1. UTI PGD in practice
… Keeping the flow (of conversation) going!

2. Aims:
Understand impact of service from the viewpoint of the trial stores
Understand the PGD forms and possible outcomes for the patient

3. Trial Impact

4. 331 supplies from Dec16 to July17
Dunfermline to St Andrews
10 Pharmacies
Extended hours and SPSP pharmacies

5. Personal impact quotes
I get great satisfaction from delivering the service and now I’m used to the questions/restrictions the consultations are much swifter
Found it great – the only thing was when I was working in a store that wasn’t covered by the PGD

6. Patients were delighted and I felt great that we could treat UTI with antibiotics
Altogether a great service that patient’s who genuinely need it are grateful for

7. Issues…
… there have been some inappropriate referrals e.g. age, male, diabetic
… some surgeries are really helpful in giving appointments/calling patients back but others still won’t take referrals from pharmacies and patient has to make direct contact which makes the service seem pretty useless to the patient.

8. Issues…
… there have been some inappropriate referrals e.g. age, male, diabetic
… with more education of surgery teams they seem to triage more effectively now

9. Inappropriate referral problem solution:
surgery tool
paperwork

11. Where next?

12. where Pharmacy First fits in nationally …

13. … and locally

14. Criteria for inclusion
Aged 16-65
Female
Presenting with 3 or more of the following symptoms
(OR if BOTH dysuria and frequency are present):-
Dysuria
Frequency
Urgency
Polyuria
Suprapubic tenderness
Valid consent to treatment in accordance with NHS Fife Consent Policy
Eligible from 16th birthday till day before 66th

15. Exclusions Age <16 or >65
Allergy to trimethroprim, co-trimoxazole or any of the components of the medication
Haematuria
Signs and Symptoms of upper UTI - any of the following:
Loin pain, flank tenderness, fever/rigor, rapid onset
nausea/vomiting/diarrhoea, systematically unwell
Taking interacting medications
Certain medical conditions
Confused/dehydrated
Pregnant (confirmed or possible)
Vaginal itch/discharge
More than 2 episodes of UTI in 6 months or 3 episodes in 12 months
Previous antibiotic treatment for UTI In last 28 days
UTI Prophylaxis
Catheter in situ
Exclusions
Paperwork: exclusions
Interacting medications: Azathioprine, ciclosporin, mercaptopurine, methotrexate, phenytoin, warfarin, digoxin, pyrimethamine, rifampicin
Medical conditions: Renal impairment, hyperkalaemia, diabetes, severe hepatic insufficiency, megaloblastic anaemia,
other blood dyscrasias, folate deficiency, porphyria, galactose intolerance, the Lapp lactose deficiency, glucose-galactose malabsorption, immunosuppressed, urinary tract abnormality, on antibiotic prophylaxis for recurrent UTI

16. Referral Paperwork
paperwork

17. Basic Data
paperwork

18. Patient outcome and consent
paperwork

19. Final Advice: Trimethoprim should be taken twice a day
Provide patient information leaflet
Provide information leaflet on self-management and the prevention of urine infections
Paracetamol and Ibuprofen may be used to relieve pain and discomfort
If condition worsens or symptoms persist for longer than 3 days to seek further medical advice
paperwork

20. Brief summary Confirm symptoms Patient to sign outcome form
Let GP/OOH know same/next day
Give patient top tips sheet and warning statement

21. Useful sites/articles
Scottish UTI network:
hps.scot.nhs.uk/haiic/sutin.aspx
Cranberry juice reduces recurrent UTIs by 39%: 
Clinical Pharmacist, Vol 8, No 7, online | DOI: /CP
SIGN 88: sign.ac.uk

22. TARGET antibiotic toolkit: www. rcgp. org
TARGET antibiotic toolkit: