PGD Presentation 2013 - Health Partnerships Learning
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Transcript PGD Presentation 2013 - Health Partnerships Learning
Patient Group Directions
Jane Swan
Senior Medicines Management Advisor
Nursing and Governance
Health Partnerships
Aims & Learning Outcomes
of the Session
Learning outcomes
Aims
Develop an
understanding of PGDs
Discuss how to use
PGDs safely
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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The Crown Report
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HSC 2000/026
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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 GSL
o P
o 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
Drug Details
Generic name, form and
Indication
strength of medicine
Inclusion criteria
Route or method of
Exclusion criteria
administration
Cautions/ need for further Dosage
advice
Frequency
Action if patient declines or Duration of treatment
is excluded
Maximum or minimum
Advice to patient/carer
treatment period
Quantity to supply or
Follow up/referral
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 Pharmacist
o Doctor
o 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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PGD Document and
Competency Framework
Available at:
http://www.npc.co.uk/
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Competency Framework
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
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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
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