PGDs and PSDs :Immunisation by Nurses and other Healthcare professionals

The ideal way for patients to receive medicines is for trained healthcare professionals to prescribe for individual patients on a one-to-one basis. Immunisation is an exception to this and requires one of two methods to keep within the Medicines Act 1968.

PGDs Patient Group Directives

Patient Group Directives are a vehicle for allied health professionals (often nurses & HCAs ) to administer treatment (often immunisations) to a group of patients rather than specific, named individuals.

The directive is developed by a senior Doctor such as a Public Health Consultant Doctor or a Clinical Director of a PCT.

Examples of when this is used:

A meningitis outbreak occurs in a school. The local Schools nursing team and Health Visiting team visit the school and on a PGD signed by the PCT Clinical Director or Consultant in Public Health, administer antibiotic prophylaxis according to the written PGD to the group of pupils and staff of the school.
The PCT commissions the School Nursing Service to administer Cervarix to the teenage girls attending schools in their area. A PGD is authorised by the Clinical Director of the PCT allowing the nurses to administer the vaccine to the students of the school.
Immunising target groups for vaccination e.g. national childhood immunisations, influenzal vaccination and pneumococcal vaccination.

National Prescribing Centre PGDs (Patient Group Directives) - a Practical Guide and framework of competencies for all professionals using PGDs

PSDs Patient Specific Directives

These are a vehicle for allowing allied health professionals (e.g. your practice nurse) to administer individual patient treatments (often immunisations but could include Depo-Provera, B12, Zoladex, etc).

Note: National Immunisations (childhood vaccinations, pneumococcal and influenzal vaccination) will be covered by PGDs.

For travel vaccines, B12, Depo-Provera, Zoladex and other treatments you should have a patient specific directive. i.e. some policy/protocol document for the member of staff to follow plus the name of the patient to whom the instruction relates.

Have a practice protocol for administering the item
Have a formal method of instructing your nurse/HCA for giving such items to your named patients

In practice, this would mean a record in the notes "go ahead with Depo-Provera" or "please administer Zoladex".

Travel vaccines are slightly more complicated as your travel nurse may be the professional assessing which vaccines are necessary according to the countries to be visited. One solution would be for the practice nurse to assess which vaccines are necessary and to get a GP to agree. (Most clinical systems allow a system of attaching an administrative message to a patient's notes.)

You need a protocol for each vaccine administered.

We are very grateful to Hampshire PCT and Neal Hardy for allowing us to use their PGDs. Practices may download them and use them as their nurse protocols for immunisations.