JCPSLP Vol 20 No 2 July 2018

Table 2. Contraindications and precautions for administration of Co-Phenylcaine Forte nasal spray

Case history item

Contraindication/ precaution

Risk mitigation procedure

Contraindication

Do not administer

Known hypersensitivity to lignocaine or other local anaesthetics of the amine type, or to other components of the spray solution

Pregnancy or breastfeeding

Contraindication

Do not administer

Children

Contraindication

Do not administer

Known wounds in nasopharynx

Contraindication

Do not administer

Acutely ill or debilitated patients

Precaution

Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration Patient counselled regarding possible adverse outcomes. If persistent concerns discuss with medical officer prior to administration paper. As such, the potential role for SLPs in prescribing medication for: (a) treatment of oral thrush, (b) topical anaesthesia during nasendoscopy and laryngectomy care, and (c) treatment of localised granulation tissue, is being investigated. Conclusion This pilot trial of trained SLPs in administering of Co- Phenylcaine forte nasal spray to a sample of 100 patients revealed no negative consequences. The results provide positive early outcomes for adopting an extended scope role for specific medication administration within a nasendoscopy clinic. Further full scale investigation including an evaluation of financial and service benefits is needed to fully understand the advantages of this extended practice role. Acknowledgements With thanks to the Allied Health Professionals Office of Queensland (AHPOQ) Allied Health Collaborative Funding and Ms Kelly Beak, Mrs Jane Smith and Mrs Ashley Brown for their efforts in developing this pathway and collecting this vital data. References Allied Health Professions Office of Queensland. (2013). Report on advanced clinical practice framework . Brisbane, Australia: Queensland Department of Health. Allied Health Professions Office of Queensland. (2014). Report on allied health practitioner extended scope of practice . Brisbane, Australia: Queensland Department of Health. Australian Capital Territory Health. (2008). Physiotherapy extended scope of practice: Phase 1: Final Report . South Australia: Centre for Allied Health Evidence.

History of epilepsy

Precaution

Impaired cardiac function including bradycardia, cardiovascular disease, hear failure

Precaution

Impaired hepatic function

Precaution

Severe shock

Precaution

Severe renal dysfunction

Precaution

History of asthma

Precaution

Administration Confidence

60

50

40

30

20

10

0

Somewhat confident

Confident

Very confident

Administered – Clinician 1 Not administered – Clinician 1

Administered – Clinician 2 Not administered – Clinician 2

Figure 2. SLP confidence with administration of Co-Phenylcaine Forte nasal spray adverse events across larger cohorts would be valuable. Larger studies should also evaluate patients and other staff (medical nursing) perceptions, examine cost benefits and quantify the service efficiencies of the model (for example, comparisons of waiting times and number of patients seen). Future directions The process of gaining approval to prescribe medications (as opposed to just administering) is not vastly more time and resource intensive than the process described in this

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JCPSLP Volume 20, Number 2 2018

Journal of Clinical Practice in Speech-Language Pathology