Microsoft word - levonorgestrel pgd august 12 final

East Riding of Yorkshire and Hull Primary Care Trusts
PATIENT GROUP DIRECTION (PGD) FOR
Levonorgestrel (Levonelle 1500)
Clinical Condition
Indication
Emergency contraception for females who meet Fraser Guidelines
Inclusion criteria
• Female patient who has had unprotected sexual intercourse or a failure of a contraceptive method within the last 72 hours Exclusion criteria
• Hypersensitivity to levonorgestrel or any of the excipients • Severe hepatic dysfunction • Porphyria • Unprotected sex more than 72 hours previously since last normal period (regardless of earlier use of levonorgestrel). • Patients taking liver enzyme inducing drugs (carbamazepine, eslocarbazipine, griseofulvin, modafinil, nelfinavir, nevirapine,oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John’s Wort, topiramate, rifamycins) Action if patient is
Urgent referral to one of the following services GP, Out of hours GP excluded
service (if appropriate) or Family Planning Clinic with a completed ‘excluded client options form’ • Inform patient of reason for exclusion • Document in patient’s clinical notes • Refer for medical advice if appropriate Action if patient
declines
• Advise patient of possible consequences to care • Document in patient’s clinical notes • Refer for medical advice if appropriate Review date: 01/07/2012 Ref: Levonorgestrel PGD August 12 Expiry date: 31/08/2014 East Riding of Yorkshire and Hull Primary Care Trusts
PATIENT GROUP DIRECTION (PGD) FOR
Levonorgestrel (Levonelle 1500)
Drug Details
Name, form & strength
of medicine

Route/Method
One tablet to be taken as soon as possible after unprotected
intercourse, (up to 72 hours afterwards).
However clients must first be informed regarding the availability
of
(1) The emergency Copper IUD) and
(2) Ulipristal tablets from their GP/FP clinic And the superior
efficacy of the copper IUD compared to other methods of
emergency contraception.
Frequency
Duration of treatment
Maximum or minimum
Single dose (see note below re. additional dose if vomiting occurs) treatment period
Quantity to
supply/administer
NB. One additional tablet can be supplied if vomiting occurs within 2 Side effects
Advice to patient/carer
• Refer to current BNF and SPC
• Possible side-effects (menstrual irregularities, nausea, low abdominal pain, fatigue, headache, dizziness, breast • Failure rate in relation to timing of dose and in relation to • What to do if vomiting occurs within 2 hours • Effects on timing of next period and action necessary if next period is unusually light, heavy, brief or is absent • Risk of sexually transmitted diseases after unprotected sex • Need to perform a pregnancy test 3 weeks later if menstruation lighter/ different from normal or has not occurred • Severe malabsorption syndromes may affect absorption (i.e. crohn’s disease, short bowel syndrome) • Breastfeeding: lactation not affected. Levonorgestrel is Review date: 01/07/2012 Ref: Levonorgestrel PGD August 12 Expiry date: 31/08/2014 East Riding of Yorkshire and Hull Primary Care Trusts
PATIENT GROUP DIRECTION (PGD) FOR
Levonorgestrel (Levonelle 1500)
Referral Arrangements and Audit Trail
Referral arrangements
Records/audit trail
The following should be recorded in the patient’s clinical
notes.
• Patient’s name, address, date of birth and consent given
• Batch number and Expiry Date • Any advice or warnings given to the patient • Any adverse drug reactions occurring after administration • Referral arrangements made (including self care) • Name and signature of health professional administering drug • Completion of Gillick competence were appropriate Staff Characteristics
Professional
• The Appropriately Registered Health Professional will ensure they Responsibility
have the relevant training and are competent in all aspects of care. They will attend training updates as requested and maintain their own CPD in this area. • The Appropriately Registered Health Professionals will have due regard for their Code of Conduct/Ethics, Scope of Professional Practice and Standards for administration Continuing training &
The practitioner should be aware of any change to the education
recommendations for the medicine listed. It is the responsibility of the individual to keep up-to-date with continued professional development and to work within the limitations of individual scope of practice.
References:

• HSC 2000/026 Patient Group Directions • Emergency Hormonal Contraception Information Booklet; CPPE. (HMSO 2005) • Summary of Product Characteristics – Levonelle 1500 ™ • Faculty of Family Planning and Reproductive Healthcare Clinical Effectiveness Unit • “Emergency Contraception” (June 2003) • “Contraceptive Choices for Women with Inflammatory Bowel Disease” (July 2003) • Faculty of sexual and reproductive healthcare clinical guidance: contraception Clinical Effectivness unit (August 2011).” Review date: 01/07/2012 Ref: Levonorgestrel PGD August 12 Expiry date: 31/08/2014 East Riding of Yorkshire and Hull Primary Care Trusts
PATIENT GROUP DIRECTION (PGD) FOR
Levonorgestrel (Levonelle 1500)
Review date: 01/07/2012 Ref: Levonorgestrel PGD August 12 Expiry date: 31/08/2014 East Riding of Yorkshire and Hull Primary Care Trusts
PATIENT GROUP DIRECTION (PGD) FOR
Levonorgestrel (Levonelle 1500)
This patient group direction must be agreed to and signed by all health care professionals involved in its use. The NHS Trust should hold the original signed copy. The PGD must be easily accessible in the clinical setting Organisations
NHS East Riding of
Yorkshire
The Maltings
Health House
Silvester Square
Grange Park Lane
Silvester Street
Willerby
Authorisation
Lead Doctor
Name: Position: Medical Director Signature: Date: Lead Nurse
Name: Position: Lead Nurse Signature: Date: Lead Pharmacist
Name: Position: Chief Pharmacist Signature: Date: GP Authorisation
(for GP Practice Use Only)
Review date: 01/07/2012 Ref: Levonorgestrel PGD August 12 Expiry date: 31/08/2014 East Riding of Yorkshire and Hull Primary Care Trusts
PATIENT GROUP DIRECTION (PGD) FOR
Levonorgestrel (Levonelle 1500)
Individual Authorisation
PGDs DO NOT REMOVE INHERENT PROFESSIONAL OBLIGATIONS OR ACCOUNTABILITY. It is the responsibility of each professional to practice only within the bounds of their own
competence and in accordance with their own Code of Professional Conduct.
Note to Authorising Managers: authorised staff should be provided with an individual copy of the clinical content of the PGD and a photocopy of the document showing their authorisation. I have read and understood the Patient Group Direction and agree to supply/administer this medicine only in accordance with this PGD. Name of Professional
Signature
Authorising Manager
Review date: 01/07/2012 Ref: Levonorgestrel PGD August 12 Expiry date: 31/08/2014

Source: http://communitypharmacyhumber.org/wp-content/uploads/sites/22/2013/08/EHC_levonorgestrel_pgd_201208.pdf