Download Patien t Group Direction for the Supply/administration of Zidovudine

Isle of Wight Healthcare NHS Trust
Department of Genitourinary Medicine
Patient Group Direction for the Supply/administration of Trichloracetic Acid 80 – 90%
solution for genital condylomata acuminata (genital wart) infection – primary and
recurrent
Define situation/condition
First line management of uncomplicated genital warts infection
National Guidelines for the management of anogenital warts,
2002 – Clinical Effectiveness Group – AGUM and MSSVD,
www.agum.org.uk
Criteria for inclusion
Criteria for exclusion
Action if excluded
Contraindications
Action if contraindications
Action if patient declines
2003
•
•
Direct clinical visualization of external genital warts
Complicated presentations, e.g. complicated by
secondary bacterial infection and/or bleeding frankly
• No visualization of genital warts
• Recalcitrant warts
• Questionable morphology
• Under 16s
• Broken skin surfaces
• Known allergies to Trichloracetic Acid
Refer to Medical Practitioner
• Co-existing inflammatory skin conditions
• Large affected areas
Refer to Medical Practitioner
Document in patient’s notes and refer to medical practitioner
Dept. of GU Medicine
Isle of Wight Healthcare NHS Trust
Department of Genitourinary Medicine
2. Characteristics of staff
Qualifications required
Additional requirements
Continued education & training
requirements
2003
RGN or RN (adult) and currently employed to work in GU
Medicine
ENB 8103, 932, 276/5 or commensurate experience
• Clinical competence in the history taking, clinical
examination/assessment and genital screening; required
to enable the accurate diagnosis and treatment of genital
warts infection
• Ability to recognize need to offer screening to contacts of
genital warts infection, who may be anxious regarding
potential exposure.
• Evidence of continuing professional development in GU
Medicine and/or the GUM nurse role
• Minimum of 1 year experience of working within the
speciality in the preceding 3 years
• Knowledge base of the interactions of Trichloracetic
Acid with other drugs, and other contra-indications for
issuing Trichloracetic Acid
• Receiving Clinical Supervision and/or review of
casenotes by a senior Medical Practitioner or Nurse, on
an ongoing basis
• Commitment to continuing professional development
identified through Clinical Supervision and appraisal
• 5 study days or the equivalent in hours, of study related to
the field of GU Medicine; every 3 years.
• Recommended attendance and participation in the
monthly educational/audit half day at Portsmouth GU
Medicine department
Dept. of GU Medicine
Isle of Wight Healthcare NHS Trust
Department of Genitourinary Medicine
3. Description of Treatment
Name of Medicine
Trichloracetic Acid solution 80 to 90%
Legal status of medicine
Prescription only Medicine (POM)
Dose
Careful topical application to lesions
Route
topical
Frequency
Once weekly
Total dose/number of
doses
May be used for a maximum of 4 weeks before a medical review is
required again – at a maximum dosage of once weekly applications
Drug
Trichloracetic
Acid Solution
2003
Contraindications/
Cautions
# Known allergies
# Under 16s
Common Adverse
Effects
# Skin irritation
# ulceration may
occur which
penetrates the
dermis
Interactions
Notes
Nil
Due to
potential for
dermis
ulceration
this is not
suitable for
application to
large volume
areas
Dept. of GU Medicine
Isle of Wight Healthcare NHS Trust
Department of Genitourinary Medicine
Follow up
treatment
Written/verbal
advice for patient
•
•
•
•
•
•
•
•
•
•
Medical review in 4 weeks if still has evidence of wart virus infection
Medical review sooner if clearly no response
Return immediately if unable to tolerate treatment
Information regarding aetiology and transmission of wart virus
infection and possibility of recurrencies; with leaflet
Advise an intense burning may be experienced for 5 – 10 minutes after
application
Advise regarding infectivity and condom use
Advise regarding general hygiene and skin care during treatment
Advise regarding discussions with partner, management of future
episodes if any and pregnancy/childbirth if appropriate
Advise of need to ensure undergoes routine cervical cytology
screening when due if female
Discussion regarding safer sex in general for future sexual health
National Guidelines for the management of genital warts infection, 2002 –
Clinical Effectiveness Group – AGUM and MSSVD, www.agum.org.uk
Specify method of
recording supply and
/or administration
2003
The following will be recorded in the patient’s clinical records:
• The basis for the diagnosis and/or treatment
• Trichloracetic Acid cream issued/administered
• The route of administration
• The frequency of administration
• The date of issue/administration
• The signature of the person administering/issuing the Trichloracetic
Acid
• The qualification of the person undertaking the administration/issuing
Dept. of GU Medicine
Isle of Wight Healthcare NHS Trust
Department of Genitourinary Medicine
Procedure for reporting ADR's to
Medical Practitioner
•
Document in the patient’s clinical records and refer to a Medical
Practitioner
Management of Group Directions:
Group direction developed by:
Mandy Tyson – GU Clinical Lead/Nurse Specialist
Dr. Elizabeth Foley – Consultant in GU Medicine
Zoe Wells – Directorate Pharmacist
Authorizing Doctor/s:
Signature
Date applicable:
Dr Elizabeth Foley – Consultant in GU Medicine
January 2003
Review date:
January 2005
Senior Nurse
Signature
Clinical Directorate Pharmacist
Gill Kennett – Operational Manager
Signature
Approved by Nursing Policy Group
Zoe Wells
Signature
Approved by Clinical Standards Group
Signature
2003
Dept. of GU Medicine
Isle of Wight Healthcare NHS Trust
Department of Genitourinary Medicine
The group direction is to be read, agreed to, and signed by all staff it applies to. One copy is to
be given to the health professional, another kept in the department.
_____________________________________________________________________________
I have read the group direction and agreed to use it in accordance with the criteria
described.
Name:
Signature:
Date:
Review date:
Name:
Signature:
Date:
Review date:
Name:
Signature:
Date:
Review date:
2003
Dept. of GU Medicine