Download Symptomatic Relief Policy

Symptomatic Relief Policy
Compiled by: Drug Adminstration Steering Group
Date:
July 2004
Review Date: July 2006
Drug Administration Steering Group
1
Index
Page
Introduction
3
Clinical Conditions to which the policy applies.
3
Clinical Criteria for Inclusion
3
Criteria for Exclusion
4
Responsibilities
4
Professional Accountability
5
Prescribing the Symptomatic Relief Policy
5
Administration of Medicines via Symptomatic Relief Policy
5
Recording Keeping for the Symptomatic Relief Policy
6
Symptomatic Relief Products
Analgesics
Paracetamol Tablets 500mg
8
Paracetamol Suppositories 500mg
9
Antacids
Gaviscon Advance
10
Gaviscon Liquid
11
Laxatives -Oral
Senna Tablets /Senna Syrup
12
Throat Preparations
Simple Linctus
13
Merocet / Strepsil Lozenges
14
Maintenance of Indwelling Urinary Catheter
Sodium Chloride 0.9% Catheter Maintenance Solution
15
Anal irritation / Uncomplicated Haemorrhoids
Anusol Cream
16
Anusol Suppositories
17
Appendix 1 - Nurse Competence Framework
18
Compiled by: Drug Administration Steering Group
2
Introduction:
All medicines must be prescribed by an authorised prescriber before they are
administered to a patient. For some patients, it is appropriate to prescribe a number of
“as required” medicines, and when that is the case, the prescription of a “Symptomatic
Relief Policy” as described below can be very useful.
The Symptomatic Relief Policy facilitates the administration of a restricted range of
medicines to patients, by registered nursing staff, from an agreed list of products in
order to relieve specified symptoms.
The policy stipulates the minimum interval and the maximum number of doses of
each medicine that can be administered before medical review. Should the patient’s
condition persist beyond that stated in the individual drug monograph then a member
of medical staff must be notified and the patient examined. Should a patient need
more frequent dosing of a particular medicine, this should then be individually
prescribed.
The policy does not replace the diagnosis and treatment of medical conditions by
medical staff and is not intended to treat long-standing/chronic conditions.
The medicines contained in this policy may be administered to patients by nursing
staff, providing certain criteria are met.
The Symptomatic Relief Policy does not contain complete prescribing information.
Staff are referred to the BNF and summary of product characteristics for further
information.
Clinical Conditions to which the policy applies.
•
•
•
•
•
Pain
Pyrexia
Dyspepsia
Constipation
Cough
•
•
•
•
Sore Throat
Maintenance of indwelling urinary catheter
Flushing an intravenous catheter
Anal irritation/haemorrhoids
Clinical Criteria for Inclusion
Each individual patient must be assessed by a doctor and have the Symptomatic Relief
Policy prescribed for them in their medicines prescription form before they can
receive treatment under this policy. The doctor may exclude any of the products that
in his/her judgement would not be appropriate for that patient.
The patient is eligible if he/she is over twelve years of age, is not a pregnant or
breastfeeding woman and has no contraindications or known sensitivities to any of the
medicines on the Symptomatic Relief policy.
Compiled by: Drug Administration Steering Group
3
Criteria for Exclusion
The symptomatic relief policy does not apply to children of twelve years of age and
under, or to pregnant or breastfeeding women.
The patient can be excluded if he/she has any contraindication to any of the medicines
listed in the Symptomatic Relief policy, or the policy can be used with those
medicines excluded.
The patient should be excluded if he/she is unable to communicate relevant symptoms
listed above.
If a patient is excluded from the Symptomatic Relief Policy, he/she must have all
medication individually prescribed on their medicines prescription form.
The patient may decline to be included on the Symptomatic Relief Policy. Those
patients must not be prescribed the Symptomatic Relief Policy and must have all
medication individually prescribed for them on their medicines prescription form.
Responsibilities
The doctor takes prime responsibility for ensuring that the policy is appropriate for the
individual patient and for highlighting any medicine that is contra-indicated and which
should not be given.
The Nurse identifies the indication and caveats as per the policy; selects and
administers the medicine; records and monitors the outcome as per guidelines in
respect of Symptomatic Relief Policy.
Any suspected adverse drug effects must be recorded in the nursing notes and doctor
informed immediately.
Only nursing/midwifery staff who have undergone additional training and whose
competence has been agreed with their Ward or Department Sister/Charge Nurse, can
administer medicines contained in this policy to patients in their care, according to the
defined procedures contained within this policy.
A competence assessment must be completed for each nurse before he/she can
administer symptomatic relief.
NHS Lanarkshire Operating Divisions are required to provide suitable training to
ensure that all registered nurses have a full understanding of the contents of this list.
Any specific areas of education will require to be addressed and ongoing competency
evaluated on at least an annual basis. The nurse must have achieved the learning
outcomes as detailed in implementation paper associated with the nursing
symptomatic relief policy.
Compiled by: Drug Administration Steering Group
4
The Sister/Charge Nurse is responsible for identifying appropriate staff for training
and competency assessment. Qualified staff of Grade D or above are eligible for
consideration.
It is required that each ward have a current and maintained staff register which lists
those staff who are competent to use the Policy. Only qualified nurses or midwives
named in these registers may administer medicines utilising the Symptomatic Relief
Policy.
Professional Accountability:
Each practitioner is accountable for maintenance and development of their
professional knowledge and competence.
Staff who make use of the Symptomatic Relief Policy must exercise independent
judgment and assert their professional expertise.
Prescribing the Symptomatic Relief Policy
1. Prescribing and administration must be in accordance with the operating division’s
Medicines Code of Practice.
2. The individual patient is identified by the doctor as being a suitable candidate for
the policy.
3. The doctor must prescribe the Symptomatic Relief Policy for the individual patient
and exclude any of the products that in his/her judgement would not be
appropriate and should not be given e.g. ‘Symptomatic Relief Policy Except
Laxatives’.
4. Within The Acute Operating Division this should be prescribed in the patient’s
Lanarkshire Medicine Prescription Form using the section on the back page of the
form i.e. ‘Nurse/Midwife Administration by protocol – Authorised
Nurse/Midwives Only’.
Within some parts of the Primary Care Operating
Division this should be done on the Aberdeen Kardex system.
Administration of Medicines via Symptomatic Relief Policy
The nurse may only administer in the ward/department where they normally work and
only when deemed competent by the Ward Manager. The Ward Manager is required
to assess their competency based on their knowledge of the policy content and
awareness of the patient’s diagnosis.
1. The patient must be over twelve years of age and must not be pregnant or
breastfeeding.
Compiled by: Drug Administration Steering Group
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2. A doctor must have prescribed the policy for that individual patient and detailed in
writing any caveats as described above.
3. A registered nurse who has undergone additional training and whose competence
has been agreed with their Ward or Department Sister/Charge Nurse may
administer medicines from the policy.
4. The nurse must identify the patient by name and as per local procedure, and ensure
that this matches the name and other details on the prescription form.
5. The nurse must identify the appropriate medicine for administration and ensure
that a dose of the medicine has not already been administered by checking:
a) That it has not been prescribed and administered ‘as required’ or regular
medication.
b) It has not been prescribed and administered in the ‘once only’ section
c) That the medicine has not been excluded by the doctor who signed the
prescription.
d) The administration record to ensure that if this drug has already been
administered to the patient via this policy that the maximum dose has not been
exceeded.
6. The nurse identifies indication and caveats as per product monograph and
administers and records as per guidelines in respect of Symptomatic Relief Policy.
7. The maximum number of doses stated in each drug monograph must not be
exceeded. If symptoms persist beyond the recommended time parameters as
stated in each protocol, an appropriate medical practitioner must be consulted.
8. Any nurse or midwife unsure of the appropriateness of administering from the
Symptomatic Relief Policy should refrain from doing so and consult with a more
experienced nursing, midwifery or medical colleague.
Recording Keeping for the Symptomatic Relief Policy
The nurse will record the administration of the medicine on the prescription form in
the normal way i.e. back page of the medicines chart for the Lanarkshire Medicine
Prescription form or Medicines Administration Record for the Aberdeen Kardex
system which is in use in some parts of the Primary Care operating Division.
Compiled by: Drug Administration Steering Group
6
Compiled by: Drug Administration Steering Group
May 2004
Signature of Chairperson…………………………………………. …………………
Approved by: Lanarkshire Acute Operating Division Drug and
Therapeutics Committee
Signature of Chairperson……………………………………….Date…………………
Approved by:
Lanarkshire Primary Care Operating Division
Drugs & Therapeutics Committee
Signature of Chairperson: ___________________________
Date: _____________
Approved by: Lanarkshire Area Drug and Therapeutics Committee
Signature of Chairperson…………………………………………..Date………………
Review Date……………………………………………………….
Compiled by: Drug Administration Steering Group
7
Analgesics
Paracetamol Tablets 500mg
Description
White Scored Tablet 500mg
White Soluble Tablet 500mg
Indication
Mild to moderate pain
Pyrexia (Give 2 tablets and advise medical staff)
Method of Use / Adult Dose
1g (2 tablets) to be administered orally
Frequency of Administration
Every 4-6 hours
Maximum number of doses that
can be administered with
authority of the “Symptomatic
Relief Policy” prescription
2 doses in 24 hours
Precautions/Contraindications
•
•
•
•
•
Known hypersensitivity to paracetamol
Hepatic or renal impairment
Soluble tablets should not be given to patients
with heart failure
Avoid use if patient is receiving any other
paracetamol containing preparations e.g. coproxamol, co-codamol, benorylate etc.
Current admission for paracetamol overdose
Drug Interactions
Warfarin: do not administer as may enhance
anticoagulant effect.
Side Effects
Occur rarely - rashes, may cause agranulocytosis,
thrombocytopenia and pancytopenia.
Referral for Medical Advice
•
•
•
•
•
Further information
Drug Administration Steering Group
Refer if more than two doses are required in
24 hours.
Refer if required on successive days
In the event of side effects or if symptoms are
not alleviated, refer to medical staff.
Any suspected adverse drug effects should be
recorded in the nursing notes and doctor
informed.
If symptoms recur within 7 days.
Liver damage can occur following overdosage
with paracetamol. Seek medical advice
immediately if overdosage is suspected.
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Analgesics
Paracetamol Suppositories 500mg - only to be used when patient is
unable to take oral preparation.
Description
Opaque white suppository with a wax-like
consistency containing 500mg of paracetamol.
Indication
Mild to moderate pain.
Method of Use / Adult Dose
1g ( 2 x 500mg suppositories) to be inserted into
the rectum in accordance with the Nursing
Procedure for the administration of Suppositories.
Every 4-6 hours
Frequency of Administration
Maximum number of doses that
can be administered with
authority of “Symptomatic Relief
Policy” prescription
2 doses in 24 hours
Precautions/Contraindications
•
•
•
•
•
•
•
•
Drug Interactions
Side Effects
Referral for Medical Advice
Warfarin: do not administer as may enhance
anticoagulant effect.
Occur rarely - rashes, may cause agranulocytosis,
thrombocytopenia and pancytopenia.
•
•
•
•
•
Further information
Compiled by: Drug Administration Steering Group
For rectal use only.
Known hypersensitivity to paracetamol
Hepatic or renal impairment.
Avoid if patient is receiving any other
paracetamol containing preparations.
Current admission for paracetamol overdose.
Do not administer if the patient has a known
bowel obstruction or undiagnosed abdominal
symptoms.
Do not administer if recent anorectal surgery.
Do not administer if rectum is impacted
Refer if more than two doses are required in
24 hours.
Refer if required on successive days
In the event of side effects or if symptoms are
not alleviated, refer to medical staff.
Any suspected adverse drug effects should be
recorded in the nursing notes and doctor
informed.
If symptoms repeat within 7 days.
Liver damage can occur following overdosage
with paracetamol. Seek medical advice
immediately if overdosage is suspected.
9
Antacids
Gaviscon Advance Liquid
Description
A pink oral suspension - peppermint flavour.
Sugar free
Indication
Gastro-oesophageal reflux such as acid
regurgitation, heartburn, indigestion occurring due
to the reflux of stomach contents.
Method of Use / Adult Dose
5ml – 10ml to be administered orally
Frequency of Administration
As required after meals and at bedtime.
Maximum number of doses
that can be administered with
authority of “Symptomatic
Relief Policy” prescription.
Up to 3 doses in 24 hours
Precautions/Contraindications
Do not administer when a highly restricted salt
diet is recommended, e.g. in some cases of
congestive cardiac failure and renal impairment or
when taking drugs which can increase plasma
potassium levels. Each 10 ml dose contains
106mg (4.6 mmol) sodium and 78 mg (2.0 mmol)
potassium.
Each 10 ml contains 200 mg (2.0 mmol) of
calcium carbonate. Care needs to be taken in
treating patients with hypercalcaemia,
nephrocalcinosis and recurrent calcium containing
renal calculi.
Contraindicated in patients with hypersensitivity
to any ingredients of the product.
Drug Interactions
None known
Side Effects
Very rarely patients sensitive to the ingredients
may develop allergic manifestations such as
urticaria or bronchospasm.
Referral for Medical Advice
•
•
Drug Administration Steering Group
If symptoms persist for more than 24hrs or
increase in severity.
If symptoms repeat within 7 days.
10
Antacids
Gaviscon Liquid
Description
A pink oral suspension - aniseed flavour. Sugar
free
Indication
Gastro-oesophageal reflux such as acid
regurgitation, heartburn, indigestion occurring due
to the reflux of stomach contents.
Method of Use / Adult Dose
10ml – 20ml to be administered orally
Frequency of Administration
As required after meals and at bedtime.
Maximum number of doses
that can be administered with
authority of “Symptomatic
Relief Policy” prescription.
Precautions/Contraindications
Up to 3 doses in 24 hours.
Do not administer when a highly restricted salt
diet is recommended, e.g. in some cases of
congestive cardiac failure and renal impairment or
when taking drugs which can increase plasma
potassium levels. Each 10 ml dose contains
141mg (6.2 mmol) sodium
Contraindicated in patients with hypersensitivity
to any ingredients of the product.
Drug Interactions
None known
Side Effects
Very rarely patients sensitive to the ingredients
may develop allergic manifestations such as
urticaria or bronchospasm.
Referral for Medical Advice
•
•
Compiled by: Drug Administration Steering Group
If symptoms persist for more than 24hrs or
increase in severity
If symptoms repeat within 7 days.
11
Laxatives
Senna Tablet/Senna Syrup
Description
Brown tablets containing standardised senna
equivalent to 7.5 mg sennoside
Fruit flavoured syrup containing standardised
senna equivalent to 7.5mg sennoside per 5ml
Indication
Stimulant laxative for constipation
Method of Use / Adult Dose
Two tablets or 10ml of syrup to be administered
orally
Frequency of Administration
Single dose at bedtime
Maximum number of doses
that can be administered with
authority of “Symptomatic
Relief Policy” prescription
One dose
Precautions/Contraindications
Not to be given when any undiagnosed acute or
persistent abdominal symptoms are present.
Do not administer if the patient is known to have
an intestinal obstruction.
Do not administer if patient has a chronic gastrointestinal condition including e.g. peptic ulcer,
Crohns disease, and ulcerative colitis.
Do not administer if patient has had recent GI
surgery
Drug Interactions
None known
Side Effects
May cause abdominal cramp
Referral for Medical Advice
Refer if there is no bowel movement within 24hrs
Refer if required more than once every two weeks
Further information
Before administering:
• Be aware of patient’s normal bowel function.
• Be sure that the patient is constipated and that
the constipation is not secondary to an
underlying undiagnosed complaint.
Document in nursing notes the rationale for
administering the laxative.
Drug Administration Steering Group
12
Throat Preparations
Sugar Free Simple Linctus or Simple Linctus
Description
Flavoured liquid containing citric acid
monohydrate 2.5%w/v
Indication
Soothing cough linctus.
Method of Use / Adult Dose
5ml to be administered orally up to four times
daily if required.
Frequency of Administration
3 to 4 times daily
Maximum number of doses
that can be administered with
authority of “Symptomatic
Relief Policy” prescription.
4 doses in 24 hours
Precautions/Contraindications
Ensure that sugar free formulation is used if
patient is a diabetic.
Drug Interactions
None known.
Side Effects
Referral for Medical Advice
If symptoms persist for more than 48hrs.
If symptoms repeat within 14 days.
Drug Administration Steering Group
13
Throat Preparations
Lozenges - e.g. Merocet or Strepsil
Description
Antiseptic throat lozenges
Indication
For the temporary relief of sore throats
Method of Use / Adult Dose
One lozenge to be given orally. Allow the lozenge
to dissolve slowly in the mouth.
Frequency of Administration
One lozenge every 2-3 hours, maximum of 8
lozenges in 24 hours.
Maximum number of doses
that can be administered with
authority of “Symptomatic
Relief Policy” prescription.
8 lozenges.
Precautions/Contraindications
If symptoms are accompanied by fever, headache,
nausea and vomiting.
Caution if sensitivity to any of ingredients is
suspected.
Drug Interactions
None Known
Side effects
May cause sore lips or tongue
Allergic reaction to ingredients are rare but can
occur.
If symptoms persist for more than 24hrs.
Referral for Medical Advice
If symptoms repeat within 14 days.
Compiled by: Drug Administration Steering Group
14
Maintenance of Indwelling Urinary Catheter
Sodium Chloride 0.9% Catheter Maintenance Solution
Description
Sodium Chloride 0.9% catheter maintenance solution
Indication
To maintain patency/ flush urinary catheter.
Method of Use / Adult Dose
To be administered in accordance with the
Lanarkshire Nursing Procedure for bladder irrigation.
“Scope of Professional Practice: Bladder Maintenance
Solution”.
Precautions
As per nursing procedure
Maximum number of doses
which can be administered
with the authority of
“Symptomatic Relief
Policy” prescription.
One only.
Referral for Medical
Advice.
If there is the perceived need for a repeat flush at any
time.
Drug Administration Steering Group
15
Anal Irritation / Uncomplicated Haemorrhoids
Anusol Cream
Description
Buff coloured cream. Each 100g contains:
Bismuth Oxide 2.14g
Balsam Peru 1.8g.
Zinc Oxide 10.75 g
Indication
Symptomatic relief associated with minor
anorectal conditions e.g. haemorrhoids, pruritus
ani.
Method of Use / Adult Dose
For rectal use only.
Thoroughly cleanse the affected area, dry gently
and apply the cream.
For internal conditions use the rectal nozzle
provided. Clean the nozzle thoroughly after each
use.
Ensure the tube is clearly labelled with the
patient’s name and date of opening.
In cold temperatures it may be difficult to squeeze
the ointment out of the tube. If this occurs warm
the tube in the hand or dip it in warm water taking
care not to overheat the cream.
Frequency of Administration
To be applied to the affected area at night, in the
morning and after each evacuation until the
condition is controlled
Maximum number of doses
that can be administered with
authority of “Symptomatic
Relief Policy” prescription.
4 doses in 24 hours.
Precautions/Contraindications
For external or rectal use only.
Do not administer if the patient is allergic to any
of the ingredients.
Drug Interactions
None known
Referral for Medical Advice
A transient burning sensation or irritation may
occur on application. If this lasts longer than 30
minutes discontinue and seek medical advice.
If symptoms persist for longer than 48hrs
If symptoms recur within 14 days.
Drug Administration Steering Group
16
Anal Irritation / Uncomplicated Haemorrhoids
Anusol Suppositories
Description
White or off-white torpedo shaped suppository.
Indication
Symptomatic relief associated with minor rectal
conditions including internal haemorrhoids.
Method of Use / Adult Dose
One suppository to be inserted into the anus in
accordance with the Nursing Procedure for the
administration of Suppositories.
Frequency of Administration
One suppository to be inserted at night, in the
morning and after each evacuation if required.
Maximum number of doses that
can be administered with
authority of “Symptomatic
Relief Policy” prescription.
Four in 24 hours.
Precautions/Contraindications
For rectal use only
Do not administer if the patient has had recent
anorectal surgery.
Do not administer to patients with rectal bleeding.
Do not administer if rectum is impacted with faeces.
Drug Interactions
None Known
Referral for Medical Advice
A transient burning sensation or irritation may occur
on application. If this lasts longer than 30 minutes
discontinue and seek medical advice.
If symptoms persist for more than 48hrs.
If symptoms recur within 14 days.
Compiled by: Drug Administration Steering Group
17
Appendix 1.
Nurse Competence Framework
NHS Lanarkshire Symptomatic Relief Policies
Before nursing staff can apply the Symptomatic Relief Policy, they must be assessed as having the competences listed below by the ward change nurse. The
attached form should be used to record the assessment.
Competencies Required.
The nurse administering medicines using the authority of the Symptomatic Relief Policy must:
•
Understand that the Symptomatic Relief Policy must be prescribed by a doctor before a medicine from it can be administered.
•
Understand the limits of dosing frequency and duration permitted for each medicine within the symptomatic relief policy.
•
Understand that some patients may have certain medicines within the Symptomatic Relief Policy excluded.
•
Understand how medicines administered under the authority of a Symptomatic Relief Policy Prescription are to be recorded.
Legal, accountability and professionally issues - The registered nurse/midwife must be able to demonstrated their knowledge of:
•
The rationale for using the Policy
•
The legal issues relating to admin istration of medicines using the Policy
•
The Registered nurse/midwife’s responsibility and accountability when assessing a patient for administration of drugs from the Policy
•
The importance of maintaining accurate records of training and achievement of co mpetence.
Using the formulary safely and effectively - The registered nurse/midwife must be able to demonstrated their knowledge of:
•
The correct use of the Policy
•
An ability to interpret the signs and symptoms of patient conditions and select appropriate medication utilising the Policy.
•
Ability to correctly record the process
•
A knowledge of the action required if the patient’s symptoms persist beyond the recommended time parameters.
Pharmacology - The registered nurse/midwife must be able to demonstra ted their knowledge of:
•
A knowledge of the doses, side effects, contraindications of the drugs within the Policy.
Drug Administration Steering Group
18
Name of Nurse
Grade
Compiled by: Drug Administration Steering Group
I confirm that I have
understood the policy
& procedure for the
administration of
Symptomatic Relief
(Signature)
Competence
Assessment completed
on (date)
Approved by:
Associate Director of
Nursing/Manager or
Named Professional
(name)
Signature of
Associate Director of
Nursing /Manager or
Named Professional
19