Walk-in Centres Medication Standing Orders 2017

Walk-in Centres: Medication Standing Orders CHO Approved August 2017 Version 1

Introduction

The standing orders contained in this document apply only to the Walk-in Centres’ (WiC) located at the Belconnen Community Health Centre and the Tuggeranong Community Health Centre, ACT. Further WiC’s (with an identical model of care as the current WiC’s) at different locations may be introduced in the ACT at a future date and these Medication Standing Orders and Clinical Treatment Protocols will apply to these new sites.

Additionally, the standing orders are only for use by the WiC Registered Nursing staff (Advance Practice Nurses) in conjunction with the approved WiC Clinical Treatment Protocols.

This document has been written using the latest clinical evidence and the expertise of the members of the Walk-in Centres Staff and Walk-in Centres Clinical Advisory Group.

The following staff (including their role and qualifications) reviewed the MSO 2017 version 1:

• Tim Bethune, WiC Advanced Practice Nurse, Bachelor of Nursing • Wendy Kroon, WiC Nurse Practitioner, Master of Nurse Practitioner • Mariusz Stachura, WiC Nurse Practitioner, Master of Nurse Practitioner • Carol Chan, Lead Pharmacist for the Division of Rehabilitation, Aged and Community

Care, Bachelor of Pharmacy, Australian Association of Consultant Pharmacist (AACP) member.

• Dr. Marianne Bookallil, GP advisor ACT Health, MBBS, FRACGP, MPHTM, FAFPHM • Michelle Lambert, Clinical Nurse Manager Belconnen WiC, Bachelor of Nursing,

Graduate Certificate in Critical Care • Karina Stewart, Clinical Nurse Manager Tuggeranong WiC, Bachelor of Nursing,

Graduate Certificate in Child and Family Health • Naree Stanton, Assistant Director of Nursing WiC, Bachelor of Applied Science

(Midwifery), Post Grad Cert Public Sector Management

Abbreviation Detail

ACT Australian Capital Territory ADEC Australian Drug Evaluation Committee ADT Adult Diphtheria and Tetanus Booster ASAP as soon as possible BGL Blood glucose level CHO Chief Health Officer CNS Central Nervous System CrCl Creatinine clearance ED Emergency Department e.g. example GP General Practitioner HIV Human Immunodeficiency Virus IM Intramuscular IV Intravenous kg kilogram mcg microgram MDI Metered dose inhaler MET Medical Emergency Team min minute mL Millilitre mm Millimetre N/A Not applicable NSAID Non-steroidal anti-inflammatory drug SIDS Sudden infant death syndrome TCH The Canberra Hospital TD Tardive dyskinesia WiC Walk-in Centres

Medications Applicable to all Walk-

in-Centres

Date of Effect

Date of Last Review Date Order

Ends

CHO Approval Number

Page Number

Adrenaline/epinephrine 15 March 2018

August 2017 31 August 2019 9201729

Adult Diphtheria and Tetanus Booster

15 March 2018

August 2017 31 August 2019 9201731

Amethocaine/Tetracaine 15 March 2018

August 2017 31 August 2019 9201732

Amoxicillin 15 March 2018

August 2017 31 August 2019 9201733

Amoxicillin and clavulanate 15 March 2018

August 2017 31 August 2019 9201734

Aspirin 15 March 2018

August 2017 31 August 2019 9201735

Carmellose 15 March 2018

August 2017 31 August 2019 9201736

Ceftriaxone 15 March 2018

August 2017 31 August 2019 9201737

Cefuroxime 15 March 2018

August 2017 31 August 2019 9201738

Cefalexin - UTI 15 March 2018

August 2017 31 August 2019 9201739

Cefalexin – mastitis/ cellulitis

15 March 2018

August 2017 31 August 2019 9201740

Cefalexin - tonsillitis 15 March 2018

August 2017 31 August 2019 9201741

Chloramphenicol 15 March 2018

August 2017 31 August 2019 9201742

Ciprofloxacin 15 March 2018

August 2017 31 August 2019 9201743

Dermabond 15 March 2018

August 2017 31 August 2019 9201744

Dexamethasone 15 March 2018

August 2017 31 August 2019 9201745

Dexamethasone, Framycetin, Gramicidin

15 March 2018

August 2017 31 August 2019 9201746

Dicloxacillin – mastitis/ cellulitis

15 March 2018

August 2017 31 August 2019 9201747

Glucagon 15 March 2018

August 2017 31 August 2019 9201748

Ibuprofen 15 March 2018

August 2017 31 August 2019 9201749

Laceraine 15 March 2018

August 2017 31 August 2019 9201750

Levonorgesterel 15 March 2018

August 2017 31 August 2019 9201751

Lignocaine 1% with Adrenaline/epinephrine

15 March 2018

August 2017 31 August 2019 9201752

Lignocaine 1% 15 March 2018

August 2017 31 August 2019 9201753

Loratadine 15 March 2018

August 2017 31 August 2019 9201754

Metoclopramide 15 March 2018

August 2017 31 August 2019 9201755

Mupirocin 15 March 2018

August 2017 31 August 2019 9201756

Normal Human Immunoglobulin (NHIG)

15 March 2018

August 2017 31 August 2019 9201757

Oxygen 15 March 2018

August 2017 31 August 2019 9201758

Paracetamol 15 March 2018

August 2017 31 August 2019 9201759

Phenoximethylpenicillin 15 March 2018

August 2017 31 August 2019 9201760

Promethazine 15 March 2018

August 2017 31 August 2019 9201761

Rifampicin 15 March 2018

August 2017 31 August 2019 9201762

Roxithromycin 15 March 2018

August 2017 31 August 2019 9201763

Salbutamol 15 March 2018

August 2017 31 August 2019 9201764

Trimethoprim 15 March 2018

August 2017 31 August 2019 9201765

Walk-in Centres MEDICATION STANDING ORDER

ADRENALINE (Epinephrine) Adrenaline (Epinephrine) 1:1000 ampoules IMI

Approved Treatment Protocols

ADRE

NALI

NE (E

pine

phrin

e)

Anaphylaxis

Included Clients

Clients aged 2 or over

Excluded Clients

Exclusion Suggested Action(s) and Notes

There are no absolute contraindications to adrenaline in severe life threatening allergic conditions

Drug Interactions

Drug Suggested Action(s) and Notes

There are no absolute contraindications to adrenaline in severe life threatening allergic conditions

Dosing and Administration Information

Age / Weight Product / Strength Dose

Adult and children >50kg Adrenaline 1:1000/1mg in 1ml 500mcg IMI (0.5ml)

40kg Adrenaline 1:1000/1mg in 1ml 400mcg IMI (0.4ml)

30kg Adrenaline 1:1000/1mg in 1ml 300mcg (0.3ml)





Instructions

• Ensure that 000 is called and all first aid measures are attended; DRSABCD • Draw up Adrenaline 1:1000 (to a maximum of 500mcg) from ampoule preferably using a

1ml tuberculin syringe and 18G drawing up needle. Prime syringe with appropriate weight-specific dose and apply 23G needle

• Prepare patient for injection, locating vastus lateralis (upper outer thigh) • Swipe mid-anterolateral thigh well with Alco wipe • After injecting adrenaline, gently rub injection area on thigh for approximately 10

seconds • Record time, location and dose of adrenaline administered. Prepare second dose,

monitor patient Repeat doses of Adrenaline 1:1000 can be administered every 3-5 minutes as necessary

Adverse Drug Reactions / Side Effects

ADRE

NALI

NE (E

pine

phrin

e)

Reaction Advice for Clients and Notes

Anxiety, restlessness, tachycardia, respiratory difficulty, tremor, weakness, dizziness, headache, dyspnoea, cold extremities, pallor, sweating, nausea, vomiting, sleeplessness, hallucinations, palpitations, fear and flushing or redness of face and skin

These effects to be managed by ACTAS and ED

Psychomotor agitation, disorientation, impaired memory, psychosis, ventricular arrhythmias, and severe hypertension which may lead to cerebral haemorrhage and pulmonary oedema

Refer client to printed Consumer Medicines Information for a full list of adverse effects

Specific Counselling Points

Call 000 and request ACTAS response to Walk in Centre location.

References

MIMs online https://www.mimsonline.com.au Australian Medicines Handbook http://amh.hcn.au

Approval

Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date Order ends: 31 August 2019 CHO approval Number: 9201729

https://www.mimsonline.com.au/

http://amh.hcn.au/

Walk-in Centre

MEDICATION STANDING ORDER

ADULT DIPTHERIA & TETANUS (ADT) BOOSTER IMMUNISATION

0.5 mL prefilled syringe


ADU

LT D

IPTH

ERIA

& T

ETAN

US

(ADT

)

Abrasions, Bites, Burns, Lacerations, Marine Stings, Paronychia, Spider Bites, Stings

Included Clients

Adults (age ≥18) who have sustained injuries deemed to be tetanus-prone (all wounds other than clean minor cuts) should receive a booster dose of ADT if more than 5 years have elapsed since the last dose of tetanus-containing vaccine

Definition: “The definition of a tetanus-prone injury is not straightforward, as tetanus may occur after apparently trivial injury, such as from a rose thorn, or with no history of injury. However, there are certain types of wounds likely to favour the growth of tetanus organisms. These include compound fractures, bite wounds, deep penetrating wounds, wounds containing foreign bodies (especially wood splinters), wounds complicated by pyogenic infections, wounds with extensive tissue damage (e.g. contusions or burns) and any superficial wound obviously contaminated with soil, dust or horse manure (especially if topical disinfection is delayed more than 4 hours).” Australian Immunisation Handbook, 10th edition

Excluded Clients


Clients with no history of receiving the 3 dose primary tetanus course

Refer to ED – may require tetanus immunoglobulin

Allergy to ADT vaccine or known hypersensitivity to any of the vaccine components

Refer to ED – may require tetanus immunoglobulin

Moderate/severe acute illness with or without fever Refer to GP

Pregnancy or breast feeding mothers Refer to GP for likely dTPa

Drug Interactions


No drug interactions need to be considered


Dose Administration

Give 0.5mL via the intramuscular route

• The vaccine should be thoroughly shaken before use to ensure adequate dispersion when it is injected.

• The vaccine should appear as a suspension of white and grey particles in a colourless fluid.

• ADT vaccines should not be mixed with any other vaccine in the same syringe. • Cover the site quickly with a Band-Aid. Gently apply pressure for 1 or 2 minutes. Do

not rub the site as this will encourage the vaccine to leak back up the needle track, which can cause pain and may lead to local irritation.


ADU

LT D

IPTH

ERIA

& T

ETAN

US

BOO

STER

(AD

T)

Reaction Advice for Clients and Notes Redness, itching, swelling, burning or pain at the injection site. Small lump at injection site. Transient fever ≥38⁰C

This is common and may last for 1-2 days. Paracetamol might be required to ease the discomfort

Headache, lethargy, malaise, myalgia These are uncommon side effects and if the client is concerned refer to GP

Rash, urticaria or anaphylactic reaction May indicate allergic reaction advise client to seek medication attention urgently if this occurs



• Paracetamol is not routinely used before or at the time of vaccination, but may be recommended as required for fever or pain.

• The vaccinated person and/or parent/carer should be advised to remain in the WiC for a minimum of 15 minutes after the vaccination. The client should be close enough to WiC staff, so that the individual can be observed and medical treatment rapidly provided if needed.

• Vaccination of people receiving immunosuppressive treatment can take place, but may result in a reduced immunological response – may require antibody titres checked by GP post vaccination

• Mild common illnesses are not contraindications to vaccination • Too frequent booster vaccination will increase the risk of adverse reactions

References

MIMs online https://www.mimsonline.com.au The Australian Immunisation Handbook 10th Edition 2017

Australian Medicines Handbook http://amh.hcn.au

Approval

Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019

CHO Approval Number: 9201731


http://amh.hcn.au/

Walk in Centre MEDICATION STANDING ORDER

Amethocaine (Tetracaine) 0.5% Eye drops (single use)


Amet

hoca

ine

(Tet

raca

ine)

1. For examination of a superficial foreign body in a single eye, that is suitable for removal with a moistened cotton bud.

2. In chemical injury, to assist immediate commencement of irrigation prior to transfer to ED.

3. Corneal abrasion protocol

4. Stye (hordeola) protocol

Included Clients

1. Patients presenting with a superficial foreign body to a single eye that is suitable for removal with a moistened cotton bud

2. Patients presenting with a chemical injury, to assist immediate commencement of irrigation prior to transfer to ED.

3. For person presenting with eye pain from a suspected corneal abrasion (age ≥ 6)

4. For use prior to gently expressing a pointing external stye

Excluded Clients


Visible trauma or suspected/visible penetrating eye injury

Refer to ED

Hyphema Refer to ED

Loss of vision Refer to ED

Deep foreign body Refer to ED

History of eye surgery in last 3 months Refer to ED

Long term use Refer to ED

History of hypersensitivity or allergy to Amethocaine (Tetracaine) or any of the other ingredients

Refer to ED

Drug Interactions

Nil significant interactions


Dose Administration

0.5% Amethocaine (Tetracaine)

1 drop into affected eye. May be repeated at 5 minute intervals to a maximum of 3 drops

Adverse Drug Reactions/Side Effects


Stinging on application Warn patient Allergy Redirect to GP or ED


Amet

hoca

ine

(Tet

raca

ine)

• Anaesthetic is temporary and reverses fully after 15-20 min • Do not rub or touch eyes • Protect eyes from dust or contamination • Safe in pregnancy, but occlude punctum with digital pressure if patient pregnant

References


Approval

Date of approval: 15 March 2018

Date of effect: 15 March 2018

Date of review: August 2017

Date order ends: 31 August 2019

CHO Approval number: 9201732


http://amh.hcn.au/

WALK-IN CENTRES


AMOXICILLIN 250mg in 5mL suspension

500mg capsules


AMO

XICI

LLIN

Acute Otitis Media, Acute Bacterial Sinusitis

Included Clients

Adults and children > 2 years old

Excluded Clients


History of non-immediate hypersensitivity reaction to penicillins/beta lactams

Refer to cefuroxime medication standing order

History of immediate hypersensitivity to a penicillin/beta lactam antibiotic

Refer to NP/GP

Known hepatic or renal impairment Refer to NP/GP

Known previous penicillin-induced cholestatic jaundice or hepatitis

Refer to GP

Clients with phenylketonuria (liquid formulations contain aspartame)

Refer to NP/GP if capsules not able to be taken

Clients with lymphoblastic leukaemia, chronic lymphocytic leukaemia, HIV infection or likely infectious mononucleosis

Have an increased risk of penicillin induced erythematous rash Refer to GP

Drug Interactions


Warfarin Anticoagulant effects may be altered. Advise client that INR may change whilst taking amoxicillin and refer to GP for increased monitoring

Allopurinol Increased risk of skin rash. Advise client to stop treatment and see their GP should this develop

Probenecid Probenecid decreases the renal tubular secretion of Amoxicillin, dose will need to be adjusted Refer to GP

Methotrexate Penicillins may reduce the renal clearance of methotrexate resulting in toxicity – refer to GP

Dosing and Supply Information

AMO

XICI

LLIN

Dosing Supply Label & Instructions

Weight / Age Dose Strength Quantity

<10kg Refer to GP

10-12.5kg 175mg

(14 - 17.5mg/kg/dose)

250mg in 5mL

suspension

1 x 100mL suspension

Take 3.5mL every 8 hours for 5 days

12.6 - 15kg 225mg

(15 – 17.9mg/kg/dose)

250mg in 5mL

suspension



15.1 – 17.5kg

275mg

(15.7 – 18.2mg/kg/dose)

250mg in 5mL

suspension



17.6 – 20kg 300mg

(15 – 17mg/kg/dose)

250mg in 5mL

suspension


Take 6mL every 8 hours for 5 days

20.1 – 22.5kg

350mg

(15.6 – 17.4mg/kg/dose)

250mg in 5mL

suspension



22.6 – 25kg 375mg

(15 – 16.6mg/kg/dose)

250mg in 5mL

suspension



25.1 – 27.5kg

425mg

(15.5 – 16.9mg/kg/dose)

250mg in 5mL

suspension



27.6 – 30kg 450mg

(15 – 16.3mg/kg/dose)

250mg in 5mL

suspension



Child >30.1kg OR

Adults

500mg

(16.6mg/kg/dose at 30.1kg)

250mg in 5mL

suspension OR

500mg capsules


OR 1 x 20

capsules


OR Take ONE capsule every 8 hours for 5

days

Reconstitute suspension as per instructions on bottle



Nausea, Vomiting, Diarrhoea Common side effects, if prolonged or worsening advise client to seek medical advice

Rashes May indicate allergic reaction, advise client to seek medical advice

Antibiotic associated colitis

This is a severe form of diarrhoea which has been associated with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.

Vaginal or oral fungal infection May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms

Refer client to printed Consumer Medicines Information for a full list of adverse effects.


Pregnancy and breast feeding: • Advise that amoxicillin is considered safe to use in pregnancy • Safe to use at recommended doses during breastfeeding. However observe the

breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush

• Amoxicillin is in ADEC category A, this means it is a drug that has been taken by a large number of women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus being observed.

Capsules and Suspension: • Take with or without food • Take antibiotic doses regularly • Complete the full treatment course. AM

OXI

CILL

IN

Suspension: • Store mixture in fridge • Shake well before use • Measure dose using a metric measure • If >1 bottle is supplied:

Bottles are the same and not intended to be taken together Open one bottle first and finish this before moving on to second bottle

Discard any unused suspension after 14 days

References

MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: online.tg.org.au/ Australian Medicines Handbook http://amh.hcn.au


http://amh.hcn.au/

Approval


CHO Order Number: 9201733

WALK-IN CENTRES


AMOXICILLIN + CLAVULANATE 400mg + 57mg in 5mL suspension

875 + 125mg tablets


AMO

XICI

LLIN

+ C

LAVU

LAN

ATE

Bites

Included Clients


Excluded Clients


Pregnant women Refer to NP/GP

History of immediate or non-immediate hypersensitivity reaction to penicillin/beta lactam antibiotic

Refer to NP/GP

Hepatic or renal impairment or previous penicillin-induced cholestatic jaundice or hepatitis

Refer to GP

Clients with phenylketonuria (liquid formulations contain aspartame)

Refer to NP/GP if capsules not able to be taken

Clients with lymphoblastic leukaemia, chronic lymphocytic leukaemia, HIV infection or likely infectious mononucleosis

Refer to GP

Drug Interactions


Warfarin Anticoagulant effects may be enhanced. Advise client that INR may change whilst taking Amoxicillin and refer to GP for increased monitoring.

Allopurinol Increased risk of skin rash. Advise client to stop treatment and see their GP should this develop.

Probenecid Probenecid decreases the renal tubular secretion of amoxicillin, dose will need to be adjusted - Refer to GP.

Methotrexate Penicillins may reduce the renal clearance of methotrexate resulting in toxicity - Refer to GP


AMO

XICI

LLIN

+ C

LAVU

LAN

ATE



< 10 kg Refer to GP

10 – 12.5kg

240/34mg

(19.2/2.7 – 24/3.4mg/kg)

400 / 57mg in 5mL

suspension

1 x 60 mL suspension

Take 3ml every 12 hours for 5 days

12.6 – 15kg 280/40mg

(18.7/2.7 – 22.2/3.2mg/kg)

400 / 57mg in 5mL

suspension


Take 3.5ml every 12 hours for 5 days

15.1 – 17.5kg

360/51.3mg

(20.1/2.9 – 23.8/3.4mg/kg)

400 / 57mg in 5mL

suspension



17.6 – 20kg 400/57mg

(20/2.9 – 22.7/3.2mg/kg)

400 / 57mg in 5mL

suspension



20.1 – 22.5kg

480/68.4mg

(21.3/3 – 23.9/3.4mg/kg)

400 / 57mg in 5mL

suspension



22.6 – 25kg 520/74.1mg

(20.8/3 – 23/3.3mg/kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension


25.1 – 27.5kg

560/80mg

(20.4/2.9 – 22.3/3.2mg/kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension


27.6 – 30kg 640/91.2mg

(21.3/3 – 23.2/3.3mg/kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension


30.1 – 32.5kg

680/97mg

(20.9/3 – 22.6/3.2mg/kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension


32.6 – 35kg 760/108mg

(21.7/3.1 – 23.3/3.3mg/kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension


35.1 – 37.5kg

800/114mg

(21.3/3 – 22.8/3.3mg/kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension


Child >37.6kg

OR

Adults

875/125mg

(23.3/3.1mg/kg at 37.6kg)

400 / 57mg in 5mL

suspension

2 x 60ml suspension

OR

10 x 875/125mg

tablets


OR

Take ONE tablet every 12 hours for 5 days




Nausea, Vomiting, Diarrhoea Common side effects, if prolonged see GP



This is a severe form of diarrhoea which has been associated with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.


Pustular drug eruption (rare) Present to ED



Capsules and Suspension: • Take with food • Take antibiotic doses regularly • Complete the full treatment course • Consider tetanus prophylaxis. • Safe to use at recommended doses during breastfeeding. However observe the


Suspension: • Store mixture in fridge • Shake well before use • Measure dose using a metric measure

• If >1 bottle is supplied: Bottles are the same and not intended to be taken together Open one bottle first and finish this before moving on to second bottle

Discard any unused suspension after 7 days.

References


Approval




http://amh.hcn.au/

Walk in Centre


ASPIRIN (Acetylsalicylic Acid)

300mg dispersible tablet Approved Treatment Protocols

Aspi

rin (

Acet

ylsa

licyl

ic A

cid)

For patients with chest pain

Included Clients

Patients with suspected cardiac related chest pain - administer whilst awaiting ambulance

Excluded Clients


Allergy to salicylates, aspirin, or NSAIDs Do not give

Pregnancy Do not give

Active bleeding (known or suspected) Do not give

Known bleeding disorder (e.g. haemophilia) Do not give

Chest pain related to drug overdose Do not give

Aspirin-sensitive asthma Do not give

Known history of duodenal ulcers/peptic ulcer Discuss with paramedics

Drug Interactions


Anti-coagulants Discuss with paramedics


Dose Administration

300mg as a single dose 1 tablet dissolved in a small amount of water or chewed



GI upset/bleeding Review by paramedics/ED doctor Allergic reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis Review by paramedics/ED doctor


• Single dose only • Administer whilst awaiting ambulance/ paramedic attendance • Give oxygen via Hudson mask if patient is hypoxaemic (SpO2<94%)

References

ANZCOR Guideline 14.2 – Acute Coronary Syndromes: Initial Medical Therapy 2016

https://resus.org.au/guidelines/

Therapeutic Guidelines https://tgldcdp.tg.org.au

Approval




Date Order ends: 31 August 2019


https://tgldcdp.tg.org.au/

WALK-IN CENTRE


Carmellose 0.5% Lubricant Eye Drops.


Carm

ello

se

Dry Eye Syndrome

Foreign Body in Eye

Included Clients

Adults and children > 2 years old – Dose on site only - do not supply

Excluded Clients


Ocular trauma Refer to GP or ED

Drug Interactions


Nil known N/A


Dose Administer Instructions

Age Dose Strength Quantity

≥ 2 years 1 drop 0.5% solution 0.4mL per ampoule Instil 1 drop per eye PRN



Possible eye irritation but not likely given nil preservatives in eye drops

May indicate allergic reaction Advise client to seek medical advice immediately



Carm

ello

se

If irritation persists or worsens, discontinue use and consult a GP

Safe to use in pregnancy and with breastfeeding

Carmellose ampoules are single use only and should be discarded immediately after use.

Refer the client to a community pharmacy for ongoing supply of Carmellose eye drops.

Suitable for use with contact lenses

Store below 25°C

References

MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: https://tgldcdp.tg.org.au/etgAccess Australian Medicines Handbook http://amh.hcn.au

Approval


Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019 CHO Approval Number: 9201736


https://tgldcdp.tg.org.au/etgAccess

http://amh.hcn.au/

Walk in Centre


CEFALEXIN 500mg capsules


CEFA

LEXI

N

For the treatment of:

1) Lactational mastitis 2) Uncomplicated cellulitis

*Cefalexin to be given if client has non-immediate hypersensitivity to penicillins

Included Clients

1) Lactating women > 16 years 2) Age ≥ 12 + weight ≥ 40kg with suspected uncomplicated cellulitis

Excluded Clients (refer to clinical protocol)


History of allergy to cephalosporin’s or a severe immediate allergic reaction (including urticaria, anaphylaxis or interstitial nephritis) to a penicillin or carbapenems

Refer to NP/GP

Known renal impairment Dose may need to be reduced-> refer to GP

Pregnant Refer to NP/GP

Drug Interactions


Probenicid Probenicid decreases the renal tubular secretion of cefalexin, dose will need adjusting -> refer to GP

Metformin Cefalexin may cause increased exposure to metformin due to reduced renal clearance -> refer to GP


Age/Weight

Supply Dose

Strength Product

1) Lactating women >16 years 500mg capsules

1 x box of 20 capsules

500mg 6 hourly for 5 days

(GP to determine if a longer course is required) 2) ≥ 12 + weight ≥ 40kg


CEFA

LEXI

N


Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness.

Common side effects, if prolonged or worsening to seek medical advice

Skin rash, urticaria or anaphylaxis May indicate allergic reaction -> advise to seek medical advice immediately

Hepatic dysfunction, with or without jaundice Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)

Vaginal or oral fungal infection May occur following the use of antibiotics. Refer to a community pharmacy if they have symptoms.

Antibiotic associated Colitis

A severe form of diarrhoea caused by an overgrowth of Clostridium difficile bacteria. The bacteria release a strong toxin that causes the lining of the colon to become inflamed and bleed. Severity of symptoms may range from mild to life threatening. Advise client to seek medical advice if they experience prolonged or severe diarrhoea.



Points for both Lactational mastitis and uncomplicated cellulitis

• To be administered with or without food • Take antibiotic doses regularly and complete the full treatment course. • Advise that all cephalosporin’s are considered safe to use while breastfeeding – may cause loose

stools in the infant. • Paracetamol and/or ibuprofen for pain management • Follow up with GP on the 3rd day of antibiotic treatment • If deterioration in condition see GP • Drink adequate fluids to prevent dehydration

Specific points for uncomplicated cellulitis

• There may be an increase in redness in the first 24-48 hours of treatment • Elevate the limb for comfort (if applicable)

References

MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: amh.hcn.com.au/

Therapeutic Guidelines: online.tg.org.au/

Approval






Walk in Centre


CEFALEXIN (Lower UTI) 500mg capsules


CEFA

LEXI

N

For the treatment of lower UTI

Included Clients

Female clients age ≥ 16




Refer to GP


Males Refer to GP

Drug Interactions




Pregnancy Refer to NP/GP


Age Supply Dose

Strength Quantity

Age ≥ 16 500mg capsules 1 x box of 10 capsules 500mg 12 hourly for 5 days



CEFA

LEXI

N

Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness.


Skin rash, urticaria, or anaphylaxis May indicate allergic reaction -> advise to seek medical advice immediately

Hepatic dysfunction, with or without jaundice Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)


Antibiotic associated Colitis




• To be administered with or without food • Take antibiotic doses regularly and complete the full treatment course. • Safe to use at recommended doses during breastfeeding. However observe the breastfed

infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush

References



Approval






WALK-IN CENTRES

MEDICATION STANDING ORDER CEFALEXIN (Tonsillitis/bacterial pharyngitis)

50mg in 1mL suspension

500mg capsules


CEFA

LEXI

N

Tonsillitis/bacterial pharyngitis

*Cefalexin to be given if client has non-immediate hypersensitivity to penicillins

Included Clients


Excluded Clients



Consider Roxithromycin medication standing order


Pregnancy Refer to NP/GP

Drug Interactions





CEFA

LEXI

N



< 10 kg Refer to GP

10-12kg 250mg (20.8 - 25mg/kg/dose)


1 x 100ml bottle

5ml every 12 hours for 10 days

12.1 - 14kg 300mg (21.4 –

24.8mg/kg/dose)


2 x 100ml bottle


14.1 – 16kg 350mg (21.9 –

24.8mg/kg/dose)


2 x 100ml bottle


16.1 – 18kg 400mg (22.2 –

24.8mg/kg/dose)


2 x 100ml bottle


18.1 – 20kg 450mg (22.5 –

24.9mg/kg/dose)


2 x 100ml bottle


20.1 – 22kg 500mg (22.7 – 25mg/kg/dose)


2 x 100ml bottle


22.1 – 24kg 550mg

(22.9 – 24.9mg/kg/dose)


3 x 100ml bottle


24.1 – 26kg 600mg

(23 – 24.9mg/kg/dose) 50mg in 1mL suspension

3 x 100ml bottle


26.1 – 28kg 650mg

(23.2– 24.9mg/kg/dose)


3 x 100ml bottle


28.1 – 30kg 700mg

(23.3– 24.9mg/kg/dose)


3 x 100ml bottle


30.1 – 32kg 750mg

(23.4 – 24.9mg/kg/dose)


3 x 100ml bottle


32.1 – 34kg 800mg

(23.5– 24.9mg/kg/dose)


4 x 100ml bottle


34.1 – 36kg 850mg

(23.6– 24.9mg/kg/dose)


4 x 100ml bottle


36.1 – 38kg 900mg

(23.7– 24.9mg/kg/dose)


4 x 100ml bottle


38.1 – 40kg 950mg

(23.8– 24.9mg/kg/dose)


4 x 100ml bottle


>40kg and adult 1000mg


OR

500mg capsules

4 x 100ml bottle OR

40 x 500mg capsules


OR

2 x 500mg capsule every 12 hours for 10 days


Reaction Advice for Clients and Notes Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness.


Skin rash, urticaria or anaphylaxis

May indicate allergic reaction -> advise to seek medical advice immediately

Hepatic dysfunction, with or without jaundice

Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)



Vaginal or oral fungal infection

May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms



CEFA

LEXI

N

• To be administered with or without food • Take antibiotic doses regularly and complete the full treatment course. • Advise that all cephalosporin’s are considered safe to use while breastfeeding – may cause

loose stools in the infant. • Paracetamol and/or ibuprofen for pain management • If deterioration in condition see GP • Drink adequate fluids to prevent dehydration

Suspension

• Store mixture in fridge (do not freeze) and shake well before use • Measure dose using a metric measure • Do not use any suspension that is left in the bottle after 14 days

If >1 bottle is supplied: • Bottles are the same and not intended to be taken together • Open one bottle first and finish this before moving on to second bottle

References MIMs online https://www.mimsonline.com.au Therapeutic Guidelines: online.tg.org.au/ Australian Medicines Handbook http://amh.hcn.au

Approval Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019



http://amh.hcn.au/

Walk-in Centres


CEFTRIAXONE

1g IM injection

Approved Treatment Indications

CEFT

RIAX

ON

E

Clearance antibiotic for contacts of cases of meningococcal disease who have been referred to the Walk-in Centres (WiC) by a Health Directorate Communicable Disease Control officer.

A list of contacts for clearance antibiotics will be emailed or faxed to the WiC prior to their visit

Included Patients

• Women who are breastfeeding or pregnant (FIRST LINE) • Adults and children >2 years who are unable to take ciprofloxacin or rifampicin

Excluded Patients


Children under 2 years old These children will not be referred to the WiC

Clients who have not been referred for clearance antibiotics by a Health Directorate Communicable Disease Control officer

Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.

Hypersensitivity to ceftriaxone, cephalosporin, penicillins, carbapenems, lidocaine (lignocaine)

Clients with renal impairment

Drug Interactions


Calcium Calcium containing solutions cannot be used as a diluent.


• Reconstitute with 3.5mls of lidocaine 1% (Do not administer with lidocaine if there is hypersensitivity to local anaesthetics).

• To remain a minimum of 15 minutes for observation following administration. Dosing Supply

Age Dose Strength (after reconstitution) Quantity

Child 2-12 years 125mg 250mg/ml 0.5ml

Adult 250mg 250mg/ml 1ml


Reaction Advice for Patients and Notes Anaphylaxis, Stevens-Johnson syndrome, angioedema

May indicate allergic reaction Redirect to ED via ACTAS

Rash, urticaria, allergy May indicate allergic reaction Advise client to seek medical advice immediately

Pain, induration, tender injection site Common side effects, if prolonged or worsening advise client to seek medical advice

Diarrhoea, nausea , vomiting Common side effects, if prolonged or worsening advise client to seek medical advice

CEFT

RIAX

ON

E

Headache, dizziness Refer to GP



Vaginal fungal infection May occur following the use of antibiotics. Refer to a community pharmacy if they have symptoms.

Eosinophilia, thrombocytosis, leukopenia Refer to GP/ED Pancreatitis, cholecystitis, pseudolithiasis, nephroliasis Refer to GP/ED

Refer patient to printed CMI for a full list of adverse effects.


• Safe to use in pregnancy • Safe to use at recommended doses during breastfeeding. However observe the breastfed

infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush • Ceftriaxone has not been registered for use as a meningococcal disease clearance antibiotic

in Australia; however, it is recommended for this indication in many countries and its use for this purpose is endorsed by the Communicable Diseases Network Australia.

• Despite prophylaxis, disease can still occur. Parent education regarding frequent, careful observation and the need for examination by a medical practitioner at the first signs of any unexplained illness is essential.

References

Therapeutic Guidelines – Meningitis Chemoprophylaxis https://tgldcdp.tg.org.au MIMs online https://www.mimsonline.com.au Australian Medicines Handbook: amh.hcn.com.au/ The Royal Women’s Hospital, Pregnancy and Breastfeeding Medicine Guide: https://thewomenspbmg.org.au/



https://thewomenspbmg.org.au/

Approval

Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date Order ends: 31 August 2019 CHO Approval Number: 9201737

WALK-IN CENTRES


CEFUROXIME 250mg tablets

25mg/mL suspension


CEFU

ROXI

ME

Patients with penicillin hypersensitivity (excluding immediate hypersensitivity) for the following indications:

- Acute otitis media - Acute bacterial sinusitis

Included Patients

All patients aged > 2 years

Excluded Patients

Exclusion Suggested Action(s) and

Notes

History of allergy to cephalosporin or a severe or immediate hypersensitivity (including urticaria, anaphylaxis or interstitial nephritis) to a penicillin or carbapenems.

Refer to NP/GP

Known renal and or hepatic impairment (CrCl < 10mL/min) Dose may need to be reduced refer to GP

Clients with phenylketonuria (oral liquids contain aspartame) Refer to NP/GP

Drug Interactions


Probenecid Probenecid decreases the renal tubular secretion of cephalosporin dose will need to be adjusted Refer to GP


Dosing Supply Label & Instructions Weight / Age Dose Strength Quantity

< 10 kg Refer to GP

10-13kg 150mg

(11.5 - 15mg/kg/dose)

125mg in 5mL suspension 1 x 70 mL

suspension


>13 - 17kg 200mg

(11.8 – 15.4mg/kg/dose)

125mg in 5mL suspension 2 x 70 mL

suspension


>17kg and up to 12

years

250mg

(14.6mg/kg/dose) 125mg in 5mL suspension



>12 years old to adult, and >33kg

500mg

125mg in 5mL suspension OR

250mg tablets


OR 20 x 250mg

tablets


OR Take TWO tablets

every 12 hours for 5 days

For age >12 but weight <33kg, dose as for >17kg and up to 12 years



CEFU

ROXI

ME

Reaction Advice for Patients and Notes Nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, fatigue, headache or dizziness

Common side effects, if prolonged or worsening see GP

Anaphylaxis, urticaria, blood dyscrasias, Stevens-Johnson syndrome, confusion

May indicate allergic reaction – present to GP/ED as appropriate


This is a severe form of diarrhoea which has been associated with many antibiotics including amoxicillin. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise patients to seek medical advice if they experience prolonged or severe diarrhoea.

Vaginal or oral fungal infection May occur following the use of antibiotics. Refer patient to community pharmacy if they have symptoms



CEFU

ROXI

ME

Pregnancy and Breastfeeding • Maternal use of cefuroxime has not been associated with an increased risk of birth

defects or adverse pregnancy outcomes • Cefuroxime is safe to use at recommended doses during breastfeeding. However

observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush..

Capsules and Suspension: • Best taken with a light meal • Swallow tablets whole, mixture can be mixed with fruit juice or milk immediately

before dosing • Take antibiotic doses regularly and complete the full treatment course

Suspension:

• Store mixture in fridge and shake well before use • Measure dose using a metric measure

If >1 bottle is supplied: - Bottles are the same and not intended to be taken together - Open one bottle first and finish this before moving on to second bottle - Discard any unused suspension after 10 days

References

MIMs online https://www.mimsonline.com.au Therapeutic Guidelines Australian Medicines Handbook

Approval




Walk In Centre

MEDICATION TREATMENT PROTOCOL

CHLORAMPHENICOL Eye Drops 0.5% 10mL


CHLO

RAM

PHEN

ICO

L

Bacterial conjunctivitis, defined as • Rapid onset of symptoms • Mucopurulent discharge

Corneal abrasion – superficial, uncomplicated

Included Patients

Bacterial conjunctivitis - Adults and children ≥ 2 years old

Corneal abrasion – Adults and children ≥ 6 years old

Excluded Patients


History of hypersensitivity or allergy to chloramphenicol or any of the other ingredients in the eye drops

Refer to NP/GP

Complicated ocular trauma – see redirection list on Corneal Abrasion Clinical Protocol

Refer to Ophthalmology Reg/ED

Drug Interactions


There are no clinically significant drug interactions when chloramphenicol is used topically


Dosing Supply

Label & Instructions Strength Quantity

Bacterial Conjunctivitis Use 1 to 2 drops every 2 hours

initially, decreasing to 6-hourly as the infection improves

0.5 % 1 x 10mL

Instil 1-2 drops into the affected eye/s every 2 hours for the first 24 hours,

decreasing to 6-hourly until discharge resolves, for up to 7 days

Discard one month after opening

Corneal Abrasion Instil 1 drop four times per day for

four days 0.5% 1 x 10ml

Instil 1 drop into the affected eye four times per day until discomfort resolves

(rarely >4days) Discard one month after opening


Reaction Advice for Patients and Notes

Unpleasant taste post dose This is due to the eye drops travelling to the back of the throat and cannot be avoided

Local eye irritation with itching or burning

This may mean the patient is allergic to the eye drops Refer to NP/GP

Skin rashes and urticaria This may mean the patient is allergic to the eye drops Refer to NP/GP

Skin blisters or fever This may mean the patient is allergic to the eye drops Refer to NP/GP

Anaphylaxis Redirect to ED



CHLO

RAM

PHEN

ICO

L

Safe to use in pregnancy and breast feeding Bacterial Conjunctivitis • If there is no improvement after 2 days with chloramphenicol drops, refer to GP • Never pad a discharging eye • Clear away debris and mucus with sterile sodium chloride 0.9% solution before using medication • Contact lenses should not be worn until 24 hours after the infection has completely resolved • Continue treatment for at least 48 hours after the eye appears normal (symptoms disappear) Corneal Abrasion • The eye will feel uncomfortable until the abrasion heals but should improve daily • Most corneal abrasions will heal in 24-72 hours • Contact lenses should not be worn until 24 hours after completion of treatment General Advice (applicable to both conjunctivitis and abrasion) • It is important to write the date you open on the bottle when you open it and to discard it 28 days

later (unless told otherwise). • Use a clean tissue to mop up any excess. • Some people find it easier to use eye medications properly if they have someone help them or if they

use a mirror.

References


Approval





CHO Order Number: 9201742


http://amh.hcn.au/

Walk-in Centres


CIPROFLOXACIN 500 mg tablet


CIPR

OFL

OXA

CIN


A list of contacts for clearance antibiotics will be emailed or faxed to the WiC prior to their visit

Included Patients

• Children ≥ 12 years (FIRST LINE) • Adults (FIRST LINE)

Excluded Patients


Children under 12 years old These children will not be referred to the WiC


Refer to Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 99624155 after hours via a paging service and leave a message in order to receive a returned call.

Women who are pregnant Consider ceftriaxone Notify Communicable Disease Control

Hypersensitivity to ciprofloxacin or other quinolones including nalidixic acid

Consider ceftriaxone Notify Communicable Disease Control

History of peripheral neuropathy, myasthenia gravis, epilepsy or CNS disorder

Consider ceftriaxone Notify Communicable Disease Control

History of renal impairment

Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 99624155 after hours via a paging service and leave a message in order to receive a returned call

Drug Interactions


Ciprofloxacin is a strong inhibitor of CYP1A2 and may increase the concentration and risk of adverse effects of drugs metabolised by this enzyme. Examples are agomelatine, amitriptyline, asenapine, axitinib, bendamustine, clozapine, duloxetine, erlotinib, fluvoxamine, imipramine, lidocaine, olanzapine, ondansetron, paracetamol, pomalidomide, propranolol, rasagiline, ropinirole, ropivacaine, theophylline, warfarin, zolmitriptan

A number of medications interact with ciprofloxacin resulting in poor absorption or toxicity of one of the drugs. Contact Communicable Disease Control as per contact details above and consider ceftriaxone

Methotrexate, phenytoin, sildenafil, glibenclamide, glimepride, tizanidine

Ciprofloxacin may increase the concentrations of each of these drugs. Contact Communicable Disease Control as per contact details above and consider ceftriaxone

CIPR

OFL

OXA

CIN

Quinolones may cause seizures; administration with other drugs that also cause seizures may increase this risk.

Examples are

Alimemazine, amantadine, amisulpride, amitriptyline, aripiprazole, asenapine, baclofen, blinatumomab, bupropion, chlorambucil, chloroquine, chlorpromazine, cinacalcet, , clomipramine, clozapine, cycloserine, daclizumab, donepezil, dosulepin, doxepin, droperidol, enzalutamide, ertapenem, fampridine, foscarnet, flupentixol, fluphenazine, galantamine, ganciclovir, haloperidol, imipenem, imipramine, interferons, isoniazid, mefloquine, memantine, mianserin, moxifloxacin, neostigmine, norfloxacin, nortriptyline, NSAIDs, olanzapine, paliperidone, periciazine, phenelzine, pizotifen, promethazine, pyridostigmine, pyrimethamine, quetiapine, risperidone, rivastigmine, theophylline, tranylcypromine, trifluoperazine, valganciclovir, ziprasidone, zuclopenthixol

Quinolones may cause seizures; administration with other drugs that also cause seizures may increase this risk. Contact Communicable Disease Control as per contact details above and consider ceftriaxone

Lanthanum, sevelamer, thyroxine

These agents may reduce one another’s efficacy if given at the same time. Give ciprofloxacin at least 2 hours before, or 4–6 hours after these medications

Iron, sucralfate, antacids containing magnesium, aluminium or calcium

These agents interfere with the absorption of ciprofloxacin. Contact Communicable Disease Control as per contact details above and consider ceftriaxone

Drugs that may prolong QT interval: Disopyramide, amiodarone, sotalol, amisulpride, droperidol, haloperidol, ziprasidone, atazanavir, chloroquine, clarithromycin, clofazimine, erythromycin, fluconazole, mefloquine, moxifloxacin, pentamidine, quinine, voriconazole, anagrelide, arsenic trioxide, ceritinib, crizotinib, dasatinib, eribulin, lapatinib, lenvatinib, nilotinib, pazopanib, sorafenib, sunitinib, toremifene, vandetanib, vemurafenib, cisapride, citalopram, cocaine, dextropropoxyphene, domperidone, escitalopram, fluoxetine, methadone, pasireotide, solifenacin, tacrolimus, tricyclic antidepressants, tetrabenazine, vardenafil

Ciprofloxacin may have an additive effect on the QT interval (very rare). Contact Communicable Disease Control as per contact details above and consider ceftriaxone

CIPR

OFL

OXA

CIN

Cyclosporins Concomitant administration associated with transient elevations of serum creatinine. Contact Communicable Disease Control as per contact details above and consider ceftriaxone

Caffeine Ciprofloxacin may increase the effects of caffeine. Suggest limiting caffeine intake.


To remain a minimum of 15 minutes post administration for observation

Age Dose Administration

≥ 12 years and Adult 500mg tablet once Oral 1 hour before or 2 hours after a meal


Reaction Advice for Patients and Notes Anaphylaxis Call ACTAS to transfer to ED Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, rash, itch

Common side effects, if prolonged or worsening advise patient to seek medical advice

Headache, dizziness, insomnia, restlessness

Avoid alcohol for 24 hours. If prolonged or worsening advise patient to seek medical advice

Arthralgia, myalgia, tendonitis, interstitial nephritis

Refer to GP

Hallucinations, seizure Refer to GP

Photo toxicity Wear protective clothing & use sunscreen



CIPR

OFL

OXA

CIN

• This medicine may cause dizziness or faintness, which can affect your ability to drive and/or operate

machinery. Drinking alcohol may worsen these effects. • Ciprofloxacin is the preferred clearance antibiotic for women on the contraceptive pill. • Ciprofloxacin has not been registered for use as a meningococcal disease clearance antibiotic

in Australia however, it is recommended for this indication in many countries and its use for this purpose is endorsed by the Communicable Diseases Network Australia.

• Despite prophylaxis, disease can still occur. Parent education regarding frequent, careful observation and the need for examination by a medical practitioner at the first signs of any unexplained illness is essential.

• Safe to use at recommended doses during breastfeeding. However observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush

References

The Australian Immunisation Handbook 10th Edition 2017 Therapeutic Guidelines – Meningitis Chemoprophylaxis https://tgldcdp.tg.org.au MIMs online https://www.mimsonline.com.au

Approval








WALK-IN CENTRES


DERMABOND Ampoule


DERM

ABO

ND

Simple, superficial, and linear lacerations on the skin surface

Included Clients

Clients aged > 2 years

Excluded Clients


Known hypersensitivity to Dermabond

Consider alternative method of wound closure

Deep or long (>4cm) wounds

Wounds with jagged or abraded edges

Wounds that are in areas subject to excessive movement (e.g. involve flexures or joints)

Wounds close to areas likely to get wet (e.g. mouth)

Wounds that involve areas with significant hair growth (e.g. forearm, head)

Wounds >12 hours old

Wounds that cross the vermillion border Redirect to ED

Wounds close to or involving the eyes Refer to GP or ED

Contaminated or infected wounds Consider alternative method of wound closure or redirect to ED

Drug Interactions


No significant drug interactions


Dose Administration

1 ampoule as per wound closure guideline



DERM

ABO

ND

• Advise to keep wound clean and dry for the first 24 hours • Do not pick at the glue/scab • Let the glue/scab fall off naturally • Any bleeding or problems return to Walk-in Centres.

References

NPS Medicinewise https://www.nps.org.au/australian-prescriber/articles/skin-glues-for-wound-closure#b1

Approval



Walk in Centre


Dexamethasone 1mg / 1 mL suspension


Dexa

met

haso

ne

For the treatment of croup

Included Clients

Child ≥ 2yrs old



History of allergy or hypersensitivity to dexamethasone or any corticosteroid

Refer to GP/ NP

Child with complex medical conditions or health issues (e.g. cystic fibrosis, Down syndrome)

Dose may need to be altered -> refer to GP/ NP

Concurrent Infection Refer to GP/ NP

Drug Interactions


Antidiabetic agents (oral or insulin)

Glucose control maybe affected, advise to increase glucose monitoring and seek medical advice if extreme or prolonged.

Vaccines, live viruses or other immunisations

Advise no live vaccination to be administered within two weeks of corticosteroid dose – low risk, avoid if possible


DEX

AMET

HAS

ON

E Age/Weight

Product/Strength Dose

Child age ≥2 years old Dexamethasone/ 1mg/mL

50 ml bottle Keep always in fridge,

opening does not shorten expiry date.

Oral dexamethasone 0.15mg/kg (max 10mg) single stat dose

Dosing Instructions

Weight (kg) Dose (mg) Strength

10 –12 kg 1.8mg 1mg/mL suspension Take 1.8mL by measure once only

13–14 kg 2.1mg Take 2.1 mL by measure once only

15 –16 kg 2.4mg Take 2.4mL by measure once only

17–18 kg 2.7mg Take 2.7mL by measure once only

19–20 kg 3 mg Take 3.0mL by measure once only


23 –24 kg 3.6mg Take 3.6mL by measure once only




31–32 kg 4.8 mg Take 4.8mL by measure once only




39-40kg 6 mg Take 6.0mL by measure once only

41-42kg 6.3mg Take 6.3mL by measure once only



DEX

AMET

HAS

ON

E


Incidence of adverse effects is related to dose and duration of treatment. Single dose administration of Dexamethasone Oral Liquid, even in doses at the high end of the dose range is unlikely to produce harmful effects associated with chronic usage

General Retardation of growth can occur with long-term corticosteroid treatment in children.

Gastrointestinal (Nausea, vomiting, diarrhoea or constipation, abdominal distension, gastric irritation, increased/decreased appetite, indigestion)

Common side effects, if prolonged or worsening advise client to seek medical advice

Integumentary Skin rash and/or urticaria may indicate allergic reaction -> seek medical advice immediately. Impaired wound healing.

Nervousness or restlessness; insomnia. If prolonged, severe or worsening advise client to seek medical advice

Immune System

Infections may be masked since corticosteroids have marked anti-inflammatory and antipyretic properties and may produce a feeling of wellbeing.



. • Children with no stridor at rest or respiratory distress may be managed at home. Easy access

to further medical review should be available. • Children need to be encouraged to drink adequate fluids to prevent dehydration • Take oral liquid with food to help reduce stomach upset. Advise parents that dexamethasone

may cause mood or sleep disturbances and to seek medical advice if prolonged or worsening • Improvement should begin from 2 hours post administration. The anti-inflammatory effect of

dexamethasone lasts 2-4 days. • Paracetamol and/or ibuprofen for fever or pain management • Follow up with GP/ NP within 24 hours of treatment • If deterioration in condition see GP or the Emergency Department

References






Approval






WALK-IN CENTRES


DEXAMETHASONE, FRAMYCETIN & GRAMICIDIN

Ear drops

8mL solution


DEX

AMET

HAS

ON

E, F

RAM

YCET

IN &

GRA

MIC

IDIN

Otitis externa

Included Clients


Excluded Clients


Tympanic membrane trauma Refer to GP

Tympanostomy tube insitu Refer to NP/GP

Known hypersensitivity to dexamethasone, Framycetin or gramicidin

Refer to NP/GP

Viral or tubercular lesions Refer to GP

If fungal cause of infection is suspected Consider use of triamcinolone + neomycin + nystatin + gramicidin ear drops or refer to NP/GP if uncertain

Drug Interactions


Nil known N/A


Dose Strength Supply Label & Instructions

3 drops per ear canal

Dexamethasone 0.05%

Framycetin sulphate 0.5%

Gramicidin 0.005%

1 x 8mL bottle Instil THREE drops per ear canal 3 times a day for 3 to 7 days


DEX

AMET

HAS

ON

E, F

RAM

YCET

IN &

GRA

MIC

IDIN


Allergic dermatitis and fungal overgrowth

Both associated with prolonged use – use drops only for duration prescribed. See GP if these symptoms develop

Inner ear damage Rare side effect - see GP



Refer to CMI for instructions on instilling ear drops Consider use of tissue spears for absorbing discharge from ear canal Pregnancy – safe to use Breast feeding:

• Dexamethasone, Framycetin and Gramicidin is considered safe for use by breast feeding mothers

References

MIMs online https://www.mimsonline.com.au AMH https://amhonline.amh.net.au/ Therapeutic Guidelines




https://amhonline.amh.net.au/

Walk in Centre


DICLOXACILLIN 500mg capsules


DICL

OXA

CILL

IN

For the treatment of:

1) Lactational mastitis

2) Uncomplicated cellulitis

Included Clients

3) Lactating women > 16 years 4) Age ≥ 12 + weight ≥ 40kg with suspected uncomplicated cellulitis



History of mild to moderate penicillin allergy Consider cefalexin

History of severe or immediate hypersensitivity reaction to a penicillin

Refer to GP

Renal or hepatic impairment Refer to GP

History of cholestatic hepatitis with dicloxacillin or flucloxacillin

Refer to GP

Pregnant Refer to GP

Drug Interactions


Probenicid Probenicid decreases penicillin excretion, prolonging its activity

-> refer to GP

Warfarin Dicloxacillin may decrease warfarin’s anticoagulant effect

-> refer to GP

Phenytoin Dicloxacillin may lead to a reduction in serum phenytoin levels

-> refer to GP

Methotrexate Penicillins may reduce the renal clearance of methotrexate resulting in toxicity -> refer to GP


Age/Weight

Supply Dose

Strength Product

1) Lactating women >16 years 500mg

capsules 1 x box of 20

capsules

500mg 6 hourly for 5 days

(GP to determine if a longer course is required) 2) ≥ 12 + weight ≥ 40kg



Nausea, vomiting, epigastric discomfort, loose stools


Rash, erythema, anaphylaxis, bronchospasm, fever, Stevens-Johnson syndrome


Transient increases in LFTs and bilirubin

Monitor hepatic function in patients having > 2 weeks of therapy. Refer for monitoring if prolonged course and advise patient to seek medical advice if they have symptoms of jaundice (yellow skin and/or eyes).

Cholestatic hepatitis Advise client to seek medical advice if they have symptoms of jaundice(yellow skin/eyes)


DICL

OXA

CILL

IN Antibiotic associated colitis




Points for both Lactational mastitis and uncomplicated cellulitis

• Dicloxacillin is absorbed best if the capsules are taken on an empty stomach at least half an hour before food or 2 hours after food.

• Take antibiotic doses regularly and complete the full treatment course. • Safe to use while breastfeeding – Dicloxacillin is safe to use at the recommended doses during

breastfeeding. However, observe the breastfed infant for potential adverse effects such as diarrhoea, vomiting, skin rash or thrush. Dicloxacillin is safe to use at the recommended doses during breastfeeding. However, observe the breastfed infant for potential adverse effects such as diarrhoea, vomiting, skin rash or thrush.

• Follow up with GP on the 3rd day of antibiotic treatment • If deterioration in condition see GP

• Drink adequate fluids to prevent dehydration • Paracetamol and/or ibuprofen for pain management

Specific points for uncomplicated cellulitis

• There may be an increase in redness in the first 24-48 hours of treatment • Elevate the limb for comfort (if applicable)

References

MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: amh.hcn.com.au/ Therapeutic Guidelines: online.tg.org.au/

Approval






http://www.mimsonline.com.au/

WALK-IN CENTRES


GLUCAGON 1mg injection kit


GLU

CAG

ON

Hypoglycaemia

Included Clients

Clients with BGL readings < 4 mmol/L and have severely altered level of consciousness and/or when a client’s blood glucose level falls to values low enough to cause signs and symptoms of hypoglycaemia

If Glucagon is administered, an ACTAS “000” call must be made.

Dosing and Administration Information Dose Administration

Adult, child >25kg, SC or IM 1 mg. Child <25kg, SC or IM 0.5 mg. Call ACTAS “000” if glucagon is required

• The glucagon should be dissolved in the accompanying diluent.

• Inject the water for injections (1.1 mL) into the vial containing the freeze dried glucagon.

• Gently shake the vial until the glucagon is completely dissolved and the solution is clear.

• Withdraw the solution back into the syringe. The reconstituted solution appears clear and colourless, and forms an injection of 1 mg (1 IU) per mL to be administered subcutaneously or intramuscularly



Nausea, vomiting,

Common side effects, if prolonged or worsening see GP

Hypokalaemia (large doses), allergic reactions Advise patient to seek medical advice


Pregnancy & Breastfeeding

• Glucagon is safe to use during pregnancy and breast feeding when indicated. Actions Post Dose

• Call ACTAS “000” if glucagon is required • The client should respond to glucagon within 10–15 minutes • Give complex carbohydrates orally when person has responded to prevent recurrent hypoglycaemia

References

MIMs online https://www.mimsonline.com.au The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide


Approval




http://amh.hcn.au/

WALK-IN CENTRES


IBUPROFEN 100mg in 5mL suspension

200mg tablets


IBU

PRO

FEN

For the treatment of mild to moderate pain or pyrexia in excess of 37.5° (that is either not relieved by Paracetamol, or where Paracetamol is contraindicated)

May be used for the following treatment protocols: Abrasions, Ankle Injury, Boils and Carbuncles, Bites, Burns, Common Cold, Contusions, Coxcackie Virus, Diarrhoea, Elbow Injury, Finger / Toe Injury, Foot Injury, Fractures, Hand Injury, Headache, Influenza, Knee Injury, Lacerations, Lactational Mastitis, Lower Urinary Tract Infection, Marine Stings, Migraine, Non-specific Viral Rash, Otitis Externa, Otitis Media, Paronychia, Primary Dysmenorrhoea, Rubella, Scaphoid Injury, Sinusitis, Spider Bites, Stings, Tonsillitis, Varicella, Wrist Injury

Included Clients

Adults and children aged > 2 years old

For clients who meet the inclusion criteria, a SINGLE dose of Ibuprofen may be administered in the WiC (a record of this dose must be documented in the clinical record)

Excluded Clients


Pregnant or breast feeding mothers Use paracetamol or refer to GP

Ibuprofen dose within the last 8 hours (including any other Ibuprofen containing product)

Use paracetamol or refer to GP

Known hypersensitivity to Aspirin, Ibuprofen or other NSAID

Ibuprofen not appropriate Use paracetamol or refer to GP

Current or previous history of dyspepsia or peptic ulceration or GI bleeding

Ibuprofen not appropriate Use paracetamol or refer to GP

Asthmatics, who have never used NSAID before or have severe asthma or had worsening of asthma symptoms after previous use

NSAIDs may increase risk of bronchospasm. Ibuprofen is not appropriate Use paracetamol or refer to GP

Clients with known severe cardiac disease, heart failure, oedema or hypertension

These disease states can be exacerbated by sodium and fluid retention caused by NSAIDs. Ibuprofen is not appropriate Use paracetamol or refer to GP

Clients with known renal impairment Pre-existing renal impairment increases the risk of NSAID-induced impairment and risk of bleeding. Ibuprofen is not appropriate Use paracetamol or refer to GP

Dehydration NSAIDs may reduce renal function and cause acute renal failure Use paracetamol or refer to GP

Coagulation disorders Nonselective NSAIDs may increase risk of bleeding due to their antiplatelet effects Use paracetamol or refer to GP

Drug Interactions

IBU

PRO

FEN


Fluconazole or Voriconazole May inhibit Ibuprofen’s metabolism, increasing its concentration and may increase risk of adverse effects. Use paracetamol or refer to GP

Alendronate May increase risk of gastric ulceration with NSAIDs; avoid combination or monitor carefully.

Tacrolimus, Cyclosporins Increased risk of nephrotoxicity with NSAIDs Use paracetamol or refer to GP

Oral Corticosteroids Increased risk of gastrointestinal bleeding Use paracetamol or refer to GP

Antiplatelet or Anticoagulants e.g. Aspirin, Clopidogrel, Phenindione, Warfarin

NSAIDs increase the risk of bleeding (antiplatelet effect) Use paracetamol or refer to GP

Other NSAIDs Avoid concomitant use of two or more NSAIDs Use paracetamol or refer to GP

Aspirin Increases risk of gastric ulceration with NSAIDs, however a single dose is safe.

Lithium, Methotrexate NSAIDs may reduce their elimination, increasing risk of toxicity Use paracetamol or refer to GP

Loop Diuretics e.g. frusemide, Bumetanide, Ethacrynic acid

Reduced diuretic effect and increased risk of nephrotoxicity Use paracetamol or refer to GP

ACE inhibitors, Angiotensin receptor blockers. E.g. Perindopril, Ramipril, Irebesartan, Telmisartan, Valsartan

May reduce antihypertensive effect of ACE inhibitor and may increase risk of renal impairment and hyperkalaemia Use paracetamol or refer to GP

http://amh.hcn.net.au/view.php?page=chapter6/monographbumetanide.html#bumetanide

http://amh.hcn.net.au/view.php?page=chapter6/monographethacrynic-acid.html#ethacrynic-acid

Potassium, Aldosterone antagonists

E.g. Spironolactone, eplerenone

NSAIDs may increase the risk of hyperkalaemia (they can cause hyperkalaemia and also reduce renal function) Use paracetamol or refer to GP

Antihypertensive NSAIDs may impair antihypertensive effect of antihypertensive agents Use paracetamol or refer to GP


NOTE: a SINGLE dose of Ibuprofen may be administered in the WiC

(a record of this dose must be documented in the clinical record)

Dosing Supply Instructions

Weight (kg) Dose (mg) Strength Quantity

10 – 14 80 100mg/5mL suspension

1 x 100mL bottle

Take 4mL by measure every 6 -8 hours when required

15 – 20 120 Take 6mL by measure every 6 -8 hours when required






46 - 50 360 Take 18mL by measure every 6 -8 hours when required

> 50kg or Adults 400 100mg/5mL

suspension 1 x 100mL

bottle Take 20mL by measure every 6 -8 hours when

required


IBU

PRO

FEN


Nausea, vomiting, heartburn or pain in the upper part of the stomach

Common side effect which can be alleviated by taking dose with food. If prolonged or worsening see GP

Loss of appetite, cramps, wind, constipation or diarrhoea, headache, dizziness, sleepiness

These side effects are usually mild, if prolonged or worsening see GP

Vomiting blood or material that looks like coffee grounds or bleeding from the back passage, black sticky bowel motions (stools) or bloody diarrhoea

This may indicate gastric bleeding or ulceration refer to ED immediately

Rash, itch, face or lip swelling, wheezing or shortness of breath

This may indicate an allergic reaction to Ibuprofen refer to the ED immediately



• Maximum of 4 doses in 24 hours • Take medicine with or after food or milk • Ibuprofen may be taken with Paracetamol if necessary • Advise the client not to take other NSAID containing products at the same time e.g. over-the-

counter medicines containing Aspirin • Discontinue if indigestion or other gastro-intestinal symptoms develop e.g. haematemesis • If condition worsens or symptoms persist then seek further medical advice

See the community pharmacist for further supply

References


Approval




http://amh.hcn.au/

Walk-in Centre


Laceraine® Lidocaine (lignocaine) hydrochloride monohydrate 4%, Tetracaine (Amethocaine)

hydrochloride 0.5%, Adrenaline (epinephrine) 0.1% - 5mL vial


Lace

rain

e®

Lacerations

Included Clients

2-12 year olds with superficial dermal lacerations ≤7cm long

*Use with caution when client history of: epilepsy; hypovolaemia; diabetes mellitus; asthma

Excluded Clients


Known allergy to any type of local anaesthetics or sensitivity to para-aminobenzoic acid and its derivatives

Redirect to ED

Not to be applied to digits, tip of nose, ears or genitalia

Laceraine® is contraindicated →Refer to Lidocaine (lignocaine) Protocol or Redirect to ED

Mucous membranes Laceraine® is contraindicated → Redirect to ED

Dental injuries Laceraine® is contraindicated → Redirect to Dentist or ED

Injuries involving a major vein/artery Laceraine® is contraindicated → Redirect to ED

Burns Laceraine® is contraindicated → Refer to Burns Protocol

Complex or contaminated wounds (bites)

Laceraine® is contraindicated → Redirect to GP or ED as appropriate

Drug Interactions


Ingestion of MAO inhibitors in the last 14 days, tricyclics antidepressants, quinidine, non-selective beta-blockers (e.g. propranolol), cardiac glycosides (e.g. digoxin)

** If any of the above are noted client needs to be re-directed to ED for review **

Dosing Information

2-12 year olds

Wounds/lacerations ≤ 7cm

Laceraine® topical wound anaesthetic – NOT for injection lignocaine (lignocaine) hydrochloride 4% (40mg/mL) Tetracaine (Amethocaine) hydrochloride 0.5% (5mg/mL) adrenaline (epinephrine) 0.1% (1mg/mL) 5mL vial Max. Daily dose 0.1mL/kg (capped at a maximum of 3mL)

• 1-2mL for <5cm laceration • 3mL for ≥5cm laceration

Administration Information

• For topical use on broken skin e.g. laceration • Clean wound to remove debris and clotted blood • Wearing gloves, soak cotton wool balls with Laceraine® and apply to wound • Cover cotton wool balls and area around wound with an occlusive dressing • Leave dressing insitu for 20-30 mins (max. 60 minutes); test sensation prior to further

treatment • Care should be taken to ensure the product is not inadvertently transferred to the eyes,

mouth and other mucous membranes


• Blanching around the wound will occur and is a sign Laceraine® has taken effect • Stinging is normal on first application • Anaesthesia will be provided but pressure will still be felt during suturing • May not provide full anaesthetic cover – infiltration may still be required

Lace

rain

e®



Increased central nervous system excitability then depression (early sign tongue or perioral numbness)

Rarely occurs

Depression of cardiovascular system Vasovagal attack Rarely occurs

Local burning, itching, redness Most common reaction

Contact dermatitis, rash and hives Most common reaction

Redirect to ED if severe reaction occurs or if unable to achieve adequate anaesthesia



• Monitor child for adverse reactions

• Advise parents the topical anaesthetic takes 20-30 minutes to take effect

• Advise parents it is normal to see blanching of the skin

References

Laceraine® Topical Wound Anaesthetic Product Information; Phebra Pty Ltd, June 2013

Smith B.C and Wilson A.H. Topical Versus Injectable Analgesics in Simple Laceration Repair: An Integrative Review. The Journal for Nurse Practitioners. 2013; 9(6): 374-380.

Berant R. and Scolnik D. Topical lidocaine-epinephrine-Tetracaine is effective in reducing pain during laceration repair with tissue adhesive in children. Evid Based Nurs October 2014; 17(4): 118. Downloaded from http:ebn.bmj.com/ on September 20, 2015 – Published by group bmj.com.

Nurse Practitioner Clinical Protocol - Pain management and procedural sedation. Medication Standing Order: Lignocaine 4%, Tetracaine 0.5% and Adrenaline 0.1% (Laceraine). Emergency Department Princess Margaret Hospital for Children. July 2015.

Canberra Hospital and Health Services Laceraine Medication Standing Order. February 2016.

Approval






WALK-IN CENTRES


LEVONORGESTREL 1.5mg tablets


LEVO

NO

RGES

TREL

• Emergency Contraception (not to be supplied to a third party)

Included Clients

Female clients who have had unprotected intercourse <120 hours prior to arrival (As per the Gillick Principle). The dose is to be given under supervision in the Walk-in Centres.

If re-presenting due to vomiting ensure Vomiting Treatment Guideline followed.

Excluded Clients


If time since unprotected sexual intercourse exceeds 72 hours

Refer to GP/NP, Sexual Health or ED

Breast cancer Refer to GP, Sexual Health or ED

Unexplained vaginal bleeding Refer to GP, Sexual Health or ED

Pregnancy Refer to GP

Drug Interactions


Warfarin

Levonorgestrel for emergency contraception has been associated with a marked increase in INR within three days of administration, and warfarin dose my need to be altered Refer to GP

Hepatic CYP3A4 enzyme inducing drugs

e.g. Aprepitant, Asunaprevir, Bosentan,Dabrafenib, efavirenz enzalutamide, etravirine, griseofulvin, lumacaftor modafinil nevirapine phenobarbital, phenytoin rifabutin, rifampicin ritonavir St John’s wort

These medications can increase the metabolism (and therefore reduce the efficacy) of Levonorgestrel. Increased doses may be required Give dose but refer to GP or Canberra Sexual Health Clinic within 12 hours


Dose Administration

1x1.5mg tablet Give 1x1.5mg tablet to be taken immediately in the Walk-in

Centres


LEVO

NO

RGES

TREL


Nausea, stomach upset or vomiting

Common side effects but should resolve within 12 hours. However if the client vomits within 2 hours of taking the tablets, the dose may not be effective and should be repeated Advise client to come back to the WiC or refer to GP or ED

Breast tenderness and headaches

Will disappear within 48 hours of dose and do not usually require treatment. Over the counter analgesia can be used if required. Refer client to GP if symptoms last longer than 48 hours.

Light vaginal bleeding

Can occur a few days after taking Levonorgestrel. This is NOT a normal period and client should see their GP if the bleeding is heavy or prolonged, or if menses is delayed by one week

Ectopic pregnancy (pregnancy in a fallopian tube) indicated by unusual pain in the low abdomen

This is a rare complication of Levonorgestrel, however if a client experiences these symptoms anytime within the month after taking the dose Immediate referral to ED is recommended



• Efficacy - Emergency contraception is not 100% effective, the time elapsed since intercourse is critical factor.

o <24 hours - 95% o 24-48 hours - 85% o 48-72 hours – 58% o 72-120 hours - <58% o >120 hours considered not effective

If a client is 70kg or more, or has Crohn’s disease, irritable bowel or acute diarrhoea or vomiting the efficacy may be reduced

• Possibility of Sexual Assault - where sexual assault is suspected, the client should be referred to a sexual assault referral centre as per Sexual Health Clinical Impression

• Ectopic Pregnancy - The client should be advised about the slight increase in the risk of ectopic pregnancy and advised what to do if they have symptoms (see adverse effects section)

• Contraceptive Advice - Emergency contraception will only cover the episode of unprotected sexual intercourse discussed and it is therefore important to use extra precautions at least until next menstrual period. Alternative contraceptive methods should be discussed and client referred to ACT Sexual Health & Family Planning as per Sexual Health Clinical Impression

• Sexually Transmitted Infections - Discuss with the client risk associated with unprotected sexual intercourse and the possibility of infection.

• Follow Up - After emergency contraception the client should be advised that their menstrual cycle should occur at the same anticipated time but could be a week early or a week late. If the client is a week or more late then pregnancy testing is advised. The emergency contraception does not provide any lasting contraception.

• Breast Feeding – Is considered safe for breast feeding mothers.

References

LEVO

NO

RGES

TREL


Direct product request guideline. Supply of Levonorgestrel as a Pharmacist Only medicine for emergency contraception. Pharmaceutical Society of Australia, October 2008.

Approval




http://amh.hcn.au/

WALK-IN CENTRES


LIDOCAINE (lignocaine) 1% 5mL ampoule


LIDO

CAIN

E (li

gnoc

aine

) 1%

Abrasions, Boils and Carbuncles, Lacerations, Paronychia

Included Clients

Clients aged 2 or over

Clients aged 2-10 may need sedation and therefore referral to ED

Excluded Clients


Known hypersensitivity to local anaesthetics

Lidocaine (lignocaine) is contraindicated Refer to ED or GP

Inflammation or sepsis at the proposed site of injection.

Lidocaine (lignocaine) is contraindicated Refer to ED or GP

Drug Interactions


No significant drug interactions exist when lidocaine (lignocaine) is administered subcutaneously

Dosing and Administration Information Dose Administration

The maximum dose is 200mg (or 3mg/kg) which is 20mL of the 1% solution

• The lowest dosage that results in effective anaesthesia should be used to avoid high plasma levels and serious undesirable systemic side effects

• Injection should always be made slowly with frequent aspirations to avoid inadvertent intravascular injection, which can produce cerebral symptoms even at low doses.

• Most local anaesthetics have limited solubility if pH >6; adding alkaline solutions (e.g. sodium bicarbonate) to increase speed of onset is not recommended as it may result in precipitation.

• Injecting slowly through the wound rather than through intact skin helps reduce the pain from the injection


Reaction Advice for Clients and Notes Localised oedema, urticaria, bronchospasm and anaphylaxis.

Client may be experiencing an allergic reaction Refer client to ED

Anxiety, pallor, tachycardia, hypertension, sweating or arrhythmias

May indicate a vasoconstrictor reaction which usually resolves on stopping administration Cease admininstration and refer client to ED

LIDO

CAIN

E (li

gnoc

aine

) 1%

Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness

May be early warning signs of CNS toxicity Refer client to ED


Pregnancy and breast feeding • Lidocaine (lignocaine) at recommended dosages is considered safe in pregnancy and

breastfeeding. Techniques that are less painful should be considered for wound repair, for example using narrow sterile adhesive strips for superficial wounds, and/or skin glues for small scalp lacerations.

References

MIMs online https://www.mimsonline.com.au Therapeutic Guidelines Analgesic The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide Australian Medicines Handbook http://amh.hcn.au

Approval




http://amh.hcn.au/

WALK-IN CENTRES


LIDOCAINE (lignocaine) 1% with ADRENALINE (epinephrine)

1:100,000 5mL glass ampoule


Lido

cain

e (l

igno

cain

e) 1

% w

ith a

dren

alin

e (e

pine

phrin

e)

Boils and Carbuncles, Lacerations

Not for hand or face

Included Clients

Adults and children aged >2 years

Clients aged 2-10 may need sedation and therefore referral to ED

Excluded Clients


Not for use on digits, face, ears or genitalia

Lidocaine without adrenaline (epinephrine) if appropriate, otherwise refer to ED

Known hypersensitivity to local anaesthetics

Lidocaine is contraindicated Refer to ED or GP

History of Raynaud’s disease or peripheral vascular disease

Lidocaine without adrenaline (epinephrine) if appropriate, otherwise refer to ED

Inflammation or sepsis at the proposed site of injection

Lidocaine with adrenaline (epinephrine) is contraindicated Refer to ED or GP

Hypertension in pregnant women Adrenaline (epinephrine) is contraindicated Refer to ED or GP

Known cardiac disease, arrhythmias Adrenaline (epinephrine) is contraindicated Refer to ED or GP

Drug Interactions


Monoamine oxidase inhibitors or tricyclic antidepressants

The use of adrenaline (epinephrine) with these medications may lead to hypertension. Persons on these medication should be referred to the ED or

their GP for further management

Oxytocic drugs of the ergot type

The use of adrenaline (epinephrine) with these medications may lead to hypertension. Persons on these medication should be referred to the ED or


Lido

cain

e (l

igno

cain

e) 1

% w

ith a

dren

alin

e (e

pine

phrin

e)

Adrenergic neuron blocking agents Persons on these medication should be referred to

the ED or their GP for further management

Cardiac glycosides, quinidine and beta blockers

The use of adrenaline (Epinephrine) with these medications may lead to arrhythmias. Persons on these medication should be referred to the ED or


Hypoglycaemics

The use of adrenaline (epinephrine) with these medications may lead to a hypoglycaemic event.

Persons on these medication should be referred to the ED or their GP for further management


Dose Administration

The maximum dose is 50mL (or 7mg/kg) of the 1% solution

• The lowest dosage that results in effective anaesthesia should be used to avoid high plasma levels and serious undesirable systemic side effects

• Injection should always be made slowly with frequent aspirations to avoid inadvertent intravascular injection, which can produce cerebral symptoms even at low doses.

• Most local anaesthetics have limited solubility if pH >6; adding alkaline solutions (e.g. sodium bicarbonate) to increase speed of onset is not recommended as it may result in precipitation.

• Injecting slowly through the wound rather than through intact skin helps reduce the pain from the injection


Reaction Advice for Clients and Notes Localised oedema, urticaria, bronchospasm and anaphylaxis.

Client may be experiencing an allergic reaction Refer client to ED

Anxiety, pallor, tachycardia, hypertension, sweating or arrhythmias

May indicate a vasoconstrictor reaction which usually resolves on stopping administration Cease admininstration and refer client to ED

Restlessness, anxiety, tinnitus, dizziness, blurred vision, tremors, depression or drowsiness

May be early warning signs of CNS toxicity Refer client to ED



Lido

cain

e 1

% w

ith a

dren

alin

e

Pregnancy and breast feeding • Lidocaine and adrenaline at recommended dosages are considered safe in pregnancy and

breastfeeding.

Techniques that are less painful should be considered for wound repair, for example using narrow sterile adhesive strips for superficial wounds, and/or skin glues for small scalp lacerations.

References

MIMs online https://www.mimsonline.com.au Therapeutic Guidelines Analgesic The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide Australian Medicines Handbook http://amh.hcn.au

Approval

Date of approval: 15 March 2018 Date of effect: 15 March 2018 Date of review: August 2017 Date order ends: 31 August 2019 CHO Approval Number: 9201752


http://amh.hcn.au/

Walk in Centre


LORATADINE 10mg tablets

1mg in 1ml suspension Approved Treatment Protocols

LORA

TADI

NE

Allergic conjunctivitis

Allergic rhinitis

Urticaria

Included Clients

Adults and children ≥ 2 years old – dose on site only, do not supply

Excluded Clients


Pregnant women or breast feeding mothers Refer to Community Pharmacist or GP

Impaired hepatic function Refer to Community Pharmacist or GP

History of hypersensitivity or idiosyncrasy to Loratadine

Refer to Community Pharmacist or GP

Drug Interactions


Nil Known N/A


Age Dose Strength Quantity Instructions

2-12 years and <30kg

5mg 1mg/ml suspension

5ml suspension

Take 5ml daily

>30kg or Adults

10mg

1mg/ml suspension

10ml suspension

Take 10ml daily

10mg tablets 1 x tablet Take ONE tablet daily

For suspension, use a dose from the stock bottle



Difficulty breathing or syncope

May indicate allergic reaction – ED via ACTAS

Urticarial rash, drowsiness, nausea, headache, sedation, fatigue or dry mouth If prolonged or worsening see GP

Hepatic dysfunction, with or without jaundice. Weight gain Refer to GP

Nervousness, hyperkinesia, sedation Refer to GP



This medication is non-sedating for most but may make some people sleepy; don’t drive or operate machinery if drowsiness develops. Avoid use with pregnancy and breast feeding See the community pharmacist for further supply. If allergic rhinitis is chronic, then topical nasal sprays are also available and the client should be advised to discuss the problem with the pharmacist or GP

References

LORA

TADI

NE

MIMS Online: www.mimsonline.com.au/ Australian Medicines Handbook: https://amhonline.amh.net.au/ Therapeutic Guidelines: online.tg.org.au/

Approval







WALK-IN CENTRES


METOCLOPRAMIDE 10mg tablets

10mg/2mL injections


MET

OCL

OPR

AMID

E

To control nausea and vomiting associated with the following treatment protocols: Migraine, Vomiting

Included Clients

Adults ≥ 20 years old

Excluded Clients


Parkinson’s disease Refer to NP or GP

Nausea caused by medication changes or additions Refer to prescriber

Suspected bowel obstruction, haemorrhage, or perforation Refer to ED

Phaeochriomocytoma Refer to GP

Drug Interactions


Anticholinergic drugs and narcotic analgesics

The effects of Metoclopramide on gastrointestinal motility are antagonised by Anticholinergic drugs and narcotic analgesics. refer to NP or GP

Alcohol, sedatives, hypnotics, narcotics or tranquillizers

Additive sedative effects can occur when Metoclopramide is given with alcohol, sedatives, hypnotics, narcotics or tranquillizers. Metoclopramide should not be administered to these clients, instead they should be referred to their GP/NP

All medications

Since Metoclopramide accelerates abnormally slow gastric and small bowel peristaltic activity, it may change absorption of orally administered drugs. The absorption of drugs from the small bowel may be accelerated (e.g. Paracetamol, Tetracycline, L-dopa), whereas absorption of drugs from the stomach may be diminished

Atovaquone Metoclopramide decreases atovaquone concentration and may decrease its efficacy refer to NP or GP


NOTE: a SINGLE dose of metoclopramide may be administered in the WiC (a record of this dose must be documented in the clinical record)

Dose Supply Label & Instructions

Age / Weight Dose Strength Quantity

<20 years old Refer to GP

30 – 59 kg 5mg 10mg tablets 3 x 10mg tablets Take HALF a tablet 3 times a day

> 60 kg or Adults 10mg 10mg tablets 3 x 10mg tablets Take ONE tablet 3 times a day

> 60 kg or Adults 10mg 10mg ampoule 1 x ampoule IM 10mg administered in WiC

IM DOSE MAY ONLY BE ADMINISTERED ONSITE IN WiC


MET

OCL

OPR

AMID

E


Urticaria rash, difficulty breathing or syncope

May indicate allergic reaction Advise client to seek medical advice immediately

Restlessness, drowsiness, dizziness, headache


Depression, extra pyramidal side effects (these are more common in children or the elderly but can include parkinsonism, involuntary movements (tardive dyskinesia and dystonia’s), akathisia, hypertension, hypotension, hyperprolactinaemia leading to galactorrhoea, diarrhoea, constipation

Infrequent side effects, if prolonged or worsening advise client to seek medical advice



• Pregnancy and breast feeding – safe when taken at recommended doses • This medicine may make you feel drowsy or dizzy; do not drive or operate machinery until

you know how metoclopramide affects you • Acute dystonic reactions are best treated by IM / IV Benztropine in the ED and should be

referred immediately via ACTAS. • Drowsiness is common with metoclopramide. Clients should be advised not to consume

alcohol whilst taking Metoclopramide

References MIMs online https://www.mimsonline.com.au

The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide



http://amh.hcn.au/

Approval



WALK-IN CENTRES


MUPIROCIN 2% ointment


MU

PIRO

CIN

Impetigo

Included Clients


Excluded Clients


Extensive burns and wounds Systemic absorption of Mupirocin is possible and a theoretical risk of polyethylene glycol toxicity exists, especially in pre-existing renal impairment Refer to GP

Widespread or recurrent impetigo infections

Systemic treatment is required Refer to GP/NP

History of sensitivity reactions to any of the ointments components

Refer to GP

Skin lesions around the eyes, nose or any mucosal surface

Mupirocin is not for ophthalmic use, intranasal use or application to other mucosal surfaces Refer to GP/NP

Drug Interactions

No drug interactions have been demonstrated with Mupirocin. However Mupirocin should not be combined with other topical preparations as there is a risk of dilution, resulting in a reduction in the antibacterial activity and potential loss of stability of the Mupirocin.


Clients Dose and Administration Supply Label & Instructions

All clients > 2 years

Apply a small amount of ointment to any crusted areas, 8-hourly for 7 days. The area treated may be covered with

gauze dressing if desired.

1 x 15g tube

Apply a small amount of ointment to affected

areas every 8 hours, for 7 days


Reaction Advice for Clients and Notes Localised skin reactions, including itch, burning, erythema, stinging, dryness, pain and swelling

Advise client to discontinue treatment and refer to GP

Allergy (E.g. urticaria, anaphylaxis, angioedema)

May indicate an allergic reaction Advise client to discontinue treatment and seek medical advice



MU

PIRO

CIN

Avoid contact with eyes and mouth. Children with impetigo should be kept home until appropriate treatment is started. Sores on exposed surfaces must be covered with a watertight dressing when the child returns to school or child care. Treatment should not continue for more than 10 days Soap and water should be used topically, 8-hourly to soften crusts before Mupirocin ointment is administered. Topical Mupirocin at recommended dosages is safe in pregnancy and breastfeeding. However when topical applications of Mupirocin are used around the nipple area, any excess ointment should be removed before feeding.

References MIMs online https://www.mimsonline.com.au Antibiotic Therapeutic Guidelines The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide


Approval




http://amh.hcn.au/

Walk-in Centres


NORMAL HUMAN IMMUNOGLOBULIN (NHIG) MEASLES


Nor

mal

Hum

an Im

mun

oglo

bulin

Susceptible contacts of infectious cases of measles within 144 hours after first exposure who have been referred to the WiC by a Health Directorate Communicable Disease Control officer.

A list of contacts for NHIG administration will be faxed to the Walk-in Centres prior to their visit

Included Clients

• A measles susceptible person who presents between 3 days – 144 hours post exposure to an infectious case of measles

• A measles susceptible pregnant woman up to 144 hours after first exposure • A measles susceptible person with impaired immunity up to 144 hours after first exposure • A measles susceptible person in whom MMR is contraindicated up to 144 hours after first

exposure • A person is considered susceptible to measles if they do not have acceptable presumptive

evidence of immunity. Acceptable evidence includes: o Persons born since 1966 who have documented evidence of receiving at least 2 doses

of a measles–containing vaccine ≥ 12 months of age (unless serologic evidence indicates otherwise)

o Persons born before 1966 (unless serological evidence indicates otherwise) o Documented evidence of immunity o Documented evidence of laboratory confirmed measles infection

Excluded Clients


Children under 2 years old This is an exclusion criteria for the Walk-in Centres for all conditions. Refer to Centre for Disease Control ph. 02 6205 2155 during business hours or 02 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.

Clients who have not been referred for NHIG by a Health Directorate Communicable Disease Control officer

Refer to Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 99624155 after hours via a paging service and leave a message in order to receive a returned call.

Contacts will be counselled and screened prior to referral to Walk-in Centres – therefore clients would not be expected to present to the WiC with any of the following:

Nor

mal

Hum

an Im

mun

oglo

bulin

Persons first exposed to an infectious measles case more than 144 hours prior

Refer to Communicable Disease Control ph. 02 6205 2155 during business hours or 02 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.

Persons exposed to an infectious measles case less than 72 hours prior who do not have a contraindication to MMR

Consider MMR if not contraindicated

Refer to Communicable Disease Control ph. 02 6205 2155 during business hours or 02 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.

Persons who have received 1 dose of MMR ≥ 12 months of age

Allergy or anaphylaxis to any component of immunoglobulin

Refer to Communicable Disease Control ph. 02 6205 2155 during business hours or 02 9962

4155 after hours via a paging service and leave a message in order to receive a returned call.

Absolute IgA deficiency

People with severe thrombocytopenia or coagulation disorder - intramuscular injection is contraindicated

Those born before 1966 – unless they have serological evidence which indicates absence of immunity

Documented evidence of immunity

Documented evidence of laboratory confirmed measles infection

Drug Interactions


Inactivated vaccines

May be administered concurrently with inactivated vaccines using separate syringes and separate injection sites

Live vaccines Delay the administration of some live vaccines (e.g. MMR, MMRV or varicella) for 5 months (6 months for those who are immunocompromised and receive a higher dose). Please refer to the Australian Immunisation Handbook


NO

RMAL

HU

MAN

NO

RMAL

Nor

mal

Hum

an Im

mun

oglo

bulin

• Complete the pre-vaccination screening checklist prior to immunisation • To remain a minimum of 15 minutes for post-vaccination observation • Medication dose should be checked by two nurses prior to administration • Consider having two nurses present when administering NHIG to children • Ensure that there is an anaphylaxis response kit

Dose Administration Healthy children > than 2 years of age, adolescents and adults (including pregnant women)

0.2 ml / kg to a maximum of 15 ml (maximum of 5 mls per site)

Deep IMI using large (19 or 20) gauge needle

People with impaired immunity 0.5 ml / kg to a maximum of 15 ml (maximum of 5mls per site)

Deep IMI using large (19 or 20) gauge needle


Reaction Advice for Clients and Notes Anaphylaxis (rare) Administer adrenaline and immediately refer to

Accident and Emergency or call MET

Local tenderness, erythema and muscle stiffness at injection site


Mild pyrexia, malaise, drowsiness, urticaria, angioedema

Common side effects – see GP/ED

Refer client to printed CMI for a full list of adverse effects.


• Immunisation with live attenuated virus vaccines (including Measles, Mumps Rubella MMR) and varicella should be delayed 5 months following administration of IM NHIG

• NHIG will only provide transient protection against measles • Immunoglobulin is derived from pooled blood donation

References

Measles National Guidelines for Public Health Units http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-measles.htm The Australian Immunisation Handbook 10th ed 2015 http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home Australian Medicines Handbook: amh.hcn.com.au/

http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-measles.htm

http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home

Approval




Date order Ends: 31 August 2019

CHO approval number: 9201757

WALK-IN CENTRES


OXYGEN


OXY

GEN

For use in medical emergencies

Included Clients


Excluded Clients


There are no absolute contraindications to oxygen in severe life threatening conditions

Drug Interactions


There are no absolute contraindications to oxygen in severe life threatening conditions


• Start oxygen if saturation using pulse oximetry is below 92% for adults and less than 95% for children.

• Face mask to be chosen to fit client i.e. child/adult. Use 5-10 litres/min administered via face mask and titrate to achieve levels 92-96% for adults and at least 95% for children.

• Patients with COPD in critical illness will have same saturation targets as Walk in Centre has no access to arterial blood gas analysis and period of stay and oxygen therapy is very short .


ACTAS “000: call is required for any client requiring Oxygen in the Walk in Centre.

References

Thoracic Society of Australia and New Zealand, 2016, Oxygen guidelines for acute oxygen use in adults. eTG Complete 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-in-children-acute-management#toc_d1e1228 eTG Complete 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=acute-oxygen-therapy

Approval



WALK-IN CENTRES


PARACETAMOL 48mg in 1mL suspension

500mg tablets


PARA

CETA

MO

L

For the treatment of mild to moderate pain or pyrexia in excess of 37.5°

May be used for the following treatment protocols:

Abrasions, Ankle Injury, Bites, Boils and Carbuncles, Burns, Common Cold, Contusions, Coxsackie Virus, Diarrhoea, Elbow Injury, Fever, Finger / Toe Injury, Foot Injury, Fractures, Hand Injury, Headache, Influenza, Knee Injury, Lacerations, Lower Urinary Tract Infection, Marine Stings, Migraine, Otitis Externa, Otitis Media, Paronychia, Primary Dysmenorrhoea, Rubella, Scaphoid Injury, Sinusitis, Spider Bites, Stings, Tonsillitis, Viral Rash, Varicella, Vomiting, Wrist Injury

Included Clients


For clients who meet the inclusion criteria for a SINGLE dose of paracetamol, may be administered in the WiC (a record of this dose must be documented in the clinical record)

Excluded Clients


Aged under 2 years Refer to GP or Community Pharmacy

Clients who have taken a Paracetamol containing product within the previous 4 hours or those who have taken 4 or more doses of Paracetamol within the previous 24 hours

Paracetamol has been given within the recommended dosing interval, another dose is unsafe Use Ibuprofen, wait specified time or refer to GP

Clients who have had a previous adverse reaction to Paracetamol

Paracetamol is not appropriate, use Ibuprofen or refer to GP or community pharmacy

Clients with liver disease Refer to GP

Drug Interactions

Para

ceta

mol


Ethanol, Imatinib Concurrent use increases paracetamol toxicity- caution with use in alcoholics as may lead to liver damage

Cholestyramine Reduces the absorption of paracetamol if given within one hour of Paracetamol ensure client has not had Cholestyramine within one hour of Paracetamol dose

Rifampicin, Alcohol, Barbiturates, Phenytoin or Carbamazepine

These drugs induce CYP450 enzymes, and therefore increase the risk of Paracetamol toxicity. A single Paracetamol dose is safe, but clients requiring ongoing use of Paracetamol should be referred to their GP

Warfarin INR may increase in clients on a stable warfarin regimen who begin taking >3.5 g paracetamol each week. Refer to GP if client has been taking >3.5 g paracetamol each week

Zidovudine When used concurrently with Paracetamol, an increased tendency for neutropenia may develop. Combination should be avoided. Use Ibuprofen or refer to GP


PARA

CETA

MO

L

Dosing Administer

Instructions Weight

(kg) Dose (mg) Strength Quantity

12 – 14 kg 192mg 48mg/mL suspension

1 x 200ml bottle Take 4mL by measure every 4 -6 hours when required

15 – 17 kg 216mg Take 4.5mL by measure every 4 -6 hours when required








39 – 40 kg 576mg Take 12mL by measure every 4 -6 hours when required

41 – 45 kg 624 mg Take 13mL by measure every 4 -6 hours when required


51 – 55 kg 768 mg Take 16mL by measure every 4 -6 hours when required

56 – 60 kg 840 mg Take 17.5mL by measure every 4 -6 hours when required

> 60 kg or Adults

960mg Take 20mL by measure every 4 -6 hours when required

1000mg 500mg tablets

2 x 500mg tablets Take TWO tablets every 4 -6 hours when required


PARA

CETA

MO

L

Reaction Advice for Clients and Notes Dyspepsia or Nausea

Rare adverse effects, advise client to seek medical advice if this worries them

Rash May indicate allergy to Paracetamol refer to GP

Jaundice, Liver dysfunction

Refer to GP if client experiences symptoms of jaundice (yellow skin and/or eyes)



• If pain and/or fever lasts for >48 hours, refer to GP. • No more than 4 doses of paracetamol or paracetamol containing products in 24 hours • There are many brands of paracetamol. It is also contained in many cough and cold products.

Prevent overdosing by checking carefully which strength product is being used, and the correct dose for that product. Avoid using more than one product containing paracetamol at the same time

• Too much paracetamol can cause liver damage. • Onset of pain relief is approximately 30 minutes after oral administration

See the community pharmacist for further supply

References

MIMs online 2017 https://www.mimsonline.com.au eTG Pain in Children 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=pain-children#MPS_d1e1148 Australian Medicines Handbook 2017 http://amh.hcn.au

Approval




https://tgldcdp.tg.org.au/viewTopic?topicfile=pain-children#MPS_d1e1148

http://amh.hcn.au/

WALK-IN CENTRES


PHENOXYMETHYLPENICILLIN (Penicillin V)


500mg tablets


PHEN

OXY

MET

HYLP

ENIC

ILLI

N

Tonsillitis

Included Clients


Excluded Clients


History of immediate hypersensitivity reaction (i.e. anaphylaxis) to penicillins or other beta-lactams such as cephalosporin or carbapenems

Refer to Roxithromycin medication standing order

Known or suspected hypersensitivity reaction (not immediate) to penicillin or other beta-lactams such as cephalosporin or carbapenems

Refer to cefalexin medication standing order

A well client with red throat, no tonsil exudates and in the absence of fever and cervical lymphadenopathy

Antibiotics are not indicated

Client who is drooling, cannot swallow or child with stridor Refer to ED

Drug Interactions


Food and Antacids Reduce absorption of Phenoximethylpenicillin administer Phenoximethylpenicillin on an empty stomach and away from any antacids

Methotrexate Penicillins reduce excretion of Methotrexate, causing increased risk of Methotrexate toxicity Refer clients on Methotrexate to their GP

Probenecid Probenecid decreases the renal tubular secretion of Penicillins, dose will need to be adjusted Refer to GP


PHEN

OXY

MET

HYLP

ENIC

ILLI

N



< 10 kg Refer to GP

10-12.5kg

180mg

(14.4 - 18mg/kg/dose)


2 x 100ml bottle


12.6 - 15kg

225mg

(15 – 17.9mg/kg/dose)


2 x 100ml bottle

7.5ml every 12 hours for 10 days

15.1 – 17.5kg

270mg

(15.4 – 17.9mg/kg/dose)


2 x 100ml bottle


17.6 – 20kg 300mg

(15 – 17mg/kg/dose)


2 x 100ml bottle


20.1 – 22.5kg

345mg

(15.3 – 17.2mg/kg/dose)


3 x 100ml bottle


22.6 – 25kg

375mg

(15 – 16.6mg/kg/dose)


3 x 100ml bottle


25.1 – 27.5kg

425mg

(15.3 – 16.7mg/kg/dose)


3 x 100ml bottle


27.6 – 30kg

450mg

(15 – 16.3mg/kg/dose)


3 x 100ml bottle


Child >30.1kg OR

Adults

500mg

(16.4mg/kg/dose at 30.1kg)


OR

500mg tablets

4 x 100ml bottle

OR

20 x 500mg tablets


OR

1 x 500mg tablet every 12 hours for 10

days



Nausea, Vomiting, Diarrhoea




This is a severe form of diarrhoea which has been associated with many antibiotics. A toxin produced with Clostridium difficile appears to be the primary cause. Severity may range from mild to life threatening. Advise clients to seek medical advice if they experience prolonged or severe diarrhoea.

Vaginal or oral fungal infection

May occur following the use of antibiotics. Refer client to community pharmacy if they have symptoms



PHEN

OXY

MET

HYLP

ENIC

ILLI

N

Pregnancy and breast feeding: • Advise that phenoximethylpenicillin is considered safe to use in pregnancy • Safe to use at recommended doses during breastfeeding. However observe the


• Penicillin is in ADEC category A, this means it is a drug that has been taken by a large number of women and women of child bearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus being observed.

Capsules and Suspension • Take on an empty stomach to maximise drug absorption. This is best done 1 hour

before meals and before bed • Take antibiotic doses regularly and complete the full treatment course

Suspension • Store mixture in fridge and shake well before use • Measure dose using a metric measure

If >1 bottle is supplied: • Bottles are the same and not intended to be taken together • Open one bottle first and finish this before moving on to second bottle

References

MIMs online https://www.mimsonline.com.au Antibiotic Therapeutic Guidelines eTG Ear, nose and throat infections https://tgldcdp.tg.org.au/viewTopic?topicfile=ear-nose-throat-infections#MPS_d1e104 Australian Medicines Handbook http://amh.hcn.au


https://tgldcdp.tg.org.au/viewTopic?topicfile=ear-nose-throat-infections#MPS_d1e104

https://tgldcdp.tg.org.au/viewTopic?topicfile=ear-nose-throat-infections#MPS_d1e104

http://amh.hcn.au/

Approval



WALK-IN CENTRES


PROMETHAZINE 10mg tablets

1mg/mL mixture


PRO

MET

HAZI

NE

Immediate treatment of allergic reactions May be used in the following treatment protocols: Allergic Rhinitis, Contact Dermatitis, Spider Bites, Stings, Urticaria, Varicella

Included Clients

Adults and children aged > 2 years

Excluded Clients


Pregnancy and Breast feeding Consider use of an alternate antihistamine refer to GP or local pharmacy

Known allergy or hypersensitivity to Promethazine

Consider use of an alternate antihistaminerefer to NP, GP or local pharmacy

Epilepsy Promethazine lowers the seizure threshold Refer to pharmacy or GP for alternative

Children and adolescents with Reye's syndrome.

Promethazine should be avoided Refer to pharmacy or GP

Glaucoma, pyloroduodenal obstruction, bladder neck obstruction, symptomatic prostatic hypertrophy, hyperthyroidism, Parkinson’s disease

These conditions may be worsened by the anticholinergic effects of antihistamines refer to Pharmacy or GP for alternative

Drug Interactions


Anticholinergics: aclidinium, amantadine, amitriptyline, atropine benzatropine, biperiden, chlorphenamine, chlorpromazine, clomipramine, clozapine, cyclizine, cyproheptadine, darifenacin, diphenhydramine, dosulepin, doxepin, glycopyrronium, hyoscine, imipramine, Ipratropium, mianserin, nortriptyline olanzapine, oxybutynin, periciazine, pheniramine, pizotifen, prochlorperazine, propantheline, solifenacin, tiotropium, tolterodine, umeclidinium

These medication may prolong and intensify the antimuscarinic, anticholinergic and CNS depressive effects of Promethazine Combination should be avoided, refer to local pharmacy or GP

CNS depressants (including alcohol, barbiturates, hypnotics, opioid analgesics, anxiolytic sedatives and neuroleptics)

Promethazine may cause drowsiness and may enhance the sedative effects of these medications. Use combination with caution

Dopamine Agonists: Apomorphine, Pramipexole, Rotigotine, Bromocriptine, Cabergoline, Pergolide, Levodopa with Benserazide or Carbidopa.

Promethazine is a dopamine antagonist will reduce the therapeutic effect of the dopamine agonist; avoid these combination refer to Pharmacy or GP for alternative

Medications that can increase the risk of seizures:

Amantadine, amisulpride, amitriptyline, aripiprazole, asenapine, baclofen, bupropion, chlorambucil, chlorpromazine, cinacalcet, ciprofloxacin, clomipramine, clozapine, daclizumab, donepezil, dosulepin, doxepin, droperidol, enzalutamide, ertapenem, foscarnet, flupentixol, fluphenazine, galantamine, ganciclovir, haloperidol, imipenem, imipramine, interferons, isoniazid, memantine, mianserin, moxifloxacin, neostigmine, norfloxacin, nortriptyline, NSAIDs, olanzapine, paliperidone, periciazine, phenelzine, pizotifen, promethazine, pyridostigmine, quetiapine, risperidone, rivastigmine, theophylline, valganciclovir, ziprasidone, zuclopenthixol

Promethazine lowers the seizure threshold; if used with other drugs that may increase the risk of seizures the risk

may further increase refer to Pharmacy or GP for alternative

PRO

MET

HAZI

NE



Age Dose (mg) Strength Quantity supplied

2-5 years 5mg every 8 hours when

required 1mg/mL

1 x 100mL mixture

Give 5mL by measure every 8 hours when required

6 – 12 years & Adults

10mg every 8 hours when

required

1mg/mL 1 x 100mL

mixture Give 10mL by measure every 8

hours when required

10mg tablets 3 x 10mg tablets Take 1 tablet every 8 hours when

required

The first dose may be administered on site in the WiC if required to give immediate relief. However please note that promethazine can cause drowsiness and clients should not drive a car once they have

had a dose


PRO

MET

HAZI

NE

Reaction Advice for Clients and Notes Promethazine may cause drowsiness and may increase the effects of alcohol. Drowsiness may continue the following day.

Those affected should not drive or operate machinery; alcohol should be avoided.

Sedation, impair alertness, dizziness, confusion, headache, blurred vision, mydriasis, dry eyes, constipation, dry mouth, urinary retention nausea, vomiting, diarrhoea, hypotension

Common side effects if prolonged or worsening see GP

Leukopenia, agranulocytosis, haemolytic anaemia, allergic reactions, arrhythmias, dyskinesia, hallucinations, elevated liver enzymes

Rare and infrequent side effects which are unlikely with a short course of treatment refer client to GP if they suspect any symptoms

CNS stimulation (excitation, hallucinations, ataxia, seizures) may occur rarely, especially in children and the elderly

Monitor client and refer to GP if symptoms occur



• This medication may make you sleepy; don’t drive or operate machinery if this happens. • Avoid alcohol and other medication which may cause sedation • Refer to GP if symptoms do not resolve in 24 hours

References


The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide

eTG Urticaria 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=urticaria-angioedema#MPS_d1e136

Approval




http://amh.hcn.au/

https://tgldcdp.tg.org.au/viewTopic?topicfile=urticaria-angioedema#MPS_d1e136

Walk-in Centres


RIFAMPICIN

100mg/5mL syrup


RIFA

MPI

CIN


A list of contacts for clearance antibiotics will be emailed or faxed to the WiC prior to their visit.

Included Patients

• Children 2-12 years (FIRST LINE) • Adults in whom ciprofloxacin is contraindicated (SECOND LINE)

Excluded Patients


Children under 2 years old This children will not be referred to WIC



Women who are pregnant or breastfeeding Consider ceftriaxone as preferred option

History of hypersensitivity to rifampicin Refer Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours via a paging service and leave a message in order to receive a returned call.

Women who are taking the oral contraceptive pill

Consider ciprofloxacin (preferably) or ceftriaxone

Hepatic impairment, jaundice or alcoholism


Undernourishment or malnourishment

Drug Interactions

RIFA

MPI

CIN


Oral contraceptives

Consider Ciprofloxacin or Ceftriaxone. If rifampicin required advise patient to take an active pill daily during course and for at least 7 days after last rifampicin dose and use extra contraceptive precautions, e.g. abstinence or a barrier method, continuing this for 4 weeks after the last Rifampicin dose.

A number of medications interact with Rifampicin If patient is taking any prescribed medication consider ceftriaxone or contact Communicable Disease Control ph. (02) 6205 2155 during business hours or (02) 9962 4155 after hours

Antacids Antacids reduce the absorption of rifampicin therefore rifampicin should be taken a minimum of one hour prior to any antacid



Weight/age Dose Strength Quantity

10-12kg 120mg 100mg/5ml suspension 1 x 60ml bottle

6ml twice daily for two days

12.1-14kg 140mg 100mg/5ml suspension 1 x 60ml bottle


14.1- 16kg 160mg 100mg/5ml suspension 1 x 60ml bottle

















RIFA

MPI

CIN

Weight/age Dose Strength Quantity





























> 58.1 kg 600mg 100mg/5ml suspension 2 x 60ml bottle



NO

RMAL

HU

MAN

NO

RMAL

Reaction Advice for Patients and Notes Anaphylaxis (rifampicin syrup contains sodium metabisulfite which may cause allergic reactions including anaphylaxis)


Nausea, vomiting, diarrhoea Common side effects, encourage fluids, if prolonged or worsening to seek medical advice

Headache, dizziness, drowsiness, ataxia Common side effects, encourage fluids, if prolonged or worsening to seek medical advice

RIFA

MPI

CIN

Rash May indicate allergic reaction -> advise to seek medical advice immediately

Arthralgia, myalgia If prolonged or worsening, seek medical advice

Refer patient to printed CMI for a full list of adverse effects


• Rifampicin is absorbed best if you take it at least half an hour before food or two hours after food

• Urine, faeces, saliva, sputum, sweat and tears may be coloured red-orange by Rifampicin and its metabolites.

• Contact lenses may be permanently stained by Rifampicin so contact lens use during treatment should be avoided.

• A two day course of rifampicin eradicates nasopharyngeal carriage in 75-95% of carriers. • The product information for Rifampicin recommends a once-daily four-day regimen for

clearance of meningococcal disease. The two day regime described above is recommended by the Communicable Diseases Network Australia.

• Ceftriaxone is the preferred antibiotic for pregnancy

References

Invasive Meningococcal Disease CDNA National Guidelines for Public Health Units http://www.health.gov.au The Australian Immunisation Handbook 10th ed update 2017. http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home

MIMS online 2017 https://www.mimsonline.com.au

eTG Complete Meningitis chemoprophylaxis, 2017, https://tgldcdp.tg.org.au Australian Medicines Handbook 2017 , https://amhonline.amh.net.au

Approval






http://www.health.gov.au/

http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home




WALK-IN CENTRES


ROXITHROMYCIN 50mg tablet for suspension

150mg tablet


ROXI

THRO

MYC

IN

An alternative antibiotic for clients with immediate penicillin hypersensitivity for the following indications:

• Otitis Media • Tonsillitis

Included Clients


Excluded Clients


Known hypersensitivity to macrolides antibiotics, including Erythromycin, Clarithromycin or Azithromycin.

Use alternative antibiotic or refer to GP

Known impaired hepatic function Use alternative antibiotic or refer to GP

Macrolides, including Roxithromycin, have the potential to prolong the QT interval

Refer client to GP if they have : - Congenital prolongation of the QT interval - Ongoing proarrhythmic conditions including

uncorrected hypokalaemia or hypomagnesaemia, clinically significant bradycardia

- Clients receiving Class IA and III antiarrhythmic agents (e.g. Disopyramide, Quinidine and Amiodarone)

Clients with Myasthenia Gravis Refer to GP

Drug Interactions


Theophylline Can increase the plasma concentration of theophylline. Use alternative antibiotic or refer to GP

Ergot alkaloids:

- Ergotamine - Dihydroergotamine

Severe reactions with possible peripheral necrosis have been reported. Use of Roxithromycin in clients taking ergot alkaloids is contraindicated Use alternative antibiotic or refer to GP

Disopyramide Roxithromycin can cause increased levels of Disopyramide Use alternative antibiotic or refer to GP

Terfenadine May increase serum levels of Terfenadine, resulting in severe cardiovascular adverse events Use alternative antibiotic or refer to GP

Astemizole, cisapride, pimozide

Are metabolised by CYP3A4 which is inhibited by macrolide antibiotics. QT interval prolongation and/or cardiac arrhythmias (typically torsades de pointes) have been reported when used in combination, therefore concomitant administration is not recommended Use alternative antibiotic or refer to GP

Drug Interactions (Continued)

ROXI

THRO

MYC

IN Drug Suggested Action(s) and Notes

Warfarin

Roxithromycin appears to interact with Warfarin. Increases in INR have been reported in clients treated concomitantly with Roxithromycin and Warfarin. Roxithromycin can be used in clients on Warfarin, however client should be referred to GP to monitor their INR

Digoxin

Roxithromycin may increase the absorption of Digoxin. This may very rarely result in Digoxin toxicity. Roxithromycin can be used in clients on Digoxin, however the client should be referred to their GP for ECG and Digoxin level monitoring.

Midazolam Roxithromycin can enhance and prolong the effects of Midazolam in clients treated with Roxithromycin Use alternative antibiotic or refer to GP

Roxithromycin Dosing and Supply Information

Dose Supply Label & Instructions

Weight Dose Strength Quantity

<2 years old Refer to GP

Treatment of Tonsillitis – 10 day course

12 – 23 kg 50mg twice daily for 10

days

50mg tablet for suspension

20 x 50mg tablets

Disperse ONE tablet in 1-2 spoonful’s of water and take TWICE

a day for 10 days

24 – 40kg 100mg twice daily for 10

days

50mg tablet for suspension

40 x 50mg tablets

Disperse TWO tablets in 1-2 spoonful’s of water and take TWICE

a day for 10 days

>40kg 300mg once a day for 10 days 150mg tablets 20 x 150mg

tablets Take TWO tablets ONCE a day for 10

days

Treatment of Otitis Media – 5 day course

12 – 23 kg 50mg twice

daily for 5 days 50mg tablet

for suspension 10 x 50mg

tablets

Disperse ONE tablet in 1-2 spoonful’s of water and take TWICE

a day for 5 days

24 – 40kg 100mg twice

daily for 5 days 50mg tablet

for suspension 20 x 50mg

tablets

Disperse TWO tablets in 1-2 spoonful’s of water and take TWICE

a day for 5 days

>40kg 300mg once a day for 5 days

150mg tablets 10 x 150mg

tablets Take TWO tablets ONCE a day for 5

days



Urticaria or rash May indicate allergic reaction Advise client to seek medical advice

Nausea, vomiting, epigastric pain (dyspepsia), diarrhoea, headache, cough, anorexia, flatulence


Hepatic dysfunction, with or without jaundice

Advise client to seek medical advice if they have symptoms of jaundice (yellow skin and/or eyes).




ROXI

THRO

MYC

IN

Roxithromycin is best absorbed on an empty stomach, so take dose at least 15 minutes before a meal. If it makes you feel sick then you can take it with food.

The 150mg tablets are designed to be swallowed whole and should not be dispersed in water.

Finish the course

Pregnancy and Breastfeeding: Safe to use in pregnancy. Safe to use at recommended doses during breastfeeding. However observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush

Tablets for Suspension

1. Remove the correct number of tablets from the foil.

2. Add one or two tablets, to water and mix well. At least a spoonful of water should be used.

3. Wait about 30 or 40 seconds for the tablet to break down into fine granules. (The tablets will not completely dissolve). Stir if necessary.

4. Ensure the water and granules are swallowed by your child straight away, otherwise the pleasant strawberry taste may disappear.

5. Have a glass of water ready and give your child a drink immediately after taking the medicine to ensure that all the dose is swallowed.

References

MIMs online 2017 https://www.mimsonline.com.au Australian Medicines Handbook 2017 http://amh.hcn.au

Approval




http://amh.hcn.au/

WALK-IN CENTRES


SALBUTAMOL 100 microgram MDI


SALB

UTA

MO

L

Acute asthma (mild, moderate or severe episode)

Included Clients


Cautions

Pregnancy - may need referral to ED if client hypoxic or signs of PE

Excluded Clients


Confirmed anaphylactic reaction to previous dose of salbutamol

Refer to ED immediately/ consider ACTAS call “000”

Angle-Closure Glaucoma Inhaled salbutamol may rarely precipitate acute angle-closure crisis, especially if used with Ipratropium Refer to ED immediately/ consider ACTAS call “000”

Drug Interactions


Theophylline, diuretics, corticosteroids and antihypertensive

Increased risk of hypokalaemia when high doses of salbutamol are used Advise client monitoring of potassium will be required by GP or ED during periods of high salbutamol usage


Dosing Administration Supply Label &

Instructions Age Dose*

Children < 6 years

2-6 puffs of 100mcg metered

dose inhaler (MDI) via Spacer

Give MDI via spacer with mask

attachment, if severe/moderate episode consider ACTAS “000” call

with application of O2 therapy if SpO2

<95%

Follow asthma protocol. Refer to ED immediately via

ACTAS “000”

Children > 6 years and adult

6-12 puffs of 100mcg MDI via

Spacer

Give MDI via spacer, if

severe/moderate episode consider ACTAS “000” call

with application of O2 therapy if SpO2

<92%

For mild symptoms

with resolution after initial salbutamol

treatment in WiC only:

1 x 100mcg Salbutamol

MDI

1 x Spacer. Follow asthma

protocol.

For asthma symptoms

Use 4 puffs via spacer

when required for shortness of

breath. Repeat as

necessary as per asthma action plan

SALB

UTA

MO

L Adverse Drug Reactions / Side Effects


Tremor, palpitations, headache

Common adverse effects. Advise client the effect is temporary and to seek medical advice if prolonged or worsening.

Urticaria, angioedema and anaphylaxis

May indicate allergic reaction advise client to seek medical advice ASAP if they experience these symptoms

Diabetic clients may experience hyperglycaemia with high doses

Advise client to monitor BGLs if using high doses



SALB

UTA

MO

L

• Client MUST be referred to the ED (or GP as indicated) for ongoing treatment ASAP as further assessment and treatment such as steroid therapy will be required

• Correct inhaler technique (in normal circumstances) with the spacer must be used to ensure adequate drug delivery, this is explained below: 1. Assemble spacer

2. Remove inhaler cap

3. Hold inhaler upright and shake well

4. Insert inhaler upright into spacer

5. Put mouthpiece between teeth without biting and close lips to form a good seal

6. Breathe out gently

7. Hold spacer level and press down firmly on canister once

8. Breathe in slowly and deeply then hold breath for about 10 seconds or as long as comfortable OR Breathe in and out normally for 4 breaths

9. Repeat the above step until the required number of puffs have been taken,

10. Remove spacer from mouth

11. Breathe out gently

12. Remove inhaler from spacer

13. If an extra dose is needed, wait 4 minutes and then repeat steps 3 to 11

14. Replace cap and disassemble spacer

References MIMs online 2017 https://www.mimsonline.com.au

National Asthma Guidelines 2017 http://www.nationalasthma.org.au Australian Medicines Handbook 2017 http://amh.hcn.au eTG Complete , First aid for acute asthma in children, 2017 https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-in-children-acute-management&guidelineName=Respiratory#toc_d1e1228 , First Aid for acute asthma in adults 2017, https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-acute-management#toc_d1e110

Approval







http://www.nationalasthma.org.au/

http://amh.hcn.au/

https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-in-children-acute-management&guidelineName=Respiratory#toc_d1e1228

https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-in-children-acute-management&guidelineName=Respiratory#toc_d1e1228

https://tgldcdp.tg.org.au/viewTopic?topicfile=asthma-acute-management#toc_d1e110

WALK-IN CENTRES MEDICATION STANDING ORDER

TRIMETHOPRIM 300 mg tablets


TRIM

ETHO

PRIM

Urinary Tract Infection (UTI)

Included Clients

Female clients > 16 years old with clinical symptoms of a UTI (see clinical impression)

Excluded Clients


Pregnant women Refer to GP

History of allergy or adverse reaction to Trimethoprim

Use cefalexin treatment guideline or Refer to GP

Have known renal impairment If CrCl < 30mL/min Refer to GP, <10mL/min contraindicated

Known haematological disorders or documented megaloblastic anaemia due to folate deficiency

Use Cefalexin treatment guideline or Refer to GP

Porphyria Trimethoprim has been associated with acute attacks of porphyria and is considered unsafe in porphyria clients Refer to GP

Have urinary symptoms that are accompanied by fever (in excess of 38°C), nausea or vomiting and flank plain

Need to rule out pyelonephritis Refer to GP/ED if appropriate

Have a known folate deficiency Use cefalexin treatment guideline or Refer to GP

Male clients Refer to GP/ED

See drug interactions for further exclusions

Drug Interactions

TRIM

ETHO

PRIM


Warfarin Trimethoprim may potentiate the anticoagulant activity of warfarin Refer to GP

Phenytoin, Digoxin, Procainamide.

Trimethoprim may increase serum concentrations and potentiate the effect of phenytoin, digoxin and procainamide Refer to GP

Zidovudine, Lamivudine Trimethoprim has been reported to reduce the renal excretion and increase blood concentrations of these medications Refer to GP

Dapsone Trimethoprim and dapsone increase each other's serum concentration when given concomitantly Refer to GP

Rifampicin Rifampicin may decrease the Trimethoprim concentration Refer to GP

Cyclosporins An increased risk of nephrotoxicity has been reported with use of trimethoprim and cyclosporin Refer to GP

Diuretics (Bumetanide, Chlorthalidone, Frusemide, Hydrochlorothiazide, Indapamide)

Hyponatremia has been reported when trimethoprim is used in combination with diuretics Refer to GP

Methotrexate or Pyrimethamine

Risk of megaloblastic anaemia if trimethoprim is given with other folate inhibitors use cefalexin

Rosiglitazone Trimethoprim inhibits rosiglitazone metabolism, increasing its concentration and the risk of adverse effects use cefalexin

ACE inhibitors (Captopril, Enalapril, Fosinopril, Lisinopril, Perindopril, Quinapril, Ramipril, Trandolapril)

Severe hyperkalaemia has been noted in clients given Trimethoprim together with an ACE inhibitor use Cefalexin


Dosing Supply

Label & Instructions Strength Quantity

300mg at NIGHT for 3 days

300 mg tabs 3 Take ONE tablet at NIGHT for 3 days

NOTE: If client presents to the WiC before 1400Hrs, then a stat dose of Trimethoprim (300mg) PO, can be given to the client in the consult room, to initiate the treatment. The client is advised to wait as long as possible to take the night dose, minimum of 8 hours. They are then to continue with the 1 (300mg) tablet PO per night as per the directions above.


TRIM

ETHO

PRIM

Reaction Advice for Clients and Notes Fever, nausea or vomiting


Rash or itching May indicate allergic reaction, advise client to seek medical advice

Hyperkalaemia Trimethoprim causes potassium retention. Hyperkalaemia can occur with usual doses. Average onset is 4–5 days. Refer to GP for monitoring if the client has renal impairment



Take with food to help minimise gastrointestinal disturbances

Take at bedtime to allow for maximum urine concentration

Breastfeeding: Trimethoprim is safe to use at recommended doses during breastfeeding. However observe the breastfed infant for potential adverse effects, such as diarrhoea, vomiting, skin rash or thrush.

Episodes of recurrent cystitis despite treatment and client education can be treated, but must also be referred back to their own GP for investigation and ongoing management

References

MIMs online 2017 https://www.mimsonline.com.au Australian Medicines Handbook 2017 http://amh.hcn.au eTG Urinary tract infections 2017, https://tgldcdp.tg.org.au The Royal Woman’s Hospital, Pregnancy and Breastfeeding Medicine Guide 2017

Approval




http://amh.hcn.au/


Version Control Version Date Modifications

1.0 5 February 2010 First draft

2.0 15 March 2010 Metoclopramide Guideline

Cefalexin Guideline

3.0 17 March 2010 Amoxicillin Guideline

Antistine Privine (Albalon-A) Guideline

Cefaclor Guideline

Dexamethasone, Framycetin & Gramicidin Guideline

Loratadine Guideline

Minims Artificial Tears Guideline

Phenoximethylpenicillin Guideline

Promethazine Guideline

Roxithromycin Guideline

Salbutamol Guideline

Trimethoprim Guideline

4.0 23 March 2010 Cefalexin Guideline

Roxithromycin Guideline

5.0 29 March 2010 Adult Diphtheria & Tetanus (ADT) Booster Guideline

Amoxicillin Guideline

Amoxicillin + Clavulanate Guideline

Artificial Tears Guideline

Cefaclor Guideline

Dexamethasone, Framycetin & Gramicidin Guideline

Ibuprofen Guideline

Levonorgestrel Guideline

Lignocaine with Adrenaline Guideline

Lignocaine Guideline

Metoclopramide Guideline

Version Date Modifications

Mupirocin Guideline

Oxygen Guideline

Paracetamol Guideline

Phenoximethylpenicillin Guideline

Promethazine Guideline

Salbutamol Guideline

Trimethoprim Guideline

6.0 1 April 2010 Introduction added

Page numbering system changed

‘Medication Guideline’ renamed to ‘Medication Standing Order’ throughout document

‘Approved Treatment Indications’ renamed to ‘Approved Treatment Protocols’ on each Standing Order

‘Breastfeeding’ replaced with ‘Breast feeding’ throughout document

Amoxicillin + Clavulanate Standing Order

Antistine Privine Albalon-A Standing Order

Artificial Tears Standing Order

Cefalexin Standing Order

Dexamethasone, Framycetin & Gramicidin Standing Order

Gastrolyte-R Standing Order

Ibuprofen Standing Order

Lignocaine and Adrenaline Standing Order

Lignocaine Standing Order

Loratadine Standing Order

Metoclopramide Standing Order

Mupirocin Standing Order

Paracetamol Standing Order

Phenoximethylpenicillin Standing Order

Promethazine Standing Order

Roxithromycin Standing Order

Salbutamol Standing Order

Trimethoprim Standing Order

6.1

CHO approved

8 April 2010 • Standing Order date of review added • Chief Health Officer approval details added to each standing order

6.2 29 April 2010 • Abbreviations list added • Appendix added: medication management protocol • Grammatical and typographical errors corrected throughout document • ‘patient’ renamed to ‘client’ throughout document • ‘reconstitute suspension as per TCH policy before supply’ changed to

‘reconstitute as per WiC Medication Management Protocol before supply’

on pages 6,9 & 48 6.3 31 August 2010 • Change of name from Gastrolyte to Oral rehydration Salts

• Roxithromycin change treatment regime in line with best practice to a 10 day course for treatment of Tonsillitis.

6.4 30 November 2010

• ADT definition added of tetanus prone wounds and specific age range. • Amoxicillin increase does as per Antibiotic Therapeutic Guidelines 500mg

(child 15mg/kg up to 500mg) orally, 8 hourly for 5 – 7 days • Penicillin: change penicillin allergy suggested action to “refer to GP: as no

alternate antibiotic available • Cefaclor: In specific counselling points “Capsules and Suspension”

changed to “Tablets and Suspension.” Note: No third line available for sinusitis for severe penicillin allergy. Roxithromycin third line for otitis media.

• Levonorgestrel: Add “2” in front of “X750mcg tablet in the dose section • Glucagon Medication Standing Order added

6.5 August 2011 – February 2012

• Chloramphenicol – add to specific counselling points: Chloramphenicol eye drops are classed as an ADEC (Australian Drug Evaluation Committee pregnancy categories) category A. i.e. it is safe to be used in Pregnancy and breast feeding

• Chloramphenicol – Add: advise the client to press at the medial corner of the eye for about 3 minutes after administration of the eye drop to minimise systemic absorption

• Dexamethasone, Framycetin and Gramicidin (Sofradex) – change from administration for 5 – 7 days to 3 – 7 days as per TGs 2011.

• Dexamethasone, Framycetin and Gramicidin (Sofradex) Add – WiC clients to be advised to administer for 5 days and if no improvement advise client to see GP. Add accordingly to label instructions.

• Cefalexin – change dose to 500mg BD X 5 days (>40kgs) as per TGs and change label accordingly.

• Promethazine – remove exclusion criteria for newborn or premature infants as they are not within WiC scope of practice

• Glucagon – new MSO added • Antistine Privine replaced with Albalon-A as product no longer available • New guideline added – Normal Human Immunoglobulin

Note: There are no versions of this document between V 6.5 and V 13.1

13.1 June 2013 • Cefuroxime WIC protocol to replace Cefaclor due to the hospital Drugs & Therapeutics Committee removal of Cefaclor from the hospital formulary late 2012.

13.2 July 2014 • Levonorgestrel: addition under inclusions: Female clients who have had unprotected intercourse <120 hours prior to arrival. Age has decreased as per the Gillick Principle.

2014 version 1 July 2014 • Cefalexin: addition for treatment of mastitis • Dicloxacillin: addition for treatment of mastitis

2015 version1 May 2015 • Remove references to MET to reflect community Operations and insert Call ACTAS – “000”

• Remove requirement to document client MRN in drug register • ADT – updated introduction to 10th edition of Immunisation Handbook • Adrenaline – change from Epi-Pen to Ampoules 1:1000

• Amethocaine 0.5% eye drops – new MSO for CHO approval • Amoxicillin – Changed Paeds dosing to a narrower range. Also changed

from 7 day dose to 5 day dose as per Therapeutic Guidelines • Aspirin – new MSO for CHO approval • Cefuroxime – change to the Weight / Age in dosing to clarify Added “and

up to 12yrs” and “> 12 yrs old to...” • Cefuroxime suspension, changed discard date from 14 to 10 days as

per Pharmacy recommendation. • Cefalexin – Added in the “exclusion suggested actions” (Trimethoprim

for UTI) • Cefalexin – uncomplicated cellulitis new MSO for CHO approval • Ceftriaxone added for treatment of meningococcal contacts per Public

Health • Ciprofloxacin added for treatment of meningococcal contacts per Public

Health • Dexamethasone, Framycetin & Gramicidin – change dosing from 4

times per day to 3 times per day as per Therapeutic Guidelines • Dicloxacillin – uncomplicated cellulitis new MSO for CHO approval • Glucagon – removed references to IV Glucose to fit with Community

setting • Ibuprofen – added “Lactational mastitis” as per the protocol, and • Lignocaine 1% with adrenaline – removed Paronychia, as is outside

Medication scope • Metoclopramide – change Included clients from “age 12 yrs and over” to

Adults age 20 yrs and over” to reflect product info and NPS advice • Phenoximethylpenicillin – change supply from 250mg to 500mg to reflect

change in supply strength • Rifampicin added for treatment of meningococcal contacts per Public

Health • Trimethoprim – added a clause for a stat dosing if client presents in the

first part of the day • Trimethoprim – remove 1st Line as per Therapeutic Guidelines • Amethocaine - added under counselling "The eye must be protected

until normal sensation has returned. Protect eyes from dust or contamination - E.g. glasses. A patch is unnecessary."

• Aspirin - Added to excluded clients “Known history of duodenal ulcers discuss with paramedics" and "Give oxygen via Hudson mask whilst awaiting ambulance/ paramedic attendance."

• Dicloxacillin - Counselling points amended “To be administered on an empty stomach one to two hours before food or two hours after food and "Consider referral to Maternal and Child Health (MACH) services" added.

• Amethocaine - Added to counselling points “Not to drive or operate machinery if vision is affected.”

• Aspirin – Added under excluded clients “Known history of duodenal ulcers/peptic ulcer.”

• NHIG - “Centre for Disease Control” changed to “Communicable Disease Control”

2017 Version 1 September 2017 • Adrenaline / Epinephrine – Dual naming added. Dosage table changed • ADT – Now adults only (age ≥18). Children who are fully immunized

should be covered until adulthood • Albalon-A – Removed as no longer recommended • Amethocaine – Tetracaine dual naming added. Dose interval changed

from every 3 to every 5 minutes as per eTG • Amoxicillin - Name change from 'amoxicillin' to 'amoxicillin'. OCP

interaction removed. Reference to TB as exclusion removed. Addition of phenylketonuria as exclusion (oral liquid formulations contain aspartame). New dosing table added.

• Amoxicillin/clavulanate - Name change from 'amoxicillin' to 'amoxicillin'. OCP interaction removed. Addition of phenylketonuria as exclusion (oral liquid formulations contain aspartame). New dosing table added.

• Aspirin – Pregnancy and aspirin-sensitive asthma exclusions added • Artificial tears – Removed as this product replaced by Carmellose • Carmellose – Nil changes • Cefalexin (mastitis/cellulitis) - Name change from 'cefalexin' to

'cefalexin'. 'Cefalexin to be given if client has non-immediate hypersensitivity to penicillins' added to show it's not the 1st line AB. "GP to determine if a longer course is needed" added to cater for eTG 5-10 day recommendation.

• Cefalexin (UTI) - Name change from 'cefalexin' to 'cefalexin' • Cefalexin (tonsillitis) – new standing order • Ceftriaxone - References to contacting CHO were replaced with

contacting Communicable Disease Control. Dosing table amended based on dilution up to 4mls with lidocaine. Adverse reaction list extended.

• Cefuroxime - Addition of phenylketonuria as exclusion. Removal of Roxithromycin as possible alternate antibiotic. Removal of hepatic dysfunction adverse reaction warning. New dosing table added.

• Chloramphenicol - Instructions on how to administer eye drops removed (same is contained within CMI)

• Ciprofloxacin - Multiple additions to the drug interaction section. Wording around breast feeding changed.

• Dermabond – nil changes • Dexamethasone – new standing order • Dexamethasone, Framycetin, Gramicidin - Pregnancy removed as an

exclusion. A time limit provided for duration i.e. "3 to 7 days". Instillation of drops info deleted (contained in CMI)

• Dicloxacillin - Methotrexate drug interaction added. "GP to determine if a longer course is needed" added to cater for TG 5-10 day recommendation.

• Glucagon – Nil changes • Ibuprofen - 'Dehydration' and 'coagulation disorders' added as

exclusion factors. Addition of several more possible drug interactions. Tablets removed from dosing table as take home packets no longer provided

• Laceraine - Added "Use with caution when client history of: epilepsy; hypovolaemia; diabetes mellitus; asthma".

• Levonorgestrel - 'Pregnancy' added as exclusion factor. Several more possible drug interactions listed. Breast feeding comment added to counselling points. Dose now 1 x 1.5g tablet (not 2 x 750mg tablets)

• Lignocaine 1% - Safe to use in pregnancy and breast feeding comment added.

• Lignocaine 1% with adrenaline/epinephrine - Dual naming added. 'History of Raynaud’s disease or peripheral vascular disease' added to exclusion criteria.

• Loratadine - Use approved for allergic conjunctivitis and urticarial

• Metoclopramide – minor changes • Mupirocin - Allergy added as possible adverse effect. Pregnancy/breast

feeding comment added. • NHIG – minor formatting changes • Oral rehydration salts – Removed as no longer stocked • Oxygen - Criteria added for when to commence oxygen and range

provided to titrate to SpO2. COPD comment added. • Paracetamol - Ethanol, Imatinib added as potential drug interaction

agents. Corrections made to dosing table. • Phenoximethylpenicillin - cefalexin added as option for penicillin

hypersensitive patients. OCP removed as possible drug interaction. Dosing table changed from age-based to weight-based.

• Promethazine - Several new potential drug interactions added. • Rifampicin - All references to CHO removed. Dosing table changed from

age-based to weight-based • Roxithromycin - remove pregnancy exclusion, add breastfeeding advice • Salbutamol – minor changes • Trimethoprim - OCP removed from drug interaction list. Breastfeeding

comment added.

Walk-in Centres Medication Standing Orders 2017

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Transcript of Walk-in Centres Medication Standing Orders 2017