Breathing Room: How Patient Group Directives (PGDs) can help COPD patients prosper without pressing the panic button.
Project overview, including who was involved in the project
The specialist COPD team in South Manchester visit patients at home experiencing COPD exacerbations. Access to treatment has traditionally been requested via the GP. However, due to increasing pressures on primary care and community pharmacies this treatment could be delayed. Therefore, increasing the risk of avoidable emergency department admissions.PGDs are written, legal frameworks in healthcare that allow qualified health professional to supply and administer specific medicines to pre-defined groups of patients without a direct prescription. The incorporation of PGDs is comprehensive and requires:
• Reviewing the individual PGDs.
• Complete the PGD e-learning.
• Medicine management
• Resuscitation mandatory training.
• Competency assessment document.
• Medication training with pharmacy.
This is then reviewed annually within those individual staff members appraisal. The PGD documents are then further reviewed every two years to ensure the remain clinically safe, legally valid and up to date with current guidance.
Overall, the integration of PGDs supports timely, high-quality care delivery while maintaining rigorous safety and governance standards.
Project outcomes/impact
The initial integration of PGDs within the CRT has been successful. The use of PGDs have reduced patients’ ‘length of stay’ from an average of 7.4 days to 5.6 days on our acute service. This has potentially prevented admissions to the emergency department and improved virtual ward capacity. Given this success it has been expanded and continues to be rolled out within the team.Positives:
• Enables immediate point of care access to antibiotics, steroids and nebulised medications.
• Supports more vulnerable patients in the community.
• Supports the NHS 10-year plan to drive better access to treatment in the community for at risk patient groups.
• Allows efficient use of the work force:
o Reduces burden in primary care (GP, pharmacy and delivery services)
o Potentially reduces hospital admissions.
o Cost saving implications
• Supports colleagues expressing an interest within non-medical prescribing for further development when patients do not fit the PGD criteria.
Negatives:
• Time burden to develop, authorise, review and update PGDs.
• Administrative workload to ensure compliance with legal and governance.
• Not suitable for ongoing or complex treatment plans.
• Professional responsibility as you must full ensure understanding and accountability.
• Risk of PGDs being used for convenience rather than clinical necessity.
If you were to run the project again, what would you do differently?
• Review how other services have integrated into their teams for interprofessional learning.• Provide more 1:1 support for staff on the initial training process.
• Streamline the process from initial training to implementation. For example:
o Staff availability to undertaking training and give them a clear time frame, such as 3-6 months.
o Availability of other members of multidisciplinary team (MDT) to support with initial training, such as consultants and pharmacists.
Advice you would have for others undertaking the same type of project.
• Ensure clear pathways, policies and processes are in place of how to:o Undertake training and the process involved.
o Documenting of PGDs and how they are recorded and logged for audit purposes.
o Training and ongoing education to ensure they remain safe and relevant to the service.
• Shadow services and how they integrate into their daily practice to ensure efficiency and compliance with legal and governance processes.