| PGD DETAILS |
| Salbutamol Nebuliser Solution- for treatment of acute asthma, wheezing, exacerbation of COPDValid from 14/01/2025Review date 01/06/2026Expiry 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: | Acute asthma attack where normal inhaler therapy has failed to relieve symptoms.Expiratory Wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause.Exacerbation of COPDShortness of breath in patients with severe breathing difficulties due to left ventricular failure (secondary treatment) |
| Inclusion Criteria: | Adults and Children 1 month and over |
| Exclusion Criteria /Contra-indications: | Children under one monthKnown hypersensitivity to Salbutamol or any of the excipients.Severe pre-eclampsiaOtherwise none in the Emergency SituationManufacturer’s list of Contraindications:https://www.medicines.org.uk/emc/product/10257/smpc/print#CONTRAINDICATIONS |
| Cautions: | Salbutamol should be used with care in patients with:HypertensionAnginaOveractive ThyroidLate Pregnancy (can relax uterus)Severe Hypertension may occur in patients on beta-blockers and half doses should be used unless there is profound hypotension.If COPD is a possibility, limit nebulisation to six minutes.Pregnancy and Breastfeeding:Use in pregnancy and breastfeeding should only take place should the benefits of treatment outweigh the riskshttps://www.medicines.org.uk/emc/product/10257/smpc/print#PREGNANCY |
| Drug Interactions | BNF List of Drug Interactionshttps://bnf.nice.org.uk/interactions/salbutamol/ |
| Action if patient declines or is excluded: | Document on PRF, consider capacity.Speak to clinical line / local GP etcAny other relevant information |
| DRUG DETAILS | |
| Name, form and strength of medication covered under this PGD: | Salbutamol Nebules containing: 2.5 milligrams in 2.5ml or 5 milligrams in 2.5ml |
| Legal Category | Prescription Only medicine (POM) |
| Storage | All preparations should be stored within manufacturers labelled guidelines and should not exceed 25 degrees C |
| Route/Method: | Nebulised with 6-8 litres Oxygen |
| Dosage: | 6 years – adults:5 milligrams Initial Dose (2.5ml or 5ml) – Check Concentration)In life threatening or acute severe asthma, undertake a time critical transfer to the nearest suitable receiving hospital and provide nebulisation en route.If COPD is a possibility, limit nebulisation to six minutes.The pulse rate in children may exceed 140 after significant doses of salbutamol, this is not usually of any clinical significance and should not usually preclude further use of the drug.Repeat doses should be discontinued if the side effects are becoming significant (e.g. Tremors, tachycardia >140 bpm in adults). 1 month – 5yrs: Initial Dose 2.5mgIn life threatening or acute severe asthma, undertake a time critical transfer to the nearest suitable receiving hospital and provide nebulisation en route.If COPD is a possibility, limit nebulisation to six minutes.The pulse rate in children may exceed 140 after significant doses of salbutamol, this is not usually of any clinical significance and should not usually preclude further use of the drug.Repeat doses should be discontinued if the side effects are becoming significant (e.g. Tremors, tachycardia >140 bpm in adults). |
| Frequency: | Further doses may be administered at 5 minute intervals not exceeding original dose |
| Duration of Treatment: | As long as required. |
| Maximum or Minimum Treatment Period: | No Maximum. |
| Quantity to Administer | As Dosage above. This medication should be administered and taken in sight of attending Clinician. Staff are not permitted to provide medications to be taken at a later date. |
| Side Effects: | HeadacheTachycardiaTremor (Shaking) PalpitationsFeeling of TensionPeripheral VasodilationMuscle CrampsRashManufacturer’s listing:https://www.medicines.org.uk/emc/product/10257/smpc/print#UNDESIRABLE_EFFECTS |
| Advice to Patient/Carer: | Where appropriate, patients should have the intended course of treatment and medication explained to them and informed consent gained, in addition patients should be informed that they will be transported to the most appropriate Emergency Department as soon as practicable. |
| 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)Condition Treated and DiagnosisIf patient excluded, why?Dose 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: | BNFhttps://bnf.nice.org.uk/drug/salbutamol.htmlManufacturer’s Informationhttps://www.medicines.org.uk/emc/product/10257/smpcPatient Leaflethttps://www.medicines.org.uk/emc/files/pil.10257.pdfAll accessed January 2025JRCALC guidelines |
| 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 |
| Individual Authorisation | |||
| Name: | Signature: | Authorising Manager: | Date: |