NHS Greater Glasgow & Clyde
Patient Group Direction (PGD) for
Optometrists & Orthoptists /
Bimatoprost 0.03% Eye Drops

GG&C PGD ref no:

YOU MUST BE AUTHORISED BY NAME, UNDER THE CURRENT VERSION OF THIS PGD BEFORE YOU ATTEMPT TO WORK ACCORDING TO IT

Clinical Condition
Indication: / Reduction of elevated intraocular pressure in chronic open-angle glaucoma and ocular hypertensionin line with guidance document for use of PGDs in glaucoma clinic.
Inclusion criteria: / Adults who are newly diagnosed as having raised intra-ocular pressure in open angle glaucoma or ocular hypertension according to defined protocols for diagnosis.
Adults who have a prior diagnosis of glaucoma or ocular hypertension and are found to have inadequate control of intraocular pressure on current treatment, or are found to have glaucomatous progression e.g. Optic disc change or visual field progression.
Exclusion criteria: / Individuals (age less than 18)
Patients with any of the following know conditions:
  • Recent Cataract surgery (within 3 months)
  • Patients with aphakia or pseudophakia with torn posterior capsules.
  • Cystoid macular oedema
  • Patients with known history of iritis/uveitis
  • Known renal impairment
  • Known hepatic impairment
  • History of significant ocular viral infections eg. Herpes simplex
  • Known hypersensitivity/ allergy to bimatoprost or prostaglandin analogues or any constituent of the product
  • Pregnancy
  • Lactation

Cautions/Need for further advice/Circumstances when further advice should be sought from the doctor: / Advice should be sought from a doctor if any uncertainty regarding diagnosis, exclusion criteria, or cautions for use
Action if patient declines or is excluded: / Advice from ophthalmic medical staff regarding patient’s condition and referral to consultant clinic
Referral arrangements for further advice / cautions: / Refer to Ophthalmologist
Drug Details
Name, form & strength of medicine: / Bimatoprost 0.03% eye drops
Route/Method of administration: / Topical ocular administration
Systemic absorption may be reduced by compressing the lacrimal sac at the medial canthus for one minute during and following the instillation of the drops.
Each bottle is intended for use for 28 days only after which they must be discarded and a repeat prescription obtained from the general practitioner. A letter detailing initiation of therapy and requesting continuation of supply will be sent to the General Practitioner.
Dosage (include maximum dose if appropriate): / One drop into the affected eye(s)
Frequency: / Once daily in the evening
Duration of treatment: / 28 Days
Maximum or minimum treatment period: / Minimum duration of 4 weeks to assess ocular response to treatment (maximum IOP lowering effect occurs 5-6 weeks after commencing treatment) and possible life long treatment if effective
Quantity to supply/administer: / One 3ml bottle supplied to patient
▼Black Triangle Drug:* / No
Legal Category: / POM
Is the use outwith the SPC:** / No
Storage requirements: / No special storage requirements

* The black triangle symbol (▼) identifies newly licensed medicines that are monitored intensively by the MHRA/CSM

** Summary of Product Characteristics

Warnings including possible adverse reactions and management of these: / Refer to Summary of Product Characteristics (SPC) available at BNF for full list of potential adverse effects, interactions and cautions for use.
Adverse Effects
Common side effects include headache,increased iris pigmentation, darkening of eyelashes, conjunctival hyperaemia, ocular pruritus, superficial punctuate keratitis, corneal erosion, ocular burning, ocular irritation, allergic conjunctivitis, blepharitis, worsening visual acuity, asthenopia, conjunctival oedema, foreign body sensation, ocular dryness, eye pain, photophobia, tearing, eye discharge, visual disturbance, hypertension, eyelid erythema, eyelid pruritus, pigmentation of periocular skin
Adverse reactions will be documented in patient’s notes and discussed with a member of medical staff.
If necessary the Yellow Card System will be used to report adverse drug reactions. Yellow Cards and guidance on its use are available at the back of the BNF or online at
Advice to patient/carer including written information provided: / Patients or carers will be advised that vision may be blurred for a few minutes after instillation and that the patient should not drive or operated hazardous machinery if affected. Drops may sting for a few moments after instillation and may produce mild redness of the eyes.
Patients will be advised to read the patient information leaflet contained with their medication.
Patients with asthma or COPD will be advised to contact the eye clinic as detailed below if they have any exacerbation of symptoms.
Patients will be advised and shown the best way to self administer eye drops and will be advised on the importance of compliance - and the risks to the sight of non-compliance. Patients will be advised to contact the eye clinic at the hospital which they normally attend during working hours or NHS 24 outwith working hours to report any unusual or severe side effects, either ocular or systemic.
Patients will be advised of the potential for harmless increased pigmentation of the iris as well as pigmentation and lengthening of the eyelashes
Remove soft contact lenses prior to application and wait at least 15 minutes before reinsertion.
Monitoring (if applicable): / Following initiation of new treatment or any treatment change, the patient will be reviewed in the glaucoma clinic within 2 months to assess the effect of treatment.
Follow up: / Patients will be reviewed periodically in glaucoma clinics and effectiveness of treatment monitored according to clinic protocols.
Staff Characteristics
Professional qualifications: / Registered Orthoptist (registered with health professions council)
Optometrist (registered with general optical council)
Specialist competencies or qualifications: / Local accreditation in Glaucoma diagnosis and management by consultant glaucoma specialist
Completion of in-house training on use of Patient Group Directions.
Annual update of Patient Group Direction training.
Continuing education & training: /
  • All healthcare professionals are personally accountable for their practice and, in the exercise of their professional accountability there is a requirement to maintain and improve their professional knowledge and competence.
  • In-house training carried out by relevant medical, nursing and pharmacy staff.
  • All authorised orthoptists/optometrists must re-read the patient group direction on an annual basis and when any changes, additions or deletions are made following a period of prolonged absence, leave or sabbatical.

Referral Arrangements and Audit Trail
Referral arrangements / New and review patients attending shared care Glaucoma service
Records/audit trail: / Clinical decision and prescribing information recorded in patient case notes.
Departmental records kept of patient name, date of birth, unit number and CHI number to record batch number and expiry of medications supplied, as well as details of who prescribed and who dispensed the medication.
References/Resources and comments: / Guidance document for use of PGDs in glaucoma clinic.
NICE guidelines on diagnosis and management of Glaucoma
Scottish Medicines Consortium
British National Formulary 59
Electronic Medicines Compendium
This Patient Group Direction must be agreed to and signed by all healthcare professionals involved in its use. The original signed copy will be held at PPSU, Queens Park House, Victoria Infirmary. The PGD must be easily accessible in the clinical setting.
Organisation: / NHS Greater Glasgow & Clyde
Professionals drawing up PGD/Authors
Designation and Contact Details
*Name:
Signature: Date: / Designation:
E-mail address:
Name:
Signature: Date: / Designation:
E-mail address:
Name:
Signature: Date: / Designation:
E-mail address:
Name:
Signature: Date: / Designation:
E-mail address:
Name:
Signature: Date: / Designation:
E-mail address:

* Lead Author

AUTHORISATION:

NHSGG&C PGD & Non-medical Prescribing Sub-Committee of ADTC
Chairman
in BLOCK CAPITALS / Signature: / Date:
Lead of the professional group to which this PGD refers:
Name:
in BLOCK CAPITALS / Signature: / Date:
Pharmacist representative of PGD & Non-Medical Sub-Committee of ADTC
Name:
in BLOCK CAPITALS / Signature: / Date:
Antimicrobial use
If the PGD relates to an antimicrobial agent, the use must be supported by the NHS GG&C Antimicrobial Management Team (AMT). A member of this team must sign the PGD on behalf of the AMT.
Microbiology approval / Name: Designation:
Signature: Date:
(on behalf of NHS GG&C AMT)

Local Authorisation:

Service Area for which PGD is applicable:
I authorise the supply/administer medicines in accordance with this PGD to patients cared for in this service area.
Lead Clinician for the service area (Doctor)
Name: / Signature: / Designation: / Date:
E-Mail contact address:
I agreethat only fully competent, qualified and trained professionals are authorised to operate under the PGD. Records of nominated individuals will be kept for audit purposes.
Name(Lead Professional): / Signature: / Designation: / Date:
E-Mail contact address:
Description of Audit arrangements:
Frequency of checks:
(Generally annually) / Names of auditor(s):

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.

Note to Authorising Managers: authorised staff should be provided with an individual copy of the clinical content of the PGD and a photocopy of the document showing their authorisation.

I have read and understood the Patient Group Direction. I acknowledge that it is a legal document and agree to supply/administer this medicine only in accordance with this PGD.

Name of Professional / Signature / Date
Date Approved: / Version:
Review Date: / Expiry Date:
Template Version: / Page 1 of 7