Download Guidelines for the training in and the

SH CP 04
Guidelines for training in and administration of Midazolam
Hydrochloride Oromucosal Solution (Buccolam®)10mg/2ml
for the Management of Tonic - Clonic Status Epilepticus
in Adults with a Learning Disability
Version: 4
Summary:
How to train in administering and administer buccal
midazolam for tonic - clonic status epilepticus.
Keywords (minimum of 5):
Epilepsy; Status epilepticus; tonic-clonic seizures;
learning disability; buccal midazolam.
(To assist policy search engine)
Target Audience:
Heads of Professions, Medical Staff, Inservice user
and community nursing staff, Pharmacists.
Next Review Date:
February 2021
Approved & Ratified by:
Date issued:
Medicines Management
Committee
Chair approval
February 2017
Author:
Dr Jennifer Dolman and Ian Wheeler
Director:
Lesley Stevens, Medical Director
Date of meeting:
16 November 2016
25 January 2017
1
SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Version Control
Change Record
Date
Author
Version
June 2011
2
June 2011
2
Page
3 and
through
out
3
4
5
6
Reason for Change
Updated in order that principles can be applied to any service
user.
Epidemiology updated.
Deleted reference to use of injectable to avoid confusion.
Prescribed changed to initiation by an epilepsy specialist.
Specific wording on when to use intra-nasal route added.
Deleted list of specific drug interactions. Reference made to
review current BNF instead.
Inserted advice to refer to PIL for up to date information
regarding storage.
Training requirements updated.
‘To contact designated nursing service annually to arrange
training’ changed to ‘recommend individuals attend refresher
course every 2 years, but will depend on frequency of use,’
due to considerable training resource required for original
statement.
‘The usual dose for a person aged 10 years and over is 10mg
(ten milligrams) of Epistatus®. However, the dose should be
checked if other products are prescribed.’
Acknowledgments with thanks to Shire Pharmaceuticals Ltd
for the use of the administration diagrams in Appendix2
October
2011
3
7
20
November
2011
3
5
November
2016
4
9
4
7
Review. Storage requirements of midazolam buccal
4
4
2
Added new updated version control page. Amendment to title
Updated reviewer/contributors list. Updated trust logo
January
2017
Feb 2017
May 2017
Juliet Wells
Reviewers/contributors
Name
Juliet Wells
Carol Bailey
Dr Muzafar Hawramy
Position
Principal Pharmacist MH & LD
Lead LD Nurse
Consultant Psychiatrist in Learning Disability
Version
Reviewed & Date
V4 January 2017
V4 January 2017
V4 January 2017
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Contents
Page
4
1
Purpose
2
Background
4
3
Requirements
5
4
Initial treatment
5
5
Repeat doses
6
6
Drug interactions
6
7
Side effects / contraindication / precautions and treatment of
overdoses
6
8
Advice to the service user and / or carer
7
9
Storage of midazolam
7
10
Legal status
7
11
Responsibilities
8
12
Training
8
13
References
8
14
Acknowledgments
8
Buccal midazolam treatment plan
Instructions for administering buccal midazolam
Responsibilities for the prescription and administration of
buccal midazolam
10
17
Appendix 1
Appendix 2
Appendix 3
18
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Guidelines for training in and administration of Midazolam Hydrochloride
Oromucosal Solution (Buccolam®) 10mg/2ml for the Management of Tonic - Clonic
Status Epilepticus in Adults with a Learning Disability
1.
Purpose
Throughout this document, midazolam hydrochloride oromucosal solution, or
Buccolam®, will be referred to as buccal midazolam
This policy provides a protocol for the training in, safe prescribing and administration of
buccal midazolam for tonic - clonic status epilepticus in Southern Health NHS
Foundation Trust adult service users with a learning disability. However, the principles
could be applied to any Southern Health NHS Foundation Trust adult service user to
whom it was clinically applicable.
This policy applies to all doctors and nurses employed in Southern Health NHS
Foundation Trust.
This policy should be read in conjunction with the Southern Health NHS Foundation
Trust Medicines Control, Administration and Prescribing Policy.
2.
Background
2.1
Epilepsy is a common condition. At least 20% of people with a learning disability across
the lifespan have epilepsy, with higher prevalence figures in institutional settings and
with decreasing IQ2. Chronic epilepsy is more likely to occur in people with a learning
disability than the general population3.
Tonic - clonic status epilepticus is defined as prolonged or recurrent tonic – clonic
seizures persisting for 30 minutes or more. Approximately 5% of all adult service users
attending an epilepsy clinic will have at least one episode of tonic - clonic status,
increased in people with a learning disability1.
2.2
Tonic - clonic status has a mortality of approximately 20%, with the risk of morbidity
increasing with the duration of the status episode1. Early treatment of tonic - clonic
seizures in the premonitory stage of status epilepticus in the community reduces
morbidity and mortality.
2.3
Until recently the most commonly used medication was rectal diazepam. Buccal
midazolam provides an alternative treatment to, but not a replacement for, rectal
diazepam for tonic - clonic status epilepticus. This is an unlicensed use of midazolam,
but there is evidence that it is effective and well tolerated. It is being used increasingly
both in the community and specialised epilepsy units. It is clinically shown to be as
effective as rectal diazepam in the acute treatment of seizures1.
2.4
Administration via the mouth is more socially acceptable and convenient than the rectal
route.
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
2.5
It is crucial to be aware of, and to raise awareness about, differences between the two
proprietary brands; Epistatus® and Buccolam®.
Epistatus®
Midazolam salt is maleate
10mg in 1ml
Unlicensed for all ages
Buccolam®.
Midazolam salt is hydrochloride
10mgs in 2mls
Licensed for infants over 3mths and children
and adolescents up to 18yrs
Buccal midazolam must always be prescribed by brand name to avoid confusion and the
risk of administering the wrong dose.
2.6
At physiological pH midazolam becomes highly lipophilic permitting rapid transfer across
the blood-brain barrier – an advantage over other benzodiazepines. The anticonvulsant
action is thought to be due to enhancement of GABA (gamma aminobutyric acid), the
main inhibitory neurotransmitter in the brain. This causes hyperpolarisation of neurons,
reducing their chance of firing and propagating a seizure. Buccal administration allows
absorption directly into the systemic circulation, bypassing first pass hepatic extraction
thus increasing the amount of active drug at the site of action.
3.
Requirements
3.1
Buccal midazolam is initiated on a named service user basis by an epilepsy specialist
(usually a learning disability consultant or higher trainee), who will determine the
suitability of the service user for buccal midazolam and the dose required.
3.2
The epilepsy specialist will explain to the carers and service user that midazolam is not
licensed for buccal use and is a controlled drug.
3.3
The service user will have a personalised rescue management protocol agreed by the
epilepsy specialist, community nurse, carer and where possible service user (see
Appendix 1).
3.4
The training of carers to administer buccal midazolam will be tailored to each individual
service user.
3.5
There is a current and valid prescription that specifies the brand and is compliant with
CD regulations – see section 10.
3.6
The efficacy and use of midazolam will be monitored by the carers informing nursing
staff, who will ensure the epilepsy specialist is updated.
3.7
Normal procedures to ensure safe drug administration should be followed.
4
Initial Treatment (Appendix 2)
4.1
As buccal midazolam can cause severe drowsiness, the solution should not normally be
administered until after the seizure has lasted 5 minutes.
4.2
However, in exception to the recommended 5 minute delay, carers of service users
known to suffer tonic-clonic seizures that usually last more than 5 minutes with loss of
consciousness, should be advised to administer midazolam immediately or even at the
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
first indicative signs of seizure onset. For those service users, until experience indicates
otherwise, it may be advisable to call an ambulance without delay.
4.3
The usual dose for a person aged 10 years and over is 10mg (ten milligrams) of
midazolam. However, the dose should be checked if other products are prescribed.
4.4
Using the oral syringe provided, administer half of the prescribed dose to each side of
the buccal cavity (between the lower gums and cheeks). If this is not possible, the whole
dose should be administered to the buccal cavity on one side of the mouth. The dose
must not be administered below the tongue since the teeth may clamp shut and break
the syringe in the mouth.
4.5
In cases of excessive salivation Buccolam® can be administered intra-nasally. This must
be documented within the individual treatment plan of prolonged or serial seizures and
staff must have appropriate knowledge, training and guidance.
4.6
In normal circumstances an ambulance should be called at the same time as the first
dose of midazolam is administered. However, if it is known that the service user usually
responds positively to the first dose then the call for an ambulance should wait until the
second dose is needed.
4.7
Ideally the service user should remain supine for at least an hour after administration.
The service user will be drowsy for several hours after administration and may be
protected from recurring seizures for up to four hours.
5
Repeat doses
5.1
Initial effects become apparent after approximately 5 minutes. If no beneficial effect
(that is reduction in seizure activity) is apparent 10 minutes after administering
midazolam, a second dose of 10mg (ten milligrams) may be administered. If calling the
ambulance was delayed at administration of the first dose, it must be called at
administration of the second.
5.2
No more than two doses of 10mg (ten milligrams) of midazolam should be administered
in any 24 hour period.
6
Drug Interactions
Refer to current BNF, ‘anxiolytics and hypnotics’ for interactions. Of particular note are
midazolam’s interactions with certain antibiotics (e.g. erythromycin, clarithromycin),
some blood pressure medications (e.g. ramipril) and anticoagulants.
7
Side Effects/Contraindication/Precautions and Treatment of Overdoses
7.1
Drowsiness, prolonged sedation and ataxia are the most commonly reported side
effects.
7.2
Nausea, vomiting, constipation, dry mouth and hiccup have also been reported.
7.3
Respiratory depression may occur after 3 doses administered closely together.
Therefore a third dose should only be administered in hospital. Buccal midazolam
should be used with caution in service users with chronic respiratory insufficiency.
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
7.4
Severe irritation to mucous membranes may occur after nasal administration.
7.5
Paradoxical reactions (e.g. agitation, involuntary movements, hyperactivity, hostility,
aggression and excitement) have been reported, although these are rare.
7.6
Contraindications include hypersensitivity and acute narrow angle glaucoma.
7.7
The safety of midazolam in pregnancy and breastfeeding has not been established.
7.8
Signs of respiratory depression and overdose may be indicated by excessive
somnolence, confusion, hypotension, decreased respiratory rate and paradoxical
excitation. An ambulance should be called immediately.
8
Advice to the Service User and/or Carer
A Service user Information Leaflet (PIL) is provided with each Buccolam® pack
dispensed. It is recommended that carers read the contents of the PIL to familiarise
themselves with its contents prior to the first administration.
9
Storage of Midazolam
9.1
Buccolam® is available in cartons containing four pre-filled, orange-coloured syringes.
The pack should be stored upright at 15-25oC and never be refrigerated or frozen. Up to
date information regarding the storage of buccal midazolam should always be obtained
from the PIL provided with each pack. Buccal midazolam oral syringes must be kept in
the protective plastic tube which must have an intact tamper evident seal.
9.2
Buccal midazolam must be kept in a locked controlled drugs cupboard and recorded in
the controlled drugs register. Where buccal midazolam is used for leave purposes, it
must be entered in and out of the controlled drugs register to maintain an audit trail.
9.3
Any buccal midazolam that needs to be destroyed must be done in accordance with
Trust guidelines for the destruction of controlled drugs (MCAPP SH CP1)
10
Legal Status
10.1
Midazolam is a schedule 3 controlled drug and should be stored, dispensed and
administered in line with Trust and Organisational Policy and Procedures on
controlled drugs (MCAPP SH CP 1).
10.2
Midazolam is not licensed for buccal use in adults and this will be explained to the carers
and service user by the epilepsy specialist. However it is recommended by NICE for use
in the community for adults and children who have had previous episodes of prolonged
and serial seizures4.
10.3
As buccal midazolam is a schedule 3 CD, prescriptions must contain the following
information: dose; form; strength; total quantity or dosage units in words and figures.
The brand name should be specified to comply with good practice. Prescriptions are
only valid for 28 days from date of signing.
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
11
Responsibilities
All professionals and carers involved in the prescription and administration of buccal
midazolam should be aware of their responsibilities, detailed in appendix 3.
12
Training
12.1
Southern Health NHS Foundation Trust staff who wish to be deemed as trainers will be
registered nurses (usually within the Community Learning Disabilities Healthcare Teams
or inpatient services.)
12.2
The nurses’ training will be approved by the Trust Chief Pharmacist and their
Directorate lead nurse.
12.3
Appropriate staff members will be able to give formal training to staff employed by
private care providers in the community. Training will incorporate both general epilepsy
awareness and the administration of buccal midazolam as suggested by the Joint
Epilepsy Council.
12.4
On successful completion of training, staff not employed by the Trust will be given a
certificate stating they have received training in the administration of buccal midazolam
and observed practicing the procedure within the classroom. However as not observed
in clinical practice, competence cannot be confirmed. It is the responsibility of the
individual’s line manager to determine their suitability to administer buccal midazolam
according to the organisation’s own policies and procedures.
13
References
1. Shorvon, S. (2010). Handbook of Epilepsy Treatment. (3rd edition). Oxford: Blackwell
Publishing Limited.
2. Working Group of the International Association of the Scientific Study of Intellectual
Disability (IASSID) (2001). Clinical Guidelines for the Management of Epilepsy in
Adults with an Intellectual Disability. Seizure, 10: 401-409.
3. Stokes, T., Shaw, E.J., Juarez-Garcia, A., Camosso-Stefinovic, J., and Baker, R.
(2004). Clinical Guidelines and Evidence Review for the Epilepsies: diagnosis and
management in adults and children in primary and secondary care. London: Royal
College of General Practitioners.
4. NICE clinical guideline 137.(2012). The epilepsies: the diagnosis and management of
the epilepsies in adults and children in primary and secondary care (last updated
February 2016).
14
Acknowledgements
This policy has been written using documents from the following:





Colchester Learning Disability Service
The Joint Epilepsy Council
Cornwall Partnership NHS Trust
Southampton and Winchester Districts Prescribing Committee
Fareham and Gosport PCT
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
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(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017



Northamptonshire Partnership NHS Trust
Bristol Royal Hospital For Children Community Paediatric Neurology Team
Gloucestershire Partnership NHS Trust
Acknowledgments with thanks to Shire Pharmaceuticals Limited for the use of the
administration diagrams in Appendix 2
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
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(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Appendix 1 – Buccal Midazolam Treatment Plan
The Treatment Plan must clearly specify the exact intervals when medication is to be
administered in an epileptic seizure.
The individual Treatment Plan is prescribed by an epilepsy specialist (learning disability
consultant or higher trainee), in collaboration with the community nurse, carer and service user.
(Please use language appropriate to the lay person when completing this form)
Service user’s Name:
Date of Birth:
Address:
Photo
Date operational from:
Review Date:
Completed by:
Seizure classification and description of seizures which may require buccal midazolam:
After how long of seizure activity should buccal midazolam be administered?
What is the first dose of midazolam that should be administered?
If there are difficulties in the administration of midazolam what actions should be taken?
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
What is the service user’s usual reaction to buccal midazolam?
Can a second dose of buccal midazolam be given?
After how long can a second dose of buccal midazolam be given?
How much buccal midazolam is given as a second dose?
What is the maximum dose that can be given in 24 hours?
When should 999 be dialled for emergency help?
When should the service users GP be consulted?
Who should witness the administration of buccal midazolam?
Who needs to be informed? (Parent/Carer/GP/Community Nurse etc. and contact details)
Under what circumstances should buccal midazolam NOT be given e.g. Rectal diazepam
already recently administered?
ALL OCCASIONS WHEN BUCCAL MIDAZOLAM IS ADMINISTERED MUST BE RECORDED
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
This Plan has been agreed by the following:
Prescribing Doctor:
Name (please print) ………………………………………
Signature ………………………
Community Nurse:
Name (please print) ………………………………………
Signature ………………………
Parent/Carer/Guardian:
Date ………………
Name (please print) ………………………………………
Signature ………………………
Service user:
Date ………………
Name (please print) ………………………………………
Signature ………………………
Respite Care:
Date ………………
Name (please print) ………………………………………
Signature ………………………
Day Services:
Date ………………
Date ………………
Name (please print) ………………………………………
Signature ………………………
Date ………………
If the service user does not have the capacity to consent to the use of buccal midazolam a
statement to that effect should be written here by the epilepsy specialist.
Signature:
Date:
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Suspected reaction to Midazolam given as emergency
treatment for Epileptic Seizures.
To be completed by the carer or nurse.
Service user Name:
Address:
Date of Birth:
Time and dose of
midazolam given and
administrative route: i.e.
buccal/intranasal
Time:
Dose:
Route:
Buccal midazolam preparation is unlicensed in adults. Please report all suspected
reactions to the consultant. Please give a clear account of the event.
Signature:
Date:
Copy to: consultant and nurse and one copy
to remain in the service user notes/ePMR
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
AUTHORISED PERSON(S) TRAINED TO ADMINISTER BUCCAL MIDAZOLAM
Service user’s Name:_____________________________________
DOB:_________________________________
NAME ……………………………………. Signature ………………………. Date ………………
(Block capitals
NAME ……………………………………. Signature ………………………. Date ………………
(Block capitals)
NAME ……………………………………. Signature ………………………. Date ………………
(Block capitals)
NAME ……………………………………. Signature ………………………. Date ………………
(Block capitals)
NAME ……………………………………. Signature ………………………. Date ………………
(Block capitals)
HEAD OF CARE HOME
…………………………………………….. Signature ………………………. Date ………………
(Block capitals)
THIS FORM SHOULD BE KEPT IN THE SERVICE USER’S MAIN FILE AND WITH THEIR
MEDICATION CHART
Expiry date of this form …………………………………………
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
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(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
When calling 999 to summon an ambulance say:
‘This is _____________________________________ (include your name, location address
and phone number). We have a service user who has had/ is having an epileptic seizure.
Buccal midazolam has/has not been given. We need a paramedic team urgently.
The service user’s name is _______________________and date of birth is_____________’

Inform ambulance control of the exact location and best entrance to use and state that the
crew will be met and taken to the service user (if possible).


Speak clearly and slowly and be ready to repeat information if asked.
Send a member of staff to wait at the entrance to direct the ambulance crew as necessary.
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
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(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
EVALUATION SHEET AND RECORD OF USE OF BUCCAL MIDAZOLAM
NAME OF SERVICE USER………………………………………………………..
D.O.B.………………………
DATE
RECORDED/ADMINISTERED
BY
TYPE OF SEIZURE
LENGTH AND/OR
NUMBER OF SEIZURES
INITIAL DOSAGE
OUTCOME
SECOND DOSAGE (IF ANY)
OUTCOME
OBSERVATIONS
PARENT/GUARDIAN
INFORMED
PRESCRIBING DOCTOR
INFORMED
OTHER INFORMATION
WITNESS
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
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(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Appendix 2- Instructions for administering buccal midazolam
®
Text from Product Administration Leaflet for Buccolam (10mg/2ml) Oromucosal solution. Permission
to use the images given by Shire Medical Information)
HOW TO GIVE THE MEDICINE
Step 1: Hold the plastic tube, break the seal at one end and pull the cap off. Take the syringe out of
the tube.
Step 2: Pull the red cap of the tip of the syringe and dispose it safely
Step 3: Using the finger and thumb gently pinch and pull back the cheek. Put the tip of the syringe into
the back of the space between the inside of the cheek and the lower gum
Step 4: slowly press the syringe plunger until the plunger stops. The full amount of the solution should
be inserted slowly into the space between the gum and the cheek. If necessary, for larger volumes or
smaller patients, approximately half the dose should be given into one side of the mouth and the other
half unto the other side.
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Appendix 3 – Responsibilities for the prescription and administration of buccal
midazolam
Aspects of care for which the epilepsy specialist is responsible
Assess suitability of service users for this treatment.
Inform the service user and carer of the unlicensed status of buccal midazolam in adults and
what this means.
Inform the service user and carer of potential side effects.
Prescribe the correct dose.
Initiate and assess the efficacy of the treatment.
Liaise with the GP to agree the service user’s shared care.
Provide the first supply of medication for use at home.
Follow up and monitor.
Keep the carers, GP and community nurses informed of any changes in treatment.
Aspects of care for which the nurse is responsible
The nurse is only to become involved when the service user is under the epilepsy specialist
and is only responsible while the service user is open to the nursing service
Discuss the provision of the service with parent/carer/service user needing buccal
midazolam.
Write the Treatment Plan on the advice of the epilepsy specialist, which includes the
epilepsy specialist’s signature.
Advise service user/parent that the Treatment Plan is specific to the service user.
Arrange date, time and place for initial training.
Train the carer in the method of administration.
Train the carer in recognising the need for urgent hospital care.
Assess and monitor the service user’s response to treatment.
Keep a copy of Treatment Plan and training attendance list (approved non-nursing staff)
within the file
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Maintain regular contact with the service user and epilepsy specialist in order to monitor the
use and effectiveness of buccal midazolam.
Monitor the Treatment Plan and evaluate effectiveness, following implementation by
volunteers.
Aspects of care for which the GP is responsible
Prescribing supplies for buccal midazolam once an effective dose has been established.
Liaise with the consultant regarding complications or efficacy of treatment if the service user
has two or more seizures in any 24 hour period.
Care Home and Service providers’ responsibilities
Identify volunteers for training.
As recommended by the Joint Epilepsy Council, to attend a refresher course every 2 years,
but this will depend on the frequency of use.’
Ensure amendments/exclusions to Treatment Plan (Appendix 1) requested by service users
are clearly documented and, where appropriate, discussed with doctor and the nursing
service.
Ensure that each service user has an up-to-date Treatment Plan.
Ensure that staff are insured to carry out this procedure.
Ensure photo of the service user requiring buccal midazolam administration is displayed with
a prescription for the medication, in an appropriate place.
Develop an action plan to be used in the event of a service user requiring buccal midazolam,
which takes into consideration their privacy and dignity, and outings.
Ensure that medication is available, stored correctly and is in date.
Copy of Treatment Plan and consent/agreement form to be kept with service user’s care file.
Copy of responsibilities of volunteers to be given to each volunteer.
Volunteers' responsibilities
Adhere to the guidance.
Only undertake the administration of buccal midazolam after satisfactory completion of the
training specified in these guidelines and subsequent up-date training. No person other than
those named on the buccal midazolam treatment plan for a specific service user can
administer the buccal midazolam.
Only deliver care specified in the buccal midazolam Treatment Plan (Appendix 1) to the
service user identified on the Plan; record, accurately, appropriate information on Evaluation
Sheets.
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SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
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(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017
Contact the designated nursing service for advice, support or queries relating to delivery of
care as specified in the Treatment Plan (Appendix 1).
The epilepsy training is ‘service user specific’.
20
SH CP 4 - Guidelines for training in and administration of Midazolam Hydrochloride Oromucosal Solution
®
(Buccolam ) 10mg/2ml for the Management of Tonic - Clonic Status Epilepticus in Adults with a Learning Disability
Version: 4
February 2017