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Prescribing and Patient Group Direction

What is meant by the term Patient Group Direction (PGD)?

What is a PGD?

PGDs are written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment. These PGDs can act as a direction to a nurse to supply and/or administer prescription only medicines to patients using their own assessment of patient need, without necessarily referring back to a doctor for an individual prescription. PGDs are not intended to be used for planned treatment and are designed for short term use.

Is PGD a form of prescribing?

No however a PGD is a legal mechanism that allows named registered heatlthcare professionals to supply and/or administer medicines to groups of patients that fit the criteria laid out in the PGD. This allows a healthcare professional to supply (e.g. provide an inhaler or tablets and/or administer a medicine (e.g. give an injection or a suppository) directly to a patient without the need for a prescription or an instruction from the prescriber. Using a PGD is therefore, not a form of prescribing.

Who can use a PGD?

All healthcare professionals where professional regulation is in place namely, Nurses, Midwives, Pharmacists, Paramedics, Physiotherapists, Chiropodists or Podiatrists, Dietitians, Optometrists, Orthoptists, Radiographers, Prosthetists, Orthotists, Speech and Language Therapists, Occupational Therapists, Dental Hygienists and Dental Therapists.

Do registered healthcare professionals require an additional formal qualification?

No. Unlike prescribing, registered healthcare professionals entitled to work with a PGD require no additional formal qualifications. Howeveer, for a PGD to be valid, certain criteria must be met, including; the information that it must contain, the patient group that the PGD can be used for and how the PGD itself is drawn up. Organisations also have a responsibility to ensure that only fully competent and trained registered healthcare professionals use PGDs.

Can Health Assistants operate PGDs?

No. Among healthcare professionals authorised to administer drugs under a PGD are registered nurses, pharmacists, midwives, health visitors, ambulance paramedics and others. They can do so only as named individuals recorded on a standard PGD form. The Medicines Act 1968 defines an "authorised" person as one who is professionally regulated. HCAs do not fall into that category and are thus not allowed to administer prescription only medicines under a PGD.

Do individuals using PGDs need to be named?

Yes. The individual must be named and have signed the PGD, which has been approved and is within expriry date, for use within their area of practice. Practitioners agree when signing the PGD to operate under the directions contained within the PGD and that they will follow the professional codes of their registering body. Practitioners should be deemed competent to operate under the PGD by their line manager or professional lead who also signs the PGD authorising the
named individuals.

Is delegation permitted when using PGDs?

No. The Health Care Professional working with the PGD is responsible for assessing that the patient fits the criteria set out in the PGD. They can only do so as named individuals. Health Care Support Workers cannot supply or administer Prescription Only Medicines under the authorisation of a PGD.

How should medicines be labelled for PGDs?

The EC Labelling and Leaflet Direction 2001/83 (revised 2009) applies to all medicinal supplies including those under PGDs. It is a legal requirement that the manufacturer's patient information leaflet (PIL) is provided each time a medicine is supplied.

Medicines for direct supply to a patient, without a prescription, should therefore be prepared and labelled with the relevant details by pharmacy staff. The professional supplying the medicine can then add the patient's name and date. The PIL must be included with the supply. If the PIL is not available in the pack it can be found on the electronic medicines compendium and printed to be included with the supply of the medicine.

Must PGDs be written down?

Yes. A Patient Group Direction is a specific written instruction for the supply or administration of named medicines in an identified clinical situation.

Can a supply of medications be given using a PGD without a signature?

No. It is essential that to comply with legal requirements that the PGD must be signed when supplying medications.

What information must be contained within a PGD?

The legislation specifies that each PGD must contain the following information:

  • the name of the business to which the Direction applies;
  • the date of the Direction comes into force and the date it expires;
  • a description of the medicine(s) to which the Direction applies;
  • class of health care professional who may supply or administer the medicine;
  • signature of doctor or dentist, as appropriate, and a pharmacist;
  • signature by an appropriate health organisation
  • the clinical condition or situation to which the Direction applies;
  • a description of those patients excluded from treatment under the Direction;
  • a description of the circumstances in which further advice should be sought from a doctor (or dentist, as appropriate)and arrangements for referral;
  • details of appropriate dosage and maximum total dosage, quantity, pharmaceutical form and strength, route and frequency of administration, and minimum and maximum period over which the medicine should be administered;
  • relevant warnings, including potential adverse reactions;
  • details of any necessary follow-up action and the circumstances;
  • a statement of the records to be kept for audit purposes

What PGDs are available for use by your professional group within your health board area?