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Clinical Indication for Use Disease/Illness this medication is utilised
Limitations Any conditions/factors relating to the disease/illness or the formulations that need to be considered that would limit its use?
Justification for Use Why is this protocol necessary?
Application of Protocol Which individuals would this protocol be applicable for? Any specific age groups? Be specific.
Inclusion Criteria
When is this protocol to be utilised? Who/what conditions can this protocol be used? What situations are applicable?
Exclusion Criteria
When is this protocol not to be utilised. What situations/disease states would exclude the use of this protocol?
Assessment
What assessment is required before administration of this medication, including laboratory sampling required as part of the assessment?
Pharmacodynamics
How does this drug work? - Mechanism of Action
Pharmacokinetics
Consider administration and absorption, distribution, metabolism and excretion of this medication.
Drug Interactions
List the medications that may potentiate or reduce the effectiveness of the medications and give explanation of the interaction. (See exemplar)
Form, Dose, Route & Duration of Therapy
Adult:
Include also any specific instructions in administration of this medication, i.e. with or without food, specific times of administration, i.e. in the evening/bedtime, etc.
Child:
If not administered to children write N/A. State any specific requirements relating to children.
Adverse Effects
List the side effects and any hypersensitivity reactions that can occur. Any serious adverse effects need to be included as well as the common side effects. (See exemplar)
Response to Adverse Event
You need to state what to do or what process is to be followed if the patient has an adverse event to the administration of this medication. Be specific and relevant to the area utilising the protocol.
Patient Advice & Education
List general Patient Advice and Education and what is important to advice on discharge. Information here needs to reflect the general information given by the nurse that is considered important to patients who are in the facility and who are to be discharged home with this medication. List general information relating to the medication not just for the individual in the case study. Individualising this information to the specific patient in the case study can be discussed in Part B – not here.
Discussion
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