In addition to the usual questions about pre-holiday immunisations, I am regularly asked about more complex travel matters, such as altitude sickness prevention and 'economy class syndrome'. I find this aspect of general practice adds to the diversity of my work.
Jane Chiodini's excellent article in last month's Guidelines in Practice, however, highlights a potential downside to offering travel vaccinations, namely the need for patient group directions (PGDs).
PGDs are the written instructions that allow a nurse to administer prescription-only medicines. Vaccines are medicines and nurse administration should occur only if the nurse is appropriately trained and has not only an explicit written description of the vaccine, but also a tightly written set of circumstances where administration is permissible.
I am sure many GPs are running excellent and effective travel and general vaccination services, but do not have PGDs in place. Is this a problem?
If my own practice is typical, then the answer is yes. We do indeed have a set of PGDs although I was previously unaware of them. Our most recently appointed practice nurse made enquiries for me and found them neatly filed in another room. This is not to suggest that the service we offer is substandard. We are very proud of our first-rate travel clinic and our impressively up-to-date nurses who do the bulk of the work.
But, as in so many areas of general practice, being very good at something is no longer good enough. We have to meet certain standards and criteria, not just for our patients' safety but also for our own and our practice nurse's safety. Technical lapses in our increasingly litigious society can leave us very exposed.1
What can we do? Well, first, Jane Chiodini's article is essential reading. I have photocopied it for my partners and nurses and intend to air the subject of PGDs at our next doctor-nurse liaison meeting.
Second, I obtained a copy of The Rose Cottage Surgery Sample Patient Group Directions and Guidelines for Travel Health. The folder contains everything you need to put PGDs in place rapidly and painlessly. It also contains a wealth of easily accessible advice for several common problem areas, e.g. the pregnant traveller, cruise ship travel and even altitude sickness. There are sample travel advice leaflets and a travel clinic note card.
So, although feeling alarmed initially, I now feel reassured that an area in which I was confused and vulnerable will rapidly be effectively addressed. This must be what's called clinical governance.
Dr Chris Barclay, GP, Sheffield
- Barton A. Medical litigation: who benefits? Br Med J 2001; 322: 1189.
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