STANDARD OPERATING PROCEDURE ADMINISTRATION OF HEPARIN FLUSHES VIA CENTRAL INTRAVENOUS ACCESS DEVICES

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1 STANDARD OPERATING PROCEDURE ADMINISTRATION OF HEPARIN FLUSHES VIA CENTRAL INTRAVENOUS ACCESS DEVICES First Issued Issue Version One Purpose of Issue/ Description of Change To promote the safe administration of heparin flushes to patients with central intravenous access devices in a community setting Planned Review Date 2014 Named Responsible Officer:- Approved by Date Medicines Governance Pharmacist Quality, Patient Experience and Risk Group September 2012 Section:- Medicines Management MM SOP N o 13 Target Audience Community nursing UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM TRUST WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 CONTROL RECORD Title Standard Operating Procedure (SOP) for Administration of Heparin Flushes via Central Intravenous Access Devices Purpose To promote the safe administration of heparin flushes to patients with central intravenous access devices in a community setting Author Quality and Governance Service (QGS) and L Knight Impact Assessment Incorporated into procedure Yes No Subject Experts Medicines Governance Pharmacist Annie Baker Document Librarian QGS Groups consulted with :- Medicines Management Group Infection Control Approved 24/8/2012 Date formally approved by October 2012 Risk and Governance Group Method of distribution Intranet Archived Date Location:- S Drive QGS Access Via QGS VERSION CONTROL RECORD Version Number Author Status Changes / Comments Version 1 AB & LK T Trust Change Status New / Revised / Trust Change Expiry date: /6

3 NAME OF DISCIPLINE: Community Nursing OBJECTIVES To promote the safe administration of heparin flushes to patients with central intravenous access devices in a community setting SCOPE To cover all aspects of the safe administration of heparin flushes including safe prescribing and to highlight the potential risks of heparin flushes. The NPSA (2008) recommends using the lowest possible dose of heparin to maintain patency. The most common strength of heparin used as a flush is 10 units per 1ml (50 units per 5ml). Strengths of heparin in excess of this should be clarified with the prescriber and the relevant community nurse manager. For flushing of Implanted Ports follow the Procedure for Flushing Totally Implanted Intravenous Access Device Ports It is beyond the scope of this document to advise on the care of intravenous access devices, this will be covered in the relevant Trust Procedures available on the Trust internet site TARGET GROUP EVIDENCE TO SUPPORT PROCEDURE All registered nurses employed by the Trust required to undertake this role and who have successfully completed the Competency for the Care of Central Lines and Administration of Heparin Flushes (excluding bank staff) NMC Standards for Medicine Management (2010) Rapid Response Report, Risks with Intravenous Heparin Flush Solutions National Patient Safety Agency (April 2008) IT IS THE RESPONSIBITITY OF ALL STAFF TO COMPLY WITH RELEVANT TRUST POLICIES, PROCEDURES AND PROTOCOLS IN CONJUNCTION WITH THIS PROCEDURE PROCEDURE ACTIVITY 1. TRAINING AND DOCUMENTATION Only nurses who have successfully completed the Trust Competencies for the Care of Central Lines and Administration of Heparin Flushes can undertake this role (see section on RATIONALE To ensure appropriate and safe treatment RESPONSIBILITY Expiry date: /6

4 training) Nurses must ensure they have all the necessary official information from the discharging organisation. This must include an unambiguous prescription for the flushes and any treatment and full written information on the flushing protocol to be used for the particular central intravenous access device in use. This information should be filed in the patient s home records Community nursing staff, should if required, attend a handover session from the discharging hospital, prior to the patient being admitted onto the caseload Before patients are accepted, the case load manager will have to consider the risks of treating the patient in the community and document outcomes in the base records. If the patient is not accepted, the team leader should discuss the reasons why the patient was not accepted with the patient s GP Practice at the nearest opportunity. The team leader s line manager should also be informed. To ensure appropriate flushing protocols are followed To promote a seamless discharge To clarify appropriate action plan and enable any identified high risks to be minimized To ensure senior leads are aware of potential hospital admission or delayed discharge 2. ENSURE THE FLUSH IS WRITTEN ON THE PATIENT MEDICINES ADMINISTRATION CHART Prior to the administration of flushes to maintain the patency of intravenous access devices, it is essential that the flushes are prescribed and that the authorised prescriber writes the prescription on the Patient Medicines Administration Chart (PMAC). To ensure nurses have legal authority to administer the flush Only central intravenous access devices may require heparin flushes There is no evidence to support the use of heparin flushes for peripheral lines the authorised prescriber The lowest possible dose of heparin should be used to maintain patency. The most common strength of heparin used Expiry date: /6 To reduce side effects Authorised prescriber

5 as a flush is 10 units per 1ml (50 units per 5ml). Strengths of heparin in excess of this should be clarified with the prescriber and the relevant community nurse manager, to check dosage is appropriate to be used in a community setting. Document all communication in the patient s health records. For Implanted Ports refer to the Procedure for Flushing Totally Implanted Intravenous Access Device Ports NPMM06 The number of units of heparin to be administered must be recorded on the PMAC with the word unit written out in full. For full details of other information that must be recorded on the PMAC refer to the SOP for the Administration of Medicines in Community Nursing MMSOP08 3. ADMINISTRATION OF HEPARIN FLUSHES Follow the SOP for Administration of Medicines in Community Nursing, and the relevant SOP for the care and maintenance of the central intravenous access device in situ, to ensure all required safety checks are carried out Two members of the nursing team should check the strength of heparin to be administered, one of the staff members must be the registered nurse who administers the flush. The second staff member could be an appropriately trained health care assistant. (NMC 2010 Standard 20) As with all injectable medicines, to avoid administration errors, the nurse preparing the flush must ensure they either label the prepared medicine or administer the heparin in one uninterrupted process where the Expiry date: /6 Nationally there have been reports of wrong doses of heparin flushes being administered to patients The use of abbreviations have resulted in administration errors To ensure correct medication is given to the right patient via the right route To reduce risk of errors and to comply with Nursing and Midwifery Standards for Medicines Management Only one unlabelled medicine must be handled at one time Registered Nurse in either another registered nurse or appropriately trained health care assistant Registered Nurse in either another registered nurse or appropriately trained health care assistant Registered nurse

6 unlabelled product does not leave the hands of the nurse who prepares it 4. INCIDENT REPORTING Any related incidents arising from carrying out this procedure which may involve a clinical error or near miss must be reported following the Trust s Incident Reporting System. To maintain patient safety and comply with Trust Incident Reporting system for effective clinical governance Health professional or delegated staff member TRAINING SPECIALIST COMPETENCIES OR QUALIFICATIONS CONTINUING EDUCATION & TRAINING RISK ASSESSMENTS ORGANISATION DEPARTMENT (IF APPLICABLE) EQUALITY ASSESSMENT All Registered Nurses employed by the Trust will work to the Standard Operating Procedure and related Trust policies where relevant to their job description. To be aware of manufacturer s instructions for specific medication. The related competency will be updated every two years as per Service Training Matrix Clinical staff must comply with mandatory training as specified in the Trust s Training Matrix and the bespoke Service Mandatory Training Matrix. Risk of administration errors including risk of selecting the wrong strength heparin, risk of infection, risk of needle stick injury Wirral Community NHS Trust Community Nursing During the development of this procedure the Trust has considered the clinical needs of each protected characteristic (age, disability, gender, gender reassignment, pregnancy and maternity, race, religion or belief, sexual orientation). There is no clinical evidence of exclusion of these named groups. If staff become aware of any clinical exclusions that impact on the delivery of care a Trust Incident form would need to be completed and an appropriate action plan put in place STANDARD OPERATING PROCEDURE APPROVED BY: Peer Review Forum Trust Formal Approval Medicines Management Group Quality, Patient Experience and Risk Group Expiry date: /6

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