Glendale Medical Centre (risk assessments using cqc template)
GPs need to carry a range of drugs for use in acute situations when on home visits.
Exactly which drugs they should carry is very dependent on the location of the practice. The drugs required by a remote and rural GP can be very different to drugs required by an inner city GP.
We are an inner city practice with a very low home visit rate for seriously acutely unwell patients – if after a telephone triage patient deemed to have MI/CVA/respiratory failure etc an ambulance will also be summoned and we may also visit – the ambulance response time is within 7 minutes for 999 calls
Therefore the choice of what to include in the GP's bag is determined by:
· the medical conditions they are likely to face.
· the medicines they are confident in using.
· the storage requirements.
· shelf-life.
· the extent of ambulance paramedic cover.
· the proximity of the nearest hospital.
· the availability of a 24-hour pharmacy.
·
As our visit rate is low we stock the below drugs in the practice and take them with us based on what we feel would be necessary to administer at home.
In the GP practice
Below is a suggested list of emergency drugs for GP practices. This list is based on current practice modified from a Drugs and Therapeutics Bulletin in 2005.
This isnotintended to be either exhaustive or mandatory and that final decision needs to be taken contextually so that choices/omissions can be professionally justifiable.
/ Drug / Indication /y / Adrenaline for injection / Anaphylaxis or acute angio-oedema
y / Atropine for practices that fit coils or minor surgery is performed (although neither now carried out here) / Bradycardia
yes / Benzylpenicillin for injection / Suspected bacterial meningitis
yes / Chlorphenamine for injection / Anaphylaxis or acute angio-oedema
yes / Glucagon (needs refrigeration) or Glucagel / Hypoglycaemia
yes / Hydrocortisone for injection / Acute severe asthma, Severe or recurrent anaphylaxis
yes / Salbutamol either nebules or inhaler with volumatic- nebuliser available / Asthma
yes / Antiemetic – prochlorperazine / Nausea and vomiting
no / We don’t stock opiates / Severe pain
no / Naloxone (dependent on if opiates are kept at the practice) / Opiates not stocked at practice
yes / Diclofenac (intramuscular injection) / Analgesia
yes / GTN Spray or unopened in date GTN SL tabs / Chest pain of possible cardiac origin
yes / Aspirin soluble (300 and 75) / Suspected myocardial infraction
yes / Rectal diazepam and/or IV diazepam / Epileptic fit
We would want to see evidence that an appropriate risk assessment has been carried out to identify a list of medicines that arenotsuitable for a practice to stock, and how this is kept under review. There should be a process and system in place to check that drugs are in date and equipment is well maintained.
CQC needs to be assured that practices are able to immediately respond to the needs of a person who becomes seriously ill.
We will consider the individual circumstances of the practice such as the practice’s knowledge and assessment of the emergency services available to them.
CQC does not have explicit guidance around emergency equipment such as pulse oximeters, defibrillators and oxygen. However, we have reviewed other guidance and national standards and have agreed some processes with the British Medical Association (BMA), Royal College of General Practitioners (RCGP), National Clinical Assessment Service (NCAS) and Medical Defence Union (MDU).
Defibrillators: we have held a defibrillator since 1995- but this has never been used in receptionist office above mail pigeon holes
Oxygen:cylinder in Dr Nanavati room in cupboard under worktop.’
Oxygen available for acute use
Oxygen is considered essential in dealing with certain medical emergencies (such as acute exacerbation of asthma and other causes of hypoxaemia). If the practice does not have oxygen they are unlikely to be able to demonstrate they are equipped for dealing with emergencies.
Oximeters:The 2009 British Thoracic Society (BTS) guideline on the management of asthma recommend SpO2 monitoring by pulse oximetry as an objective measure of acute asthma severity, particularly in children.
Every doctors desk has a pulse oximeter and in addition taken on home visits
In addition, the Primary Care Respiratory Society (PCRS) states that it should be used to assess all acutely breathless patients in primary care.The need for pulse oximeters and a paediatric pulse oximeters should be risk assessed within a GP practice.
Paediatric pulse oximeters not available—however low threshold for referral to 2ry acre if any clinical suggestion of hypoxia – we have found these unreliable in the past with false negetives however technology/costs improving and we will evaluate whether we should purchase the newer lower cost models
It would be unlikely that a practice could demonstrate that they are equipped for dealing with emergencies without a pulse oximeter.
CPR:This is mandatory. If a practice has not trained its staff, it would not have evidence that their staff could immediately respond to a person who requires resuscitation.
All staff regularly trained in BLS-certificates available for inspection