patient group direction - South Western Ambulance Service Guidelines SWASFT staff/ECP_… · Nurse (Non-ECP) Emergency Care Practitioner ... Any patient with haematuria when ketamine

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p a t i e n t g r o u p d i r e c t i o nT R I M E T H O P R I M

TRIMETHOPRIM | v01 | 1/12

PGD Details

Version 1.0

Legal category POM

Staff grades

Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner (Nurse)

Approved by Medicines Management Group

Date issued 01/02/2013

Review date 30/01/2015

Clinical Publication Category

MandaTORy (REd) - No deviation from document permissible

Clinical Requirements

Competencies

❙ Successful completion of a competency assessment in the use of this medicine for the indications stated;

❙ Completion of education in both the legal and professional aspects of PGD administration and the supply of medicines;

❙ Registered paramedics must have successfully completed a recognised Emergency Care Practitioner course;

❙ Registered nurses must be employed as Nurse Practitioners or have successfully completed a recognised Emergency Care Practitioner course.

Continuing education

❙ The clinician is responsible for keeping him/herself aware of any changes to the recommendations for the medicine listed. It is the responsibility of the individual to keep up-to-date with continued professional development and to work within the limitations of their own individual scope of practice.

p a t i e n t g r o u p d i r e c t i o n



Clinical Situation

Clinical situation ❙ Acute lower urinary tract infection;

❙ Acute prostatitis.

Inclusion criteria

❙ Adults and children 6 months of age and over with acute lower urinary tract infection;

❙ Pregnant women in second and third trimester (off licence use);

❙ Men aged 16 years and over with acute prostatitis.




Exclusion criteria

❙ Hypersensitivity to sulphonamides, trimethoprim, co-trimoxazole (Septrin™);

❙ Children under 6 months with acute lower UTI;

❙ Boys under 16 years of age with acute prostatitis;

❙ Children with haematuria;

❙ Any patient with haematuria when ketamine abuse is known or suspected;

❙ Severe renal impairment (as trimethoprim accumulates and causes liver damage);

❙ Acute porphyria;

❙ Pregnancy in first trimester (requires co-administration of folic acid);

❙ Breast feeding;

❙ Women with vaginal discharge or itching (STD or candida infection);

❙ Known blood dyscrasia or folate deficiency;

❙ Marked liver damage;

❙ Fever and loin pain;

❙ Patient already taking prophylactic trimethoprim;

❙ Patient currently taking any of the following drugs: ▲ Phenytoin; ▲ Procainamide; ▲ Dapsone; ▲ Repaglinide; ▲ Lamivudine; ▲ Eplerenone; ▲ Pyrimethamine; ▲ Ciclosporin; ▲ Azathioprine; ▲ Mercaptopurine; ▲ Methotrexate; ▲ Digoxin.




Cautions

❙ Adult patients with macroscopic haematuria or haematuria confirmed on testing. All definite haematuria, whether macroscopic or microscopic, requires investigation to exclude serious underlying conditions, especially urinary tract neoplasm. The clinician must refer these patients to their own GP for further investigation;

❙ Patients taking anticoagulants with haematuria should be investigated. Anticoagulants are more likely to provoke, rather than be the cause of, haematuria;

❙ Patients experiencing frequent UTIs or catheterised patients may be treated if considered appropriate but must be advised to contact their GP;

❙ Elderly patients should be advised to maintain adequate urinary output as the drug is excreted primarily through the kidneys.

Side effects

❙ Nausea, vomiting, sore mouth;

❙ Photosensitivity and other allergic reactions including angioedema, anaphylaxis;

❙ Rarely aseptic meningitis and uveitis;

❙ Rarely more severe skin effects including Steven-Johnson syndrome and toxic epidermal necrolysis;

❙ Pruritus, rashes.

Action if excluded

❙ If patient meets exclusion criteria refer to medical practitioner;

❙ In acute urinary tract infections consider second line treatment (nitrofurantoin);

❙ Children under 6 months old with suspected UTI should be admitted;

❙ Short-term use of trimethoprim in pregnancy is unlikely to cause problems to the foetus but use in first trimester requires co-prescription of folic acid so patient must be referred to a GP;

❙ Record in patient clinical record the reason for exclusion and any action taken.




Action if patient declines

❙ If patient declines treatment or advice, ensure the patient clinical record details:

▲ The advice given by the clinician; ▲ Details of any referral made; ▲ The intended actions of the patient (including parent or guardian).




Description of Treatment

Generic name Trimethoprim.

Presentation ❙ Tablets 200mg;

❙ Suspension 50mg/5ml.

Route Oral.

Method Administration Supply

Dose

❙ Child 6 months to 6 years 50mg;

❙ Child 6 to 12 years 100mg;

❙ Adults and children aged 12 years and over 200mg.

Frequency Twice a day (every 12 hours).

Duration of treatment

❙ Urinary tract infection: ▲ 3 days women (7 days if pregnant); ▲ 7 days men; ▲ 7 days children.

❙ Prostatitis: 28 days

Quantity to supply

❙ 6 x 200mg tablets (women);

❙ 14 x 200mg tablets (men and pregnant women);

❙ 1 or 2 x 100ml suspension (children depending on dose);

❙ Prostatitis: 56 x 200mg tablets;

❙ Ensure that each pack of medicine supplied is labelled with the patient’s name, the date and the Trust’s contact details.




Follow Up

Referral arrangements and safety netting

❙ Referral to patient’s own GP for further assessment must always be arranged for patients with haematuria whether macroscopic or microscopic and children, pregnant women, and male patients with UTI;

❙ Take MSU sample before treatment and send for microscopy (for use in case of treatment failure) in men, pregnant women and children;

❙ Ensure that there is a communication to the patient’s registered GP to inform him/her about the consultation, the outcomes of that consultation and any treatment given using local mechanisms. This information must also be available to other healthcare professionals who may be required to administer care to the patient following the consultation;

❙ Patients should be told to seek further medical advice if they become generally unwell, they suffer new symptoms, if there is no improvement within 48hrs or if there is a deterioration in their condition.

Advice to patients

❙ If rash or other signs of hypersensitivity occur, stop taking the medicine and contact your doctor for advice;

❙ Complete the course even if feeling better;

❙ Seek medical attention if symptoms persist or if their condition deteriorates;

❙ Paracetamol may be used to relieve pain/discomfort;

❙ 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 and vomiting occur. N.B. Rifampicin does induce liver enzymes.

Urinary Tract Infection

❙ If condition becomes a recurring problem, consult your GP;

❙ Consideration of sexual history may indicate investigation for STD. Advise attendance at GUM clinic if appropriate.

Records ❙ Complete patient clinical record.




References

❙ British National Formulary 64, September 2012 (BNF);

❙ Clinical Knowledge Summaries http://www.cks.library.nhs.uk;

❙ Scottish Intercollegiate Guideline Network (SIGN) July 2006. SIGN 88: Management of suspected bacterial urinary tract infection in adults. Accessed at http://www.sign.ac.uk/pdf/sign88.pdf;

❙ Health Protection Agency’s guidance for primary care prescribing http://hqwebxwcas-tr.swest.nhs.uk/SWAST/clinical/pgd/HPAmanagementofinfectionguidanceforprimarycare.pdf.




Authorisation

Chief Executive Officer

Name Ken Wenman

Signature Date 01/02/2013

MedicalDirector

Name Dr Andy Smith


Pharmaceutical Advisor

Name Sue Oakley


❙ This patient group direction must be signed by the Chief Executive Officer, Medical Director and Pharmaceutical Advisor to be legally valid.




Individual Authorisation (Staff Copy)

Individual

Name

Signature Date / /

Authorising officer

Name

Signature Date / /

❙ I have read and understood the Patient Group Direction and agree to supply this medicine only in accordance with this document.

❙ PGDs 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.

❙ This signed page must be retained by the member of staff, together with the full PGD, which must be available in clinical practice.




Individual Authorisation (Trust Copy)

Individual

Name

Signature Date / /

Authorising officer

Name

Signature Date / /

❙ I have read and understood the Patient Group Direction and agree to supply this medicine only in accordance with this document.

❙ PGDs 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.

❙ This signed page must be retained by the member of staff, together with the full PGD, which must be available in clinical practice.

Documents

patient group direction - South Western Ambulance Service Guidelines SWASFT staff/ECP_… · Nurse (Non-ECP) Emergency Care Practitioner ... Any patient with haematuria when ketamine