Medical Bag Ursula Treadgold August 2008

Why important? Home visits Home visits During day as routine During day as routine During day as emergency During day as emergency Out of hours Out of hours Change due to contract changes Change due to contract changes

Safety precautions Inform people where you are going Inform people where you are going Mobile phone Mobile phone Torch Torch Lock car Lock car Limited drugs and prescriptions Limited drugs and prescriptions Ask family member to meet you/ have towel/ blanket somewhere obvious Ask family member to meet you/ have towel/ blanket somewhere obvious Ask police to meet you if violence a possibility Ask police to meet you if violence a possibility Consider rape alarm Consider rape alarm

Visits in day House bound House bound Nursing homes Nursing homes Post natal visits Post natal visits Acute unwell and unable to get to surgery Acute unwell and unable to get to surgery Psychiatric assessments Psychiatric assessments Terminal illness Terminal illness

Before you go Why are you going? Why are you going? Do you need any equipment e.g. nebuliser? Do you need any equipment e.g. nebuliser? Confirm address Confirm address Directions ( sat nav, map) Directions ( sat nav, map) Urgency of visit so you can go in correct order Urgency of visit so you can go in correct order

When you get there –Introduce yourself –Make friends with the dog –Ask for tv/ radio to be turned off –Good light –In bedroom for examination –Wash hands after

No answer at door Make lots of noise Make lots of noise Stick nose through letter box ( be careful of dogs) Stick nose through letter box ( be careful of dogs) Find another entrance, you may not have been told the back door is open Find another entrance, you may not have been told the back door is open Phone from mobile phone Phone from mobile phone High level of concern, phone police High level of concern, phone police

Your bag It’s yours! It’s yours! It will evolve with time It will evolve with time Your responsibility Your responsibility Keep drugs in date Keep drugs in date Drugs should be in a lockable container Drugs should be in a lockable container

Equipment Stethoscope Stethoscope Pen Pen Phone Phone Patient records Patient records Sphyg Sphyg Opthalmoscope/ auriscope Opthalmoscope/ auriscope Thermometer Thermometer Peak flow meter Peak flow meter Tape measure ( DVTs) Tape measure ( DVTs)

Paperwork Headed notepaper Headed notepaper Envelopes Envelopes BNF BNF Phone number list Phone number list Prescriptions Prescriptions Reference chart of emergency drug doses Reference chart of emergency drug doses Map book Map book Controlled drugs record book Controlled drugs record book Pathology forms Pathology forms Peak flow chart/ obstetric wheel Peak flow chart/ obstetric wheel

Clinical Tongue depressors Tongue depressors Urine pots Urine pots Urinalysis sticks Urinalysis sticks Gloves Gloves KY jelly KY jelly BM test BM test Venesection equipment and blood bottles Venesection equipment and blood bottles Venflons/ butterflies Venflons/ butterflies Mini sharps box Mini sharps box Fluorescein strips Fluorescein strips

Emergency Drugs What conditions are you going to see? What conditions are you going to see? Anaphylaxis Anaphylaxis Asthma Asthma MI MI LVF LVF Diabetic hypo Diabetic hypo Epileptic fit Epileptic fit Meningitis Meningitis Analgesic cases e.g. renal colic Analgesic cases e.g. renal colic

Anaphylaxis Adrenaline 1ml in 1000 Adrenaline 1ml in 1000 Chlorpheniramine 10mg/ml Chlorpheniramine 10mg/ml Hydrocortisone injection 100mg Hydrocortisone injection 100mg Water for reconstitution Water for reconstitution Card for doses!!! Card for doses!!!

Asthma Salbutamol nebules (N.B. once packet opened it has only few weeks before it has to be thrown away, put date on) Salbutamol nebules (N.B. once packet opened it has only few weeks before it has to be thrown away, put date on) Salbutamol inhaler Salbutamol inhaler Prednisolone soluble tablets Prednisolone soluble tablets Hydrocortisone (as before) Hydrocortisone (as before)

MI Aspirin 300mg Aspirin 300mg GTN spray GTN spray Diamorphine injection (N.B. this needs to be stored in locked compartment and book kept in bag to ensure batch numbers correspond with CD book in surgery) Diamorphine injection (N.B. this needs to be stored in locked compartment and book kept in bag to ensure batch numbers correspond with CD book in surgery) Metoclopramide 10mg Metoclopramide 10mg

LVF Furosmide 20mg ampoules Furosmide 20mg ampoules Diamorphine injection Diamorphine injection Bradycardia- atropine 600 mcg Bradycardia- atropine 600 mcg

Diabetic hypo Hypostop Hypostop Glucagon injection Glucagon injection Glucose i.v. solution Glucose i.v. solution

Epileptic fit Rectal diazepam Rectal diazepam

Meningitis Benzylpenicillin 600mg x2 ampoules Benzylpenicillin 600mg x2 ampoules Data sheet for doses Data sheet for doses Water to reconstitute Water to reconstitute ?? Penicillin allergy ?? Penicillin allergy Cefotaxime or chloramphenicol Cefotaxime or chloramphenicol

Analgesics Diclofenac injection 75 mg Diclofenac injection 75 mg Pethidine injection Pethidine injection Diamorphine Diamorphine

Oral preparations Depends on where you are Depends on where you are Generally now I only carry the following Generally now I only carry the following Aspirin Aspirin Prochlorperazine (labyrinthitis) Prochlorperazine (labyrinthitis) Chlorpheniramine Chlorpheniramine

What you need to ensure Check drugs regularly ( every 3 months) Check drugs regularly ( every 3 months) In date In date Book of injections with their expiry dates Book of injections with their expiry dates

Dispensing drugs Into bottle or envelope you can seal Into bottle or envelope you can seal Clearly label Clearly label Patient name Patient name Drug Drug Date Date Dose Dose How to take How to take How many tablets given How many tablets given Warnings e.g. keep away from children Warnings e.g. keep away from children

Your documentation Drug given Drug given Batch number Batch number Expiry date Expiry date

Ordering supplies –Dispensing practice, easy it comes from your dispensary! –The practice may order in small stock of injectables –Local pharmacy, NHS prescription written in patients name

Other equipment Nebuliser Nebuliser Oxygen Oxygen Emergency box:- Emergency box:- Airways, pulse oximeter, ECG, defibrillator, urinary catheterisation set, Laerdel mask Airways, pulse oximeter, ECG, defibrillator, urinary catheterisation set, Laerdel mask Torch Torch Dressing pack, suture equipment Dressing pack, suture equipment