Ear Infection Consultation

Consultation Session

Check patient ID presented e,g passport, Drivers License or Photocard

Not required as examination is face to face with patient

Patient ID Confirmation: Confirm ALL patient details that was completed on the assessment form

GP information share consent

Inform patient that we will share consultation with GP

Action if EXcluded (tick to confirm action)

Reschedule or refer to General Practitioner, specialist or appropriate clinic as clinically indicated.
If a serious complication or underlying pathology is suspected (e.g. malignant otitis), the patient should be urgently referred for further investigations.
Discuss with patient/guardian and document the reasons for exclusion from treatment under the PGD
Advise patients/guardians on how to aid recovery of otitis externa and reduce the risk of future infection
Record any advice given and actions/decisions in notes (written or electronic)

Document reason for exclusion and any advice given or action taken in patient’s clinical records

Tick to confirm below have been done, caution have been reviewed and considered

An ear examination
Exclude chronic alternate diagnoses, including chronic otitis media, before treatment is commenced
If the patient has a skin condition that is associated with the development of otitis externa, ensure that it is well controlled. If the condition is poorly controlled, consider referring the patient to their GP for management. This does not apply
Perforation of the tympanic membrane. This doe snot apply
Theoretical risk that sufficient steroid may be absorbed to cause adrenal suppression. This does not apply
Open wound and damaged skin. This does not apply

Diagnosis

Additional information that may be relevant (e.g. patient temperature)

Non-supply/administration

Tick as apply

I confirm that the patient did NOT receive the medication
Patient referred to GP

Reason for non-supply/administration

Supply/administration

Action if patient declines treatment

Record refusal, advice given, actions/decisions in notes (written or electronic).
Inform or refer to doctor as appropriate if patient has consented.
Ensure patient/guardian fully understands the risks of declining treatment
Advise patients/guardians on how to aid recovery of otitis externa and reduce the risk of future infection

Record refusal, advice given, actions/decisions in notes

Drug name, strength

Otomize Ear Spray – One dose: 60 mg (Neomycin/Dexamethasone/Acetic Acid) • Composition: ̵ Neomycin Sulfate: 0.5% w/w (3250 IU/ml) ̵ Dexamethasone: 0.1% w/w ̵ Glacial Acetic Acid: 2.0% w/

Advise Patient

Route/Method of administration

Liquid ear spray for application into the external auditory meatus.
• The medicine should be shaken before use and primed by pressing the pump
down several times until a fine spray is seen.
• The nozzle tip should be placed gently into the ear and pressed once to
administer a 60 mg dose into the affected ear.

Frequency of Administration

One metered dose (60mg) to be administered directly into each affected ear
three times daily.
• Treatment should be continued until two days after symptoms have disappeared.

Maximum or minimum treatment period

Treatment should not be continued for more than 7 days in the absence of any clinical improvement, since prolonged use of corticosteroid/antibiotic combinations may lead to occult extension of infections due to the masking effect of the steroid.
• The patient should be referred appropriately if the condition worsens or does not respond to treatment within 7 days

Tick ALL to confirm

I confirm that the patient is not contraindicated based on the information provided by the PGD
I have explained the potential warnings and side effects of the treatment to the patient, and requested they report them if they occur
Send email for PIL, CONSENT and PAYMENT link to patient
CONFIRM patient content via email and completion of form

Healthcare Professional Name

First

Last

GPHC Number

Date / Time

Date

Time

HCP Signature (typed name accepted)

Pre-Consultation Assessment

Consultation Session

Non-supply/administration

Supply/administration

Advise Patient

Start Assessment

Complete Patient Details