Patient Group Direction No
Patient Group Direction for the Supply/ Administration of Betnovate–C ointment, [Betamethasone 0.1% and Clioquinol 3%] by Specialist Ear Care Nurses or Registered Nurses with Diploma in Primary Ear Care (or equivalent)
1. Clinical Condition
Betnovate-C Ointment
Clinical Indications Acute or chronic otitis externa or secondary otitis externa resulting from chronic otitis media, which is confirmed by otoscopy Informed consent of patient prior to examination Children over one year of age (without occlusive dressing) Adults
Criteria for inclusion
Patients presenting with any of the following: Itchy ears Early symptoms of otitis externa Inflammation of the meatus following 1. Wax removal Inflammation of the meatus following 2. Inappropriate use of cotton bud or other trauma Inflammation of the meatus following 3. Other trauma. Inflamed mastoid cavity following toilet Dry /flaky, red or mildly inflamed meatus/pinna Seborrhoeic dermatitis, eczema, or psoriasis of meatus or pinna Criteria for exclusion Action if excluded Patient has allergy/hypersensitivity to any component of Betnovate-C or iodine Children under one year of age Children over one year of age when using an occlusive dressing [wick] Adults who have had this treatment for 5 days and there is absence of clinical improvement Meatus is inflamed but discharge and debris are also present Pregnancy and lactation Acne vulgaris affecting the pinna Primary cutaneous viral infections e.g. herpes simplex, chicken pox Rosacea Impetigo or ringworm If patient allergic/hypersensitive to Betnovate-C, treat according to the Patient Group Direction for the relevant ear problem/condition Refer to Specialist Ear Nurse Refer to GP / ENT consultant Record in patient records
This Patient Group Direction is operational from and will be reviewed annually or in the light of new national guidance.
Rotherham
Primary Care Trust
Patient Group Direction No Consider reasons for declining Inform specialist ear care nurse Inform GP/ ENT consultant Record in patient records None
Action if declines
Drug Interactions
2.
The Medication
BETNOVATE- C OINTMENT Betamethasone Valerate 0.1%, and Clioquinol 3 % POM Store below 30 C Apply sparingly into the external auditory meatus/pinna Following aural toilet, paint the ointment onto the affected area using cotton wool wound round a Jobson Horne probe. Alternatively ointment may be applied sparingly on a ribbon gauze wick, which can remain in the meatus for up to 48hrs. All ear treatments must be carried out under direct vision using a light source A ‘one-off’ application is frequently sufficient. Alternatively can be repeated in 48hrs. If meatus is inflamed and there is no improvement after 48hrs, consider taking a swab for culture and topical sensitivities In children courses should be limited to 5 days In adults, do not continue for more than 5 days in the absence of clinical improvement. The number of treatments will be dependent on clinical judgement related to the individual patient’s presentation Note: There is a theoretical risk of neurotoxicity from the topical application of clioquinol particularly when Betnovate-C is used for prolonged periods or under occlusion Advise about the nature of treatment Give ear care education to prevent further problems Advise ointment may stain hair skin or fabric Warn about possible sensitivities to treatment and instruct accordingly Excessive use may result in fungal infections and resistance to treatment
o
Betnovate-C Ointment
Name of product
Legal status Storage
Dose Route/ method
Frequency
Total dose number
Advice
This Patient Group Direction is operational from and will be reviewed annually or in the light of new national guidance.
Rotherham
Primary Care Trust
Patient Group Direction No
3. Records
1. The following records should be kept either paper or computer based Records should be kept at The Primary Ear Care Centre, GP Practice, or Specialist Ear Clinic Name and brand of medication Batch Number and Expiry Date Route and site of administration Signature Date administered
2. Medication audit trail data collection
Reconciliation: Stock balances should be reconcilable with Receipts, Administration, Records and Disposals on a patient by patient basis Storage: Standards must be consistent with the Summary of Product Characteristics
4. Anaphylaxis - Emergency Treatment
When giving any medication the following should be available: Prior consent obtained Access to the patients notes Epinephrine (Adrenaline) 1 in 1000 for i.m. use in emergency (NB: check expiry dates regularly ) Syringes and needles of suitable size and capacity for dose
Epinephrine (Adrenaline) 1 in1000 (1mg/ml) Age Under 6 months 6months to 6 years 6 – 12 years Adults and adolescents These doses may be repeated if necessary at 5-minute intervals according to blood pressure, pulse and respiratory function Special cautions: see BNF 3.4.3
BNF (47th edition) section 3.4.3 page 156 and 157
For intramuscular injection Volume of adrenaline 1 in 1000 0.05ml 0.12ml 0.25ml 0.5ml
Epinephrine/ Adrenaline
5. Professional Responsibility (all Nurses)
1. The nurse will ensure he/she has the relevant training and is competent in ear care, including contra-indications and the recognition and treatment of anaphylaxis. He/she will attend training updates as appropriate The nurse will have due regard for the NMC Code of Conduct, Scope of Professional Practice and Standards of Administration for Nurses
2.
Sources: HSC 200/026 Patient Group Directions; BNF 47th Edition 03/2004; Current Summary of Product Characteristics for product
This Patient Group Direction is operational from and will be reviewed annually or in the light of new national guidance.
Rotherham
Primary Care Trust
Patient Group Direction No
Administration of Betnovate-C Ointment by Specialist Ear Nurses or Registered nurses who have completed the Diploma in Primary Ear Care (or equivalent) employed by Rotherham Primary Care Trust or GP Practices in Rotherham This Patient Group Direction for use of Betnovate-C Ointment is authorised by us
Job Title PCT Chairman PCT Medical Adviser PCT Pharmaceutical Advisor PCT Nurse (Board/Executive Member) Senior Partner (or delegate) - for GP employed nurses only Name Signed Date
The Nurses named below, being employees of Rotherham Primary Care Trust based at Doncaster Gate Hospital or employed by …………………………. practice are authorised to administer Betnovate-C Ointment specified under this Patient Group Direction
We agree to administer Betnovate- C Ointment in accordance with this Patient Group Direction Name of Nurse Job Title Signed Date
This Patient Group Direction is operational from and will be reviewed annually or in the light of new national guidance.
Rotherham
Primary Care Trust