PATIENT GROUP DIRECTION
draft
For the supply of Chloramphenicol eye ointment and eye drops
for the treatment of conjunctivitis
1.
2.
BUSINESS TO WHICH THE DIRECTION APPLIES:
1.1
Community Pharmacies in the former Peterborough Primary Care Trust Area
1.2
Issue date:
1.3
Review date: October 2016
October 2014
CLASS OF HEALTH PROFESSIONAL WHO MAY SUPPLY THE MEDICINE
2.1
Professional qualifications
Member of the GPhC
Practising community pharmacist
2.2
Specialist qualifications, training, experience and competence that
must be achieved relevant to the clinical conditions and medicines
used
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2.3
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.
Requirements for continued training or education for staff
Attendance on relevant study days and training session
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
Page 1 of 8
3.
CLINICAL CONDITION OR SITUATION TO WHICH THE PATIENT GROUP
DIRECTION APPLIES
3.1
Definition of the clinical condition/situation
Infective conjunctivitis
3.2
Clinical 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
3.3
Criteria for excluding a patient from Treatment under the Patient Group
Direction
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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
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
Page 2 of 8
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3.4
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
Description 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.
3.5
Action 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
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
Page 3 of 8
4.
DESCRIPTION OF THE MEDICINES TO WHICH THIS PATIENT GROUP
DIRECTION APPLIES
4.1
Medicines to be supplied
Name
Dose Range
Route of
Administration
Frequency of
administration
Maximum dose
Follow Up
treatment
Advice to
Patient/Carer
Chloramphenicol
0.5% eye drops 10ml bottle
1.0% eye ointment 4g tube
Drops
Instil one drop every two hours during waking hours for 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
Topical
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
Drops - 1 drop two hourly
Ointment - four times a day or once at night if in
conjunction with drops
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
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
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
Page 4 of 8
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
When to refer
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.
Refer patients who present for treatment but are excluded
by the patient group direction
Advice on
concurrent
medication
Do not use whilst using other eye drops or ointments
Legal Status
POM (Prescription Only Medicine)
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
Page 5 of 8
4.2
Facilities and supplies that must be available at sites
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4.3
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
Records to be kept for audit purposes
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4.4
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
Bibliography
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Brochlor Product Information Leaflet from www.medicines.org.uk
BNF 64 September 2012
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
Page 6 of 8
5.
AUTHORISATION
5.1
Names and signatures of multidisciplinary group which drew up the
patient group direction.
NAME
DESIGNATION/TITLE
Dr S Yogasundrum
GP Nene
Practice
Ms R Bali
Pharmacist
Signed by email 04.10.12
Sofina Taj
Pharmacist
Signed by email 27.09.12
5.2
Valley
Medical
SIGNATURE
Signed by email 09.10.12
Authorisation 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
5.3
Individuals working under this patient group direction
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In signing this I accept personal responsibility for working in accordance with this Patient
Group Direction
Pharmacy name
Address
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
Page 7 of 8
6.
THIS PGD IS TO BE READ, AGREED AND SIGNED BY ALL HEALTH CARE
PROFESSIONALS 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
Page 8 of 8