1. C McCaughey, D McKelvey, J Stewart, C Mallon, P Scullin
Introduction of a Piperacillin and Tazobactam Patient Group Direction (PGD) IN haematology
C McCaughey, D McKelvey, J Stewart, C Mallon, P Scullin

2. National Chemotherapy Advisory Group 2009
Background
Neutropenic sepsis (NS) is a potentially fatal complication of systemic anti-cancer therapy
National Chemotherapy Advisory Group 2009

3. NS toolkit
Regional Policy
Care Bundles
Care Pathway
Staff Education

4. 95%
18%

5. ....but 100% of door to needle breaches out of hours

6. Patient Group Direction
PGDs provide a legal framework that allows the supply and/or administration of a specified medicine(s), by named, authorised, registered health professionals, to a pre-defined group of patients needing prophylaxis or treatment for a condition described in the PGD, without the need for a prescription or an instruction from a prescriber. (NICE, 2013)

7. Legislation & Guidance
Legislation Change PGDs Established 2000
The
Human
Medicines
Regulations
2012
Final
Crown
Report
1999
Supplementary
Prescribing
2002/3
Independent
Prescribing
2006
Health
Service
Circular
2000/026
Evolved to allow flexibility and accessibility to patients
NICE - MPG2 stands for ‘Medicine Practice Guidelines’
NICE PGD overview ‘pathway’ published January 2015
This traditional 'medical model' changed in the years after publication of the final Crown report Review of prescribing, supply and administration of medicines in Legal frameworks were developed that have allowed services to be redesigned and health professionals to work more flexibly for the benefit of patients. In particular, prescribing responsibilities have been extended to enable other health professionals to complete additional training and qualify as non-medical prescribers. In addition, at some key steps in a care pathway, some of these frameworks enable medicines to be supplied and/or administered directly by a health professional, without the need for prescribing.
NICE Medicines
Practice
Guideline 2013
(MPG2) &
NICE PGD
Pathway (2015)
Using a PGD is not a form of prescribing.

8. PGD proposed, written and authorised
Pharmacy
Medicine
Microbiology
Nursing

10. Criteria for staff utilising PGD
Registered nurses who have following training:
Venepuncture and cannulation (one of training)
Administration of medicines and medicines code update (three yearly update)
Anaphylaxis (two yearly update)
Resuscitation (in hospital life support two yearly update)
PGD training
Mandatory training challenge. Ward sister had won Award from Trust to have highest levels of mandatory training attainment despite very challenging staffing vacancies

11. Patient inclusion criteria
18 years and over
Patient must give (verbal) consent to treatment under PGD

12. Patient EXCLUSION criteria
Under 18 years
Known allergy to penicillin or any beta lactams or to beta lactamase inhibitors
Pregnancy or lactation
Patients who do not consent
Staff member must ensure Piperacillin and Tazobactam is appropriate in combination with other medication

13. Standards and guidelines Trust wide implementation

14. Models of training and assessment
Nursing or pharmacy led face to face sessions
Self directed
E learning module
Theoretical knowledge and clinical competence
Completion of questions
Simulated practice assessment
Register

15. Record keeping
Record on patient kardex and on neutropenic sepsis pathway
State: date, time, indication, drug, dose/volume, route, print name and sign
State “administered under PGD”
Document any adverse effects in notes
A record must be kept of all patients treated under PGD for audit purposes

17. Pilot Commenced 24th August 2015
54% of staff trained and training ongoing
Since 2011 average 4 patients with NS a month
Therefore projected around 24 patients

18. Eight patients in 6 week period
1/3 of average NS episodes in last 4 years

20. Results Door to needle time audit - 100% compliance
PGD audit - 100% compliance

21. Conclusions and recommendations
Continue with PGD implementation
Extra focus on sepsis, secondary to PGD education, has perhaps aided 100% door to needle compliance
Continued implementation of PGD has potential to maintain this high standard

22. Ciprofloxacin PGD (for Penicillin sensitive patients) written and ready for launch once Piperacillin and Tazobactam PGD evaluated
Also PGDs for saline flushes, Lidocaine, Chloramphenamine and Hydrocortisone (in event of hypersensitivity reaction) in final stages of development

23. References
NICE (2013) Medicines Practice Guidelines 2 PGDs
NICE (2014) Competency framework: For health professionals using Patient Group Directions
NICE (2015) PGD overview pathway
NHS PGD website: