Administration of medicines in emergencies: MHRA consults

The Medicines and Healthcare products Regulatory Agency (MHRA) has launched a consultation about exemptions to the POM Order, which will extend the range of medicines that can be administered by non-prescribers, in emergency situations. This could be good news, says ANP Committee member Matt Griffiths, who points out that Patient Group Directions (PGD) legislation does not allow authorised practitioners to delegate this responsibility.

Legislation specifies that prescription-only medicines (POMs) can only be supplied through registered pharmacy premises against prescriptions written by appropriate practitioners (including non-medical prescribers). There are two separate sets of exemptions to this: the Article 7 (of the POM Order) list and the paramedic list.

The Article 7 list allows some parenteral medicines (all parenteral medicines are POMs) to be administered by anyone to save a life – given people doing this have to have access to the medicine at the time, this usually takes place in hospitals or ambulances. The proposed change here is that glucose, used to treat hypoglycaemia in people with diabetes, should be allowed to be administered at strengths other than 50%. At present, only glucose 50% is included in the list but modern practice is to use 10% (particularly for children) or 20%, as 50% can be both difficult to administer and an irritant.

The other set of exemptions allows registered paramedics to administer some parenteral medicines on their own initiative to meet immediate needs. The specific change proposed here is that adrenaline hydrochloride be added to the list as an alternative to adrenaline acid tartrate, for paramedics to use in anaphylaxis and cardiac arrest.

Professor Griffiths is concerned that certain medicines, such as adrenaline 1:10,000, used in cardiac arrests by advanced life support providers (some of whom are not prescribers) are not included in the current legislation. He urges organisations to respond to this consultation, and to consider including any other life-saving medicines, as the list of exemptions has become out of date and doesn’t support current clinical guidelines. The closing date is 7 May 2010.