriaExclusion criteria here:Patients who are penicillin allergic ( see Clarithromycin PGD)Acute sore throat : Children less than 2 years oldPatients who are otherwise well other than a red/sore throatKnown severe renal impairment: CrCl <30ml/min Child who is drooling, cannot swallow or with stridor Presence of a quinsyAcute rhinosinusitis Children under 12yWhere there are suspected complications eg sepsis, intraorbital or intracranial – refer to hospital Cautions / Need for Further AdviceRefer to medical practitioner patients who are immune- compromised and have active infectionPatients taking Methotrexate should be advised to withhold their next dose (or doses, and folic acid if prescribed) until this course of antibiotic is finished, and they are infection free. They can then restart Methotrexate treatment on their usual day of the weekPatients taking warfarin should be advised to have an INR test 2days after starting the medicineCheck with patient if taking any current medicines which could give rise to a drug-drug interaction Consult the current BNF and/or SPC for full detailsAction if Patient is Excluded Document advice given and decision reached. Refer to A&E or medical practitionerAction if Patient Declines Treatment Seek medical advice Document advice given and decision reachedDrug DetailsName, form and strength of DrugPhenoxymethylpenicillin tablets 250mgPhenoxymethylpenicillin oral liquid 125mg/5ml and 250mg/5mlLegal StatusPOMIs product a black triangle drug NoIs product being used outside terms of license NoRoute / MethodORALDosagePlease note-although a range of doses are provided here, practitioners should ONLY supply for children within the age range specified for their contracted service AND within the bounds of their professional competenciesBNF/SPC Acute Sore Throat Children aged from 2 to 5 years: 125mg Children aged from 6 to 12 years: 250mgAdults and children over 12 years: 500mg Acute rhinosinusitisAdults and children over 12 years: 500mg FrequencyFour times a dayDuration of TreatmentAcute sore throat – children : 10 days – remains PHE advice, lower relapse rate in under 18’s Acute rhinosinusitis : 5days Maximum or Minimum Treatment PeriodAs aboveQuantity to Supply / AdministerChildren: 1 x 100ml liquid (Plus the remainder of course(i.e. a further 1x100ml) to be supplied as dry powder with instructions given on how to make up or 1 x 28 tabletsAdults: 2 x 28 tablets or if liquid required issue one bottle and complete course with tabletsSide Effectsdiarrhoea and nausea urticaria, rashfever, joint painsangiodemaThis list may not represent all reported side effects of this medicine. Refer to the most current BNF and/or SPC for more information. Special Considerations and Additional InformationThis PGD is only for use when providing NHS treatment to patients in primary care settings by Organisation Name staffUnder a PGD medication can only be supplied when:the Healthcare Professional (HCP) has had a face to face consultation with the patientthe HCP administers or supplies directly to the patient. Supply via a third party is not permitted] Reporting procedure of Adverse ReactionsAll adverse reactions (actual and suspected) will be reported to the Patients own GP Where appropriate, a Yellow Card Report will be sent to the Commission on Human Medicines.? A supply of these forms can be found at the rear of the BNF. Alternatively, a report can be submitted electronically via using the yellow card system always remains the responsibility of the healthcare professional who supplies and/or administers a medication.Additional Facilities and SuppliesLockable storage cupboard Product information leafletCurrent BNF or access to Access to working telephoneSuitable waste disposal facilitiesPatient education leafletsAnaphylaxis kitSuitable refrigeration facilities where items require storage between +2° - +8° Celsius.Public Health England Infection guidance see Faculty of Sexual and Reproductive Healthcare (January 2017) to Patient The patient/carer should be given the following information verbally and in writing if appropriate and available.Please read the Patient Information Leaflet provided with the product Doses should be taken half to one hour before food or on an empty stomach, and evenly spread throughout the dayComplete the courseIf a rash develops stop treatment and consult a GPReconstituted liquid should be stored in a fridge and any unused liquid discarded after 7 days.Pregnancy and breastfeeding – not known to be harmfulWomen taking Oral Contraceptives Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur. These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. Phenoxymethylpenicillin is not a liver enzyme inducerFollow UpAdvise patient to seek further medical advice if symptoms fail to improve or worsen.Error ReportingAs per the Organisation Name incident reporting policy.Staff CharacteristicsQualificationsIs a:Registered Nurse (Nursing and Midwifery Council: NMC)Pharmacist (General Pharmaceutical Council).Paramedic (UK Health & Care Professions Council: HCPC) with a current professional registration.Other (to be agreed).Specialist Competencies or QualificationsThe registered HCP must complete the declaration on the PGD section for each commissioned service in which they are delivering services under this PGDThe registered HCP must hold a full Nurse Practitioner degree,ORhave passed the following modules from the nurse practitioner degree: Minor Illness management, Consultation and Clinical Examination.ORhave passed the following paramedic practitioner modules: Clinical Reasoning in Physical Assessment (CRIPA), Management of Minor Health Problems and Drugs and Therapeutics.ORhave relevant and documented clinical experience in an appropriate healthcare role and qualifications equivalent to those already cited.The HCP must fulfil the competency framework as reviewed annually.The registered HCP must have completed their annual Resuscitation training (Basic Life Support) within the last 18 months. The registered HCP is willing to be professionally accountable for this work as defined in their Code of Professional Conduct and Ethics.Continuing Training & EducationThe registered HCP should be aware of any change to the recommendations for the medicine listed. It is the responsibility of the individual to keep up-to-date with continued professional development (CPD) in line with post registration and practice (PREP/CPD) and to work within the limitations of individual scope of practice.The registered healthcare professional should be aware of local benchmarking policies regarding the stewardship of the medication that is the subject of this PGD.Referral Arrangements and Audit TrailReferral ArrangementsAs per local arrangementsRecords / Audit TrailIn all cases records must be made in electronic/paper clinical record and should include:Patient’s name and date of birth That the medication has been given by the healthcare professional under PGDBrand, batch number and expiry date of medication Date and time givenSignature and printed name of staff who administered or supplied the medicationThe diagnosis as per inclusion criteriaDetails of any adverse drug reaction and actions taken including documentation in the patient’s clinical record Advice given to patient (including side effects)Referral arrangements (including self-care)Each pack of medication to be labelled with patient’s name and date of supply (only where supply permitted under PGD)Guidance/References/ Resources and CommentsBNF/cBNF onlineSummary Product Characteristics (SPC): Generic or brand nameAccessed on:Date of last text revision of SPCPenicillin VK tablets (Sandoz)18.8.1722.2.17Phenoxymethylpenicillin 125mg/5ml oral solution (Kent Pharmaceuticals)18.8.1721.3.16NMC (2007) Standards for Medicines ManagementNMC (2015) The CodeStandards of Proficiency-Paramedics Health Professions Council Sept 2014Standards of Conduct, Performance and Ethics Health and Care Professions Council January 2016PHE Summary tables 2017 Clinical Guideline 69:Respiratory tract infections – antibiotic prescribing July 2008NICE MPG 02 Patient Group Directions August 2013.This PGD must be agreed to and signed by all registered healthcare professionals involved in its use. Organisation Name (Main office) will hold the original signed copy. The PGD must be easily accessible in the clinical anisationOrganisation NameAuthorisationNHS Authorising Body Signature Name:Sarah VauxPosition:Chief Nurse for East Kent CCGsSignature:Date: Name:Position:Signature:In the event that the above is not available then deputy to sign:Dr. Simon Lundy Clinical Lead Deputising for Clinical Chair Canterbury and Coastal CCG Date: Organisation NameSignatoriesSignature:SENIOR CLINICIANName:Click here to enter text.Position:Signature:Date: PHARMACISTName:Click here to enter text.Position: Signature:Date: Patient Group Direction Reviewed byNamePositionOrganisationDr Richard Brice GP Prescribing Lead Whitstable Minor Injuries ServiceDr Daniel MooreGP Prescribing LeadFaversham Medical PracticeDr Jeremy CarterGP Prescribing LeadPark Medical Practice (Herne Bay ICCU)Kathy EllisLead Nurse/Advanced Nurse PractitionerWhitstable Medical PracticeHeidi EdmundsLead Emergency Nurse PractitionerWhitstable Medical PracticeSheila Brown Head of Medicines ManagementCanterbury & Coastal CCGLaraine Clark Pharmacist Reviewed at PGD Virtual Review Meeting on: 16/08/2018Responsibilities of the Contracted Service Provider (e.g. General Practice, Community Pharmacy), Their Lead Or Their Nominated Deputy The contracted service provider, their lead or their nominated deputy will be responsible for ensuring that:PGDs are implemented within a robust clinical governance structure The most recent, in date version of all PGDs are implemented and in use in all relevant areasAny expired or abandoned PGDs are removed from practice and the date of change recorded in case of any litigation following an incidentThe CCG is informed of any changes to services that may affect how the PGD is used in practice e.g. increased cohort of non-medical prescribers/change in demographics.There is a process in place to train registered healthcare professionals who will work under the PGDs, relating to both the clinical management and legal aspects of the PGD and the service.There is a process in place whereby registered healthcare professionals are deemed competent and given individual authorisation to practice under the PGDs. The record of authorisation (see overleaf) has been signed by both the registered Healthcare Professional and the Contracted Service Provider or their nominated deputy.The original signed copy of the record of authorisation is retained by the Contracted Service Provider.The registered Healthcare Professional is provided with a copy of the signed record of authorisation as their record to supply medication under this PGD for this provider. All authorised registered Healthcare Professionals are supplied with an up to date hard copy of this PGD if requested.There is a mechanism in place to authorise, record and maintain a list of those registered healthcare professionals approved under the PGD and this record is available to the CCG on request. Any incidents, near misses, or errors are reported via the NPSA system at which is applicable to a GP practice or Out of Hours setting.PGDs are audited annually and the results of audits are available to the CCG.PGDs for antimicrobials are audited annually in line with the CCG’s recommendations to practices and the results of audits are submitted to the Antibiotic Stewardship Group.Multiple practitioner authorisation sheetPGD: EK039Phenoxymethylpenicillin v.4Expiry: November 2021PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY.It is the responsibility of each professional to practice only within the bounds of their own competence and in accordance with their own Code of Professional Conduct.Practitioner’ declarationI confirm that I have read and understood the content of this PGD and that I am willing and competent to work under it within my professional code of conduct.I confirm that I will only supply for children within the age range specified for the contracted service AND within the bounds of my professional anisation Name is contracted to provide a service for children aged xx months and over.By signing this patient group direction you are indication that you agree to its contents and that you will work within it. I confirm that I have read and understood the content of this Patient Group Direction and that I am willing and competent to work to it within my professional code of conduct.NameDesignationSignatureDateAuthorising ManagerI confirm I have read and understood the responsibilities of Organisation Name . I confirm that the practitioners named above have declared themselves suitably trained and competent to work under this PGD. I give authorisation on behalf of Organisation Name for the above named health care professionals who have signed the PGD to work under it.NameDesignationSignatureDateNote to Authorising ManagerScore through unused rows in the list of practitioners to prevent additions post managerial authorisation and use a further sheet for any additional staff. This authorisation sheet should be retained to serve as a record of the practitioners authorised to work under this PGD. ................
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