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Intravenous Administration for Adults

TCP 021

Cross reference

This policy should be read in conjunction with:

Progress and date of approval (Approved /under review Safe & Secure handling of

medicines MM 026

Approved Aseptic Non Touch Technique TCP

113

Approved Policy for the use of infusion

devices in BSUH TCP 075

Approved Cannulation policy TCP 035 Approved

Manager Responsible Deborah Bolton

Authors Deborah Bolton

Date 26/02/08

Policy Number TCP 021

Previous code CO 021

Version number 2

Approving Committee Trustwide Clinical Policies Signed by Chair of the Committee

Review Date February 2010

Consultation and Ratification Schedule

Name of Committee Date of Committee

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Contents

1. Introduction

2. Indications for IV therapy 3. Contra-indications 4. Principles for practice 5. Infection control 6. Equipment needed 7. Procedure 8. Requirements to be an assessor 9. Electronic documentation 10. Monitoring effectiveness References Appendices

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Intravenous Therapy Administration for Adults 1. Introduction

All staff who undertake the administration of intravenous (IV) therapy via an established route must have attended an IV course within the Trust or be able to provide evidence of study in other organisations. This must be followed by a period of supervised practice and successful completion of the BSUH

competency based assessment.

Staff must attend a theoretical IV update every 3 years. This update needs to be followed up by a competency based assessment within 4 weeks of the theory session. This assessment will be carried out using the NPSA competencies. (see appendices)

Bank and agency staff may administer IV therapy as long as they have

completed the above training. If an agency nurse is a former employee of BSUH and was competent to administer IVs, they may continue to do so within BSUH, as long as they attend an IV update every 3 years.

This document should be used in conjunction with other BSUH policies: Safe and secure Handling of Drugs (TCP026), Cannulation (TCP035), Aseptic Non-Touch Technique (TCP113), Policy and Guidelines for infusion devices in BSUH (TCP 075).

The emphasis is to meet the holistic needs of the patient/client. Practitioners should only administer IVs to patients in their own care. A practitioner is one who is professionally registered and legally accountable for practice. E.g. Doctors, Nurses, Operating Department Practitioners, Radiographers, Midwives.

A register of all training and staff competent in IV skills is held by the IV Team, Garden Room, Rosaz Cottage, RSCH. Ext 4922.

2. Indications for IV Therapy

a) Administration of prescribed IV fluids and medication. b) To maintain and correct electrolyte imbalance.

c) Administration of emergency and lifesaving medication – where rapid effect is required.

d) Administration of blood and blood products. e) Administration of Total Parenteral Nutrition.

f) Administration of medication that may not be administered by any other route.

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a) When alternative routes would be as effective e.g. oral b) When the patency of the vascular access device is in doubt.

c) When administration exceeds a practitioner’s competence. This should be passed on to a more experienced practitioner and not omitted.

d) When workload exceeds the ability to carry out administration safely. e) If a patient does not give consent.

f) Where it is not clinically indicated.

4. Principles for Practice

a) IV therapy may only be administered by a currently registered practitioner who has received appropriate training and successfully completed the BSUH competency based assessment.

b) First and subsequent doses of medication may be given by a practitioner, provided they are confident that it is safe to do so.

c) Each department manager should maintain a register of staff who are competent to administer IVs.

d) Practitioners moving between specialities should ensure that they have relevant specialist knowledge and skills before continuing to administer IV therapy.

e) Practitioners should only administer IVs in the area within which they are working. They must not move to other areas for the sole purpose of

administration of IVs. Exceptions to this are: Medical Staff, Chemotherapy Team, Pain Team, Night Co-ordinators, IV Team and Bleep holders. f) If administering IVs for clinical trials, the practitioner must be sure that a

protocol for the trial is available. The Local Research Ethics Committee must have ratified the protocol.

g) The practitioner should only administer drugs with which he/she is familiar. All therapy must be administered via an established vascular access device. E.g. cannula, central venous catheter.

h) IV therapy should be administered according to a correctly completed

prescription. i.e. legible, correct patient details, correct drug, dose, time, route of administration, signed and dated. If this is not the case, the practitioner should not administer the IV. Medical staff must be informed of any omissions and it must be documented in the notes. If the practitioner is concerned, they should complete a Datix Form.

i) The practitioner must positively identify the patient/client to whom the IV is being administered. The patient/client hospital number must be checked against both the identity band and the prescription chart. If for any reason there is no name band, the practitioner may identify the patient/client verbally. If a patient is unconscious, a practitioner other than those administering the IV must identify the patient and apply a name band.

j) 2 registered practitioners must check medication to be administered

intravenously, one of whom should also be the practitioner who administers the IV medication.

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• The fluid/drug is the one prescribed • The integrity of the container

• The expiry date of the drug/fluid • The appearance of the fluid

• The mode of reconstitution from a powder to a liquid • Date and time of previous dose

• Any allergies • Blood levels

• The patency of the vascular access device.

l) Student nurses must not act as a second checker for any IV therapy. They must not check infusion devices and must not be used as escorts for patients leaving the ward with IV Therapy in progress.

m) Student Nurses must never administer/supply medicinal products without direct supervision. Their mentor must understand that as a Registered Nurse they are accountable for this.

n) Health Care Assistants are not permitted to check IVs in BSUH unless there is a local protocol in place.

o) All IV therapy must be administered using an aseptic non-touch technique. p) When an infusion is in progress, the practitioner must ensure that drugs to be

given and infusion fluids are compatible. If this is not the case, flushes should be given prior to administration, in between drugs and following

administration.

q) All IV therapy should be administered using a 10ml syringe or larger, to comply with manufacturers guidelines.

r) For intermittent injection, the patency of the vascular access device must be demonstrated with a flush of 5 mls of sodium chloride 0.9% in a 10ml syringe. If more than one drug is being given, the practitioner should administer 2-3mls flush in between administration. Once administration is complete, the practitioner must administer a flush to ensure that the vascular access device is clean. The amount may vary depending on the device in use.

s) All flushes must be prescribed and the amounts administered documented on fluid balance charts. Medical staff or nursing staff who are IV competent may prescribe flushes, on the PRN part of the prescription chart. When signing the prescription chart, nurses must print RN in the signature box.

t) Intravenous fluids should be prescribed on the correct infusion chart. Rates should be checked hourly. All fluid administered should be documented accurately on a fluid chart (see appendix)

u) All fluids containing potassium must be administered using a volumetric pump. Ideally all fluids should be administered using pumps if they are available.

v) All lines should be clearly labelled with the date and time they were connected.

w) All lines on critically ill patients should be clearly labelled with the drug they are administering.

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x) If a patient is to be moved from the ward area with IV therapy in progress e.g. to x-ray, a registered practitioner should accompany them.

y) Patients with IV fluids and pumps are not permitted to leave the wards without a nurse escort in order to smoke. They will be doing so against medical

advice. If they have an infusion device, they must be accompanied by a registered nurse and they must not use their mobile phone.

z) Cannula sites should be checked for signs of phlebitis, infection and infiltration every shift and each time a drug is administered, or infusion connected. Use visual phlebitis score and infiltration scale below. Scores should be documented on the observation chart and be placed at the end of the patients’ bed. Treatment should be commenced according to scores.

Visual phlebitis score (VIP)

Findings Score Action

IV site appears healthy 0 No sign of phlebitis.

OBSERVE CANNULA One of the following is

present

-pain at IV site, slight redness at IV site

1 Possible signs of

phlebitis

RESITE CANNULA Two of the following are

present- pain, swelling, erythema

2 Early stages of phlebitis

RESITE CANNULA All the following are

present-pain, erythema, induration 3 Medium stage of phlebitis RESITE CANNULA CONSIDER

TREATMENT (this may

be heat application to cause vaso dilation)

ALL of the following are

present-pain, erythema, induration, palpable venous cord, 4 Advanced stage of phlebitis or start of thrombophlebitis. RESITE CANNULA CONSIDER TREATMENT All of the following are

present- pain, erythema, induration, palpable venous cord, pyrexia

5 Advanced stage of

thrombophlebitis

RESITE CANNULA TREAT WITH ANTI BIOTICS

CONSIDER ANTI COAGULANT THERAPY

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Infiltration Scale

Grade Clinical Criteria

0 No symptoms

1 Skin blanched

Oedema <2.5cm in any direction Cool to touch

With or without pain

2 Skin blanched

Oedema 2.5-15cm in any direction Cool to touch

With or without pain

3 Skin blanched

Gross oedema >15cm Cool to touch

Mild to moderate pain Possible numbness

4 Skin blanched

Skin tight and leaking

Skin discoloured, bruised, swollen Gross oedema >15cm in any direction

Deep pitting tissue oedema Circulatory impairment Moderate or severe pain

Infiltration of any blood product, irritant, or vesicant

(INS 2000)

Any action taken should be recorded in the clinical records.

All peripheral cannulae and central lines should be removed prior to a patients’ discharge, unless the patient is to receive IV therapy in the Community.

Intravenous drugs that may not be given by nursing staff/ODPs/ radiographers/midwives

If staff are working in high dependency or critical care areas, they may be required to give drugs not usually administered in ward areas eg sedatives and anti-arrythmics, that may lead to a loss of consciousness, and cytotoxic drugs. These drugs can only be administered by Nursing staff, ODPs or Radiographers, if they can demonstrate knowledge of the drug and/or have received additional training to administer. This should involve a competency based assessment. Information and training may be given by pharmacy. Training for some drugs is included in the Advanced Life Support course.

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Staff should seek help for administration of drugs with which they are unfamiliar.

5. Infection Control

All vascular access devices and administration sets should be viewed as a closed system and a source of microbial infection.

a) Aseptic non-touch technique must be employed at all times.

b) Manipulations of IVs should be kept to a minimum and lines observed for leakage.

c) Standard gravity lines must be changed no more frequently than every 72 hours unless otherwise indicated. e.g. when the cannula is resited or there is blood in the joints. All new lines must be labelled with the time and date of change. Both should be recorded in the clinical record.

d) Peripheral cannulas should be routinely changed every 72 hours.

e) Cannula must be secured using a sterile, moisture permeable, IV dressing. E.g. Tegaderm.

f) Adhesive tape must not be placed over the IV dressings

g) Date and time of insertion of cannula should be documented using the micropore strip provided with the cannula dressing.

h) IV dressings should be changed when they are soiled. Film dressings will last for the life of the cannula.

i) All infusions containing medication e.g. Heparin, Ionotropes, Insulin must be changed every 24 hours.

j) Administration sets for intermittent drug infusion e.g. antibiotics, should be changed every 24 hours or according to the stability of the drug. They should not be disconnected from the patient and bunged off for long periods of time and then reconnected. If lines are not in use, they should be left connected to the patient.

k) Cannula caps should be closed when not in use, and all 3 way taps have caps applied.

l) Caps should be changed each time the line is accessed.

m) Needle free connectors e.g. Swanlock, are recommended for all central lines. These may be accessed 100 times and should be changed weekly.

6. Equipment needed

• Clean plastic tray or receiver • Syringes (10 ml or larger)

• Needle (blue needles or filter needles should be used for reconstitution to reduce the risk of particulate contamination) • Drugs

• Reconstitution Fluids/ fluid for administration • IV additive labels

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• 2% chlorhexidine wipes eg PDI wipes should be used for accessing lines.

• Single use 2% chlorhexidine eg Chloraprep should be used for dressing changes

• 0.9% sodium chloride flushes • Non-sterile gloves

• Apron • Sharpsbin

7. Procedure

Two practitioners must be present.

a) Wash hands with soap and water, followed by alcogel.

b) Put on non- sterile gloves and apron. (NB handwashing protects the patient, gloves protect the practitioner)

c) Gather together all equipment

d) Clean out plastic tray with chlorhexidine wipes

e) Reconstitute drugs as per manufacturers’ recommendations and prescription chart. Remember to take displacement values into consideration to ensure correct concentration if dividing the dose. This information is available on the summary of product characteristics (data sheet). Information is also available on the internet, National IV Guidelines. (MEDUSA)or via the Medicines

information helpline.

f) Remove gloves, alcogel hands and apply fresh pair of gloves. g) Check identity of patient.

h) Check if they have any allergies.

i) Check capacity of patient. If they have capacity ensure they understand the proposed procedure and ensure they have no objections. If not, take advice on consent prior to proceeding

j) Inspect vascular access device for patency, signs of infiltration and signs of infection and phlebitis. (use phlebitis score for cannulae)

k) Clean administration/injection port/needlefree valve with alcohol swab for 30 seconds and allow to dry.

l) Instil 5 ml 0.9% saline flush into peripheral cannulae, monitoring the patient for pain and swelling. For central lines, aspirate blood back up the line and flush with 10 mls 0.9% saline.

m) If patency is in doubt, stop. Resite cannula, or use alternative lumen of central lines if possible. If patency is proven, continue.

n) Insert syringe of drug into port.

o) Administer slowly following manufacturers' guidelines. This will ensure proper haemodilution and prevent ‘speed shock’ If patient complains of any

discomfort or shows signs of a reaction, stop the administration and call for help as required.

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q) Flush cannula with 5 mls 0.9% NaCl, flush central lines with at least 10 mls of 0.9% NaCl. (short term central lines require locking with heaprinised saline to maintain patency.)

r) Remove gloves and decontaminate hands. s) Document on the prescription chart

t) When several drugs are to be administered down the same vascular access device, ensure that at least 2 mls of 0.9% NaCl is flushed down the line in between the drugs to reduce risks of incompatibility.

u) Not all drugs are compatible with 0.9% saline. Read manufacturers recommendations for flushes required. e.g. use 5% dextrose with amphoteracin and amiodarone.

8. Requirements to be an Assessor

Assessors must fulfil the following criteria:

• A Registered Practitioner who holds a current IV Certificate and a recognised teaching/assessing certificate. E.g. ENB 998. D32,33, A1,A2, CG7307, PHCHSE.

• Administer IV Therapy regularly.

9. Electronic Documentation

Where there is reference made to documentation on charts, this includes

electronic charts and signatures in areas where they are used. This conforms to the Data Protection Act and the NMC Guidelines for the administration of

medicines and record keeping.

10. Monitoring Effectiveness

• The aim of this policy is to provide guidance to staff in the delivery of IV preparations, thereby ensuring safe administration.

• This policy will be monitored for effectiveness by keeping a record staff who administer IV therapy being kept by BSUH. This record will be kept both by electronic and paper versions.

• Annual audit of incidents reported on Datix, enabling identification of trends across the trust.

References

CDC Guidelines 2007

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Dougherty, L and Lamb, J. 1999. Intravenous Therapy in Nursing Practice. Churchill Livingstone : London

EPIC Guidelines 2007 ICNA Guidelines 2001 INS Guidelines 2000

Jackson, A. 1998. Infection Control: A Battle in Vein Phlebitis. Nursing Times

94(4), 68-71.

Manual of Clinical Nursing Procedures. Intravenous Management. The Royal Marsden Hospital 2007

Nursing and Midwifery Council (NMC) Standards for Medicines Management 2007.

NMC Code of Professional Conduct 2007

Pickstone, M.1999. A Pocketbook for Safer IV Therapy. Scitech Educational: Kent

Royal College of Nursing (RCN) 2005. Standards for Infusion Therapy

Richardson, D.1999. Handbook of Infusion Therapy. Springhouse: Pennsylvania. Weinstein,S.M. 2001. Plumers Principles and Practice of Intravenous Therapy. 7th Ed. Lippincott: Philadelphia.

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APPENDIX 1 Please forward this document to the IV Team.

This will be kept as proof of competency and names will be entered into the IV database. (Please do not send NPSA documentation)

Assessment for Intravenous Therapy.

Name ………..

Job Title ……….……….

Area of Work ……….. Directorate ……….. Competent to Practise: Yes / No

Date Assessed ……….

Signature of Assessor ………..

Comments

Please complete and return to:

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APPENDIX 2

NPSA workforce competence March 2007

statement on prescribing injectable medicines Word file available at

www.npsa.nhs.uk./health/alerts

Workforce competence statement

Injectable medicines competence 1

Prescribing injectable medicines Prescribing of injectable medcines

Summary This workforce competence is directly applicable to

healthcare professionals who undertake the prescribing of injectable medicines for adults or children. Its content is also relevant to healthcare professionals who are

responsible for the delivery of healthcare to adults or children. It includes the reviewing of indications and contraindications for use, calculation of administration volume and rate of administration, selection of injectable medication and initiation of a monitoring regimen.

Competent Y/N Indicative links to KSF Dimension & Level

Health and wellbeing HWB7: Interventions and treatments Level 3: Plan, deliver and evaluate interventions and/or

treatments

Activity scope Key words and concepts

Prescription

The document which describes the medication determined by a properly authorised individual for an individually named patient. It includes the medication to be used, the dose, dilution, mode of delivery and time period for delivery.

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A systematic plan for observing the physiological impact of prescribed medication therapy enabling subsequent adjustment to maintain or improve the health of a patient.

Communication with professional colleagues includes

communication within and between appropriate members of teams.

Appropriate member of the team

Include: registered nurse, midwife, doctor, pharmacist, laboratory scientific officer and phlebotomist.

Adverse reactions related to any fluid or drugs given through a cannula

Include: neurogenic, anaphylactic and hypovolaemic shock, cardio-genic shock, septic shock and allergy.

Performance criteria

You need to:

1. Read the patient’s notes, prescription and relevant protocol or clinical guideline and identify any special instructions, investigations (including abnormal blood test results), baseline parameters such as weight, or issues for which you need to seek advice.

2. Confirm that the parenteral route is the most appropriate route for administration of injectable

medication to the patient (i.e. consider and exclude oral or other routes of administration).

3. Determine the appropriate regimen for the patient, which medication to prescribe, dose, frequency, route, rate of administration, type and frequency of monitoring e.g., blood test results, clinical assessment and body weight measurements.

4. Assess the appropriateness of the intended treatment against the patient’s current health status and concurrent medication, particularly in relation to intended therapeutic outcomes and potential drug interactions with concurrent medication.

5. Prescribe according to legislation, national and local prescribing guidelines and relevant clinical information to ensure safe and optimal delivery of treatment.

Include the following in the prescription for injectable medicines:

• Patient’s name, hospital/NHS Number, date of birth or address;

• the allergy status of the patient; • date and time;

• the approved name of the injectable medication (in full, do not abbreviate);

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that recent parameters have been used to calculate dose, for example, weight and laboratory test results);

• the route of administration, for example, intravenous, sub-cutaneous, epidural;

• date and time for re-assessment of the prescription; • start and finish date/time or maximum number of doses; • prescriber’s signature.

Where relevant, the prescription or a readily available local protocol must specifiy the following:

• brand name and formulation of the medicine;

• concentration of the total quantity of medicine in the final infusion container or syringe;

• name and volume of diluent or infusion fluid; • rate and duration of administration;

• stability information concerning the medicine to help determine the correct expiry date and time;

• type of rate control infusion device or pump required; • the age and weight of all children under the age of 16 years;

• arrangement for fluid balance or clinical minitoring should be made on an individual basis and according to local protocol and clinical need.

6. Process the prescription legibly, ensuring your intention for treatment is clear, accurate and complete, and that there are no ambiguities.

7. Record requirements for monitoring the patient’s

response to treatment (for example, frequency and type of blood tests and weight measurement) in the patient’s notes and communicate requirements to professional colleagues.

8. Record the reason(s) for any deviations from the clinical guidelines on the prescription and in the patient’s notes.

9. Explain the treatment and potential side effects and their management to the patient and/or carer and

accurately answer any questions at a level and pace that is appropriate to:

• their level of understanding; • their culture and background;

• their preferred ways of communicating; • their needs.

10. Check that the patient and/or carer understand the treatment to be given and any potential side effects together with their management.

11. Modify any subsequent prescriptions in light of the patient’s tolerance, side effects, complications, monitored

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parameters and response to treatment.

12. Communicate with appropriate professional colleagues as required by local guidelines.

13. Recognise when you need help and seek advice and support from an appropriate source when the needs of the individual and the complexity of the case are beyond your competence and capability.

Knowledge and

understanding

You need to apply:

Legislation, regulations and guidelines

14. An in-depth understanding of national and local injectable medication guidelines and their application. 15. A working understanding of the local guidelines for patient records, their storage and confidentiality of information.

16. An in-depth understanding of the national and local prescribing guidelines.

17. A working understanding of the Guidelines on the Administration of Medicines.

18. A working understanding of local guidelines for waste and sharps handling and disposal.

19. A working understanding of risk management and patient safety principles and causes of medication errors.

Clinical knowledge

20. An in-depth understanding of the disease progression and the potential impact on physiological systems.

21. An in-depth understanding of the relevance of other treatment modalities and clinical conditions.

22. An in-depth understanding of diagnosis, care plan, protocol and guidelines.

23. An in-depth understanding of principles and practice of prescribing injectable medication.

24. An in-depth understanding of the indications and contraindications for the injectable medication. 25. An in-depth understanding of drug calculations

appropriate to the prescribed injectable medication, dose dilution and length of delivery.

26. An in-depth understanding of the side effects of injectable medicines and their assessment, monitoring, prevention and management.

Technical knowledge

27. A working understanding of different venous access devices and their care.

28. A working understanding of administration by the subcutaneous route, and intravenous bolus and/or infusions.

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Procedures and patient management

29. A factual knowledge of the roles and responsibilities of other team members.

30. A working understanding of the limits of one’s own knowledge and experience and the importance of not operating beyond these.

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NPSA workforce competence March 2007 statement on prescribing injectable medicines Word file available at

www.npsa.nhs.uk./health/alerts

Workforce competence statement

Injectable medicines competence 2

Preparation of injectable medicines

Summary This practice competence is directly applicable to

healthcare professionals who undertake the preparation of injectable medicines in clinical areas prior to

administration to adults or children. It includes

interpretation of the prescribed instruction, reviewing indications and contraindications for use, calculation of administration volume and rate of administration, and preparation and labelling of the injectable medication in readiness for administration.

Competent Y/N Indicative links to KSF Dimension & Level

Health and wellbeing HWB7: Interventions and treatments Level 3: Plan, deliver and evaluate interventions and/or

treatments

Origin This is a new workforce competence proposed and

developed by the National Patient Safety Agency (NPSA).

Activity scope Prescription

The document which describes the medication determined by a properly authorised individual for an individually named patient. It includes the medication

to be used, the dose, dilution, mode of delivery and time period for delivery.

Monitoring regimen

A systematic plan for observing the physiological impact of prescribed medication therapy, enabling subsequent

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adjustment to maintain or improve the health of a patient.

Communication with professional colleagues includes

communication within and between appropriate members of teams.

Appropriate members of the team

Include: registered nurse, midwife, doctor, pharmacist, laboratory scientific officer and phlebotomist or any other member of the healthcare team.

Adverse reactions related to any fluid or drugs given through a cannula

Include: neurogenic, anaphylactic and hypovolaemic shock, cardiogenic shock, septic shock and allergy.

Performance criteria

You need to:

1. Read the patient’s notes, prescription and relevant protocol or clinical guideline and identify any special instructions, investigations (including abnormal blood test results), baseline parameters such as weight, or issues for which you need to seek advice.

2. Confirm that the prescription has been written clearly and fully to enable accurate and safe interpretation of the therapeutic instruction intended by the prescription, and also safe preparation. The prescription should include the following:

• patient’s name, hospital/NHS number, date of birth or address;

• the allergy status of the patient; • date and time;

• the approved name of the injectable medication (in full, do not abbreviate);

• the dose and frequency (ensuring, where necessary, that recent parameters have been used to calculate dose, for example, weight and laboratory test results);

• the route of administration, for example, intravenous, sub-cutaneous, epidural;

• date and time for re-assessment of the prescription; • start and finish date/time or maximum number of doses; • prescriber’s signature.

Where relevant, the prescription or a readily available local protocol must specify the following:

• brand name and formulation of the medicine;

• concentration of the total quantity of medicine in the final infusion container or syringe;

• name and volume of diluent or infusion fluid; • rate and duration of administration;

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determine the correct expiry date and time;

• type of rate control infusion device or pump required; • the age and weight of all children under the age of 16 years;

• arrangement for fluid balance or clinical minitoring should be made on an individual basis and according to local protocol and clinical need.

3. Confirm that the parenteral route is the most

appropriate route for administration of medication to the patient (i.e. consider and exclude oral or other routes of administration).

4. Assess the appropriateness of the intended treatment against the patient’s current health status and concurrent medication.

5. Check the medication against the treatment plan, prescription, patient information and local protocol with regard to:

• patient’s identification on prescription chart and on labelled medication;

• allergy status (where relevant for the medication involved);

• critical test results (including blood results); • regimen and individual medication name; • name of medication;

• the medication’s fitness for administration (assessed by appearance and condition);

• diluents and dilution volumes; • dose;

• administration route and duration; • type of infusion control device or pump; • expiry date/time of the medication.

6. Assemble the required materials in a clean location designated for the task. This area should be uncluttered and free from interruption and distraction. Materials will include; medication ampoules/vials, diluent, needle(s), alcohol wipes, disposable protective gloves, clean re-useable plastic tray and sharps bin for disposal of waste. 7. Check that the medication selected matches with the product prescribed. Check packaging and containers for damage and ensure that the materials have not passed their expiry date. Check that storage up to this point has been as required, for example, in the fridge.

8. Calculate the volume of medication required to give the prescribed dose. Make a record of the calculation in the patient’s notes and arrange for an appropriate co-worker to check the calculation.

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9. Prepare the label for the prepared medication.

10. Cleanse hands according to local policy and put on a pair of disposable gloves. Disinfect the surface of the plastic tray in which preparation is to be undertaken. 11. Prepare and arrange the medication, diluents and needles on the tray and using a ‘non-touch technique’ (i.e. avoid touching areas where bacterial contamination may be introduced), prepare the medication according to prescription requirements, with reference to relevant technical information, NPSA guidance on Safer use of

injectable medication and Health and Safety procedures.

12. Immediately label the prepared medication. Do not leave unlabelled syringes or infusion bags unattended or in the presence of other unlabelled medication, as this may lead to error.

13. If multiple preparations of injectable medications are being undertaken, or if there is a delay between

preparation and administration, syringes and infusion fluids should be labelled immediately, according to local policy.

14. Place the final syringe or infusion, the empty ampoule/vial and prescription chart in a clean tray for transportation to the patient for immediate administration. 15. Where a monitoring regimen has been prescribed, ensure that appropriate documentation for recording monitored parameters is made available, for example, fluid balance chart.

16. Record the reason(s) for any deviations from the clinical guidelines on the prescription and in the patient’s notes.

17. Communicate with appropriate professional colleagues as required by local guidelines.

18. Recognise when you need help and seek advice and support from an appropriate source when the needs of the individual and the complexity of the case are beyond your competence and capability.

Knowledge and

understanding

You need to apply:

Legislation, regulations and guidelines

1. An in-depth understanding of national and local injectable medication guidelines and their application. 2. A working understanding of the local guidelines for patient records, their storage and confidentiality of information.

3. An in-depth understanding of the national and local prescribing guidelines.

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4. A working understanding of the Guidelines on the Administration of Medicines.

5. A working understanding of local guidelines for waste and sharps handling and disposal.

6. A working understanding of risk management and patient safety principles and causes of medication errors.

Clinical knowledge

7. A working understanding of the disease progression and the potential impact on physiological systems. 8. A working understanding of the relevance of other treatment modalities and clinical conditions.

9. An in-depth understanding of diagnosis, care plan, protocol and guidelines.

10. An in-depth understanding of the principles and practice of prescribing injectable medication.

11. An in-depth understanding of the indications and contraindications for injectable medication.

12. An in-depth understanding of drug calculations

appropriate to the prescribed injectable medication, dose dilution and length of delivery.

13. An in-depth understanding of the side effects of injectable medicines and their assessment, monitoring, prevention and management.

Technical knowledge

14. A working understanding of different venous access devices and their care.

15. A working understanding of administration by the subcutaneous route, and intravenous bolus and/or infusions.

Procedures and patient management

16. A factual knowledge of the roles and responsibilities of other team members.

17. A working understanding of the limits of one’s own knowledge and experience, and the importance of not operating beyond these.

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NPSA workforce competence March 2007 statement on prescribing injectable medicines Word file available at

www.npsa.nhs.uk./health/alerts

Workforce competence statement

Injectable medicines competence 3

Administration of injectable medicines

Summary This practice competence is directly applicable to

healthcare professionals who undertake the administration of injectable medicines to adults or children. It covers the preparation and administration of injectable medicines. It includes the assessment of the patient’s fitness for treatment, the checking of the treatment drugs against the prescription and patient information, calculation of the amount needed to deliver the required dose, drug

administration and the education of the patient/carer with regard to benefits and side effects.

Competent Y/N Indicative links to KSF Dimension & Level

Health and wellbeing HWB7: Interventions and treatments Level 3: Plan, deliver and evaluate interventions and/or

treatments

Origin This is a new workforce competence proposed and

developed by the National Patient Safety Agency (NPSA).

Activity scope Key words and concepts

Prescription

The document which describes the medication determined by a properly authorised individual for an individually named patient. It includes the medication to be used, the dose, dilution, mode of delivery and time period for delivery.

Monitoring regimen

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prescribed medication therapy, enabling subsequent adjustment to maintain or improve the health of a patient.

Communication with professional colleagues includes

communication within and between appropriate members of teams.

Appropriate members of the team

Include: registered nurse, midwife, doctor, pharmacist, laboratory scientific officer and phlebotomist.

Adverse reactions related to any fluid or drugs given through a cannula

Include: neurogenic, anaphylactic and hypovolaemic shock, cardiogenic shock, septic shock and allergy.

Performance criteria

You need to:

1. Read the patient’s notes, prescription and relevant regimen protocol and identify any special instructions, investigations (including abnormal blood test results) or issues for which you need to seek advice.

2. Greet and accurately identify the patient.

3. Introduce yourself and any colleagues involved in the procedure to the patient and/or carer.

4. Assess the patient’s physical condition and their fitness for treatment, and seek advice from an appropriate team member if required.

5. Check the medications against the treatment plan, prescription, patient information and local protocol with regard to:

• patient’s identification on prescription chart and on any labelled medication;

• allergy status (where relevant for the medication involved);

• critical test results (including blood results); • regimen;

• name of medication;

• the medication’s fitness for administration (assessed by appearance and condition);

• diluents and dilution volumes;

• dose (ensuring where necessary, that recent parameters have been used to calculate dose, for example, weight and laboratory test results);

• administration route, rate and duration of treatment; • expiry date/time of the medication;

• arrangements for fluid balance and clinical monitoring should be made on an individual basis and according to local protocol and clinical need.

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reaction and their management to the patient and/or carer and accurately answer any questions at a level and pace that is appropriate to:

• their level of understanding; • their culture and background;

• their preferred ways of communicating; • their needs.

7. Check that the patient and/or carer understand the treatment to be given and any potential side effects together with their management.

8. Prepare the dose, carrying out calculations, dilutions etc in accordance with local policy and with reference to

technical information provided for the medication.

9. Undertake a final check of the medication against the prescription and the patient’s identity before administration, according to local checking procedures.

10. Give the required medication via the prescribed route, at the prescribed rate according to local medicines

administration guidelines, local control of infection and Control of Substances Hazardous to Health (COSHH) guidelines.

11. After administration, observe the patient and the site of administration to monitor for immediate adverse effects. 12. Record the administration in the patient’s notes, prescription chart and/or patient-held records, as appropriate, according to local guidelines.

13. Dispose of waste materials (sharps etc) in accordance with local guidelines.

14. Communicate with appropriate professional colleagues as required by local guidelines.

15. Recognise when you need help and seek advice and support from an appropriate source when the needs of the individual and the complexity of the case are beyond your competence and capability.

Knowledge and

understanding

Legislation, regulations and guidelines

1. An in-depth understanding of national and local injectable medication guidelines and their application. 2. A working understanding of the local guidelines for patient records, their storage and confidentiality of information.

3. An in-depth understanding of the national and local prescribing guidelines.

4. An in-depth understanding of the Guidelines on the Administration of Medicines.

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and sharps handling and disposal.

6. A working understanding of risk management and patient safety principles and causes of medication errors.

Clinical knowledge

7. A working understanding of the disease progression and the potential impact on physiological systems.

8. A working understanding of the relevance of other treatment modalities and clinical conditions.

9. An in-depth understanding of diagnosis, care plan, protocol and guidelines.

10. An in-depth understanding of principles and practice of prescribing injectable medication.

11. An in-depth understanding of the indications and contraindications for the injectable medication. 12. An in-depth understanding of drug calculations

appropriate to the prescribed injectable medication, dose dilution and length of delivery.

13. An in-depth understanding of the side effects of injectable medicines, and their assessment, monitoring, prevention and management.

Technical knowledge

14. A working understanding of different venous access devices and their care.

15. A working understanding of administration by the subcutaneous route, and intravenous bolus and/or infusions.

Procedures and patient management

16. A factual knowledge of the roles and responsibilities of other team members.

17. A working understanding of the limits of one’s own knowledge and experience, and the importance of not operating beyond these.

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NPSA workforce competence March 2007 statement on prescribing injectable medicines Word file available at

www.npsa.nhs.uk./health/alerts

Workforce competence statement

Injectable medicines competence 4

Monitoring the administration of injectable medicines

Summary This workforce competence covers monitoring the

administration of injectable medicines for adults or children. It includes the initiation and delivery of a monitoring

regimen Competent Y/N Indicative links to KSF Dimension & level

Health and wellbeing HWB7: Interventions and treatments Level 3: Plan, deliver and evaluate interventions and/or

treatments

Origin This is a new workforce competence proposed and

developed by the National Patient Safety Agency (NPSA). Activity scope Prescription

The document which describes the medication determined by a properly authorised individual for an individually named patient. It includes the medication

to be used, the dose, dilution, mode of delivery and time period for delivery.

Monitoring regimen

A systematic plan for observing the physiological impact of prescribed medication therapy, enabling subsequent adjustment to maintain or improve the health of a patient.

Communication with professional colleagues includes

communication within and between appropriate members of teams.

Appropriate members of the team

Include: registered nurse, midwife, doctor, pharmacist, laboratory scientific officer and phlebotomist or any other member of the healthcare team.

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through a cannula

Include: neurogenic, anaphylactic and hypovolaemic shock, cardiogenic shock, septic shock and allergy.

Performance

criteria You need to: 1. Read the patient’s notes, prescription and relevant protocol or clinical guideline and note any previously identified special instructions,

investigations (including abnormal blood test results), baseline parameters such as weight, or issues for which you need to seek advice. The arrangements for fluid balance or clinical monitoring should be made on an individual basis and according to local protocol and clinical need.

2. Assess the appropriateness of the intended treatment against the patient’s current health status and concurrent medication.

3. Refer to technical infor mation relating to the injectable medication being prescribed and identify any monitoring recommendations for which you need to seek advice. 4. Determine the appropriate regimen for the patient and include both type and frequency of monitoring activity. Give consideration to fluid balance, potential effect of interaction between concurrent medications, adverse

reactions, access site, laboratory tests and physical parameters, for example, weight.

5. Record requirements for monitoring the patient’s response to treatment and record the reason(s) for any deviations from the clinical guidelines in the patient’s notes. Communicate requirements to professional colleagues. 6. Explain the treatment and potential side effects, monitoring regimen and their management to the patient and/or carer and accurately answer any questions at a level and pace that is appropriate to:

• their level of understanding; • their culture and background;

• their preferred ways of communicating; • their needs.

7. Check that the patient and/or carer understand the treatment to be given and any potential side effects

together with their management. Communicate the role that the patient and/or carer can play in the early

alert of staff to adverse reactions to medication therapy and how this assists the monitoring process.

8. Ensure that local arrangements are in place to deliver the monitoring regimen requested according to local policy.

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9. Record the results of monitoring in the patient’s notes, on the prescription chart, or on the monitoring chart according to local policy.

10. Communicate results of monitoring to members of the clinical team and ensure that any deviations from expected monitoring results are communicated in a timely way to appropriate members of the team so that action can be taken.

11. Modify any subsequent prescriptions in light of the patient’s tolerance, side effects, adverse reactions, complications and response to treatment.

12. Communicate with appropriate professional colleagues as required by local guidelines.

13. Recognise when you need help and seek advice and support from an appropriate source when the needs of the individual and the complexity of the case are beyond your competence and capability.

Knowledge and

understanding You need to apply: Legislation, regulations and guidelines

1. An in-depth understanding of national and local injectable medication therapy guidelines and their application.

2. A working understanding of the local guidelines for patient records, their storage and confidentiality of information.

3. An in-depth understanding of the national and local prescribing guidelines.

4. A working understanding of the Guidelines on the Administration of Medicines.

5. A working understanding of local guidelines for waste and sharps handling and disposal.

6. A working understanding of risk management, patient safety principles and causes of medication errors.

Clinical knowledge

7. A working understanding of the disease progression and the potential impact on physiological systems.

8. A working understanding of the relevance of other treatment modalities and clinical conditions.

9. An in-depth understanding of diagnosis, care plan, protocol and guidelines.

10. An in-depth understanding of principles and practice of prescribing injectable medication therapy.

11. An in-depth understanding of the indications and contraindications for injectable medication therapy. 12. An in-depth understanding of drug calculations

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appropriate to the prescribed injectable medication; dose dilution and length of delivery.

13. An in-depth understanding of the side effects of injectable medicines, and their assessment, monitoring, prevention and management.

Technical knowledge

14. A working understanding of different venous access devices and their care.

15. A working understanding of administration by the subcutaneous route, and intravenous bolus and/or infusions.

Procedures and patient management

16. A factual knowledge of the roles and responsibilities of other team members.

17. A working understanding of the limits of one’s own knowledge and experience, and the importance of not operating beyond these.

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Appendix 3

Promoting safer use of injectable medicines

A standard operating procedure for: prescribing, preparing and administering injectable medicines in clinical areas

Introduction

The use of injectable medication has many healthcare benefits for patients. The complexities associated with the prescription, preparation and

administration of injectable medicines means that there are greater potential risks for patients than for other routes of administration. Weak operating systems increase the potential risk of harm, and safe systems of work are needed to minimise these risks.

Step 1: Prescribing

1.1 All prescriptions for injectable medicines must specify the following: . • patient’s name;

. • prescriber’s signature;

. • the approved medicine name;

. • the dose and frequency of administration; . • the date and route of administration; . • the allergy status of the patient.

1.2. Where relevant, the prescription, or a readily available local protocol, must specify the following:

. • brand name and formulation of the medicine;

• concentration or total quantity of medicine in the final infusion container or syringe;

. • name and volume of diluent and/or infusion fluid; . • rate and duration of administration;

. • stability information to determine the expiry date of the final product;

. • type of rate-control pump or device(s) to be used;

. • the age and weight of any patient under 16 years of age, where relevant;

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. • date on which treatment should be reviewed;

. • arrangements for fluid balance or clinical monitoring should be made on an individual patient basis and according to local protocol and clinical need.

Step 2: Preparation 2.1 General

2.1.1 Read all prescription details carefully and confirm that they relate to the patient to be treated.

2.1.2 Ensure that the area in which the medicine is to be prepared is as clean, uncluttered and free from interruption and distraction as possible. Ideally, preparation should take place in an area dedicated to this process.

2.1.3 Assemble all materials and equipment: sharps bin for waste disposal, medicine ampoule(s)/vial(s), diluent, syringe(s), needle(s), alcohol wipes, disposable protective gloves, clean re-usable plastic tray.

Check the following: . • expiry dates;

. • damage to containers, vials or packaging;

. • that medicines were stored as recommended, e.g. in the refrigerator.

2.1.4 Beware of the risk of confusion between similar looking medicine packs, names and strengths. Read all labels carefully.

2.1.5 Check that:

• the formulation, dose, diluent, infusion fluid and rate of administration correspond to the prescription and product information;

. • the patient has no known allergy to the medicine (see 1.1); . • you understand the method of preparation.

2.1.6 Calculate the volume of medicine solution needed to give the prescribed dose. Write the calculation down and obtain an independent check by another qualified healthcare professional.

2.1.7 Prepare the label for the prepared medicine (see standard 2.7). 2.1.8 Cleanse your hands according to local policy.

2.1.9 Put on a pair of disposable protective gloves.

2.1.10 Use a 70% alcohol wipe or spray to disinfect the surface of the plastic tray. 2.1.11 Assemble the syringe(s) and needle(s). Peel open wrappers carefully and arrange all ampoules/vials, syringes and needles neatly in the tray.

2.1.12 Use a ‘non-touch’ technique, i.e. avoid touching areas where bacterial contamination may be introduced, e.g. syringe-tips, needles, vial tops. Never put down a syringe attached to an unsheathed needle.

2.1.13 Prepare the injection by following the manufacturer’s product information or local guidelines, and the relevant guidance in standards 2.2 to 2.7.

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2.2 Withdrawing solution from an ampoule (glass or plastic) into a syringe

2.2.1 Tap the ampoule gently to dislodge any medicine in the neck.

2.2.2 Snap open the neck of glass ampoules, using an ampoule snapper if required.

2.2.3 Attach a needle to a syringe and draw the required volume of solution into the syringe. Tilt the ampoule if necessary.

2.2.4 Invert the syringe and tap lightly to aggregate the air bubbles at the needle end. Expel the air carefully.

2.2.5 Remove the needle from the syringe and fit a new needle or sterile blind hub.

2.2.6 Label the syringe (see standard 2.7).

2.2.7 Keep the ampoule and any unused medicine until administration to the patient is complete to enable further checking procedures to be undertaken. 2.2.8 If the ampoule contains a suspension rather than solution, it should be gently swirled to mix the contents immediately before they are drawn into the syringe.

2.2.9 The neck of some plastic ampoules is designed to connect directly a syringe without use of a needle, after the top of the ampoule has been twisted off.

2.3 Withdrawing a solution or suspension from a vial into a syringe

2.3.1 Remove the tamper-evident seal from the vial and wipe the rubber septum with an alcohol wipe. Allow to dry for at least 30 seconds.

2.3.2 With the needle sheathed, draw into the syringe a volume of air equivalent to the required volume of solution to be drawn up.

2.3.3 Remove the needle cover and insert the needle into the vial through the rubber septum.

2.3.4 Invert the vial. Keep the needle in the solution and slowly depress the plunger to push air into the vial.

2.3.5 Release the plunger so that solution flows back into the syringe.

2.3.6 If a large volume of solution is to be withdrawn, use a push-pull technique. Repeatedly inject small volumes of air and draw up an equal volume of solution until the required total is reached. This ‘equilibrium method’ helps to minimise the build-up of pressure in the vial.

2.3.7 Alternatively, the rubber septum may be pierced with a second needle to let air into the vial as solution is withdrawn. The tip of the vent needle must always be kept above the solution to prevent leakage.

2.3.8 With the vial still attached, invert the syringe. With the needle and vial uppermost, tap the syringe lightly to aggregate the air bubbles at the needle end. Push the air back into the vial.

2.3.9 Fill the syringe with the required volume of solution then draw in a small volume of air. Withdraw the needle from the vial.

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2.3.10 Expel excess air from the syringe. Remove the needle and exchange it for a new needle or a sterile blind hub.

2.3.11 The vial(s) and any unused medicine should be kept until administration to the patient is complete.

2.3.12 If the vial contains a suspension rather than solution, it should be gently swirled to mix the contents, immediately before they are drawn into the syringe.

2.4 Reconstituting powder in a vial and drawing the resulting solution or suspension into a syringe

2.4.1 Remove the tamper-evident seal from the vial and wipe the rubber septum with an alcohol wipe. Allow to dry for at least 30 seconds.

2.4.2 Use the procedure in 2.2 above to withdraw the required volume of diluent (e.g. water for injections or sodium chloride 0.9%) from ampoule(s) into the syringe.

2.4.3 Inject the diluent into the vial. Keeping the tip of the needle above the level of the solution in the vial, release the plunger. The syringe will fill with the air which has been displaced by the solution (if the contents of the vial were packed under a vacuum, solution will be drawn into the vial and no air will be displaced). If a large volume of diluent is to be added, use a push-pull technique (see

above).

2.4.4 With the syringe and needle still in place, gently swirl the vial(s) to dissolve all the powder, unless otherwise indicated by the product information. This may take several minutes.

2.4.5 Follow the relevant steps in 2.3 above to withdraw the required volume of solution from the vial into the syringe.

2.4.6 Alternatively, the rubber septum may be pierced with a second needle to let air into the vial as solution is withdrawn. The tip of the vent needle must always be kept above the solution to prevent leakage.

2.4.7 If a purpose-designed reconstitution device is used, the manufacturer’s instructions should be read carefully and followed closely.

2.5 Adding a medicine to an infusion

2.5.1 Prepare the medicine in a syringe using one of the methods described in 2.2 to 2.4 above.

2.5.2 Check the outer wrapper of the infusion container is undamaged.

2.5.3 Remove the wrapper and check the infusion container itself in good light. It should be intact and free of cracks, punctures/leaks.

2.5.4 Check the infusion solution, which should be free of haziness, particles and discolouration.

2.5.5 Where necessary, remove the tamper-evident seal on the additive port according to the manufacturer’s instructions or wipe the rubber septum on the infusion container with an alcohol wipe and allow to dry for at least 30 seconds. 2.5.6 If the volume of medicine solution to be added is more than 10% of the initial contents of the infusion container (more than 50ml to a 500ml or 100ml to a

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1litre infusion), an equivalent volume must first be removed with a syringe and needle.

2.5.7 Inject the medicine into the infusion container through the centre of the injection port, taking care to keep the tip of the needle away from the side of the infusion container. Withdraw the needle and invert the container at least five times to ensure thorough mixing before starting the infusion.

2.5.8 Do not add anything to any infusion container other than a burette when it is hanging on the infusion stand since this makes adequate mixing impossible. 2.5.9 Before adding a medicine to a hanging burette, administration must be stopped. After the addition has been made and before administration is re-started, the contents of the burette must be carefully swirled to ensure complete mixing of the contents.

2.5.10 Check the appearance of the final infusion for absence of particles, cloudiness or discolouration.

2.5.11 Label the infusion (see standard 2.7).

2.6 Diluting a medicine in a syringe for use in a pump or syringe-driver

2.6.1 Prepare the medicine in a syringe using one of the methods described above.

2.6.2 Draw the diluent into the syringe to be used for administration by the pump or syringe-driver. Draw in some air (slightly more than the volume of medicine needed) and remove the needle.

2.6.3 Stand the diluent syringe upright. Insert the needle of the syringe

containing the medicine into the tip of the diluent (administration) syringe and add the medicine to it. Alternatively, a disposable sterile connector may be used to connect two syringes together directly.

2.6.4 Check the following:

. • the total volume of injection solution in the syringe is as specified in the prescription and that the infusion can be delivered at the

prescribed rate by the administration device chosen;

. • the rate of administration is set correctly on the administration device and according to the manufacturer’s instructions.

2.6.6 Fit a blind hub to the administration syringe and invert several times to mix the contents.

2.6.7 Remove the blind hub. Tap the syringe lightly to aggregate the air bubbles at the needle end. Expel the air and refit the blind hub.

2.6.8 Carefully check the syringe for cracks and leaks and then label it (see standard 2.7), especially noting the requirements specific to syringe drivers. 2.6.9 Check that the rate of administration is set correctly on the device before fitting the syringe, priming the administration set and starting the infusion device.

2.7 Labelling injection and infusion containers

2.7.1 All injections should be labelled immediately after preparation, except for syringes intended for immediate push (bolus) administration by the person who

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prepared them. Under no circumstances should an operator be in possession of more than one unlabelled syringe at any one time, nor must an unlabelled syringe be fitted to a syringe driver or similar device.

2.7.2 Labels used on injectable medicines prepared in clinical areas should contain the following information:

. • name of the medicine; . • strength;

. • route of administration; . • diluent and final volume; . • patient’s name;

• expiry date and time;

. • name of the practitioner preparing the medicine.

2.7.3 Place the final syringe or infusion and the empty ampoule(s)/vials(s) in a clean plastic tray with the prescription for taking to the patient for

administration.

Step 3: Administration of an injectable medicine 3.1 Before administering any injection

3.1.1 Check all the following:

. • patient’s name, hospital/NHS Number or date of birth or address; . • prescriber’s signature;

. • the approved medicine name;

. • the dose and frequency of administration; . • the date and route of administration; . • the allergy status of the patient. 3.1.2 Also check, where relevant:

. • brand name and formulation of the medicine;

. • concentration or total quantity of medicine in the final infusion container or syringe;

. • name and volume of diluent and/or infusion fluid; . • rate and duration of administration;

. • type of rate-control pump or device(s) to be used;

• the age and weight of any patient under 16 years of age, where relevant;

. • date on which treatment should be reviewed.

3.1.3 Check that the medicine is due for administration at that time and has not already been given.

3.1.4 Assemble everything you need including any flushing solution(s) needed. 3.1.5 Explain and discuss the procedure with the patient.

3.1.6 Check any infusion already in progress. It should be free of haziness, particles and discolouration.

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before and after administration of a medicine, and between doses of different medicines administered consecutively, according to local policy. Also check the administration site for signs of leakage, infection or inflammation.

3.2 Administration of injections – general

3.2.1 Check infusions. They should be should be free of haziness, particles and discolouration.

3.2.2 Use aseptic (non-touch) technique at all times.

3.2.3 Attach administration sets to infusion containers carefully, on a flat surface and using the technique appropriate to the type of container.

3.2.4 Prime the access device according to local policy immediately before starting an infusion.

3.2.5 Before adding a medicine to a hanging burette, administration must be stopped. After the addition has been made and before re-commencement, the contents of the burette must be carefully swirled to ensure complete mixing.

3.3 After administration

3.3.1 After completion of an intermittent infusion, flush the access device according to local policy.

3.3.2 Ask the patient to report promptly any soreness at the injection site or discomfort of any sort.

3.3.3 Make a detailed record of administration.

• Discard the empty ampoules/vials from which the injection was prepared and any unused medicine. Ampoules or vials should

never be used to prepare more than one injection unless

specifically labelled by the manufacturer for ‘multi-dose’ use. 3.4.5 Re-check the administration site for signs of leakage, infection or inflammation and continue to monitor the patient, contents of the infusion container and the rate of infusion according to local policy.

3.4.6 Check that arrangements for monitoring fluid balance or clinical parameters have been made. Ensure that relevant documentation is made available for subsequent regular monitoring to take place.

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Equality Impact Assessment Action Plan – Action Sheet Issue Action

Required

How would you measure impact/outcomes in practice Timescale Responsible Officer Race Cultural sensitivity to religious needs Muslim male – provide male member of staff where possible Muslim female – provide chaperone ongoing Disability Patient able to lie flat Patient able to move head

Time will be taken with each

procedure to ensure that the patient is as comfortable as possible

Ongoing

Disability

Stroke Ensure enough

time is taken to carry out the procedure. Ensure understanding – mental capacity ongoing Race Language requirement South Coast interpreting services Ongoing Race Patient literature When produced, work to top 5 languages Ongoing

You are required to report back on your Action Plan on a yearly basis to the Equality and Diversity Manager in order for the progress to be

measured and shared with all stakeholders.

Figure

Updating...

References

Related subjects :