Best Practice at South East Coast Ambulance Service NHS Foundation Trust
JRCALC Plus APP for Patient Group Directions (PGDs) at SECAmb
To date, SECAmb paramedics have used a paper-based PGD system which required them to sign and forward the PGDs to the Medicines Governance Team. This system created extra work and full compliance was not achieved.
Recommendation 2.8.7 of Patient Group Directions NICE MPG2 2013 states the following:
Ensure that appropriate organisational records are maintained, stored securely and archived, in line with relevant legislation and the Information Governance Alliance Records Management Code of Practice for Health and Social Care 2016. In relation to PGDs these records should include:
- Terms of reference and minutes or notes of the PGD approval group
- A list of all PGDs in use within the organisation, including their review date and expiry date
- Master authorised copies of PGDs
- Expired versions of PGDs
- Signatures of people signing a PGD
- A list of named, registered health professionals authorised to practise under each PGD used within the service
- Training records
- Results of monitoring and evaluation.
While PGD legislation or guidelines states that hard copies of documents must be signed by hand or that individuals must sign a hard copy of the PGD as part of the individual authorisation process, Organisations may have electronic systems in place to receive, accept and record evidence and a declaration of competency from an individual practitioner.
Authorisation of individual paramedics to administer PGDs
The practitioner is responsible for ensuring that they have a copy of the authorised PGD and a record of their individual authorisation, whatever format that takes, before practicing under the PGD. The MHRA has confirmed that electronic systems and processes can be used to record individual authorisation of those using PGDs. These systems must comply with Patient Group Directions NICE MPG2 2013 which state the following:
For each PGD, the provider organisation should:
- Identify a senior, responsible person from within the service to authorise named registered health professionals to practise under the PGD
- Ensure that authorised health professionals have signed the appropriate documentation
Before practising under a PGD, health professionals should ensure that they:
- Have undertaken the necessary initial training and continuing professional development
- Have been assessed as competent and authorised to practise by the provider organisation
- Have signed the appropriate documentation (see recommendation 2.4.9)
- Are using a copy of the most recent and in date, final signed version of the PGD
- Have read and understand the context and content of the PGD.
New SECAmb JRCALC Plus specifications/functions
The new SECAmb app will be capable of the following;
- Hold a database of staff authorised to sign PGDs in the Trust, along with all app users who would be marked as not eligible to use PGDs
- Be able to differentiate between healthcare professionals who are legally entitled to use PGD, and other staff who may only view the PGD for information (and supporting HCP colleagues)
- Organise these staff into groups based on the PGDs they use. The following groups have been suggested, but further groups may be added, and so ability to add new groups should be included;
- All Paramedics
- Specialist/advanced Paramedics (Critical Care)
- Specialist/advanced Paramedics (Urgent & Emergency Care)
- Where PGDs are published in the app, an alert notification will be shown on the home screen:
- The Trust can select whether these PGDs are visible, or hidden, to groups of staff who are not signed users of the PGD (i.e. Technicians)
- Where the PGDs is visible to non-user clinicians, there will be a display banner stating ‘Information Only’
- Where a new or amended PGD is uploaded to the app, clinicians who are eligible to sign the PGD should see a button stating “unauthorised”
- Once the clinician has read the PGD they must take the associated applied knowledge test to complete their ‘authorisation’.
- The applied knowledge comprises of a bank of 10-15 questions for each PGD. The user must pass this to receive authorisation to administer the PGD.
When SECAmb launches the updated app, which is planned for later this month, we will be the first Trust in the country to use an app to assess, track and audit PGDs. The Trust will be able to access a list of staff authorised to use the PGD. Staff will be authorised to administer under PGD, once they take part in a short online competency assessment through the app and a quick e-sign process to verify successful completion for all our PGDs.
It will also make it easier to audit our medicines governance and give us greater visibility of how well we’re doing. That in turn will make it easier to compare our PGD compliance records with our patient care records.