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Download Protocol for the use of Symptomatic Relief for Patient Areas of South
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Protocol for the use of Symptomatic Relief for Patient Areas of South West Yorkshire Mental NHS Health Trust Approved by: Drug & Therapeutics Trust wide Action Group July 2006 (Addendum approved January 2007) Protocol for the use of Symptomatic Relief in Inpatient Areas of South West Yorkshire Mental Health Trust Rationale: Patients occasionally need treatment for minor problems which can be treated with “symptomatic relief”. It is not always necessary to contact a doctor for advice in these circumstances unless the problem persists. The medicines specified in this policy can be administered to inpatient areas of South West Yorkshire Mental Health NHS Trust by qualified nurses, regularly employed on the ward (at least two shifts served in the last three months). This policy allows the administration of the following medications: Simple Linctus Paracetamol tablets Antacid mixture Glycerin suppository Throat lozenge Senna tablets/liquid Nicotine gum Responsibility of doctor: Check the symptomatic relief section on the reverse of the inpatient prescription chart. Insert the names of any medicines for symptomatic relief which are not appropriate for the patient and then sign the symptomatic relief section of the chart. Responsibility of nurse: Administer only the medicines as specified in this policy Record the following details on the appropriate section of the medicines chart • Date/time • Nurse signature C:\Documents and Settings\davidbi\Desktop\Symptomatic Relief January 2007.doc 1 Simple Linctus Indications Situation/condition when it can be used Do not give in these circumstances Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Cough Raised temperature Coloured sputum Allergy to any of the other contents, including citric acid – check label Simple linctus One 5ml spoonful Oral Every 4 hours Three doses Inform doctor and ensure prescription written if further doses necessary Rare report of allergy to citric acid , saccharin and sodium benzoate Paracetamol Indications Situation/condition when it can be used Do not give in these circumstances Patient requiring pain relief for headache, musculoskeletal pain, period pain, or similar Pyrexia in a patient taking clozapine (refer for medical advice). If other Paracetamol containing medicines are prescribed on current prescription chart and these have been administered within four hours C:\Documents and Settings\davidbi\Desktop\Symptomatic Relief January 2007.doc 2 Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Paracetamol 500mg to 1000mg ( One or two tablets) Oral Four to six hours between doses Three doses If other Paracetamol containing medicines are prescribed and may be given in the next four hours, ensure nursing colleagues are notified at handover Inform doctor and ensure prescription written if further doses necessary Side effects rare – rash, blood disorder, liver damage in overdose Antacid mixture (Peptac/Gaviscon Advance) Indications Situation/condition when it can be used Do not give in these circumstances Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Advice to Patient Dyspepsia (heartburn) Porphyria – use Gaviscon Advance Any alarm signs – medication can be given, but doctor must be informed of symptoms Peptac or Gaviscon Advance Peptac 10ml after a meal, Gaviscon 5 – 10ml after a meal Oral After meals Three doses Inform doctor and ensure prescription written if further doses necessary. Advise doctor if patient reports any alarm signs: dyspepsia with GI bleeding, difficulty swallowing, unintentional weight loss, abdominal swelling, persistent vomiting. None If appropriate – lifestyle advice (avoid known percipients of dyspepsia - e.g. smoking, alcohol, coffee, chocolate, fatty foods), healthy eating, weight reduction, smoking cessation C:\Documents and Settings\davidbi\Desktop\Symptomatic Relief January 2007.doc 3 Glycerin suppository Indications Situation/condition when it can be used Do not give in these circumstances Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Advice to Patient Simple constipation Rectal Irritation, patient complaining of severe pain Glycerol (glycerine) suppository One Rectal, remove wrapper and moisten with water before use One daily One dose Inform doctor and ensure prescription written if further doses necessary Discuss with pharmacist if patient on medications which may cause constipation None Maintain adequate fluid intake, increase fibre in diet Throat lozenge Indications Situation/condition when it can be used Sore throat Do not give in these circumstances Sore throat in patient taking clozapine (refer for medical advice) Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Advice to Patient Merocet, Merocaine, Bradosol One Suck, oral Four hours between doses Three doses Inform doctor and ensure prescription written if further doses necessary Anaesthetic action of Merocaine Merocaine anaesthetises the mouth so care is necessary when taking hot food or drink after lozenge C:\Documents and Settings\davidbi\Desktop\Symptomatic Relief January 2007.doc 4 Senna tablets/liquid Indications Situation/condition when it can be used Do not give in these circumstances Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Advice to Patient Patient requiring relief of constipation Intestinal obstruction Senna tablets or liquid Two tablets or two 5ml spoonfuls Oral Daily at night One dose Inform doctor and ensure prescription written if further doses necessary, or alternative fibrecontaining product Discuss with pharmacist if patient on medications which may cause constipation May cause abdominal cramp Avoid prolonged use Maintain adequate fluid intake, increase fibre in diet C:\Documents and Settings\davidbi\Desktop\Symptomatic Relief January 2007.doc 5 Addendum to the Protocol for the use of Symptomatic Relief for Patient Areas of South West Yorkshire Mental Health Trust Introduction This addendum is intended to provide relief from the symptoms of nicotine withdrawal in the context of patients subject to the Trust Smokefree Policy. This symptomatic relief protocol is intended to allow short-term relief from physical symptoms of nicotine withdrawal until such time as a formal assessment of needs can be made. Nicotine Gum 2mg Indications Situation/condition when it can be given Do not give in these circumstances Treatment to be given Name of Medicine Dose Route Frequency Total Dose Number Follow up Warning/Adverse Reactions Cigarette craving Patient is a non-smoker, patient has an exemption permitting them to smoke Nicotine gum 2mg for patients who report smoking their first cigarette more than 30 minutes after waking 4mg for patients who report smoking their first cigarette within 30 minutes of waking Buccal (chew slowly for one minute, then place between the gum and cheek) When required Normally 8-12 pieces per day, maximum 15 Ensure patient will be assessed formally, either by a doctor or by smoking cessation trained staff, at the earliest opportunity. This will permit a more appropriate nicotine replacement/substitution strategy to be used during their stay Throat irritation, dyspepsia, indigestion, jaw ache, palpitations C:\Documents and Settings\davidbi\Desktop\Symptomatic Relief January 2007.doc 6
