Pharmacy First Protocol
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PHARMACY FIRST Service Specification Version 15 January 2009 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Index Acknowledgements ........................................................................ 3 1. Introduction ................................................................................. 4 2. Duties of participating Community Pharmacists ........................ 4 3. Service Funding and Payment Mechanism ............................... 6 4. Responsibilities of the GP Practice ........................................... 6 5. Responsibilities of Nottingham City Primary Care Trust ............ 6 6. Role of the Specialist Senior Pharmacy Technician .................. 7 7. Monitoring and Evaluation ......................................................... 7 8. The Process – Flow Chart ........................................................ 9 Appendix 1) 2) 3) 4) 5) 6) Nottingham City GP Practices ................................... 10 Participating Pharmacies .......................................... 19 Minor Ailments .......................................................... 23 CPPE Distance Learning Pack – Minor Ailments ...... 24 Formulary .................................................................. 25 Protocols ................................................................... Athletes foot .............................................. 26 Diarrhoea .................................................. 28 Haemorrhoids ........................................... 30 Threadworm ............................................. 32 Vaginal Thrush ......................................... 34 Head lice ................................................... 36 Temperature ............................................. 38 Sore Throat ............................................... 39 Earache..................................................... 40 Teething .................................................... 41 Toothache ................................................. 42 Bacterial Conjunctivitis…………………… 43 Constipation………………………………….45 Insect bites and stings………………………46 Warts and Verrucas…………………………48 Cystitis/simple UTI………………………… 49 Cystitis/simple UTI PGD………………….…52 Hayfever………………………………………59 7) Comment Form ......................................................... 63 8) Contact details .......................................................... 64 2 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Acknowledgements The Pharmacy First Steering Group: Samantha Travis – Senior Pharmacist – Clinical Governance Lead Tania Cook – Technician Team Manager-Medicines Management Specialist Trevor Mills – GP Prescribing Lead & Clinical Lead Clinical Governance Gordon Ross – Community Pharmacist Project Manager Mindy Bassi – Head of Medicines Management (Joint) Jonathan Bemrose – Assistant Director of Finance Andy Roylance – Commissioning Officer Dayaram Mistry – Pharmacist Rachael Newman – Practice Manager Sam Aderson – Prescribing Data Analyst With support and advice from: Fiona Schofield – Practice Nurse Dara Coppel – Evaluation and Learning Manager 3 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme SERVICE SPECIFICATION 1. Introduction 1.1. This service is available to all patients registered with Nottingham City Primary Care Trust surgeries, which are identified in Appendix 1. Patients are at liberty to refuse this service. 1.2. The service is only available for the minor ailments identified in Appendix 3. 1.3. All patients wishing to use the Pharmacy First services must first complete a voucher booklet to provide the names and dates of birth of eligible members of the household, and provide the name of their GP practice. 1.4. Only Community Pharmacies who are committed to making staff available to provide the service and who have received the necessary training in the implementation of the scheme will be included in the service. (Appendix 4.) 1.5. Only Community Pharmacists who complete within six months of the start date of the scheme, or have already completed Manchester University’s CPPE distance learning pack on minor ailments will be considered to conduct patient consultations under the Pharmacy First scheme. Confirmation of successful completion should be provided to the PCT. (Appendix 4). 1.6. Pharmacies should be aware of the requirements for training in minor ailments required by the Pharmacy First scheme when recruiting locum staff to work in the pharmacy. 2. Duties of participating Community Pharmacists 2.1. Any patient registered with a Nottingham City PCT practice may be accepted into the scheme by the Pharmacist. The patient does not have to produce evidence of registration to access the Pharmacy First scheme services. 2.2. All patients who wish to join the Pharmacy First scheme will complete a voucher booklet, and provide the details of name, address, postcode, date of birth, and the name of the GP surgery where they are registered. 2.3. All participating Pharmacists will provide a professional consultation service for patients requesting access to the Pharmacy First scheme, presenting with one of the specified conditions. (Appendix 3.) 2.4. The Pharmacist will assess the patient’s condition. The consultation will consist of: Patient assessment by Pharmacist Provision of advice as laid out in the protocol for the appropriate minor ailment 4 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Provision of medication, only if necessary, from the agreed formulary appropriate to the patient’s condition. If the Pharmacist considers it necessary following the consultation then referral of the patient to their GP practice for an appointment with an appropriate healthcare professional, including the provision of a ‘Referral to surgery’ form detailing the reasons for the referral. The Pharmacist will complete a consultation form within the voucher booklet for each patient a copy of which will be retained in the pharmacy. The Pharmacist will, at the end of each calendar month, send the top copy of each voucher booklet consultation form to the Medicines Management Administrator at Standard Court for payment, attached to the Summary Sheet and Fee Claim form. Any spoilt or cancelled forms should also be attached and returned to the PCT to ensure continuity of numbering. The Pharmacist will be paid for each consultation undertaken whether medicines are supplied or not, with the exception of those consultations which result in an over the counter sale to patients who normally pay for their prescriptions. The Pharmacist should ensure that evidence of exemption from prescription charges is provided before medicines are provided to the patient without charge. In the event of the consultation under this scheme not leading to the supply of a product, the Pharmacist should indicate this on the consultation form . 2.5. Normal rules of patient confidentiality apply. 2.6. The Pharmacist should ensure that the patient has completed and signed the declaration of exemption of prescription charge on the back of the consultation form within the voucher booklet. 2.7. If, in the opinion of the Pharmacist, the patient presents with symptoms outside the scheme, they should be referred to their GP. 2.8. If a patient presents more than twice within any month with the same symptoms, the patient should be referred to their surgery. The referral form should be completed and given to the patient to take to the surgery. 2.9. If a fee-paying patient requires onward referral to the surgery following an over the counter consultation then the Pharmacist should ensure that all Pharmacy First documentation is completed for that patient so that a consultation fee may be claimed. 5 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme 2.10.If the patient presents with symptoms which are outside the Scheme, they should be advised to refer back to their GP (within surgery hours), or to contact the on-call doctor, or to attend the Walk in Centre. (As appropriate, outside surgery hours). 2.11.The parents, carers, or guardians of children supplied with Paracetamol will be supplied with an ‘Alert Card’ which contains advice on further action should the child’s condition not improve, deteriorate, or if the parents have continuing concerns. 2.12.If the Pharmacist suspects that the patient and/or parent is abusing the Pharmacy First Scheme, they should alert the Specialist senior pharmacy technician. 3. Service Funding and Payment Mechanism The Pharmacy will be paid according to the following schedule: Fee: Drug Costs: £2.60 (per consultation) (reviewed annually) Consultation for Cystitis/simple UTI will be £5.20 (2 consultation fees) Over-the-counter Packs only to be supplied at cost price. Headlice combs will be supplied free of charge by the Nottingham City Primary Care Trust. All records of pharmacy consultation forms should be forwarded to the Technician Team Manager-Medicines Management Specialist at Standard Court at the end of each calendar month, securely attached to the summary and fee claim Form. The vouchers are the basis on which consultation fees are paid, and all forms including any which are spoilt, damaged or cancelled should be returned so that the numerical sequence is complete. 4. Responsibilities of the GP Practice The patients GP practice will make an appropriate response to any patient provided with a ‘referral to surgery’ form by the Pharmacist. 5. Responsibilities of the Nottingham City Primary Care Trust Nottingham City Primary Care Trust shall be responsible for: Providing all stationery associated with the Pharmacy First process Providing, free of charge, headlice combs for issue under the Pharmacy First scheme. Paying a fee of £2.60per consultation to the Pharmacist for all consultations (cystitis/simple UTI = £5.20) carried out under the Pharmacy First scheme with the exception of those over the counter consultations which result in the sale of medicines to patients who are not exempt from prescription charges, and who shall pay in full for the medicines supplied. Providing training and support in the processes associated with the administration of the Pharmacy First scheme. 6 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Providing continuing support to pharmacies in all aspects of the service throughout the life of the scheme. Periodic review of the processes involved with the Pharmacy First Scheme Annual review of the consultation payment (£2.60 at April 2009), in line with the terms and conditions set out in the Service Level Agreement. 6. Role of the Technician Team Manager-Medicines Management Specialist Overall responsibility for co-coordinating and managing the project - Managerial leadership Processing forms for payments Payment of fees due Data entry Coordinating and evaluation Production of regular reports Maintaining contact with the participating pharmacies. Providing initial training in the processes involved with the administration of the scheme. Providing ongoing support in all aspects of the processes of the Pharmacy First scheme to all participating stakeholders. 7. Monitoring and Evaluation The scheme shall be evaluated periodically e-pact data allowing, in terms of: - Prescribing data – GPs Number of items Total quantities and quantities PPU Total costs and cost PPU An on-going comparison will be made between these parameters for the period the scheme is operating and with the similar period for the previous year. - Prescribing data – Pharmacy service – from Pharmacist Prescriptions Number of items Quantities Costs Indications/Actions taken These will be evaluated on an individual Pharmacy basis and in terms of an overall service. - Qualitative survey of: GPs Receptionists Pharmacists Patients 7 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Quantitive survey of: Measurement of patient activity at participating Community Pharmacies Measurement of repeat patient activity at participating Community Pharmacies - Measurement of activity at Community Pharmacies - Measurement of count of prescriptions issued - Measurement of activity by postcode - 8 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme The Process Init Patient presents at Pharmacy asking for advice on health issue YES Is the patient exempt from prescription charges? NO Pharmacist discusses health problem with patient and decides on: Pharmacy staff registers the patient onto the Pharmacy First scheme If patient requires referral Over the Counter sale of medicines Pharmacist discusses health problem with patient and decides on: Pharmacist offers advice – no medication Pharmacist offers advice and supplies appropriate medicine from agreed formulary Pharmacist refers the patient to the surgery for appointment with appropriate health professional Referral to Emergency Services Pharmacy provides patient with a referral to practice form 9. Process and Administration Procedures. 9 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Appendix 1 Practice Name Bulwell Health Centre St Marys Medical Centre Hucknall Road Medical Centre The Medical Centre Zulu Rd Bestwood Park Health Centre Alice Medical Centre (Branch Surgery) Sherwood Health Centre Bulwell Health Centre Nottingham City PCT GP Practices GP’s Address Dr AD Adams Bulwell Health Centre Dr SM York Main Street Dr A Deolkar Bulwell Nottingham NG6 8QJ Dr S Arya St Mary’s Medical Dr T Arya Centre Old Farm Road Top Valley Nottingham NG5 9AJ Dr A McLachlan Hucknall Road Medical Dr MA Butler Centre Dr M Crowe Off Kibworth Close Dr AC Bloor Nottingham Dr AE Gilbert NG5 1NA Dr G Bajek Dr E Gladman Dr L Glasgow Dr S Balendran The Medical Centre 2a Zulu Road Basford Nottingham NG7 7DS Dr KR Bhajantri Bestwood Park Health Centre Pedmore Valley Bestwood Park Nottingham NG5 5NZ Dr KR Bhajantri Alice Medical Centre 1 Carnwood Road Bestwood Estate Nottingham NG5 5HN Dr DG Black Sherwood Health Centre Dr IM Trimble Elmswood Gardens Dr J Milburn Sherwood Dr PJ Dexter Nottingham Dr RL King NG5 4AD Dr AI Malik Dr E Clark Dr U Carolan Leenview Surgery Dr GS Ripley Bulwell Health Centre Dr HS Pabla Main Street Dr MI Ripley Bulwell 10 Contact Numbers Tel: 0115-9279119 Fax: 01159130692 Tel: 0115-9276038 Fax: 0115-9653972 Tel: 0115-9606652 Fax: 0115-9691746 Tel: 0115-9792255 Fax: 0115-9701705 Tel: 0115-9208597 Fax: 0115-9671910 Tel: 0115-962787 Fax: 01159691123 Tel: 0115-9607127 + 0115-9624516 Fax:0115-9857899 Tel: 0115-9771181 Fax: 0115-9771377 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme The Dale Surgery Dr PS Chahal Dr S Abbas Dr L Steiner Strelley Health Centre Dr J Cockrill Dr MK Dal The Surgery Queens Bower Road Dr B Collinson Dr T Arya Melbourne Park Medical Centre Dr SA Cox Dr AS Russell Dr RL Davies Dr D Ridley Dr F Khalid Sherrington Park Medical Centre Dr AP Flewitt Dr M Vindla Wollaton Vale Health Centre Dr K Ghaharian Sunrise Medical Practice Dr AS Ghattaora Dr RS Ghattaora Sunrise Medical Practice (Branch Surgery) Dr AS Ghattaora Dr RS Ghattaora Clifton Medical Practice Dr ED Gregson Dr PN Parken Dr HD Taylor Dr LJ Beale Dr JH Poon Nottingham NG6 8QJ The Dale Surgery 67 Sneinton Dale Sneinton Nottingham NG2 4LG Strelley Health Centre 116 Strelley Road Nottingham NG8 6LN The Surgery 201 Queens Bower Road Bestwood Park Nottingham NG5 5RB Melbourne Park Medical Centre Melbourne Park Aspley Nottingham NG8 5HL Sherrington Park Medical Centre 402 Mansfield Road Nottingham NG5 2EJ Wollaton Vale Health Centre Wollaton Vale Nottingham NG8 2GR Radford Health Centre Ilkeston Road Radford Nottingham NG7 3GW Nottingham Trent University Clifton Campus Clifton Lane Nottingham NG11 8NS Clifton Medical Practice Clifton Cornerstone Southchurch Drive Clifton Nottingham 11 Tel: 0115-9110254 Tel: 0115-9299219 Fax: 0115-9296522 Tel: 0115-9208615 Fax: 0115-9666073 Tel: 0115-9787070 Fax: 0115-9249334 Tel: 0115-9858552 Fax::0115-9858553 Tel: 0115-9281842 Fax:0115-9280590 Tel: 0115-9196662 Fax: Tel: As above Fax: Tel: 0115-9211288 Fax: 0115-9844047 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Dr A Walton NG11 8EW Beechdale Road Dr MD Hage Dr MA Bicknell Tel: 0115-9290754 Fax: 0115-9296843 Churchfields Medical Practice Dr DJ Harrison Dr L Hall Dr TA Mills Dr KA Roy Dr R Ibrahim Dr L Cookson Dr M Crowe Dr T Atiomo Dr S Hazarika 439 Beechdale Road Aspley Nottingham NG8 3LF Old Basford Health Centre 1 Bailey Street Old Basford Nottingham NG6 OHB Wilford Grove Surgery 55 Wilford Grove Meadows Nottingham NG2 2DR Tel: 0115-9528200 Fax: 0115-9529248 Tudor House Medical Practice 138 Edwards Lane Sherwood Nottingham NG5 3HU Victoria Health Centre Perth Street Off Glasshouse Street Nottingham NG1 3LW Derby Road Health Centre 336 Derby Road Nottinghan NG7 2DW Tel: 0115-9661233 Fax: 0115-9620792 The Forest Practice Mary Potter Health Centre Gregory Boulevard Nottingham NG7 5HY Tel: 0115-9420330 Fax: 0115-9792765 Wilford Grove Surgery Tudor House Medical Practice Dr RIF Henry Dr JK Henry Victoria Health Centre Dr M Hepden Dr GM Leuty Dr TP Connery Dr J Shaw Dr H Mawji Dr PW Horsfield Dr J Maskery Dr KK Morar Dr SA Jones Dr TD Daniel Dr KL Hambleton Dr JE Jones Dr G Srinivasan Dr HF Parken Dr SJ Taylor Dr S Bedi Dr M Mistry Dr WB Tan Derby Road Health Centre The Forest Practice 12 Tel: 01159-781231 Fax: 01159-790419 Tel: 0115-9483030 Fax: 0115-9111074 Tel:08444-773096 Fax: 08444772533 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme The Forest Practice Trentham Gardens (Branch Surgery) St Ann’s Health Centre Dr HF Parken Dr SJ Taylor Dr S Bedi Dr M Mistry The Forest Practice 6 Trentham Gardens Aspley Nottingham NG8 3NF St Ann’s Health Centre St Ann’s Well Road St Ann’s Nottingham NG3 3PX Tel: 0115-9299280 Western Boulevard Dr MK Kachroo 635 Western Boulevard Nottingham NG8 5GS Tel: 0115-9786557 Fax: 0115-9788314 Limetree Surgery Dr S Karim Dr R Karim Tel: 0115-9791281 Fax: 0115-9792864 Radford Health Centre Dr K Kaur Dr RE Lonsdale Dr FO Liau Limetree Surgery 1 Limetree Avenue Cinderhill Nottingham NG8 6AB Radford Health Centre Ilkeston Road Radford Nottingham NG7 3GW Student Health Dr K Kaur Centre Dr RE Lonsdale Nottingham Trent Dr FO Liau University (Branch Surgery) Nottingham Trent University Student Health Centre Shakespeare Street Nottingham NG1 4FW Tel: 01158-486481 Bilborough Medical Centre Dr A Khalique Dr RJ Williams Tel: 0115-9292354 Fax: 0115-9291656 Assarts Farm Medical Centre (Branch Surgery Bilborough Medical Centre) Dr A Khalique Dr RJ Williams Bilborough Medical Centre Bracebridge Drive Bilborough Nottingham NG8 4PH Assarts Farm Medical Centre Upminster Drive Nuthall Nottingham NG8 4PN Mary Potter Health Centre Dr Z Khan Dr V Silgram Mary Potter Health Centre Tel: 0115-9423216 Fax: 0115-9704640 Dr P Ibrahim 13 Tel: 0115-9501883 Tel: 0115-9792691 Fax:0115-9422672 Tel: Fax: As above NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme St Luke’s Surgery Dr SJ Kingdom Dr K Worth Dr S Amin Meadows Health Centre Dr JR Larner Dr NS Jadoon Rivergreen Medical Centre Dr HA Lewis Dr C Lewis Dr S McGibbon Dr EF Hampson Dr M Arora Lenton Medical Centre Dr D Maini Dr S Bashir Dr E Alawale Greenwood & Sneinton Family Medical Centre Dr GDR Martin Dr SO Fradd Dr ME Smith Dr S Layzell Dr J Taplin Oakdale Road Dr BS Mehat Dr K Kamalanathan Wollaton Vale Health Centre Dr JR Merry Dr S Raybould Dr GMD Rose Dr S Vogelzang Dr W Tao Chilvers McCrea partnership Nirmala Medical Centre John Ryle Medical Practice Dr P Lavelle Dr SP Riley Dr HS Ko Gregory Boulevard Hyson Green Nottingham NG7 5HY St Luke’s Surgery Radford Health Centre Ilkeston Road Nottingham NG7 3GW Meadows Health Centre 1 Bridgeway Centre The Meadows Nottingham NG2 2JG Rivergreen Medical Centre 106 Southchurch Drive Clifton Nottingham NG11 8AD Lenton Medical Centre 266 Derby Road Nottingham NG7 1PR Greenwood & Sneinton Family Medical Centre 249 Sneinton Dale Sneinton Nottingham NG3 7DQ 141 Oakdale Road Bakersfield Nottingham NG3 7EJ Wollaton Vale Health Centre Wollaton Vale Nottingham NG8 2GR Nirmala Medical Centre 112 Pedmore Valley Bestwood Park Estate Nottingham NG5 5NN Clifton Cornerstone Southchurch Drive Clifton Nottingham NG11 8EW 14 Tel: 0115-9784374 Fax: 0115-9701478 Tel: 0115-9865410 Fax: 0115-9851821 Tel: 0115-9211566 Fax: 0115-9405579 Tel: 0115-9411208 Fax: 0115-9412931 Tel: 0115-9501854 Fax: 0115-9580044 Tel: 0115-9401007 Fax: 0115-9402022 Tel: 0115-9282216 Fax: 0115-9280590 Tel 0115-9208501 Fax:0115-9666113 Tel: 0115-9212970 Fax: 0115-9846878 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme The Surgery, Church Close Radford Health Centre Dr PR Patrick Dr LM Brown Dr MC Jones Dr SJ Parker Dr M Salisbury Dr N Phillips Bilborough Surgery Dr NV Phillips Phoenix Practice Dr PP Tiwari Dr SR Tiwari Sherwood Rise Surgery Dr SM Qureshi Dr GF Finnegan Dr M Iqbal The Springfield Medical Centre Dr AR Rao Dr S Mohindra Mayfields Medical Centre Dr YVS Rao The Fairfields Practice Dr S Rudrashetty Dr SM Taylor Dr EB Shapiro Dr JE Coleman Dr S Velupiliai Dr JD Sayers Welbeck Surgery The Surgery Church Close Rise Park Nottingham NG5 5EB Radford Health Centre Ilkeston Road Radford Nottingham NG7 3GW Bilborough Surgery 112 Greylands Road Bilborough Nottingham NG8 4FD Tel: 0115-9272525 Fax: 0115-9797056 The Medical Centre Valley House St Anns Well Road Nottingham NG3 3PX Sherwood Rise Surgery 31 Nottingham Road Sherwood Rise Nottingham NG7 7AD The Springfield Medical Centre 301 Main Street Bulwell Nottingham NG6 8ED Greenfields Medical Centre 12 Terrace Street Hyson Green Nottingham NG7 6ER Tel: 0115-9502703 Fax: 0115-9588493 Mary Potter Health Centre Gregory Boulevard Hyson Green Nottingham NG7 5HY Welbeck Surgery 481-491 Mansfield Road Sherwood Nottingham Tel: 0115-9424352 Fax: 0115-9792765 15 Tel: 0115-9791313 Fax: 0115-9791470 Tel: 0115-9292358 Fax: 0115-9295878 Tel: 0115-9622522 Fax: 0115-9622987 Tel: 0115-9756501 Fax: 0115-9166004 Tel: 0115-9423582 Fax: 0115-9002330 Tel: 0115-9620932 Fax: 0115-9620065 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Meadows Health Centre Dr D Shankar Dr RSC Rao RHR Medical Centre Dr K Sharma Greenfields Medical Centre Dr OP Sharma Wollaton Park Medical Centre St Albans Medical Practice Dr NA Silcock Dr AM Duffy Dr JS Ambrose Dr EH McVicar Dr C David Dr A Walsh Dr RH Thomas Dr NC Sood Dr JR ArdenJones Dr KP Brown Dr JS Day Dr D Sathananthan Dr S Bashir Chilvers McCrea partnership Malvern House Dr MAJ Stevens Riverlyn Medical Centre Dr AK Tangri Dr C Tangri Family Medical Centre NG5 2JJ Meadows Health Centre 1 Bridgeway Centrae Meadows Nottingham NG2 2JE RHR Medical Centre Calverton Drive Strelley Nottingham NG8 6QN Greenfields Medical Centre 12 Terrace Street Hyson Green Nottingham NG7 6ER Wollaton Park Medical Centre 12 Harrow Road Wollaton Park Nottingham NG8 1FG Tel: 0115-9861128 Fax: 0115-9861397 Tel: 0115-9797910 Fax: 0115-9753888 Tel: 0115-9423386 Fax: 0115-9704640 Tel: 0115 -9855016 Family Medical Centre 171 Carlton Road Carlton Nottingham NG3 2FW Tel: 0115-9504068 Fax: 0115-9509844 St Albnans Practice Hucknall Lane Bulwell Nottingham NG6-8AQ Malvern House 41 Mapperley Road Mapperley Park Nottingham NG3 5Aq Riverlyn Medical Centre Station Road Bulwell Nottingham NG6 9AA Tel:0115-9273444 Fax:0115-9278000 16 Tel: 0115-8412022 Fax: same Tel: 0115-9752666 Fax:0115-9279555 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NDU Surgery Dr CC Udenze Dr C Worsey The Windmill Practice Dr MD Abbott Dr SG Knights Dr SA Willot Dr H Sperry Dr RA Scott Dr N Brown Dr K Hunt Dr J Lloyd Dr P Scullard Dr MS Verma Hartley Road Medical Centre Cripps Health Centre The Wellspring Surgery Aspley Medical Centre Arboretum Health Team Dr DL Nash Dr ER Gibbs Dr JF Porter Dr FE Armitage Dr TM Baker Dr C Manktelow Dr A Connor Dr S Royal Dr M Arora Dr RJ Wilson Dr AR Teed Dr SA Caplin Dr A Neville Dr CE Campbell Dr OH Miles Dr SR Wright Dr JR Harte Dr CA Michel Dr PA Shields Dr M Macarthur Chilvers McCrea partnership NDU Surgery St Anns Health Centre St Anns Well Road Nottingham NG3 3PX The Windmill Practice Sneinton Health Centre Beaumont Street Sneinton Nottingham NG2 4PJ Tel: 0115-9505455 Fax: 0115-9588493 Hartley Road Medical Centre 91 Hartley Road Radford Nottingham NG7 3AQ Cripps Health Centre University Park Nottingham NG7 2QW Tel:0115-9422622 Fax: 0115-9257007 The Wellspring Surgery St Anns Health Centre St Anns Well Road Nottingham NG3 3PX Tel: 0115-9505907 Fax: 0115-9881582 Aspley Medical Centre 511 Aspley Lane Aspley Nottingham NG8 5RW Tel: 0115-9292700 Fax: 0115-9298276 The Arboretum Health Team Waverley Centre 105-107 Portland Road Radford Nottingham NG7 4HE Tel: 0115-9791204 17 Tel: 0115-9505426 Fax: 0115-9505404 Tel: 0115-8468888 Fax: 0115-9480347 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme 18 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Appendix 2 Nottingham City Primary Care Trust Pharmacies participating in the Pharmacy First Minor Ailments Scheme Applegate Chemist 132 Alfreton Road Radford Nottingham NG7 3NS Radford Road Hyson Green Nottingham NG7 5DU 541 Aspley Lane Aspley Nottingham NG8 5RW 441a Beechdale Road Aspley Nottingham NG8 3LF 11-19 Victoria Centre Nottingham NG1 3QS 54-57 Long Row Nottingham NG1 6HL 1-3 Commercial Road Bulwell Nottingham NG6 8HD 40 Lister Gate 2 Broadmarsh Centre Nottingham NG1 7LB 222-224 Southchurch Drive Clifton Nottingham NG11 8AA 594 Mansfield Road Sherwood Nottingham NG5 2FS 71 Bracebridge Drive Bilborough Nottingham NG8 4PH Cripps Health Centre University Park Nottingham NG7 2RD Tel: 0115-9785744 Boot the Chemist Unit a, Riverside Retail Park, Queens Drive, Nottingham, NG2 1GS Tel: 0115 9864182 Burrows & Close 234 Beckhampton Road Bestwood Park Nottingham NG5 5PA Tel: 0115-9266209 ASDA Boots the Chemist Lloyds Pharmacy Boots The Chemist Boots The Chemist Boots The Chemist Boots The Chemist Boots The Chemist Boots the Chemist Boots the Chemist Boots the Chemist 19 Tel: 0115-9002510 Tel: 0115-9291009 Tel: 0115-9183331 Tel: 0845-1231000 Tel: 0115-9587341 Tel: 0115-9278057 Tel: 0115-9507381 Tel: 0115-9215630 Tel: 0115-9605482 Tel: 0115-9292316 Tel: 0115-8466384 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Burrows & Close Burrows & Close Burrows & Close Burrows & Close Canning Ltd Canning Ltd Carrington Pharmacy Boots the Chemist Asim’s Chemist Lloyds Chemist Radford Road Pharmacy Cox Pharmacy Evergreen Pharmacy Forest Pharmacy Co-op Pharmacy Co-op Pharmacy 334 Derby Road Lenton Nottingham NG7 2DW 164 Bramcote Lane Wollaton Nottingham NG8 2QP 1-5 Main Street Bulwell Nottingham NG6 8QH 71 Ilkeston Road Radford Nottingham NG7 3HA 2 Beastmarket Hill Old Market Square Nottingham NG1 6FB 61 Ilkeston Road Radford Nottingham NG7 3GR 351 Mansfield Road Carrington Nottingham NG5 2DA 10 Broxtowe Lane Cinderhill Nottingham NG8 5NP 14/16 Colwick Road Sneinton Nottingham NG2 4BU 113 Sneinton Road Sneinton Nottingham NG2 4QL 544 Radford Road New Basford Nottingham NG7 7EA 87 Oakdale Road Bakersfield Nottingham NG3 7EJ 232 Highbury Road Bulwell Nottingham NG6 9AF 131 Arnold Road Bestwood Park Nottingham NG5 5HR 42 Bailey Street Old Basford Nottingham NG6 0HA Robin Hood Chase St Ann’s Nottingham NG3 4EZ 20 Tel: 0115- 9787169 Tel: 0115-9281048 Tel: 0115-9275352 Tel:0115-9783389 Tel: 0115-9418402 Tel: 0115-9780620 Tel: 0115-9605453 Tel: 0115-9786928 Tel: 0115-9480365 Tel: 0115-9504938 Tel: 0115-9782336 Tel: 0115-9875487 Tel: 0115-9278336 Tel: 0115-9608798 Tel: 0115-9703819 Tel: 0115-9504951 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Jayplex Jaysons Pharmacy Lloyds Pharmacy Knights Chemist Medina Chemist Mistrys Dispensing Chemist Boots UK Co-op Pharmacy Co-op Pharmacy Omega Chemist Co-op Pharmacy Co-op Pharmacy Phakeys Pharmacy 724 Mansfield Road Woodthorpe Nottingham NG5 3FW 97 Arleston Drive Wollaton Nottingham NG8 2GB Tel: 0115-9605226 103-105 Hartley Road Radford Nottingham NG7 3AQ 1 Knights Close Top Valley Nottingham NG5 9AJ 85-89 Radford Road Hyson Green Nottingham NG7 5DR Unit 2-4 Tesco Development Top Valley Way Top Valley Nottingham NG5 9DD Mary Potter Centre Gregory Boulevard Hyson Green Nottingham NG7 5JE 176 Southchurch Drive Clifton Nottingham NG11 8AA 121 Middleton Boulevard Wollaton Nottingham NG8 1FW 25 Flamstead Road Strelley Nottingham NG8 6LR The Hucknall Road Pharmacy Off Kibworth Close Heathfield Nottingham NG5 1NA 412 Broxtowe Lane Aspley Nottingham NG8 5ND The Family Medical Centre 171 Carlton Road Nottingham NG3 2FW Tel: 0115-9785826 21 Tel: 0115-9284563 Tel: 0115-9277948 Tel: 0115-9790700 Tel: 0115-9752466 Tel: 0115-9704294 Tel: 0115-9842910 Tel: 0115-9289256 Tel: 0115-9296608 Tel: 0115-9604140 Tel: 0115-9291708 Tel: 0115-9507402 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Shalleys Chemist Turners Pharmacy Vantage Pharmacy Late Night Pharmacy Day Lewis Pharmacy S M Walker Ltd Lloyds Pharmacy Lloyds Pharmacy Manor Pharmacy Glasshouse Chemist D Parmar Sainsbury’s Pharmacy 37 Beech Avenue Sherwood Rise Nottingham 249 Sneinton Dale Sneinton Nottingham NG3 7DQ 407 Nuthall Road Aspley Nottingham NG8 5DB Tel:0115-9604483 Late Night Pharmacy 69 Sneinton Dale Sneinton Nottingham NG2 4LQ 372 Southchurch Drive Clifton Nottingham NG11 9FE Hucknall Lane Bulwell Nottingham NG6 8AQ 678 Mansfield Road Sherwood Nottingham NG5 2GE 158 Russell Drive Wollaton Nottingham NG8 2BE 9 Bridgeway Centre Meadows Nottingham NG2 2JD 41-44 Glasshouse Street Nottingham NG1 3LW 298 Woodborough Road Mapperley Nottingham NG3 4JP Castle Bridge Road Castle Marina Nottingham NG7 1GX Tel: 0115-9582990 22 Tel: 0115-9504076 Tel: 0115-9787472 Tel:0115-9212878 Tel: 0115-9276381 Tel:0115-9604512 Tel:0115-9282831 Tel:0115-9865526 Tel:0115-9480658 Tel: 0115-9604208 Tel: 0115-9484595 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Appendix 3 Minor Ailments Currently covered by the Pharmacy First Scheme As at 1st April 2008 Headlice Temperature Teething Toothache Earache Sore Throat Athlete’s Foot Diarrhoea Haemorrhoids Threadworm Vaginal Thrush Bacterial Conjunctivitis Constipation Insect bites and stings Warts and verrucas Cystitis/Simple UTI Hayfever This list will be periodically reviewed for the inclusion of other minor ailments. Review date: April 2009 23 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Appendix 4 The University of Manchester CPPE Distance Learning course for Pharmacists It is a condition of the agreement between Nottingham City Primary Care Trust and the Pharmacy, that the Pharmacist’s, and any locum pharmacy staff should complete, within 6 months of commencement of the scheme, the CPPE pack for minor ailments. The CPPE distance learning pack is available from: The Centre for Pharmacy Postgraduate Education Manchester University Telephone: 0161 2372058 www.cppe.man.ac.uk 24 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Appendix 5 Pharmacy First Nottingham City Primary Care Trust Minor Ailments Scheme Drug Paracetamol tablets Paracetamol suspension SF Paracetamol suspension SF Malathion Aqueous Lotion Permethrin Cream Rinse Headlice detector comb Dimeticone Solution Clotrimazole pessary Clotrimazole cream Piperazine & Senna sachets Mebendazole tablets Oral rehydration salts sachets Loperamide capsules Anusol cream Anusol suppositories Chloramphenicol eye drops Hydrocortisone cream Loratadine tablets Loratadine syrup Senna syrup Senna tablets Salactol paint Trimethoprim tablets Sodium Cromoglicate eye drops Beclomethasone nasal spray Cetirizine Syrup Cetirizine Tablets FORMULARY Brand Strength Pack size Medinol paed 500mg 120mg/5ml 32 tablets 100ml bottle Medinol over 6 250mg/5ml 100ml bottle Derbac M 50ml x 2 Lyclear 59ml (twin pack) Each Hedrin Canesten 4% 500mg 50ml x 2 1 pessary Canesten Pripsen 1% 20g tube 2 dose pack Ovex Dioralyte 100mg 1 tablet 6 sachet Entrocalm 2mg 6 capsules 0.5% 23g Pack of suppositories 10ml bottle 1% 15g tube 10mg 5mg/5ml 7.5mg/5ml 7.5mg Anusol Anusol Optrex infected Clarityn Clarityn Sennokot Sennokot Salactol Optricom Allergy 200mg 2% 7 tablets 100ml bottle 150ml bottle 20 tablets 10ml bottle 6 tablets 10ml bottle Beconase Allergy 50 microgram 180 dose bottle Zirtek Allergy 1mg/ml 10mg 150 ml bottle 30 tablets Pharmacy First Protocol 25 12 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme ATHLETE’S FOOT (tinea pedis) – Guidance for Treatment Definition: A cutaneous fungal infection, commonly affecting the inter-digital space of the fourth and fifth toes, that causes the skin to itch, flake, and fissure. Criteria for INCLUSION: Symptoms of fungal infection confined to the skin between the toes and other nearby areas of the foot, e.g. inflamed and sensitive to the touch; persistent itching of the skin; sweaty-smelling, milky-white peeling, sore and cracked skin. Criteria for EXCLUSION: Infection that has spread to the toenails or to other areas of the body Secondary bacterial infection Any patient presenting with symptoms of cellulitis (e.g. spreading redness, pain and tenderness) Blistering or wet and weeping rash Treatment failures Action for Excluded Patients: Refer to GP Rapid referral: Any patient presenting with symptoms of cellulitis, who is showing signs of being unwell, should be referred immediately Recommended Treatment: Clotrimazole 1% Cream, 20g Dosage and Route: Apply topically to the affected area and surrounding skin two or three times a day for 28 days (or at least 7 to 14 days after the rash has healed). Advice and Follow up: Continue to use the cream for two weeks after the infection appears to have cleared General Advice: Keep feet as dry as possible Wash and dry feet thoroughly, especially between the toes Patients should use separate towels and washcloths from other family members Patients should avoid going barefoot and never share footwear Athlete’s foot is more common in people that wear artificial soles and especially trainers and sports shoes – avoid plastic lined shoes/trainers Anti-fungal sprays and powder may be purchased for direct application to inside of shoes and socks Wearing clean wool or cotton socks and changing them at least once daily allows the skin to breathe Where possible, it can help to expose feet to the air Alternate shoes to allow “airing” 26 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Reviewed: July 2007 Review Date: July 2009 27 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Pharmacy First Protocol DIARRHOEA – Guidance for Treatment Definition: An acute increase in the normal frequency of bowel movements with the passage of abnormally soft or watery faeces. Abdominal cramps, flatulence, weakness and malaise may be also be present. Criteria for INCLUSION: Patients experiencing symptoms of acute diarrhoea (sudden and recent onset) 5 or more watery or loose stools in the past 24 hours Criteria for EXCLUSION: Children under one year of age Patients who have symptoms persisting for more than 48 hours Patients who pass blood (red or black) in motion or are vomiting blood Patients with a persisting high fever and severe malaise Patients who are severely ill or dehydrated Patients with diabetes Patients who have recently been to countries with poor hygiene (need stool sample) Patients with a history of bowel disease, especially ulcerative colitis, Crohns or diverticular diseases. Patients with chronic diarrhoea problems (recurrent episodes or persisting) Persisting trickling diarrhoea suggestive of overflow, especially with constipation risk factors Patients who are immunocompromised Action for Excluded Patients: Refer to GP Rapid referral: Adults, where symptoms have lasted more than 5 days Children, where symptoms have lasted more than 2 days and are not starting to settle or who look ill or dehydrated Pregnant women Consider supply, but patient should also be advised to see their GP: Patients taking medication where diarrhoea is a recognised effect Recommended Treatments: Oral Rehydration Salts (6 sachet pack) Loperamide 2mg Capsules x 6 28 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Dosage: Oral Rehydration Salts: The contents of a sachet should be dissolved in 200ml of fresh drinking water (for infants and, where drinking water is unavailable, the water should be freshly boiled and cooled). Child between 1 and 2 years: One to one and a half times the usual 24 hour feed volume. Child: One sachet after every loose motion. Adult: One or two sachets after every loose motion. More may be required initially to ensure early and full volume repletion. Loperamide 2mg capsules: Adults and children 12 years and over: 2 capsules initially followed by 1 capsule after every loose stool. Advice and Follow up: Patient should drink plenty of fluids (at least 1.5 litres daily and more if hot weather). Adults and older children should avoid dairy products and fruit juice for the duration of the symptoms. After 12 hours, patient can start high calorie, low fibre, milk free diet (e.g. jelly, bread or toast and honey, boiled rice, water porridge and honey/sugar, arrow root/rich tea biscuit. See GP if symptoms do not resolve within 48 hours. General Advice: Hand washing and general hygiene after using toilet facilities and before eating Whilst ill, patient should not to prepare food for other people unless absolutely necessary Food handlers should not work until symptoms have subsided Reviewed: July 2007 Review Date: July 2009 29 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Pharmacy First Protocol HAEMORRHOIDS – Guidance for Treatment Definition: A varicose condition of the external or internal rectal veins causing painful swellings at the anus. Criteria for INCLUSION: Patients over 16 with previously diagnosed haemorrhoids Criteria for EXCLUSION: Children under 16 Patients not previously diagnosed with haemorrhoids Patients re-presenting within 6 months of a previous Pharmacy First consultation for haemorrhoids Patients reporting anal bleeding (other than small amount of bright red on tissue only with local irritation) Action for Excluded Patients: Refer to GP Rapid referral: Profuse bleeding Extreme pain Irregular anal swelling Severe thrombosed haemorrhoids Diagnostic uncertainty Routine referral: Persistent or severe or dark bleeding Severe prolapse Moderately severe pain Haemorrhoids affecting daily living Conditional referral: Pregnancy – patient could discuss with midwife Recommended Treatments: Anusol Cream, 23g and/or Anusol Suppositories, 12 Dosage and Route: Anusol Cream: Apply topically to the affected area morning and night, and after bowel movements. Anusol Suppositories: Insert into the rectum morning and night, and after bowel movements. 30 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Advice and Follow up: One Pharmacy First treatment for haemorrhoids in any period of 6 months. If symptoms persist, the patient should see their GP. Patients should be given advice that the most common cause of haemorrhoids is straining during bowel movements, often associated with constipation. Patients should eat a high-fibre diet with plenty of fluids as part of treatment and prevention. This means eating more fruit and vegetables (stimulant fruits, such as prunes, are particularly useful), more cereals (e.g. wholemeal bread), and drinking at least 8 glasses (12 cups) of caffeine-free fluid a day. Fibre supplements (e.g. bran) or lactulose are options, if a high fibre diet has not helped constipation or stools are particularly hard. General Advice: Haemorrhoids in pregnancy usually resolve after the baby is born. Reviewed: July 2007 Review Date: July 2009 31 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Pharmacy First Protocol THREADWORM – Guidance for Treatment Definition: Infestation by the threadworm parasite resulting in symptoms of peri-anal itching, especially at night. Confirmed by presence of cotton-like threadworms in the faeces or around the anus, e.g. adhesive tape test (or warm wet wad of cotton wool held by mother on anus of nappy age child for 1 minute, 20 minutes after bedtime). Criteria for INCLUSION: Affected individuals with definite sighting of threadworms. Criteria for EXCLUSION: Pregnancy or breastfeeding Children under 1 year old Recent tropical travel (due to risk of other parasitic infections) Patients with renal or hepatic problems or epilepsy (piperazine contraindicated) Action for Excluded Patients: Pregnant women – good hygiene to break life cycle Refer to GP: Children under 1 year old Patients who have recently returned from tropical travel Patients with renal or hepatic problems or epilepsy Conditional referral: Pregnant women and breastfeeding mothers who have failed to eradicate after 6 weeks of hygiene. Consider supply, but patient should also be advised to see their GP: Regular treatments required (may need more intensive advice on hygiene measures – referral to health visitor may be more appropriate). If there is a risk of a secondary infection due to intense scratching of the peri-anal skin. In persistent or heavy cases of infection where patient has suffered loss of appetite, weight loss, insomnia and irritability. Recommended Treatments: Patients over 2 years: Mebendazole 100mg Tablet x 1 Child between 1 and 2 years: Piperazine and Senna Sachets (2 dose sachet pack) Dosage: Piperazine and Senna: (Child between 1 and 2 years) level 5ml spoonful from sachet, repeated in 14 days Mebendazole: 1 tablet. If re-infection occurs, a second dose can be taken after 14 days. 32 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Advice and Follow up: All other members of household should be treated simultaneously. Hygiene measures should be taken for 14 days after treatment: Wash hands and scrub nails first thing every morning, after using the toilet or changing nappies, and immediately before eating (even snacks) or preparing food Have a bath or wash around the anus each morning immediately on rising Keep fingernails short Change and wash underwear, nightwear, and bed linen the morning after treatment Vacuum all carpets and clean bathroom surfaces daily Wear clean underwear daily Children can wear cotton underwear at night to help prevent scratching or spreading eggs General Advice: Avoidance of re-infection = personal hygiene Reviewed: July 2007 Review Date: July 2009 33 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Pharmacy First Protocol VAGINAL THRUSH – Guidance for Treatment Definition: Fungal yeast infection of the lower female genital tract. Presenting symptoms include thick, white or creamy vaginal discharge, external stinging or burning (pain) on urination with soreness and itching. Criteria for INCLUSION: Women with a recurrence of symptoms previously diagnosed as vaginal candidiasis (thrush) who are confident that it is a recurrence of the same condition. Criteria for EXCLUSION: Men Girls under 16 years Women over 60 years Pregnant women Women unsure if it is thrush Women with green, yellow or offensive discharge, or watery discharge Women reporting blistering, ulcerative genital rash (some erythema, cracking & fissuring is common) Women with no previous diagnosis Women with symptoms in addition to those of vaginal candidiasis (Abdominal pain, fever, irregular bleeding) Women allergic to treatment options Women representing within 2 weeks of initial treatment Action for Excluded Patients: Refer to GP Rapid referral: Presence of loin pain. Fever Urethral or bladder dysuria (i.e. not just external) If blood present in discharge Vaginal bleeding, pain or blistering Conditional referral: On third occurrence Patients re-presenting within 2 weeks Possible treatment failure or resistance (may require alternative agent or longer course) Pregnancy – patient could discuss with midwife Consider supply, but patient should also be advised to see their GP: Post-menopausal women Recurrent thrush + high risk of diabetes (e.g. obesity) Patients suffering more than 4 episodes in 12 months – refer to GP but provide symptomatic relief. Recommended Treatments: Clotrimazole 500mg Pessary and (if required) Clotrimazole 1% Cream, 20g 34 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Dosage and Route: Clotrimazole 500mg pessary: Insert into the vagina. Clotrimazole 1% cream: Apply topically to affected area twice a day for up to two weeks. Advice and Follow up: Pessary treats the infection; cream is used to reduce itching. Pessary best used last thing at night (to aid retention); advise that it will likely cause a slight white “chalky” residue. See GP if symptoms do not resolve within 7 days. Sexual partners should be reminded of hygiene and see their GP if sore glans and/or foreskin General Advice: Avoid tight clothing, especially synthetic, and, for example, wearing tights under trousers; use cotton underwear Make aware of problems with using vaginal deodorants, scented soap etc. Hygiene methods to prevent re-infection (water mostly, no internal washing/douching, avoid bubble bath) If ever prescribed antibiotics or other medication (e.g. steroids, chemotherapy), patient should remind the doctor that they are prone to thrush. Reviewed: July 2007 Review Date: July 2009 35 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Guidelines for consultations for: PHARMACY FIRST NOTTINGHAM Head Lice Definition / Criteria Infestation with head lice Criteria for INCLUSION Patients who are proven to be infested with head lice. Criteria for EXCLUSION Family / siblings of patient, who are not proven to be infested (note: infestation is not indicated by the presence of nits (hatched and empty eggshells). Children under the age of six months. Liquid should not be used or applied by pregnant women. A further request for medicated treatment within one week ie request for third bottle after initial supply of 2 bottles for complete treatment. Action for excluded patients & non-complying patients Referral to Practice Recommended Treatments and Route AT ALL TIMES REINFORCE CORRECT USE OF COMB Head Lice Comb Malathion aqueous liquid (50ml/treatment) topically Permethrin crème rinse (59ml) topically If treating more than one family member complete separate patient records and make separate supplies. Dosage and Criteria Appointment 1 Patients to be issued with a lice comb, leaflet and verbal advice Appointment 2 Check previous medication and head lice history Issue one course of product = 2 bottles, second for repeat application7 days later. Reinforce verbal advice and encourage repeated combing throughout follow up treatment. Encourage regular combing to prevent re-infestation. Use the Mosaic policy of alternative drug treatment if infestation persists Frequency of administration & maximum dosage The same chemical should not be used for the next re-infestation (i.e. alternate treatments) Follow-up & advice Shampoo out any conditioner prior to use and dry hair. Apply liquid to scalp and hair, which should be allowed to dry naturally. Do not use hair dryers. Remove by washing after 12 hours. Broad comb, then wet comb well conditioned hair to remove dead lice & eggs with fine-toothed comb. For Malathion products-avoid using chlorinated swimming pools for at least 12 hours after treatment. Permethrin crème rinse – After shampooing, apply to damp, towel dried hair. Rinse out after 10 minutes. Broad comb, then wet comb well conditioned hair to remove dead lice & eggs with fine-toothed comb. General Advice Regular detection combing as treatment will not prevent re-infestation from classmates. Not suitable for prevention. Encourage parent to notify the school. If there is any doubt – the patient should telephone the pharmacy or NHS Direct (tel. 0845 4647) Side effects and their management Side effects are experienced rarely. Refer patient to individual product literature. There may be residual scalp irritation following application which could be inadvertently mistaken for reinfestation. Reviewed: July 2007 Review Date: July 2009 36 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM CITY PCT Pharmacy First Protocol / Guidance for treatment Guidelines for consultations for: Head lice (non-insecticidal option) Definition / Criteria: Infestation with head lice. Criteria for inclusion: Patients who are proven to be infested with head lice requesting a non insecticidal product. Criteria for exclusion: Family / siblings of patient, who are not proven to be infested. Infestation is not indicated by the presence of nits (hatched and empty eggshells). Children under the age of six months. A further request for treatment within one week i.e. request for third bottle after initial supply of 2 bottles for complete treatment. Action for excluded patients & non-complying patients: Referral to GP practice. Recommended treatments: Head Lice Comb. Dimeticone 4% lotion (50ml topical treatment). If treating more than one family member complete separate patient records and make separate supplies. Dosage and frequency of administration: Hedrin is a non-insecticidal preparation that can be used in severe eczema, asthmatic patients, pregnancy and young (>6months) children. The same preparation may be used for the next re-infestation. Appointment 1 -Patients to be issued with a lice comb, leaflet and verbal advice. Appointment 2 -Check previous medication and head lice history. Issue one course of product = 2 bottles, the second bottle is for repeat application 7 days later. Reinforce verbal advice and encourage repeated combing throughout follow up treatment. Encourage regular combing to prevent re-infestation. Follow up and advice: Explain treatment and course of action. 1. Apply sufficient lotion evenly over DRY hair ensuring that the scalp is fully covered. 2. Work into the hair spreading the liquid evenly from the roots to tips. 3. Allow the hair to dry naturally. 4. Leave on the hair for at least 8 hours or overnight. 5. Wash the hair with normal shampoo, rinse thoroughly with water and dry. It is important that Hedrin Lotion is applied again after 7 days to deal with any lice which may hatch in that time. Failure to repeat the treatment may result in the return of a louse infestation. Advise patient to seek further advice if symptoms persist or worsen. Side effects and their management: Side effects are experienced rarely however itching and irritation around the eyes, flaking of the scalp may occur. There may be residual scalp irritation following application which could be inadvertently mistaken for re-infestation. General advice and follow up: Regular detection combing as treatment will not prevent re-infestation from classmates. Not suitable for prevention. Encourage parent to notify the school. If there is any doubt – the patient should telephone the pharmacy or NHS Direct (tel. 0845 4647) Written April 2008 Review date April 2010 37 PHARMACY FIRST NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM Guidelines for consultations for: Temperature/Fever with URTI (Upper Respiratory Tract Infection) Definition / Criteria Normal body temperature is 36.8C, 98.4G, taking the temperature under the arm. Fever occurs with all the infectious diseases.(Check which site the temperature was taken for variation in fever threshold.) Criteria for INCLUSION Patients with a fever associated with obvious upper respiratory tract infections and temperature over 36.8C. Criteria for EXCLUSION Children under the age of 3 months Alcohol dependency, known renal or liver disease, known hypersensitivity to Paracetamol, recent history of taking Paracetamol containing medicines. Fever due to cause other than obvious URTI. Action for excluded patients & non-complying patients Referral to Practice Recommended Oral Treatments Paracetamol 500mg tabs (32) Paracetamol Susp SF 120mg / 5ml (100 ml) Paracetamol Susp SF 250mg/ 5ml (100 ml) Frequency of administration & maximum dosage ) ) 4 – 6 hourly according to age ) Maximum of 4 doses in 24 hours Follow-up & advice Enquire about concurrent analgesic use Lack of effect from treatment doses of Paracetamol Combination of Paracetamol + Ibuprofen (OTC) in children with fever is possible This protocol does not support protracted use (More than 7 days) of these agents without GP intervention .if symptoms develop – the enquirer should ring the pharmacy or NHS Direct (tel. 0845-4647).Patients should be advised to: Drink plenty of fluids Tepid sponging Do not overheat home Rest. Avoid going outside in very cold weather Do not over-wrap the child indoors Patients who are immunocompromised Side effects and their management Side effects are rare with occasional use of Paracetamol. Rapid Referral: A patient with any of the following, particularly if a child: If fever is severe – more than 38.2C (101F) or 37.5C (100F) if under 6 months. (From under arm measurement) Vomiting Severe headache / stiff neck Photophobia Sore throat or earache unless mild White coating on tongue (not caused by milk) or spots in mouth Rash which doesn’t blanche to the ‘glass’ test If fever does not lessen after 48 hours despite analgesia or rapid increase of temperature over a 12 hour period. Patients who have an infected wound People who have recently been abroad especially to countries where malaria occurs. Any other symptoms giving cause for concern-patient appears very unwell Unexplained fever lasting longer than 7 days Fever fits Reviewed: July 2007 Review Date: July 2009 38 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme PHARMACY FIRST NOTTINGHAM Guidelines for consultations for: Analgesia for Sore Throat Definition / Criteria A painful throat, which is often accompanied by viral symptoms Criteria for INCLUSION Sore throat which requires soothing. Criteria for EXCLUSION Symptoms lasting longer than 7 days Signs of severe infection Suspected ADRs Immuno compromise due to drugs or illness Child very sick, drooling, cannot swallow Large swelling around one tonsil (Quinsy) Baby under 3 months. corticosteroids or carbimazole Altered immunity (in diabetes, leukaemia, AIDs) Alcohol dependency, known renal or liver disease, known hypersensitivity to Paracetamol, recent history of taking Paracetamol containing medicines. Action for excluded patients & non-complying patients Referral to Practice Recommended Oral Treatments dosage Paracetamol 500mg tabs (32) Paracetamol Susp SF 120mg / 5ml (100 ml) Paracetamol Susp SF 250mg/ 5ml (100 ml) Frequency of administration & maximum ) ) 4 – 6 hourly according to age ) Maximum of 4 doses in 24 hours Follow-up & advice Patients should avoid smoky or dusty atmospheres and reduce or stop smoking Patients who find swallowing painful should take a light fluid diet Paracetamol daily dose – caution with other products containing Paracetamol particularly any prescribed medicines. Side effects and their management There are unlikely to be any side effects. When & How to refer to GP Conditional referrals: If symptoms persist for more than one week, the patient should consult the GP. (If less than 3 out of 4 criteria as listed below - likely to make it a bacterial infection – & referral would be beneficial. If symptoms develop or intensify – ring NHS Direct ( Tel 0845 4647) o History of fever o Absence of cough o Swollen tender anterior cervical lymph nodes o Tonsillar exudate. ) Consider supply, but patient should be advised to make an appointment to see the GP: Symptoms suggesting oral candidiasis / tonsillitis Patients on immunosuppressants / oral steroids / drugs causing bone marrow suppression The condition has persisted more than one week. A second request within one month Rapid Referral: Patients known to be immunosuppressed ,accompanied by other clinical symptoms or blood disorders. Suspected ADRs – which may have fever and rash accompanying sore throat. Reviewed: July 2007 Review Date: July 2009 39 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme PHARMACY FIRST NOTTINGHAM Guidelines for consultations for: Earache Definition / Criteria Pain in the ear Can occur after a cold Pain is a subjective experience, the nature of which can vary considerably. Criteria for INCLUSION Patients requiring relief of earache of less than 3 days duration. Criteria for EXCLUSION Severe earache Earache accompanied by fever or sore throat If there is a hearing problem after an ear infection Children under the age of 3 months Discharge from ear Alcohol dependency, known renal or liver disease, known hypersensitivity to Paracetamol, recent history of taking Paracetamol containing medicines. Action for excluded patients & non-complying patients Referral to Practice Recommended Oral Treatments Frequency of administration & maximum dosage Paracetamol 500mg tabs (32) Paracetamol Susp SF 120mg / 5ml (100 ml) Paracetamol Susp SF 250mg/ 5ml (100 ml) ) ) 4 – 6 hourly according to age ) Maximum of 4 doses in 24 hours Follow-up & advice Enquire about concurrent analgesic usage Ear drops are not recommended for children Go to the GP if condition worsens or does not get better in 2 – 3 days This protocol does not support protracted (more than 7 days) use of these products without GP intervention. Lack of effect from treatment doses of analgesics. Side effects and their management Side effects are rare with occasional use of Paracetamol When & How to refer to GP Conditional referrals: If moderate symptoms persist for more than one week, the patient should consult the GP. If symptoms change – telephone the pharmacy or NHS direct (tel.0845-4647) for advice. Rapid Referral: Severe earache Earache accompanied by fever or sore throat If there is a hearing problem after infection. If there is a yellow discharge after head injury Persistent fever Hearing problem persisting 2 weeks after infection. Reviewed: July 2007 Review Date: July 2009 40 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme PHARMACY FIRST NOTTINGHAM Guidelines for consultations for: Teething Definition / Criteria Pain/discomfort associated with teething, a selection of symptoms which can include: Excess salivation, dribbling Restlessness Will not sleep Pain, discomfort associated with teething Chews hard objects Criteria for INCLUSION Child 3 – 36 months old Patient with pain/discomfort associated with teething Criteria for EXCLUSION Children under the age of 3 months Action for excluded patients & non-complying patients Referral to Practice Recommended Oral Treatments Frequency of administration & maximum dosage 4 – 6 hourly – Maximum of 4 doses Paracetamol Susp SF 120mg / 5ml (100 ml) in 24 hours Follow-up & advice – Non Pharmaceutical treatment The use of teething rings, which can be cooled in the fridge, can help reduce the sensation of pain and give the baby something to chew on. Side effects and their management Side effects are rare with occasional use of Paracetamol. Referral: Child with: Only if acutely unwell Persistent fever triggering rapid referral under Temperature protocol Digestive tract disorders Rash If symptoms develop or intensify and the parent is in doubt -they should telephone the pharmacy or NHS Direct (tel. 0845 4647) Reviewed: July 2007 Review Date: July 2009 41 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme PHARMACY FIRST NOTTINGHAM Guidelines for consultations for: Analgesia for dental pain Definition / Criteria A painful tooth or teeth, or pain in the immediate area surrounding the tooth or teeth Criteria for INCLUSION (For under 3 year olds – see teething protocol.) Treatment of mild to moderate dental related pain in 3 year olds and above –including adults Criteria for EXCLUSION Mouth ulcer type lesion present over 3 weeks Symptoms lasting longer than 7 days Signs of severe infection such as fever in septicaemia Signs of gingivitis such as red swollen gums that easily bleed Jaw movement problems, particularly after an accident. Alcohol dependency, known renal or liver disease, known hypersensitivity to Paracetamol, recent history of taking Paracetamol containing medicines. Action for excluded patients & non-complying patients Referral to their own NHS dentist or NHS Direct if not registered with a dental practice. Recommended Oral Treatments Frequency of administration & maximum dosage Paracetamol 500mg tabs (32) Paracetamol Susp SF 120mg / 5ml (100 ml) Paracetamol Susp SF 250mg/ 5ml (100 ml) ) ) 4 – 6 hourly according to age ) Maximum of 4 times in 24 hours Follow-up & advice Concurrent intake of ibuprofen if required – if suitable for the patient – avoid sucking aspirin Patients who find chewing painful should take a light soft diet Paracetamol daily dose – caution with other products containing Paracetamol particularly any prescribed medicines. Gargle with salty water and spit out afterwards Register with an NHS dentist and visit as frequently as recommended for routine check ups Side effects and their management There are unlikely to be any side effects. When & How to refer to Dentist Conditional referrals: If symptoms persist for more than one week, the patient should consult their NHS Dentist, or NHS Direct on tel.0845-4647 Please Note: If you do not visit your NHS Dentist within 15 months – you will be removed from their NHS list and you will need to find yourself a new NHS Dentist. Some Dentist’s only offer limited NHS dental places and some dentists do not offer NHS places. Consider supply, but patient should be advised to make an appointment to see their dentist. Symptoms suggesting neuralgia or accompanying gingivitis or dental decay The condition has persisted more than one week. A second request within one month Rapid Referral: - Refer to Accident & Emergency Unit at QMC Jaw movement problems (e.g. mandibular osteomyelits), Suspected Jaw fracture (post-trauma) Uncontrolled bleeding ,Suspected septicaemia (accompanying fever)- 42 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Nottingham City PCT Pharmacy First Guidelines for the treatment of Bacterial Conjunctivitis Definition / Criteria: Patients with superficial eye infections thought to be bacterial Criteria for Inclusion: Superficial eye infections characterised by red, sore, painful (burning or gritty) conjunctiva and green/yellow discharge. These symptoms indicate a high probability of the infection being bacterial in origin. Criteria for Exclusion: Women who are pregnant or breast-feeding Children under 2 years old Known hypersensitivity to chloramphenicol or any other ingredient in the product. Visual disturbances other than simple blurring caused by discharge Foreign body in the eye Severe pain within the eye Patients known to have neutropenia or patients on drugs known to cause neutropenia i.e. cytotoxins Patients with recurrent eye infections i.e. > 2 per months or >4 per year Patients who feel unwell Patients with liver disease Allergic and viral conjunctivitis (these generally have a more watery discharge than bacterial conjunctivitis, and allergic will also often involve itching) Photophobia Eye inflammation associated with a rash on the scalp or face The eye looks cloudy The pupil looks unusual, ie. torn, irregular, dilated or non-reactive to light Family history of aplastic anaemia Patients with glaucoma Patients with previous eye disease Patients who have had eye surgery or laser treatment in the past 6 months Patients with dry eye syndrome Contact lens use (can refer to optician) Associated pain, swelling or redness on the face or around the eye. Patients who have experienced myelosuppression during previous exposure to chloramphenicol Patient is already using other eye drops or eye ointment Eye movement is restricted Personal or family history of bone marrow problems Patient has recently returned from abroad Penetration or chemical eye injury Reduced visual acuity Shingles/herpes simplex suspected Action for excluded patients Referral to GP. Rapid referral to GP: Patients with associated vesicular rash which may indicate herpes zoster infection Patients with affected vision or severe pain in the eye Patients with glaucoma or dry eye syndrome Patients who have had eye surgery or laser treatment in the past 6 months 43 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Features of a serious cause of “Red eye” eg photophobia, irregular pupil shape, severe pain Copious discharge (that re-accumulates after being wiped away), which may indicate hyperacute conjunctivitis. Conditional referral: If no improvement within 48 hours or worsening symptoms Consider supply, but patient should be advised to make an appointment so see the GP: Unilateral conjunctivitis of more than a few days Recommended treatment Chloramphenicol 0.5% eye drops (10ml) Frequency of administration & maximum dosage Use one drop in the affected eye(s) every 2 hours for first 48 hours then four times a day thereafter, for a total of 5 days. Tilt the head back and gently pull the lower eyelid out to form a pouch. Squeeze the bottle to release one drop into the lower eyelid. Blink several times to help spread the drug. Sleep need not be interrupted in order to administer eye drops. Do not share bottles if more than one family member is affected. Advice & Follow up: Discuss side-effects and administration with patient and provide a manufacturers Patient Information Leaflet (PIL) Advise patient that the infection can spread therefore need to wash hands before and after touching eyes and not to share towels, pillows etc. Patient should dispose of any eye cosmetics that may be contaminated Do not touch the eye or lashes with the tube or nozzle as this may contaminate the medicine Blurring of vision can occur with the drops and patients should be warned not to drive or operate machinery unless their vision is clear Do not use contact lenses during treatment and for 24 hours afterwards (NB all contact lens wearers should be referred) Store eye drops in the fridge. Discard 5 days after opening. Consult your GP if there is no improvement within 48 hours of treatment Side effects: Local transient irritation, burning, stinging, itching, dermatitis can occur Serious side effects include hypersensitivity reactions, and treatment must be discontinued in such cases. Aplastic anaemia has been reported. Interactions: This medication should not be used simultaneously with bone marrow suppressant drugs Reviewed: July 2007 Review Date: July 2009 44 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM CITY PCT Pharmacy First Protocol / Guidance for treatment Guidelines for consultations for: Constipation Definition / Criteria: Increased difficulty and reduced frequency of bowel evacuation compared to normal. Criteria for Inclusion: Significant variation from normal bowel evacuation, which has not improved following adjustment to diet and other lifestyle activities. Criteria for Exclusion: Patients currently receiving laxatives as part of their regular medication. Constipation is associated with vomiting and/or previous abdominal operation. Sudden change in bowel habit, weight loss or rectal bleeding in adults. Symptoms persist or treatment is still necessary after one week in children. Action for excluded patients & non-complying patients: Referral to Practice Recommended Treatments and Route: Senna Syrup 7.5 mg/5ml syrup (150ml) Senna Tablets 7.5 mg tablets (20) Dosage and Criteria: Senna Syrup (2 years to 6 years) 2.5ml to 5ml syrup each morning. (6 – 12 years) 1 to 2 5ml spoons each morning. Senna Tablets (13 years and over) 2 tablets at night (increase to 4 tablets if required). Follow up & Advice: If constipation persists beyond one week patient should be advised to consult the GP. Patients taking medication with recognised constipating effects should consult their GP. Side effects and their management: Senna Tablets may cause stomach cramps. General Advice and Follow up: Patients should be advised to include more fluid in diet and to include more highfibre items (fruit and vegetables, bran cereal, wholemeal bread) Patients should be advised to increase exercise. If there is any doubt – patient should telephone the pharmacy or NHS Direct (Tel: 0845 – 4647) Reviewed: July 2007 Review Date: July 2009 45 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM CITY PCT Pharmacy First Protocol / Guidance for treatment Guidelines for consultations for: Insect Bites and Stings Definition / Criteria: Insect bites and stings are painful but they are rarely serious. A red and/or inflamed spot or area identified by the patient as being caused by an insect bite or sting. Criteria for Inclusion: Pain and irritation at the site of the bite or sting. Precipitating factors: Walking in areas of long grass, with skin exposed. Criteria for Exclusion: Hydrocortisone cream should not be used in children under 10 years old. Patient has swelling of lips or tongue. Patient has symptoms of anaphylactic shock (extremely rare). Patients with epilepsy, hepatic or renal impairment Action for excluded patients & non-complying patients: Referral to Practice. Referral to GP: If sting in the mouth suck on an ice cube, or sip cold water and seek immediate medical attention. If have known allergy to bites and stings seek medical attention. Medical attention should be sought if the bite becomes larger in size and the redness spreads. If the patient experiences shortness of breath or fever. Symptoms of a severe allergic reaction are: - swollen lips and eyelids. - difficulty in breathing (wheezing) - becoming pale and fainting - increased generalised itchiness - aches/pains, feeling unwell. IF ANY OF THE SYMPTOMS ARE FELT THE PATIENT MAY BE HAVING A SEVERE ALLERGIC REACTION AND AN AMBULANCE SHOULD BE CALLED Consider referral: Child under 6 years. Bites or stings on mucous membranes or very close to the eye. Recommended Treatments and Route: Hydrocortisone 1% cream 15gm *P. (Clarityn) Loratidine 10mg tablets 7 tablets po *P. (Clarityn Allergy Relief) Loratidine 5mg/5ml syrup 100ml po *P. Dosage and Criteria: Hydrocortisone 1% cream. Apply 1-2 times daily sparingly for maximum of 7 days. Loratidine 10mg tablets. (Over 12 years) One daily. Loratidine 5mg/5ml syrup (Child 2-6 years) 5ml daily (Child 6-12 years) 2 x 5ml daily Follow up & Advice: Apply a cold compress Use of insect repellent products for future potential exposure. Advise symptoms that may indicate local or systemic infection. It may be difficult distinguish allergy from infection which usually develops 24 hours after being bitten and becomes progressively worse Side effects and their management: 46 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Hydrocortisone should not be used for more than 7 days without consulting a GP. Topical antihistamines may cause irritation and should be avoided. General Advice and Follow up: Recurrent bites on the legs are usually due to dog or cat fleas in carpets or rugs. Reviewed: July 2007 Review Date: July 2009 47 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme PHARMACY FIRST NOTTINGHAM Guidelines for consultations for: Warts and Verrucas Definition/Criteria A wart is a small (often hard) benign growth on the skin caused by a virus, usually occurring on the face, hands, fingers, elbows and knees. Verrucas (Plantar warts) occur on the sole of the foot, usually painful and may be covered by a thick callus. Criteria for INCLUSION Symptoms and signs suggestive of a wart or verruca. Criteria for EXCLUSION Warts on face, ano-genital region or large areas Diabetes mellitus Impaired peripheral blood circulation Broken skin or redness around area of wart / verruca Single warts in the elderly (over 60) - may be a squamous carcinoma. Action for excluded patients & non-complying patients Referral to General Practitioner Recommended Treatments, Route and Legal status. Frequency of administration & maximum dosage Salactol topical P apply daily. Remove dead skin with an emery board. Follow-up & advice Warts usually disappear spontaneously in time, but may take years Advice on hygiene, for example not sharing towels, as warts spread rapidly in communities, especially schools. Patients do not need to avoid swimming Rub wart surface with file or pumice stone once weekly Removal can take several weeks and treatment may need to be continued for up to 12 weeks. Avoid healthy skin Do NOT apply to face or ano-genital warts Side effects and their management Stinging, dryness and peeling When & how to refer to GP See exclusion criteria Conditional referral: Consider supply, but patient should be advised to make an appointment to see the GP: Rapid referral Single warts in the elderly (may be a squamous carcinoma) Reviewed: July 2007 Review Date: July 2009 48 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Nottingham City PCT Pharmacy First Guidelines for the treatment of Urinary tract infections Definition / Criteria: Presentation of simple acute urinary tract infections Typical symptoms are burning sensation or pain on passing urine, and passing urine frequently. Patients may also present with pain in the lower abdomen, blood in the urine, and fever (high temperature). Criteria for Inclusion: Non-pregnant females aged 18 to 65 years Criteria for Exclusion: Informed consent not obtained Previous allergic reaction to trimethoprim Severe renal impairment Blood dyscrasias Pregnancy Breastfeeding Confused or dehydrated Systemically unwell Significant flank pain Patients taking prophylactic trimethoprim Porphyria Complicated urine infections – post-operative Patients taking warfarin, phenytoin (Epanutin), procainamide (Pronestyl), ciclosporin, digoxin, pyrimethamine, azathioprine, mercaptopurine or methotrexate. Patients under 18 Male gender Concurrent medication should be checked with the BNF 49 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Action for excluded patients Referral to GP / NEMS Rapid referral to GP: If patient presents with high fever / loin pain / severe pain / malaise History of kidney stones / pyelo-nephritis Frank or painful haematuria Conditional referral: If condition worsens or does not improve after 48 hours then patients should be advised to seek further advice from their GP or NEMS. Patients with recurrent bouts should see GP practice Patients with haematuria that does not settle quickly with antibiotics or recurs should also consult their GP Caution: Chlamydia infections may cause symptoms similar to cystitis. If patient presents with associated vaginal discharge refer to GP / practice nurse Some women may confuse the symptoms of thrush and cystitis Recommended treatment Trimethoprim 200mg tablets Frequency of administration & maximum dosage One tablet twice daily (twelve hourly) for 3 days only Advice & Follow up: Complete the 3 day course of medication Maintain a high fluid intake Drink cranberry juice – avoid citrus drinks Toilet hygiene -during urination ensure the bladder is emptied completely. Always wipe from front to back. Some women may find it helpful to be made aware of the risk factors for recurrent infection i.e. use of spermicide, frequent sexual intercourse, new sexual partner Report any adverse outcomes or side-effects to the pharmacist or general practitioner If condition worsens or does not improve after 48 hours then patients should be advised to seek further advice from their GP or NHS direct Tel: 0845 – 4647). For patients using oral contraception or contraceptive patches: FPA advice is: Additional contraceptive precautions should be taken whilst taking a short course of broad-spectrum antibiotics and for 7 days after stopping. If these 7 days run beyond the end of the packet, the next packet should be started immediately without a break (in case of ED tablets the inactive ones should be omitted) If concomitant administration runs beyond the 3 weeks of patch treatment, a new treatment cycle should be started immediately without a patch-free week. Side effects: 50 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Nausea and vomiting Pruritis and rashes Hyperkalaemia Erythema multiforme (rarely) Allergic reactions – photosensitivity, angioedema and anaphylaxis Aseptic meningitis has been reported Please refer to BNF or SPC for full details. All serious adverse reactions must be reported under the yellow card system, preferably electronically. The card can be accessed on www.mca.gov.uk. In addition, yellow cards and directions and guidance on its use are available at the back of the BNF. Interactions: Warfarin, phenytoin (Epanutin), procainamide (Pronestyl), ciclosporin, digoxin, pyrimethamine, azathioprine, mercaptopurine or methotrexate. Clinical Governance review date: April 2010 51 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme SUPPLY & ADMINISTRATION OF MEDICINES BY HEALTH PROFESSIONALS UNDER PATIENT GROUP DIRECTIONS SUPPLY & ADMINISTRATION OF TRIMETHOPRIM 52 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme SUPPLY & ADMINISTRATION OF MEDICINES BY HEALTH PROFESSIONALS UNDER PATIENT GROUP DIRECTIONS Introduction The enclosed Patient Group Direction has been developed by practitioners working in Nottingham Primary Care Trusts. All Patient Group Directions need to be developed in accordance with Health Service Circular (HSC 2000/026) “Patient Group Directions” (England Only). The legislation enables health professionals to supply and administer medicines safely and effectively within the context of the 1968 Medicines Act. It covers treatment “provided by NHS Trusts, Primary Care Trusts, Health Authorities (including SHAs) GP or dentist practices, walk-in centres and NHS funded family planning clinics”. Patient Group Directions (PGDs) may now also be used to cover treatment provided by independent hospitals, medical clinics, prison healthcare services, police services and defence medical services. As with all PGDs these must be developed and authorised within the service. Clinicians working to a PGD should sign a copy to confirm that they have understood its content and received any necessary additional local training to implement it effectively. The “Crown” report (1998) says that health professionals “supplying or administering medicines ---must--- have evidence of competence, training, knowledge, experience and continuing education relevant to the clinical condition to which the PGD applies”. Patient Group Directions will be regularly reviewed within the clinical governance framework of the Trusts. 53 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme SUPPLY AND ADMINISTRATION OF MEDICINES BY HEALTH PROFESSIONALS UNDER PATIENT GROUP DIRECTIONS PATIENT GROUP DIRECTION FOR PHARMACIST ADMINISTRATION OF TRIMETHOPRIM You must be authorised by name, under the current version of this PGD before you attempt to work according to it. Clinical Condition: Indication Presentation of acute simple urinary tract infections Inclusion Criteria Non-pregnant females aged 18 to 65 years Exclusion Criteria Cautions/Need for further advice Action if patient declines or is excluded Informed consent not obtained Previous allergic reaction to trimethoprim Severe renal impairment Blood dyscrasias Pregnancy Breastfeeding Confused or dehydrated Systemically unwell Significant flank pain Patients taking prophylactic trimethoprim Porphyria Complicated urine infections – post-operative Patients taking warfarin, phenytoin (Epanutin), procainamide (Pronestyl), ciclosporin, digoxin, pyrimethamine, azathioprine, mercaptopurine or methotrexate. Concurrent medication should be checked with the BNF Refer to general practitioner / NEMS Document action/ refusal in patients medication record 54 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Drug Details Name, form & Strength of medicine Route/Method Oral Legal Category Prescription Only Medicine (POM) Dosage 200mg (one tablet) Trimethoprim 200mg tablets Frequency Twice daily (every 12 hours) Duration or minimum treatment period Quantity to supply/administer Concurrent Medication 3 days Side effects/ Adverse outcomes 6 tablets Check concurrent medication with the patient or carer for interactions using App 1 BNF. Not to be given to patients taking medication previously highlighted under exclusions. Nausea and vomiting Pruritis and rashes Hyperkalaemia Erythema multiforme (rarely) Allergic reactions – photosensitivity, angioedema and anaphylaxis Aseptic meningitis & uveitis have been reported Please refer to BNF or SPC for full details. Patients or carers should be advised to report adverse outcomes to the appropriate healthcare professional. A pharmacy incident form must be completed. All serious adverse reactions must be reported under the yellow card system, preferably electronically. The card can be accessed on www.mca.gov.uk. In addition, yellow cards and directions and guidance on its use are available at the back of the BNF. Advice to patient or carer Complete course of medication Report any adverse outcomes or side-effects to the 55 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme pharmacist or general practitioner If condition worsens or does not improve after 48 hours then patients should be advised to seek further advice from their GP or NEMS. For patients using oral contraception or contraceptive patches: FPA advice is: Follow up Treatment and referral Facilities & Supplies Records and Audit Trail Additional contraceptive precautions should be taken whilst taking a short course of broadspectrum antibiotics and for 7 days after stopping. If these 7 days run beyond the end of the packet, the next packet should be started immediately without a break (in case of ED tablets the inactive ones should be omitted) If concomitant administration runs beyond the 3 weeks of patch treatment, a new treatment cycle should be started immediately without a patch-free week. Explain further action required i.e. appointment with GP or practice nurse Staff Characteristics Qualifications Specialist Competencies or Qualifications Professional qualification required. Pharmacist registered with RPSGB Has undertaken training in the clinical assessment and treatment of the condition covered by this PGD. Has received training to undertake administration and supply of medicines under Patient Group Directions A stock of patient packs of 6 tablets of trimethoprim 200mg should be maintained by the pharmacy Records of receipt & issue of named medicine must be maintained. Record in patients notes: o Patient’s name, address, date of birth and informed consent given. o GP (if registered). o Any observations taken o Impression of presentation. o Dose, form administered, Batch Number and Expiry Date. 56 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme o Advice/Information given to patient. o Details of any adverse drug reactions and action taken. o Document if patient declines or is excluded under PGD. o A copy will be sent to the patient’s GP for his or her own records with the patient’s consent. Management and monitoring Monitoring will be undertaken during routine pharmacy and clinical governance visits and record keeping audits. References: British National Formulary 55 March 2008 Prodigy –Urinary tract infection (lower) – Women. Revised: July 2005 57 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Patient Group Direction Developed by: Representative of appropriate Professional Group (State discipline-e.g. Pharmacist) Senior Pharmacist – clinical governance lead Signature…………………………………..Date…………………… Samantha Travis Medical Director Signature…………………………………..Date…………………… Trevor Mills Patient Group Direction Authorised by: Signature……………………… Janet Sheard Executive Director of Service Provision Date………………….. Practitioner I have read the contents of the Patient Group Direction and agree to work within its remit. Signed: (Pharmacist) Print Name: Date: Review Date: November 2009 or sooner if new information received Expiry Date: May 2010 58 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM CITY PCT Pharmacy First Protocol / Guidance for treatment Guidelines for consultations for: Hay fever (Oral medication) Definition / Criteria: Symptomatic treatment of seasonal allergic rhinitis in adults and children aged two years and over. Criteria for Inclusion: Adults and children over 2 years of age presenting with symptoms of allergic rhinitis previously diagnosed as hayfever requiring symptomatic treatment. Criteria for Exclusion: Patients under 2 years of age. Pregnancy. Breast feeding. Hypersensitivity to antihistamines or any of the ingredients. Patients with epilepsy, hepatic or renal impairment Action for excluded patients & non-complying patients: Patients should be referred to their GP if the treatment is ineffective or the symptoms persist for longer than 3 months. Patients who are not eligible for treatment under this protocol should be referred to their GP Special considerations/Concurrent medication: Increased sedative effect when antihistamines given with anxiolytics & hypnotics Recommended Treatments: Cetirizine hydrochloride 10mg tablets (30) *P Cetirizine hydrochloride 5mg/5ml oral solution (150ml) *P (Zirtek Allergy Solution) Dosage and Frequency of administration: Adults and children 6 years and above: one (10mg) tablet daily. Children aged between 6 to 11 years: Either one 5ml spoonful (5mg) twice daily or two 5ml spoonfuls (10mg) once daily. Children aged between 2-5 years: one 5ml spoonful (5mg) daily. Follow up & Advice: Explain treatment and course of action. Advise patient not to exceed recommended dose. Advise patient not to drive or operate machinery if they experience any transient drowsiness. Advise patient to seek further advice if symptoms persist or worsen. Avoid allergen contact as much as possible e.g. long grass, fragrant flowers and newly mowed lawns. There is no evidence to support the standard advice to sleep with windows closed. Avoid excess alcohol intake while taking antihistamine. Side effects and their management: Transient side-effects such as headache, dizziness, drowsiness, agitation, dry mouth and gastrointestinal discomfort can be reduced by dividing the dose, 5mg in the morning and 5mg in the evening. General Advice and Follow up: Advise patient to seek medical advice if symptoms persist or worsen. Written Feb 2008 Review date Feb 2010 59 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM CITY PCT Pharmacy First Protocol / Guidance for treatment Guidelines for consultations for: Hay fever (Beconase Nasal Spray) Definition / Criteria: Symptomatic treatment of seasonal allergic rhinitis in adults 18 years of age and over. Criteria for Inclusion: Adults 18 years of age and over presenting with symptoms of allergic rhinitis (sneezing, itchy nose, runny nose and eyes, congestion) previously diagnosed as hayfever requiring symptomatic treatment. Criteria for Exclusion: Patients under 18 years of age. Not to be used in the presence of an untreated nasal infection. Not to be used after nasal surgery (until healing has occurred). Hypersensitivity to any of the components of the nasal spray. Pregnancy Breast feeding Action for excluded patients & non-complying patients: Patients should be referred to their GP if the treatment is ineffective or the symptoms persist for longer than 3 months. Patients who are not eligible for treatment under this protocol should be referred to their GP. Special considerations/Concurrent medication: Systemic effects of nasal corticosteroids may occur, particularly at high doses when used for a prolonged period of time. Recommended Treatments: Beclometasone Dipropionate 50 microgram/ metered spray *P (Beconase Allergy Nasal Spray 180 doses) Dosage and Frequency of administration: 100 micrograms (2 sprays) into each nostril twice daily; max. total 400 micrograms (8 sprays) daily. Follow up & Advice: Explain treatment and course of action. Advise patient not to exceed recommended dose. Advise patient to seek further advice if symptoms persist or worsen. Avoid allergen contact as much as possible e.g. long grass, fragrant flowers and newly mowed lawns. There is no evidence to support the standard advice to sleep with windows closed. Side effects and their management: Local side-effects include dryness, irritation of the nose and throat. Headaches, smell and taste disturbances may also occur. General Advice and Follow up: Advise patient to seek medical advice if symptoms have not improved after 14 days. Written Feb 2008 Review date Feb 2010 60 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme NOTTINGHAM CITY PCT Pharmacy First Protocol / Guidance for treatment Guidelines for consultations for: Hay fever (Opticrom Allergy Eye Drops) Definition / Criteria: Symptomatic treatment of seasonal allergic rhinitis in adults and children aged two years and over. Criteria for Inclusion: Adults and children over 2 years of age presenting with symptoms of allergic rhinitis (red, watery, itchy and puffy eyes) previously diagnosed as hay fever requiring symptomatic treatment. Criteria for Exclusion: Patients under 2 years of age. No nose symptoms. Only one eye is affected. Patient’s eyesight is affected. Pregnancy. Breast feeding. Hypersensitivity to any of the ingredients of the eye drops. Action for excluded patients & non-complying patients: Patients should be referred to their GP if the treatment is ineffective or the symptoms persist for longer than 3 months. Patients who are not eligible for treatment under this protocol should be referred to their GP Special considerations/Concurrent medication: Do not use the eye drops within 2 hours of applying any other eye drops or ointment. Recommended Treatments: Sodium Cromoglycate 2% eye drops (10ml) *P. (Opticrom Allergy Eye Drops) Dosage and Frequency of administration: Adults and children 2 years of age and above: apply one drop four times daily. Follow up & Advice: Explain treatment and course of action. Advise patient not to exceed recommended dose. Advise patient to seek further advice if symptoms persist or worsen. Avoid allergen contact as much as possible e.g. long grass, fragrant flowers and newly mowed lawns. Soft contact lenses should not be worn while using these eye drops. Temporary blurring of the vision can occur after application, wait until the vision is clear before driving or operating machinery. There is no evidence to support the standard advice to sleep with windows closed. Side effects and their management: Transient burning and stinging of the eye may occur. If stinging is severe or lasts for a long time seek medical advice. General Advice and Follow up: Advise patient to seek medical advice if symptoms get worse or are no better after 2 days of using the eye drops. Written Feb 2008 Review date Feb 2010 61 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme The following Pharmacy First Protocols were reviewed in July 2007: Warts and Verrucas Constipation Insect Bites and Stings Bacterial Conjunctivitis Earache Head Lice Athletes Foot Diarrhoea Thrush Haemorrhoids Threadworms Analgesia for Sore Throat Teething Fever/Temperature with URTI (Upper Respiratory Tract Infection) Analgesia for Dental Pain Pharmacy First Protocols approved by: Signature… ……… Dr Trevor Mills GP Prescribing Lead Nottingham City PCT Date………………….. Signature…… …… Mindy Bassi Head of Medicines Management (Joint) Date………………….. 62 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Please photocopy as required PHARMACY FIRST Minor Ailments Scheme Nottingham City Primary Care Trust To: Tania Cook Technician Team Manager –Medicines Management Specialist Pharmacy First Co-ordinator Nottingham City PCT Wollaton Vale Health Centre Wollaton Vale Nottingham NG8 2GR I wish to make the following comments: ………………………………………………………………………………………… ………………………………………………………………………………………….. ………………………………………………………………………………………….. ………………………………………………………………………………………….. ………………………………………………………………………………………….. …………………………………………………………………………………… ………………………………………………………………………………………….. Please continue on a separate sheet if required. Name: …………………………………………………………………………………. Job Title: ………………………………………………………………………………. Practice/Pharmacy/Base: ……………………………………………………………… …………………………………………………………………………………………. ……………………………………………Post Code…………………………………. Telephone No: ……………………………… e-mail: ………………………………… 63 NOTTINGHAM CITY PRIMARY CARE TRUST- Pharmacy First – Minor Ailments Scheme Pharmacy First Contact Details Tania Cook – Technician Team Manager –Medicines Management Specialist Pharmacy First Co-ordinator ………………………………………………………………0779 0003 761 E-mail: tania.cook@nottinghamcity-pct.nhs.uk Samantha Travis – Senior Practice Pharmacist-Clinical Governance ………………………………………………………………0115-8454545 Mindy Bassi-Prescribing Adviser ………………………………………………………………0115-8454545 Caroline Badder – Medicines Management Administrator ..................................................................................... 0115-9123388 Financial Accounts – payments section ........................ 01115-8454545 Ext.39262 By post: Caroline Badder Medicines Management Administrator Nottingham City Primary Care Trust 1 Standard Court Park Row Nottingham NG1 6GN 64
