A two month preparation period was set aside for the development of the posts by the appointees and the service went “live” in February 2001. During this preparatory period patient group directions (PGDs) for the thrombolytic agents streptokinase and recombinant total plasminogen activator (rt-PA), as well as aspirin and bolus heparin, were written and subsequently approved by the local medicines and therapeutic committee, clinical managers, and senior clinicians. The PGD is a nationally agreed protocol format for the “prescription” of a named medicine in an explicitly identified clinical situation by nurses and other health care professionals.