| PGD DETAILS |
| Dexamethasone tablets/oral solution to treat mild, moderate and severe/life-threatening childhood croup Valid from 14/01/2025 Review date 01/06/2026 Expiry date 31/12/2027 |
| Version Control- Record of Amendments | |
| January 2025 | Introduction of new PGD- version 1.0 |
| RATIONALE FOR PATIENT GROUP DIRECTIONS (PGDs) | |
| Eligible Healthcare Professional | Only healthcare professionals specified in the PGD (e.g., registered nurses, paramedics) who have completed the required training and are authorized may administer this medication. Unauthorized administration is prohibited and may result in disciplinary or legal consequences. Always adhere to PGD guidelines to ensure patient safety and compliance. Registered Paramedic [ü] Registered Nurse [ü] |
| Qualifications and Professional Registration | Current registration with the HCPC as a Paramedic. Current registration with the NMC as an Advanced Nurse Practitioner |
| Training and Competency | All registered healthcare professionals are personally accountable for their practice and in the exercise of professional accountability. There is a requirement to demonstrate and maintain competence in the following before undertaking administration under this PGDAn understanding of professional standards for the administration of medicinesFamiliarity with the local policies and procedures relating to medicines. Appropriate training to carry out the clinical assessment of a patient.Basic training in the legal framework and use of PGDs for the supply and administration of medicinesUnderstanding of pharmacology of drugs being administered to patients and relevant medical condition. |
| Continued Training and Competency | The clinician must meet the requirements of the prevailing level of education required for PGD use at this level of practice.All ongoing regular training requirements (e.g. statutory and mandatory training) as required by the company for this role must be completed. The clinician is responsible for keeping themself aware of any changes to the 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 their own individual scope of practice.This PGD should be read in conjunction with JRCALC Guidelines |
| CLINICAL CONDITION | |
| Indication: | Mild, moderate and severe/life-threatening childhood croup. |
| Inclusion Criteria: | Children aged 1month to 10 years with mild, moderate or severe/life-threatening croup as defined by the Modified Taussig Croup Score or the Westley Croup Score. |
| Exclusion Criteria /Contra-indications: | Systemic infections/sepsisHypertensionKnown hypersensitivity to dexamethasone or any excipient. |
| Cautions: | Upper airway compromise can be worsened by any procedure distressing the child, including the administration of medicines.Immunocompromised children. Ensure they have access to tertiary care input and have contacted their local team for advice. A single dose will not typically impact on their subsequent care.If an alternative diagnosis is considered most likely refer to JRCALC and NICE guidance.Subsequent doses- Where a child has been given a corticosteroid previously by a different clinician a repeat dose may be given where clinically indicated such as a deterioration in clinical condition. This must be within a different consultation episode.OsteoporosisDiabetes (including family history)Epilepsy |
| Drug Interactions | For information on drug interactions see (SmPC):A detailed list of drug interactions is available in the SPC or BNF: https://www.medicines.org.uk/emc/product/3351/smpc (solution)Also see BNF:-https://bnf.nice.org.uk/drugs/dexamethasone/#interactions |
| Action if patient declines or is excluded: | If patient meets exclusion criteria, explain to patient/parent/guardian and document on EPCR.Document reason for exclusion and any action taken.Consider nebulised adrenaline 1:1000 PGDTreat time critical/life-threatening symptoms and ensure conveyance to the Emergency Department.Consider any need to safeguard. |
| DRUG DETAILS | |
| Name, form and strength of medication covered under this PGD: | Dexamethasone, tablets 2mg or liquid 2mg/5ml. |
| Legal Category | Prescription Only medicine (POM) |
| Storage Conditions | All preparations should be stored within manufacturers labelled guidelines and should not exceed 25 degrees C |
| Route/Method: | Oral |
| Dosage: | Oral solution9 – 10 years:6mg of (15ml liquid)7 – 8 years:4mg (10ml liquid) 4-6 years:3.2 mg (8ml liquid)3 years:2.4mg (6ml liquid) 1 – 2 years:2mg (5ml liquid)6- 9 months:1.6mg (4ml liquid) 3 – 5 months:1.2mg (3ml liquid) 1 – 2 month:0.8mg (2ml liquid) Birth: N/AOral Tablet- Tablets if used are to be dissolved in water prior to administrationUse oral syringe to administer the solution.• Dissolve in water and administer to the patient. Dosages should be titrated to match those of the solution above- 0.15mg/kg where this is possible and the weight can be ascertained. This may result in providing partial amounts of diluted liquid. • It is recognised that exact dosing of dissolved tablets may be challenging, clinicians are to endeavour to ascertain patient weight. If this is not possible utilise the JRCALC table below.9-10 years 6 milligrams (3 tablets)4-8 years 4 milligrams (2 tablets)1 month to 3 years 2 milligrams (1 tablet) Birth N/A |
| Frequency: | Single Dose |
| Duration of Treatment: | Once only |
| Maximum or Minimum Treatment Period: | N/A |
| Quantity to Administer | Single dose supplied by clinician only |
| Side Effects: | See manufacturer’s SmPChttps://www.medicines.org.uk/emc/product/3351/smpc#UNDESIRABLE_EFFECTSThese reactions are common to all steroid based drugs and although listed below are unlikely from a single dose to treat acute illness.Increased appetite and weight gain.Insomnia or difficulty sleeping.Mood swings (e.g., euphoria, irritability, or anxiety).Facial swelling (\\\”moon face\\\”).Increased blood sugar levels. |
| Advice to Patient/Carer: | When administering dexamethasone, the patient (and or parent/guardian) should have the treatment and the course of treatment explained (where appropriate).Provide the patient with a copy of a patient information leaflet for the product: https://www.medicines.org.uk/emc/files/pil.3351.pdfWhere transported to the most appropriate Emergency Department as soon as practicable.GP Referral for non-conveyed patients. |
| REFERAL ARRANGEMENTS & DOCUMENTATION | |
| Referral Arrangements: | As per local arrangements/national guidelines |
| Records/Audit Trail: | Patients name, address, date of birth and consent given.Contact details of GP (If registered)DiagnosisDose and form administeredBatch and expiry date detailsAdvice given to patient (including side effects)Signature/name of staff who administered or supplied medication, and also, if relevant, signature/name of staff who removed/discontinued the treatmentDetails of any adverse drug reaction and actions taken including documentation in the patients’ medical record. Usage documented on PRF & drug Administration book |
| References/ Resources and Comments: | JRCALC guidelinesBNF details:-https://bnf.nice.org.uk/drugs/dexamethasone/NICE Health Topics – Croup, Clinical Practice Guidelines. Updated May 2022.https://cks.nice.org.uk/topics/croup/Accessed January 2025 |
| PGD AUTHORISATION | ||
| ORGANISATION | Coast Medic Ambulance Ltd | |
| MEDICAL DIRECTOR | Name: | Dr Rhys Owens |
| Signature: | ||
| Date: | 14.01.2025 | |
| PHARMACIST | Name: | Neil Hayward |
| Signature: | ||
| Date: | 14.01.2025 | |
| CHIEF EXECUTIVE | Name: | Luke Tudor |
| Signature: | ||
| Date: | 14.01.2025 |