PATIENT GROUP DIRECTIONS*

The Supply of

Fusidic Acid 2% Ointment

for the treatment of small localised lesions of Impetigo

By Community Pharmacists participating in the
NHS West Cheshire Clinical Commissioning Group
Minor Ailments Service
Version 1.0
Date of Introduction:October 2014

(It is intended that this document will be updated in 2 years

subject to no amendments in the interim period )

Review Date:September 2016

*HSC 2000/026 Patient Group Directions (England Only)

Version control: Fusidic Acid ointment 2% for the treatment of small localised lesions of impetig

Version / Date of introduction / Author / Status / Comment
V0.1 / October 2014 / Adopted from model document Fusidic Acid Cream 2% for the treatment of small-localised lesions of impetigo V3 Date of introduction April 2014 written and approved for use in Eastern Cheshire Clinical Commissioning Group, South Cheshire Clinical Commissioning Group, Vale Royal Clinical Commissioning Group. / draft / Awaiting ratification
V0.1 / October 2014 / Circulated to West Cheshire Area Prescribing Committee for comment / Draft / Awaiting comments/ratification
V0.2 / October 2014 / Amendments made by Barbara Perry Locality Lead for Medicines Management North West Commissioning Support Unit / Draft / Awaiting ratification
V1.0 / October 2014 / Ratified and signed by Dr Andy McAlavey Medical Director and Dr Andy Dunbavand Clinical Lead for Prescribing West Cheshire Clinical Commissioning Group; Barbara Perry Locality Lead for Medicines Management North West Commissioning Support Unit / Final
Patient Group Direction: / Fusidic Acid 2% ointment for the treatment of acute, small, localised lesions of impetigo typicallycaused by staphylococcal skin infection.
Clinical Department/Service: / NHS West Cheshire Clinical Commissioning Group
Community Pharmacy Minor Ailments Service.

1.Clinical Condition

1.1 / Define situation/condition / Acute, small, localised lesions of impetigo typically caused by staphylococcal skin infection.
Typical appearance, yellow crusty exudates/lesions.
1.2 / Criteria for inclusion / Adult or child 1yearor overpresenting with acute, small, isolated lesions of impetigo.
Maximum of two small lesions of impetigo. Each lesion should be no bigger than a size of a one pence piece.
Patient (or parent/carer) agrees to treatment under this PGD.
1.3 / Criteria for exclusion /
  • Large non-localised areas of infection or infected dermatitis.
  • Impetigo secondary to some other underlying skin disease such as eczema or scabies.
  • Where treatment would involve application to an area of skin sensitised (inflamed) by another topical agent, dressing or bandage.
  • Signs of systemic illness.
  • Immuno-compromised due to disease or treatment.
  • Known hypersensitivity / allergy to fusidic acid or any excipient in the product.
  • Is already taking a prescribed antibiotic.
  • Is pregnant or breast-feeding.
  • Any course of similar treatment in the previous 6 months.

1.4 / Cautions/additional information / Refer to Summary of Product characteristics.
(
1.5 / Action if patient excluded /
  • Refer to GP practice.
  • Supply the patient with a referral note to hand to the GP indicating the reasons for the referral.
  • Clearly record the decision on the patient's consultation proforma, advice given and any action taken.

1.6 / Action if patient declines / Advise on contagious nature including hygiene and the potential of developing secondary infection.
Record decision on the patient’s consultation proforma, including any advice given and any action taken, refer to GP as appropriate.

2.Characteristics of staff

2.1 / Class of Health Professional for whom PGD is applicable (professional qualification and training) / Qualified pharmacist registered with the General Pharmaceutical Council (GPhC).
2.2 / Additional requirements /
  • Competent to work under Patient Group Directions, including satisfactory completion of training to administer /supply in accordance with this patient group direction.
  • Working as a community pharmacist and accredited to provide the Minor Ailments Service levels 1 and 2.

2.3 / Continued training requirements /
  • Commitment to continuing updating and re-validation according to the accreditation requirements of the commissioning organisation.
  • Commitment to keep up to date with clinical developments or changes to the recommendations for the medicine listed, as part of their Continual Professional Development.

3.Description of Treatment

3.1 / Generic name of medicine and form / Fusidic Acid 2% Ointment.
3.2 / Legal status / POM
3.3 / Storage / Room temperature not above 25oC.
3.4 / Licensed or unlicensed / Licensed.
3.5 / Dose(s) / Apply thinly and evenly to the affected area three times a day for 5 days.
3.6 / Route/Method of Administration / Topical to skin.
3.7 / Frequency of administration / As detailed above (3.5).
3.8 / Total dose and number of times treatment can be administered over what time /
  • Maximum duration of treatment 5 days.
  • Supply one 15g tube.

3.9 / Side effects of drugs (including potential Adverse Drug Reaction) /
  • Rarely, hypersensitivity reactions.
  • Refer to SPC and current BNF for full details.

3.10 / Advice/management of adverse reactions/events / Seek advice from GP practice.
3.11 / Procedure for reporting Adverse Drug Reactions (ADR’s) /
  • Report serious suspected adverse drug reactions (or all suspected ADRs if the medicine is black triangle) to the Medicines Health and Regulatory Agency using either the yellow cards or via
  • Record any adverse drug reaction in the patient’s consultation record and PMR.
  • Notify patients GP.

3.12 / Information on follow up treatment / Contact GP if no improvement after three days, or sooner if symptoms worsen.
3.13 / Written/verbal advice for patient/carer before/after treatment. /
  • Advise to avoid touching any impetigo patches as infection is easily spread.
  • Do not share flannels / towels / pillows.
  • Reinforce the need to wash hands thoroughly after touching any patch of impetigo and / or after applying the fusidic acid ointment.
  • Advise crusting skin lesions should be softened and removed by soaking in warm soapy water prior to applying treatment. – Failure to wash away the crust is a common cause of relapse.
  • Advise on preventative measures to avoid reoccurrence of infection e.g. good personal hygiene, such as keeping fingernails short and clean.
  • Avoid close contact with others. Children with impetigo should be kept from nursery, playgroup or school until lesions are dry and scabbed over.
  • Advise to seek GP advice if after 5 days of treatment the lesions are not fully cleared or are getting worse.
  • Advise to contact the GP if the infection recurs.

3.14 / Specify method of recording supply/ administration, names of health professional, patient identifiers, sufficient to enable audit trail. / Record the following in the patient’s consultation proforma:
  • Advice given to patient.
  • Date of supply.
  • The signature of the person supplying the medicine.
  • Inform the patients GP of the supply.

  1. Development of the PGD

Multidisciplinary Group:

The group who have been involved in the review prior to adoption of this PGD included the following people:

Name / Designation / Signature
Barbara Perry / Locality Lead Medicines Management North West Commissioning Support Unit
Dr Andrew Dunbavand / Prescribing Lead NHS West Cheshire Clinical Commissioning Group

5. References

  • SPC for contraindications and cautions (
  • BNFSeptember 2014

Responsible Organisations:

NHS West Cheshire Clinical Commissioning Group

Responsibilities of each Organisation:

Each organisation is required to:

  1. Approve the contents of this documentation (in the knowledge that it has been prepared by a multidisciplinary group as above).
  2. Ensure that every PGD is approved and signed by a nominated Senior Pharmacist and Senior Doctor.
  3. Ensure that the PGD is approved and signed by a senior member of staff, representative of the staff to whom the PGD relates e.g. nurses, chiropodists etc.
  4. Ensure that the PGD is approved and signed by the Clinical Governance Lead for the Organisation.
  5. Ensure that individual health professionals working under the direction sign appropriate documentation.

PATIENT GROUP DIRECTION for the Supply of Fusidic Acid Ointment 2% for the treatment of small localised lesions of impetigo

Organisation (s) / NHS West Cheshire Clinical Commissioning Group
Approved by
Lead pharmacist
Name
Position
Signature
Date / Barbara Perry
Locality Lead for Medicines ManagementNorth West Commissioning Support Unit
Lead Clinician
Name
Position
Signature
Date / Dr Andrew Dunbavand
Clinical Lead for Prescribing NHS West Cheshire Clinical Commissioning Group
Medical Director
Name
Position
Signature
Date / Dr Andrew McAlavey
Medical Director NHS West Cheshire Clinical Commissioning Group

Patient Group Direction for the supply of Fusidic Acid ointment 2% Version 1Final

Date of first Introduction October 2014 Review date September 2016

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