PATIENT GROUP DIRECTION

draft

For the supply of Chloramphenicol eye ointment and eye drops for the treatment of conjunctivitis

1.BUSINESS TO WHICH THE DIRECTION APPLIES:

1.1Community Pharmacies in the former Peterborough Primary Care Trust Area

1.2Issue date:October 2014

1.3Review date:October 2016

2.CLASS OF HEALTH PROFESSIONAL WHO MAY SUPPLY THE MEDICINE

2.1Professional qualifications

Member of the GPhC

Practising community pharmacist

2.2Specialist qualifications, training, experience and competence that must be achieved relevant to the clinical conditions and medicines used

  • Undertaken appropriate training to carry out clinical assessment of patient leading to determination of treatment according to the indications listed in the PGD.
  • Has undertaken appropriate training for working under patient group directions for the supply and administrations of medicines.
  • Has undertaken training appropriate to this PGD.

2.3 Requirements for continued training or education for staff

Attendance on relevant study days and training session

3.CLINICAL CONDITION OR SITUATION TO WHICH THE PATIENT GROUP DIRECTION APPLIES

3.1Definition of the clinical condition/situation

Infective conjunctivitis

3.2Clinical criteria under which a patient will be eligible for inclusion

Individuals aged over 6 months old presenting in the pharmacy with two or more of the following symptoms of conjunctivitis

  • Diffuse redness of the conjunctiva
  • Redness of the sclera
  • Presence of discharge that tends to be purulent in bacterial infection and watery in viral infection
  • Discharge may prevent the eye from opening, particularly in the morning (sticky eye)
  • Gritty feeling in the eyes
  • Slight disturbance of vision due to the presence of secretions
  • Mild itching

3.3Criteria for excluding a patient from Treatment under the Patient Group Direction

  • Infants under 6 months
  • Known allergy to chloramphenicol or any other

ingredient

  • Pregnant or breast feeding
  • Pain in the eye
  • Ocular or facial pain
  • Eye movement restricted
  • Photophobia
  • Blurring of vision not caused by secretions
  • Concurrent eye medication being used
  • Systemically unwell
  • Presence of pain 2 hours after removal of a foreign body
  • Treated with chloramphenicol for conjunctivitis on 2 other occasions in the past 3 months
  • Inflammation of the eye associated with a rash on

the scalp or face

  • The eye looks cloudy or the pupil appears unusual
  • The eye appears injured or there is suspicion of

contact with a foreign body

  • Those who have undergone eye surgery or laser

treatment in the past six months

  • Contact lens use

Patients who have experienced myelosupression during previous exposure to chlorampenicol

  • Patients who have a known personal or family history of blood

dyscrasias including aplastic anaemia

  • Patients who are concurrently on myelotoxic drugs
  • For children who are not Fraser competent whose

parents do not give consent for treatment

3.4Description of circumstances in which further advice should be sought from a doctor/dentist and arrangements for referral

Any patient who presents for treatment but is not eligible due to the criteria for exclusion should be referred to their own GP for further medical assessment or Accident and Emergency.

3.5Action for patients who do not wish to receive, or do not adhere to, care under the patient group direction

Document all advice given and refer patient to their GP

4.DESCRIPTION OF THE MEDICINES TO WHICH THIS PATIENT GROUP DIRECTION APPLIES

4.1Medicines to be supplied

Name / Chloramphenicol
0.5% eye drops10ml bottle
1.0% eye ointment 4g tube
Dose Range / Drops
Instil one drop every two hours during waking hoursfor two days and then reduce frequency as infection is controlled to one drop four times a day and continue for 48 hours after healing.
Ointment
Apply three to four times a day
Apply at night if drops are being used during the day
Route of
Administration / Topical
Frequency of administration / Drops – use every two hours reducing frequency as infection is controlled
Ointment – Use 3 – 4 times a day or at night if drops are used during the day
Maximum dose / Drops - 1 drop two hourly
Ointment - four times a day or once at night if in conjunction with drops
Follow Up treatment / Advise the patient to consult their GP if they see no sign of improvement in 2 days
If condition worsens, advise patient to stop chloramphenicol and visit their GP
Advice to Patient/Carer / The patient should be given full advice on how to administer the preparation.
Drops
  • Pull down the lower lid of the eye being treated
  • Instil one drop in the centre of the lower lid
  • Close eye for about one or two minutes
  • Compressing the lacrimal sac for a minute during and following instillation of the drops may reduce systemic absorption. This blocks the naso-lacrimal duct. This procedure is especially advisable in children
Ointment
  • Pull down the lower lid of the eye being treated.
  • Apply ointment by squeezing a thin line along half the inside margin of the eyelid
  • The ointment will melt and blinking will help spread it over the eye
Hygiene
  • The patient should also be advised on certain hygiene procedures.
  • Wash hands thoroughly with soap and water prior to and after touching the eye
  • Use a separate towel to other members of the household
  • If wiping the eye with a tissue, discard it carefully
Other
  • Do not wear contact lenses
  • Avoid wearing make-up
  • Keep drops in the fridge
  • Discard any unused medication carefully

Adverse outcomes / Transient blurring of vision may occur on instillation
The following reactions may be observed
Irritation
Burning
Stinging
Itching
Dermatitis
If a localised reaction occurs, the patient should stop using chloramphenicol and further medical advice should be sought promptly if needed. The pharmacist can recommend the use of antihistamines which may be purchased.
When to refer / Refer patients who present for treatment but are excluded by the patient group direction
Advice on concurrent medication / Do not use whilst using other eyedrops or ointments
Legal Status / POM (Prescription Only Medicine)

4.2Facilities and supplies that must be available at sites

  • Adequate supplies of chloramphenicol drops and ointment
  • Chloramphenicol eye drops should be stored in a fridge
  • Both the ointment and the drops when issued are to be labelled with the date of dispensing and the client’s name

4.3Records to be kept for audit purposes

  • A record of supply under PGD should be kept. The record can be made in the PMR, Prescription book or a copy of the assessment form completed by the pharmacist can be kept.
  • Prescription charges need to be collected in the usual manner and exempt patients will need to fill in a exemption declaration form
  • Record the details of the patient’s name, address and date of birth and GP practice on the assessment form and return to the Primary Care Trust for payment
  • Obtain patient consent to pass on this information to the GP practice

4.4Bibliography

  • Brochlor Product Information Leaflet from
  • BNF 64 September 2012

5.AUTHORISATION

5.1Names and signatures of multidisciplinary group which drew up the patient group direction.

NAME
/ DESIGNATION/TITLE / SIGNATURE
Dr S Yogasundrum / GP Nene Valley Medical Practice / Signed by email 09.10.12
Ms R Bali / Pharmacist / Signed by email 04.10.12
Sofina Taj / Pharmacist / Signed by email 27.09.12

5.2Authorisation of Cambridgeshire and Peterborough Clinical Commissioning Group, name and signature of GP Clinical Lead for Prescribing, Chief Pharmacist and Lead Nurse

NAME
/
SIGNATURE
Richard Spiers - GP Clinical lead for prescribing / Signed by email 07.10.2014
Sati Ubhi- Chief Pharmacist / Signed by email 07.10.2014
Jill Houghton - Director of Quality and Nursing / Signed by email 06.10.2014

5.3Individuals working under this patient group direction

Pharmacy name………………….

Address………………….

………………….

………………….

………………….

In signing this I accept personal responsibility for working in accordance with this Patient Group Direction

6.THIS PGD IS TO BE READ, AGREED AND SIGNED BY ALL HEALTH CAREPROFESSIONALS IT APPLIES TO:

The Pharmacist should retain a copy of the document after signing.

Pharmacy authorisation for supply of chloramphenicol eye drops and ointment for the treatment of conjunctivitis without a prescription for a named individual

I, …………………………….. Pharmacist give authorisation on behalf of the pharmacy for the named pharmacists who have signed this Patient Group Direction, to supply chloramphenicol drops or ointment for the treatment of conjunctivitis without a prescription under patient group direction

Signed …………………………Date …………………….

PHARMACY STAMP

Patient Group Direction: Chloramphenicol

Date of Policy:November 2002 Reviewed Oct 03, Oct 04,Oct 06, Oct 08, Oct 10, Oct 12, Oct 14

Review Date: Oct 2016

PGD No: 00056

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