Question 1 · Law, Ethics & Human Factors · Moderate
A registered paramedic working for a private event medical company at a music festival wants to give a parenteral medicine for which JRCALC carries a monograph, but which is not among the medicines in the paramedic exemption in Schedule 17 of the Human Medicines Regulations 2012. The company holds no Patient Group Direction (PGD) for it, although the paramedic's previous NHS trust employer did. Which statement is correct?
- AThe JRCALC monograph is itself sufficient legal authority to give the medicine
- BThe previous NHS employer's Patient Group Direction authorises it at the festival
- CIt needs a PGD from the current employer, a prescription or a legal exemption
- DSchedule 19 lets any registered professional give any parenteral medicine in an emergency
- EAn independent double-check of dose and route by a second registrant provides authority
Show answer
Answer: C
It needs a PGD from the current employer, a prescription or a legal exemption
JRCALC's medicines overview sets out the legal basis for paramedic administration of parenteral medicines: a prescription from an appropriate practitioner (including a Patient Specific Direction, PSD), an exemption under the Human Medicines Regulations 2012 (Schedule 17 for registered paramedics, Schedule 19 for anyone saving life in an emergency), or a Patient Group Direction. JRCALC may carry a monograph for a medicine outside the paramedic exemption, and states plainly that the monograph is not a legal authority to administer; a PGD must be supplied by the employing organisation, and PGDs are not transferable, so the former NHS employer's PGD gives no authority at a festival run by a different company. Schedule 19 is not a general emergency licence: it is a short list of named parenteral medicines (for example adrenaline 1 in 1,000 for anaphylaxis, glucagon, hydrocortisone and naloxone products) that anyone may give to save life. An independent double-check is a safety step within the six rights, not a source of legal authority. Remember too that administration under a PGD cannot be delegated, whereas a PSD may be followed by a suitably trained and competent person.
Where this comes from
- JRCALC Clinical Guidelines — Medicines overviewJRCALC / AACE·1. Introduction — legal basis for administration“Medicines overview — 1. Introduction, legal basis for administration”
- JRCALC Clinical Guidelines — Medicines overviewJRCALC / AACE·1. Introduction — Patient Group Directions (monograph not a legal authority; not transferable)“Medicines overview — 1. Introduction, legal basis: Patient Group Direction (PGD)”
- JRCALC Clinical Guidelines — Medicines overviewJRCALC / AACE·2. Safety aspects — six rights and double checks“Medicines overview — 2. Safety aspects: six rights and double checks”
- Human Medicines Regulations 2012, Schedule 19“Medicinal products for parenteral administration in an emergency”Open at this sentence
- Patient Specific Directions (PSD)NHS Specialist Pharmacy Service·Governance: who may follow a PSD“any suitably trained and competent person may follow a PSD for administration”Open at this section