Emergency medicines for your practice

The CQC can’t – and won’t – dictate what drugs GPs should have available in the practice, or in their home-visit bag, but they can provide some recommendations. Practice Business looks at what emergency medicines you should have to hand

GPs need the ‘knowledge, skills, drugs and equipment for managing medical emergencies’ says the CQC. Falling under S4 in its assessment framework, during an inspection the CQC will investigate what planning your practice has done to deal with medical emergencies.

The CQC expects to see evidence that appropriate risk assessments have been conducted, that the practice has adequate stocks of appropriate medicines and has identified a list of medicines that are not suitable for stocking.

The regulator states that there should be a process and system in place to manage all medicines, checking that drugs are in-date and that equipment is well-maintained, as well as ensuring that the practice only keeps the drugs that it needs in stock. If someone does need urgent help, practices should have accessible treatment rooms that enable emergencies to be managed while waiting for an ambulance.

While clear on the abilities of surgeries to deal with emergencies, the CQC doesn’t provide a comprehensive list of medicines a practice needs to carry, suggesting instead that this depends on the individual practice. It does, however, provide some suggestions.

In the GP practice

This list is based on current practice modified from a Drugs and Therapeutics Bulletin in 2005.

Drug	Indication
Adrenaline for injection	Anaphylaxis or acute angio-oedema
Antiemetic – cyclizine, metoclopramide or prochlorperazine	Nausea and vomiting
Aspirin soluble tablets	Suspected myocardial infarction
Atropine for practices that fit coils or perform minor surgery	Bradycardia
Benzylpenicillin for injection / cefotaxime 1g for Injection.	Suspected bacterial meningitis
Chlorphenamine for injection	Anaphylaxis or acute angio-oedema
Dexamethasone 5mg/2.5ml oral solution	Croup (children)
Diclofenac (intramuscular injection)	Analgesia
Furosemide or bumetanide	Left ventricular failure
Glucagon (needs refrigeration) or Glucogel	Hypoglycaemia
Glyceryl trinitrate (GTN) spray or unopened in date GTN sublingual tablets	Chest pain of possible cardiac origin
Hydrocortisone for injection – soluble prednisolone	Acute severe asthma; severe or recurrent anaphylaxis
Midazolam (buccal)	Epileptic fit
Naloxone (see section below)	Opioid overdose
Opiates – diamorphine, morphine or pethidine ampules for injection	Severe pain, including myocardial infarction
Salbutamol – either nebules with a nebuliser or inhaler with volumatic ipratropium bromide (children)	Asthma

Naloxone

• Naloxone is a medicine used to reverse the effects of opiates.
• Providers who stock opiates, either in the practice or in the doctor’s bag, should also stock naloxone.
• Other providers should risk assess the need to stock naloxone based on their patient group e.g. do they provide particular services for patients with addiction, or may patients present with opiate-related problems?

The doctor’s bag

GPs need to carry a range of drugs for dealing with acute situations should they arise when they are on home visits.

The CQC advises that the drugs each GP needs to carry are dependent on the location of the practice. They point out that the drugs required for a remote and rural GP can be very different to those required by a doctor working in an inner city.

The choice of what to include in the GP’s bag is, therefore, at their discretion, but the CQC suggests it is determined by:

• the medical conditions they are likely to face;
• the medicines they are confident in using;
• the storage requirements;
• shelf-life;
• the extent of ambulance paramedic cover;
• the proximity of the nearest hospital;
• the availability of a 24-hour pharmacy.

For more information visit the CQC website.

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