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Patient Group Direction (PGD) for the Administration of:


Prescription Only Medicine (POM)

as a local anaesthetic for the insertion & removal of Implanon Contraceptive Implant YOU MUST BE AUTHORISED BY NAME UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO IT CLINICAL CONDITION OR SITUATION TO WHICH DIRECTION APPLIES Females aged 13 years and over who require local anaesthesia for Indication the insertion or removal of an Implanon contraceptive implant.

Inclusion Criteria

• • • •

Exclusion Criteria

Cautions/Need for Further Advice

Approval Date: 9/12/09

Informed patient consent has been given for the insertion of the implant and the use of Lidocaine (Lignocaine) 1% injection. Females aged 13 years and over who require local anaesthesia for the insertion or removal of Implanon. Medical history has been taken and there is no reason for exclusion. Treatment of clients aged 16 years or younger must meet Fraser guidelines.

Informed consent has not been given in accordance with current PCT guidelines for the supply of the medicine. • Fraser competence not confirmed where applicable. • Women who decline treatment by a nurse • Aged under 13 years of age • Pregnancy • Blood pressure diastolic reading above 160/100 • Known hypersensitivity to Lidocaine (Lignocaine) or amide type local anaesthetics. • Porphyria • Hypovolaemia • Patients with epilepsy • Those with cardiac impaired function. • Cardiac conduction disturbances • Congestive heart failure • Bradycardia / heart block • Impaired respiratory function. • Not for intravenous injection • Use with caution in patients with impaired hepatic function and severe renal disease. • Potential drug interactions – check concurrent medication for interactions before administration under this PGD. Refer to appendix 1 of the current BNF. • Facilities for resuscitation must be available when administering local anaesthetics. If in doubt always refer to an appropriate medical practitioner •

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Action if Patient Declines or is Excluded

• •

Refer to supervising doctor if appropriate. Document findings and action taken in patient’s record.

DESCRIPTION OF TREATMENT Lidocaine (Lignocaine) 1% injection Name, Form & Strength of Medicine Route/Method Local infiltration / subdermal Dosage

Recommended Dose for Fitting of Implanon 2mls Recommended Dose for Removal of Implanon 0.5-1ml


A single dose at the time of Implanon insertion / removal

Duration of Treatment

Single dose

Quantity to Administer

See dosage

Approval Date: 9/12/09

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Side Effects

• Stinging at the injection site. • Redness, bruising / tenderness at injection site Systemic side effects are rare but include: CNS - light-headedness, drowsiness, dizziness, apprehension, nervousness, euphoria, tinnitus, blurred or double vision, nystagmus, vomiting, sensations of heat, cold or numbness, twitching, tremors, paraesthesia, convulsions, unconsciousness, respiratory depression and arrest. CVS- hypotension, cardiovascular collapse and bradycardia which may lead to cardiac arrest. This list is not exhaustive. Refer to current BNF and individual product SPC for complete list. Anaphylaxis is rare but can occur up to 72 hours after injection. Managing and Reporting Adverse Events • Report any adverse drug reactions to the doctor. • In addition use the Yellow Card Scheme to report serious adverse drug reactions directly to the CSM and complete a critical incident form. See below. • It is the responsibility of the nurse identifying the suspected ADR to report it. Yellow Card Scheme Report all serious suspected adverse reactions in adults, and all serious and minor reactions in children (under 18 years), to the Medicines and Healthcare products Regulatory Agency (MHRA) using a yellow card (located at the back of the BNF) or on- line via Report serious suspected reactions even if they are listed above, in the BNF, or in the product SPC. Serious reactions are those that are fatal, life threatening, disabling, incapacitating or which result in or prolong hospitalisation and/or are medically significant. Yellow cards may be completed by a nurse, pharmacist, the patient or a doctor.

Additional Facilities

Special Considerations / Additional information

Advice to Patient

• • • •

• •

Approval Date: 9/12/09

Immediate access to adrenaline/epinephrine for treatment of anaphylaxis. See protocol for the administration of Lidocaine (Lignocaine) by CaSH Service Nurses. Give a copy of the manufacturer’s patient information leaflet if available and discuss as required Discuss risks associated with Lidocaine (Lignocaine) injection. Full sensation should return within 2 hours Warn the client about the possibility of bruising and tenderness for the first few days when the effects of the Lidocaine (Lignocaine) wear off. Advise to keep the site clean and dry for 48 hours. Advise the client to return or seek medical advice if there are

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unacceptable or serious side effects. Give the client a contact telephone number to access further advice. Anaphylaxis is rare but can occur up to 72 hours after injection. Advise to seek urgent medical attention if the patient develops breathlessness, swelling or rash

• •

Follow Up

Non required

REFERRAL ARRANGEMENTS AND AUDIT TRAIL Referral Arrangements Records/Audit Trail

Approval Date: 9/12/09

To an appropriate medical practitioner

• To Accident & Emergency in the event of anaphylaxis In all cases manual records and computerised records including communication to the General Practitioner should include: • Patient’s name, address, date of birth and consent given. If consent is either refused or withdrawn, this decision should also be documented. • Contact details of GP • Dose administered and route. • Site of injection. • Batch details, expiry date and manufacturer, including brand name • Advice given to patient (including side effects, and risks) • Date administered • Signature and name of staff who administered or supplied the medication. • Details of any adverse drug reaction and actions taken including documentation in the patient’s medical record

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STAFF CHARACTERISTICS Registered nurse with recognised post graduate qualification in Qualifications Specialist Training or Qualifications

Continuing Training & Education

contraception and sexual health currently working within NHS Kirklees • Has undertaken appropriate training and is competent to undertake the clinical assessment of patients according to the indications listed in this PGD. • Registered nurses who hold a qualification in contraception and reproductive health once their competencies have been assessed and training for implanon insertion completed under RCN guidelines. • Has undertaken appropriate training and is competent for working under PGDs for the supply and administration of medicines • Has undertaken training appropriate to this PGD – e.g. updates in Contraception and Sexual health at recommended intervals • Has undertaken training and is competent in the recognition and treatment of anaphylaxis. •

Has undertaken training and is competent in resuscitation skills.

Accepts personal responsibility for working within the PGD, understands the legal implications of doing so and works within the scope of the PGD.

References/Resources and Comments

Approval Date: 9/12/09

The practitioner should be aware of any change 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 scope of practice. Attends updates in administration of medicines through the use of patient group directives at recommended intervals including updates on anaphylaxis and resuscitation. Practitioner should have access to current BNF, Faculty of Contraception and Sexual Health Guidance (including current UK Medical Eligibility Criteria For Contraceptive Use), and updated DH advice where appropriate 1. SPC from Electronic Medicines Compendium 2. BNF No 51 (march 06 – chapter 7) 3. Faculty of Sexual & Reproductive Healthcare Clinical Guidance, Progestogen-only Implants, April 2008 (updated January 2009)

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This PGD is an updated version of CaSH Services PGD No 7, ‘Lidocaine (Lignocaine) 1% Injection’, July 2007. It was updated for use within NHS Kirklees CaSH Services by the individuals listed below: Name


Dawn Broadbent Shirley Tabner Lucianne Ricketts

CaSH Team Leader CaSH Clinical Lead Senior Medicines Management Adviser, Stratey and Operational Develeopment Specialist Technician, Community and Support Services

Lisa Meeks

Approval Date: 9/12/09

Date November 2009 November 2009 November 2009 November 2009

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Individual Authorisation for the Administration of Lidocaine (Lignocaine) 1% Injection by appropriately qualified Nurses working in CaSH Services within NHS Kirklees. 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 I have read and understood the Patient Group Direction and agree to supply/administer this medicine ONLY in accordance with this PGD. In signing this declaration the registered healthcare professional is willing to be professionally accountable for this work as defined in their Code of Professional Conduct. Name of Professional Signature Authorising Manager and Date signature

Staff who are no longer required to supply/administer under this PGD should be removed from it. This can be done by crossing through the relevant name, adding date and initials. Authorising Managers For PCT staff this will be the team leader, or relevant clinical manager. Note to Authorising Managers: Authorised staff working at a fixed base should have access to the signed PGD held at the base. Authorised staff working under a PGD should have an individual copy of the relevant signed PGD with them when supplying or administering medicines

Approval Date: 9/12/09

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AUTHORISATION 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.

Organisation Kirklees Primary Care Trust Director of Patient Care Name : Sheila Dilks & Professions Signature:


Assistant Director of Name: Neill McDonald Medicines Management and Prescribing Signature:

Medical Director

Name: Dr Judith Hooper


PEC Chair


Name: Dr David Anderson


Approval Date: 9/12/09



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