Health (Drugs and Poisons) Regulation Drug Therapy Protocol Rural and Isolated Practice Area Endorsed Nurse

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1 Health (Drugs and Poisons) Regulation 1996 Drug Therapy Protocol Rural and Isolated Practice Area Endorsed Nurse Health Protection Unit Medicines Regulation and Quality PO Box 21 Fortitude Valley BC QLD 4006 Telephone (07) Facsimile (07) Disclaimer: Please note that any material printed is regarded as an uncontrolled copy. It is the responsibility of the person printing the document to refer frequently to for updates

2 Health (Drugs and Poisons) Regulation 1996 Drug Therapy Protocol Rural and Isolated Practice Area Endorsed Nurse This drug therapy protocol, made under sections 67(2) and 175(2) of the Health (Drugs and Poisons) Regulation 1996 states the circumstances and conditions under which a rural and isolated practice area endorsed nurse is authorised to administer or supply the restricted and controlled drugs listed in Appendix 1 to this document. Conditions and circumstances of this drug therapy protocol 1. A rural and isolated practice area endorsed nurse may only administer and supply those drugs listed in Appendix 1 for which a Health Management Protocol has been developed and approved by the employer. The minimum requirements for a Health Management Protocol are contained in Appendix The actions of the rural and isolated practice area endorsed nurse must at all times be in accordance with this Drug Therapy Protocol and the Health Management Protocol The rural and isolated practice area endorsed nurse must have access to current versions of the following literature: 3.1 A copy of this Drug Therapy Protocol; and 3.2 Health Management Protocols relevant to this Drug Therapy Protocol; and 3.3 A current MIMS Annual and Australian Medicines Handbook; and 3.4 A copy of the Health (Drugs and Poisons) Regulation 1996; and 3.5 Current edition of the NHMRC Australian Immunisation Handbook. 4. The rural and isolated practice area endorsed nurse must be aware that practising within the Drug Therapy Protocol does not relieve that person of their legal responsibility or accountability for that person's actions and may not provide immunity in case of negligence. 5. Prior to the and/or supply of a drug, the rural and isolated practice area endorsed nurse must familiarise himself/herself with the contra-indication(s) and known side effects of the drug, and advise the patient accordingly. 6. Where a drug is supplied by the rural and isolated practice area endorsed nurse, the primary medicine container must be labelled as required by the Health (Drugs and Poisons) Regulation When Consumer Medicine Information is available for a particular drug, the rural and isolated practice area endorsed nurse should offer this information to each person when administering or supplying medication. Certification Certified at Brisbane on this 3rd day of June Dr Jeanette Young Chief Health Officer Department of Health 1 Unless, if in the opinion of the nurse such actions would be detrimental to the patient. In such instances, a doctor must be consulted Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

3 Appendix 1 Controlled Drugs: Opioid Analgesics Fentanyl Adult only IM or 1.5 microgram / kg to a max. of 100 microgram IV Up to a maximum of 100 micrograms in increments, repeated every 10 minutes if required. Morphine Sulphate Pethidine Adult only IM / : Up to 10 mg, based on 0.1 mg 0.2 mg / kg IV: Up to 10 mg. For chest pain due to Acute coronary syndrome (ACS) / unstable angina / myocardial infarction: Initial dose of 2.5 mg then 2.5 mg increments, repeated every 5-10 minutes if required. All other uses: Initial dose of 2 mg then increments, repeated every 3-5 minutes if required. Up to 100mg, either stat (IM) OR IN 25 mg (IV) increments for relief of acute trauma pain only Analgesics and Antipyretics Indomethacin Rectal Ketorolac trometamol Adult only. Single dose up to 30 mg Methoxyflurane Inhalation Adult: 3 ml may be repeated after 20minutes to a maximum of 6 ml Paracetamol 500 mg / Codeine 30 mg Antibiotics and other Anti-infective agents () Acyclovir Albendazole Amoxycillin Amoxycillin/Clavulanic Acid Azithromycin Administer one dose and supply one full course as necessary Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

4 Antibiotics and other Anti-infective agents () continued Cefaclor Child only Administer one dose and supply one full course as necessary Cefuroxime Adult only Administer one dose and supply one full course as necessary Cephalexin Administer one dose and supply one full course as necessary Ciprofloxacin Single dose only Clindamycin Dicloxacillin Doxycycline Erythromycin Flucloxacillin Metronidazole Nitrofurantoin Administer one dose and supply one Phenoxymethypenicillin full course as necessary Roxithromycin Tinidazole Trimethoprim Trimethoprim/ Sulfamethoxazole Valaciclovir Antibiotics (Parenteral) Benzathine Benzylpenicillin (Pan Benzathine Benzylpenicillin) Benzathine Penicillin (Bicillin L-A) Benzyl/Procaine/Benzathine Penicillin (Bicillin All purpose) Administer one dose Ceftriaxone Administer one dose reconstituted with Lignocaine 1% injection Procaine Penicillin Administer one dose Antibiotics and other Anti-infectives (Topical) Clindamycin Intravaginal Dexamethasone 0.5 mg/ Ear drops Framycetin Sulphate 5 mg/ Gramicidin 0.05 mg/ml Flumethasone Pivalate Ear drops 0.02%/ Clioquinol 1% Mupirocin Topical Cream/ointment Silver Sulphadiazine 1% Topical cream Triamcinolone Compound Ear ointment Ear drops (ear wicks) Administer first dose and supply remainder of pack Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

5 Antibiotic Adjuncts Probenecid Antidotes and other Reversal Agents (Agents to treat adverse effects) Benztropine Glucagon Hydrocortisone Naloxone Maximum 2mg 2-4mg/kg to maximum 200mg Maximum 0.4mg Antiemetics Metoclopramide Adults Only: Single dose only maximum 10mg Prochlorperazine Adults Only: Single dose only maximum 20mg Antihistamines Promethazine Maximum 25mg Antivenoms Snake polyvalent anti-venom One ampoule (40,000 units) Box jellyfish anti-venom One ampoule (20,000 units) Bronchodilators Ipratropium Bromide Salbutamol Nebulised Metered dose inhaler (MDI) Nebulised Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

6 Cardiovascular Medicines Frusemide Adults Only: IM 40 mg maximum one dose only OR IV 40 mg maximum - one dose only Glyceryl Trinitrate Transdermal Patches Up to a maximum of 14 hours daily Nifedipine Dermatologic Preparations Podophyllotoxin Topical Treat with local application twice daily to a maximum of 6 weeks Insulin Insulin Local anaesthetic Lignocaine 1% Lignocaine with Adrenaline Oxybuprocaine eye drop 0.4% (minim) Local infiltration Or mixed with Ceftriaxone IM injection Topical only Topical to eye Single dose minim - never to be given to take home Sedatives Diazepam Haloperidol Rectal Adults: 10mg Children: Dose adjusted on weight per Health Management Protocol Adults only 5 mg Stat with second 5 mg dose if required to maximum of 10 mg Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

7 Sedatives continued Lorazepam Adult Only 1 mg stat Midazolam Olanzapine Intranasal Buccal Must consult Medical Officer, Nurse Practitioner unless circumstances do not allow, in which case notify as soon as circumstances allow Adults only Must consult Medical Officer, Nurse Practitioner unless circumstances do not allow, in which case notify as soon as circumstances allow Immunisation General circumstances, restrictions and conditions applying to all vaccines administered by a Rural and Isolated Practice Area Endorsed Nurse Circumstances when of vaccine authorised An agent registered by the Therapeutic Goods Administration (TGA) for vaccination: in accordance with the current National Immunisation Program schedule (NIPs); or as approved by the National Health and Medical Research Council (NHMRC) for future inclusion in the NIPs; or for use in other immunisation programs that have been approved by the Chief Health Officer; or for use in a case/outbreak situation, or other specific situations, as directed by a Public Health Medical Officer; or vaccines in Table 1; or vaccines used in Restricted Immunisation Programs Table 2. applying to the of all vaccines Consider and evaluate the potential for actual severe adverse reactions as specified in the current edition of the NHMRC Australian Immunisation Handbook. Consider and evaluate contraindications to the of a vaccine as specified in the current edition of the NHMRC Australian Immunisation Handbook or as approved by the NHMRC to appear in future editions of the handbook. In other instances, refer to the contraindications section of the product information. Ensure the dose and route of of vaccines is as specified in the current edition of the NHMRC Australian Immunisation Handbook or recommended/approved by the NHMRC. Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

8 Table 1 Vaccines that include the following antigens which may be administered by a Rural and Isolated Practice Area Endorsed Nurse Antigens Diphtheria Tetanus Pertussis Haemophilus influenzae type b Hepatitis A Hepatitis B Human Papillomavirus Poliomyelitis Influenza Measles Mumps Rubella Meningococcal C Meningococcal (ACWY) Pneumococcal Rotavirus Varicella Conditions of Use These antigens may be used singularly or in combination form, as available, under an approved a immunisation programs or an immunisation program carried out by a local government, hospital and health services, the department (Queensland Health) or a certified immunisation program b. a Approval by the Chief Health Officer. b Certified by the chief executive Queensland Health or delegate. Table 2 Restricted immunisation programs Restricted Immunisation Programs Japanese Encephalitis inactivated JE vaccine Q Fever purified killed suspension of Coxiella burnetii (including skin tests) Tuberculosis BCG (including tuberculin testing) Restrictions on Use The immunisation program is approved by the relevant Public Health Medical Officer. The immunisation program is approved by the Chief Health Officer. Only if the Immunisation Program Registered Nurse is certified by the Centre for Healthcare Related Infection Surveillance and Prevention and Tuberculosis Control and only under the Queensland Department of Health Tuberculosis Control Program Note:Immunisation program means (a) an immunisation program carried out by the department (Queensland Health); or (b) an immunisation program carried out by a local government; or (c) a certified immunisation program Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June

9 Appendix 2 Health Management Protocol Minimum Requirements 1. The employer must have a current Health Management Protocol that supports and details the clinical use, or supply of or supply of the scheduled drugs and poisons listed in Appendix 1 of this Drug Therapy Protocol. 2. The Health Management Protocol must be developed or another organisation s Health Management Protocol may be adopted by an inter-disciplinary health team appointed by the employer under whose jurisdiction the Health Management Protocol will be implemented. 3. As a minimum, the team must consist of a medical practitioner, a rural and isolated practice area nurse and pharmacist, and may include other identified professional personnel as considered appropriate by the employing organisation. 4. Following a period of two years or sooner if considered necessary, the Health Management Protocol must be reviewed by the inter-disciplinary team. Content of a Health Management Protocol The Health Management Protocol clearly identifies the following: 1. The procedures for clinical assessment, management and follow-up of patients, including the recommended drug therapy for the relevant clinical problem. 2. A clinical indication or time when medical referral/consultation must occur for that condition 3. The name, form and strength of the drug and the condition/situation for which it is intended. 4. The recommended dose of the drug. 5. The route of of the drug. 6. The frequency (including rate where applicable) and duration of of the drug. 7. The duration of the drug supply before medical intervention/follow-up is required. 8. The type of equipment and management procedures required for management of an emergency associated with the use of the drug. Endorsement of a Health Management Protocol 1. A new or reviewed Health Management Protocol must be endorsed and dated by Chief Executive Officer of a Hospital and Health Service or the Chief Executive Officer of a non-queensland Health employing organisation. 2. The Health Management Protocol shall be effective for a maximum of two (2) years from the date of endorsement by the employer. 3. The Primary Clinical Care Manual contains the principal Health Management Protocols to be used in rural and remote ambulatory settings by rural and isolated practice area endorsed nurses. Drug Therapy Protocol: Rural and Isolated Practice Area Endorsed Nurse June