Developed / Reviewed by the Collaborative Provider PGD (Patient Group Direction) Group (CPPGDG) and approved by the following members of the CPPGDG:

Transcription

1 Patient Group Direction 7.02 version 4.0 Administration of Intravenous Adrenaline (Epinephrine) 1 in 10,000 (100micrograms per ml) Injection in Cardiopulmonary by Registered Practitioners in Torbay and Southern Devon Health and Care NHS Trust Date of Introduction: June 2015 Review Date: May 2017 Developed / Reviewed by the Collaborative Provider PGD (Patient Group Direction) Group (CPPGDG) and approved by the following members of the CPPGDG: Developed By Name Signature Date CPPGDG Physician Dr Ben Leger CPPGDG Pharmacist CPPGDG Practitioner Ope Owoso Deidre Molloy Standing members of CPPGDG from Northern Devon Healthcare Trust / Torbay & Southern Devon Health & Care NHS Trust: Dr Ben Leger (physician) Karena Mulcock (pharmacist), NDHCT Jane Wason (NMP), NDHCT Matt Kaye (pharmacist), NDDH Ian Nash (pharmacist), NDHCT Ope Owoso (pharmacist), TSDHCT Karen Watts (MIU lead), NDDH Lynda Price (pharmacist), TSDHCT Deirdre Molloy (MIU lead), TSDHCT Sally Jarmain (NMP lead), NDHCT Liz Mallyon (administrator), TSDHCT PGD developed / reviewed in consultation with: Organisation: Torbay and Southern Devon Health and Care NHS Trust Name: Steve Williams Title: Officer Ratified on behalf of: TORBAY AND SOUTHERN DEVON HEALTH AND CARE NHS TRUST Signed: Title: Date: Collaborative Provider PGD (Patient Group Direction) Group Page 1 of 6

2 PATIENT GROUP DIRECTION 7.02 version 4.0 ADMINISTRATION OF INTRAVENOUS ADRENALINE (EPINEPHRINE) 1 IN 10,000 (100 MICROGRAMS PER ML) INJECTION IN CARDIOPULMONARY RESUSCITATION BY REGISTERED PRACTITIONERS 1. Clinical Condition Definition of condition/situation Criteria for inclusion Adjunctive use in the emergency management of cardiac arrest. dial 999 immediately Patients aged 12 and over meeting the criteria as defined in the Council (UK) Advanced Life Support (ALS) algorithm for cardiopulmonary resuscitation and relevant Trust resuscitation policy. Intravenous Adrenaline (epinephrine) is indicated: If VF/VT (ventricular fibrillation/ventricular tachycardia) persists after third shock For PEA (pulseless electrical activity) / asystole as soon as intravenous access is achieved Criteria for exclusion Documented DO NOT ATTEMPT RESUSCITATION (DNAR) decision Children under the age of 12 Caution Cautions and contraindications are relative as adrenaline (epinephrine) is intended for use in lifethreatening emergencies, its use should not be delayed see cardiopulmonary resuscitation policy. For information: The effects of adrenaline may be potentiated by tricyclic antidepressants Volatile liquid anaesthetics increase the risk of adrenaline induced ventricular arrhythmias and acute pulmonary oedema if hypoxia is present. Severe hypertension and bradycardia may occur with monoamine oxidase and nonselective beta blocking drugs eg propranolol The risk of cardiac arrhythmias is higher when adrenaline is given to patients on digoxin or quinidine Adrenaline induced hyperglycaemia may lead to loss of blood sugar control in diabetic patients The vasoconstrictor and pressor effects of adrenaline may be enhanced by concomitant administration of drugs such as ergot alkaloids and oxytocin. Pregnancy: Adrenaline crosses the placenta, and may cause foetal tachycardia, cardiac irregularities, extra-systoles and anoxia. There is some evidence of a slight increase in congenital abnormalities. Adrenaline should only be used in pregnancy if the potential benefits outweigh the risks. Action if excluded If patient not for resuscitation, discuss URGENTLY with doctor. Document not for resuscitation status and refer to DNAR policy (Treatment Escalation Plan TEP and Decision record) If under the age of 12, dial 999, maintain the patient s airways, and deliver chest compressions as appropriate. Action if patient refuses medication Not applicable 2. Characteristics of Staff Qualifications required Registered Practitioners who have completed appropriate Council (UK) approved to a minimum level of intermediate adult life support training and cannulation and IV therapy training from relevant Trust. Collaborative Provider PGD (Patient Group Direction) Group Page 2 of 6

3 Additional requirements Working knowledge of relevant Trust Policies, including Medicines Policy and associated Standard Operating Procedures, policy, Anaphylaxis Policy, Consent Policy and Injectable Medicines Policy and associated risk assessments where appropriate. Working knowledge of relevant trust protocols Knowledge of the Trust resuscitation policy and Adult Life Support algorithm with evidence of competency in adult Immediate Life Support (ILS) training. Evidence of continuing professional development, training and competence in IV cannulation and IV drug administration. Working knowledge of the Nursing Midwifery Council (NMC) Standards for Medicines Management 2008, (updated 2010) and other relevant codes of professional practice. 3. Description of Treatment Name of Medicine Legal Class Storage Adrenaline (epinephrine) injection 1 in 10,000 (100micrograms per ml) pre-filled 10ml syringe. POM (prescription only medicine) Store below 25 o C and protect from light. Store in outer carton. Expiry date should be checked on a daily basis Dose to be used (including criteria for use of differing doses) Method or route of administration All doses refer to the 1 in 10,000 (100micrograms per ml) dilution INITIAL DOSE: 1mg (10ml) SUBSEQUENT DOSES: 1mg (10ml) to be repeated every 3-5 minutes if necessary. Intravenous injection via cannulae However, if injected through a peripheral line, the drug must be flushed with at least 20ml Sodium Chloride 0.9% injection (to aid entry into the central circulation). Total dose and number of times drug to be given. Details of supply (if supply made) Advice and information to patient/carer including follow-up Dosage to be administered every 3-5 minutes during cardiac arrest Unusual or life threatening reactions require immediate medical attention. Explain the current course of action to patient and/or carer and the need for urgent medical assessment. Highlight any known medical history to emergency services on hand over. Confirm dose and number of doses of adrenaline given. Specify method of recording supply /administration including audit trail Document allergies and other adverse drug reactions clearly in patient records and inform the GP and other relevant practitioners/patient/carer for further reporting and action if required. Report any adverse drug reactions to the Medicines and Healthcare products Regulatory Agency (MHRA) through the yellow card reporting system ( The following will be recorded in the patient s records: The diagnosis and treatment Collaborative Provider PGD (Patient Group Direction) Group Page 3 of 6

4 The dose of adrenaline (epinephrine) 1 in 10,000 administered Batch number and expiry date The route of administration and site of administration where appropriate The frequency of administration duration of treatment with adrenaline (epinephrine) 1 in 10,000 The time and date of administration of each dose The signature and name of the person administering the adrenaline References used in the development of this PGD: Council (UK) Guidelines 2010 (Accredited by NICE July 2012) Torbay and South Devon Health and Care Trust Protocol Version 8 Adrenaline 1 in 10,000 sterile solution Summary of Product Characteristics (accessed January 2015 via British National Formulary (BNF) 68 September 2014 Please refer to the summary of product characteristics for full information This Patient Group Direction is operational from the start of June 2015 and expires end of May 2017 Collaborative Provider PGD (Patient Group Direction) Group Page 4 of 6

5 Version History Version Date Brief Summary of Change Owner s Name Initial draft version developed from East, Mid & North Devon PCT PGD for the administration of IV adrenaline 1 in 10,000 injection Comments from Cathy Bellamy, Officer, Devon PCT Revised draft version Amendments made following discussion at Devon PGD Group meeting Further comments from Cathy Bellamy, Officer, Devon PCT Reviewed draft version Amendments made following discussion at Devon PGD Group meeting Final version Amendments made following discussion at Devon PGD Group Meeting February 2011 Ratified NHS Devon Patient Group Direction 3.0 March 2013 Approved by NHS Pan Devon Patient Group Direction NHS Pan Devon Patient Group Direction (Provider Services) 3.1 Feb 2015 Reviewed and amended Collaborative Provider Patient Group Direction Group (CPPGDG) Ope Owoso 4.0 April 2015 Approved by Collaborative Provider Patient Group Direction Group Collaborative Provider Patient Group Direction Group (CPPGDG) For more information on the status of this document, contact: Liz Mallyon Torbay and Southern Devon Health & Care NHS Trust Bay House Nicholson Road Torquay TQ2 7TD Direct Dial: [email protected] Date of Issue Reference PGD 7.02 version 4.0 Path H:SH&WD/prescribing/PGDs/Devon Wide PGDs/Adrenaline 1:10,000 (100 micrograms per ml) Injection in Cardiopulmonary Collaborative Provider PGD (Patient Group Direction) Group Page 5 of 6

6 Patient Group Direction 7.02 version 4.0 Administration of Adrenaline (Epinephrine) 1 in 10,000 (micrograms per ml) Injection in Cardiopulmonary by Registered Practitioners The registered practitioners named below are authorised to administer ADRENALINE (EPINEPHRINE) 1 in 10,000 (MICROGRAMS PER ML) INJECTION IN CARDIOPULMONARY RESUSCITATION as specified under this Patient Group Direction, being employees of Torbay and Southern Devon Health and Care NHS Trust CLINICAL AREA LOCATION / DEPARTMENT I agree to administer/supply the above preparation in accordance with this Patient Group Direction: NAME (please print) PROFESSIONAL TITLE SIGNATURE AUTHORISING MANAGER (please print) MANAGER S SIGNATURE DATE Collaborative Provider PGD (Patient Group Direction) Group Page 6 of 6