SAFE USE OF MCKINLEY SYRINGE PUMP POLICY

Transcription

1 SAFE USE OF MCKINLEY SYRINGE PUMP POLICY Version Version 3.0 Ratified by Risk Assurance Sub-committee Date ratified February 2010 Author(s) Responsible/Approving Committee Associate Director of Operations Adults Medicines Management Patient Safety Group Date issued March 2010 Review date March 2015 Target audience Registered Nurses using the Mckinley Syringe Pump Impact Assessed June 2008

2 Further information about this document: Document name Safe Use of McKinley Syringe Pump Policy Category of Document in The Policy Schedule Author(s) Contact(s) for further information about this document This document should be read in conjunction with Published by Copies of this document are available from Clinical Linda Spall, Associate Director of Operations Adults Telephhone: Community Care Western Cheshire: Safe and Secure Management of Medicines Policy (including Controlled drugs) Corporate and Local Induction Policy Decontamination Policy End of Life Care Pathway Health Records Policy Incident Reporting Policy Infection Prevention and Control Strategy Policy for the Management of and Training Needs for Medical Devices and Equipment Policy for Verification of Expected Patient Death by Registered Nurses Risk Management Patient Safety Strategy Safe and Secure Management of Medicines Policy (including Controlled drugs) NHS Western Cheshire: Corporate Records Retention Policy Western Cheshire Primary Care Trust 1829 Building Countess of Chester Health Park Liverpool Road Chester, CH2 1HJ Main Telephone Number: (Freephone) Main Address: Extranet: nww.wcheshirepct.nhs.uk Website: Sandra Birnie, Modern Matron, Ellesmere Port & Neston, Western Cheshire PCT Telephone: Copyright Western Cheshire Primary Care Trust, All Rights Reserved

3 Version Control: Version History: Version Number Reviewing Committee/Officer Date Version 0.1 Western Cheshire Primary Care Trust Macmillan Nursing Service Palliative Care Consultant, Countess of Chester Hospital NHS Foundation Trust March 2008 Version 0.2 District Nurse Guidelines Group April 2008 Version 1.0 Clinical Guidelines Ratification Group June 2008 Version 1.1 Further amendments Clinical Guidelines Ratification Group July 2008 Version 2.0 Clinical Guidelines Ratification Group August 2008 Version 2.1 Patient Safety Medicines Management Group March 2010 Version 3.0 Risk Sub-committee March 2010

4 This document can be made available in a range of alternative formats including various languages, large print, Braille and audio cassette. To discuss your requirements please ring

5

6 Contents Section Page 1. NHS WESTERN CHESHIRE AND COMMUNITY CARE WESTERN CHESHIRE ARMS LENGTH PROVIDER ARRANGEMENTS INTRODUCTION AND PURPOSE DEFINITIONS DUTIES: ROLES AND RESPONSIBILITIES SCOPE DEVELOPMENT AND CONSULTATION MEDICINES MANAGEMENT PROCESSES MCKINLEY T34 SYRINGE PUMP EQUIPMENT INDICATIONS FOR THE USE OF THE MCKINLEY T34 SYRINGE PUMP PRESCRIBING MEDICATION FOR USE IN A MCKINLEY SYRINGE PUMP ADMINSTRATION OF MEDICATION IN MCKINLEY T34 SYRINGE PUMP PROCESS FOR ENSURING THE ACCURACY OF THE CARE PATHWAY MEDICATION DOCUMENTATION PROCEDURES FOR USING THE MCKINLEY T34 SYRINGE PUMP PROCEDURE FOR THE SAFE DISPOSAL OF CONTROLLED DRUGS USED IN MCKINLEY SYRINGE PUMPS ARRANGEMENTS FOR ADVERSE EVENT, ERROR AND NEAR MISS REPORITNG CENTRAL COMMUNICATION SYSTEM (CAS) DRUG ALERTS DISSEMINATION IMPLEMENTATION MEDICINES MANAGEMENT TRAINING AND MCKINLEY SYRINGE PUMP TRAINING DOCUMENT CONTROL AND ARCHIVING ARRANGEMENTS MONITROING COMPLIANCE WITH THE IMPLEMENTATION OF THE SAFE USE OF MCKINLEY SYRINGE PUMP POLICY TABLE 1: RISK MANAGEMENT STANDARD KEY PERFORMANCE INDICATORS ACKNOWLEDGEMENTS REFERENCES APPENDICES APPENDIX A - GOVERNANCE STRUCTURE APPENDIX B - PATIENTS BEING ADMITTED TO HOSPITAL WITH SYRINGE PUMP APPENDIX C - DETACHMENT OF SYRINGE PUMPS ON ADMISSION TO/DISCHARGE FROM HOSPITAL APPENDIX D - ASSESSING CAPACITY TO CONSENT APPENDIX E SYRINGE PUMPS APPENDIX F T34 FEATURE RECOGNITION Clinical Guideline for the Safe Use of McKinley Syringe Pumps Version 1.0

7 1. NHS WESTERN CHESHIRE AND COMMUNITY CARE WESTERN CHESHIRE ARMS LENGTH PROVIDER ARRANGEMENTS 1.1. Community Care Western Cheshire operates as an arm s length provider of services. In September 2008 a sub-set of the Scheme of Reservation and Delegation was agreed by the NHS Western Cheshire Board that enables Community Care Western Cheshire to operate autonomously in terms of governance, whilst NHS Western Cheshire retains overall accountability and responsibility as the statutory body The NHS Western Cheshire Scheme of Reservation and Delegation can be found in the Corporate Governance Manual on the public facing website Community Care Western Cheshire Governance Structure 1.4. The Community Care Western Cheshire governance meeting structure (Appendix A) enables policies to be approved or ratified as identified in the Policy Schedule. The governance structure also sets out the reporting and accountability arrangements between the Community Care Western Cheshire Board and the NHS Western Cheshire Board. The Community Care Western Cheshire Board operates as a Committee of the NHS Western Cheshire Board Equality And Diversity Statement Community Care Western Cheshire is fully committed to its function as a fair employer, an equitable provider of services and a community partner. In meeting this obligation, Community Care Western Cheshire will provide equality of opportunity in employment, service delivery and engagement with its local community to ensure that its job applicants, employees, service users and carers do not experience any form of discrimination. Community Care Western Cheshire will strive to ensure that every service user is treated with dignity and respect in a safe environment. The services we provide will be delivered in a fair and equitable manner, equally accessible to all sections of the community regardless of their race, ethnicity, cultural background, religion, belief, disability, gender, sexual orientation, age, employment or HIV status, or responsibilities as a carer. All services should be responsive and adaptive to the individual needs of its service users and carers, ensuring that these needs are at the centre of any service delivery. Services will be sensitive to the needs of our diverse community and will not disadvantage on the grounds of age, disability, race, nationality, ethnic origin, gender, religion, beliefs, sexual orientation, caring commitments, social/economic background, HIV status, gender reassignment or any other difference. Safe Use of McKinley Syringe Pumps Policy 1

8 2. INTRODUCTION AND PURPOSE 2.1. From 1st April 2010, the regulation of health and adult social care will change. Legislation is bringing in a new system that applies to all regulated health and adult social care services. All health and adult social care providers, who provide regulated activities, will be required by law to register with the Care Quality Commission. The new registration system comes into force on 1st April 2010 for NHS trusts (including primary care trusts as providers) and 1st October 2010 for adult social care and independent healthcare providers. As part of the registration requirements providers are expected to be compliant with the law and in relation to medicines will: a) Handle medicines safely and appropriately b) Ensure that medicines are prescribed and taken by people safely c) Follow published guidance about how to use medicines safely The Care Quality Commission expects that patients receive personalised care through the effective use of medicines. Services users who receive care, treatment and support in relation to medicines must be given appropriate and person-centred by taking into account their: a) Choices b) Life-style c) Allergies d) Existing medical conditions e) Recommended prescribing regimes This includes: a) Ensuring that medication prescriptions, which the service is responsible for, are up to date and are reviewed and changed as a patients needs or condition changes in relation to their medicines. b) Ensuring complex drug regimes are reviewed to specifically prevent polypharmacia, wherever possible. c) Supporting patients to take their medication independently, or through giving them their medicines when they are unable to so. d) Monitoring the effect of medicines and taking action if their condition changes including side effects and adverse reaction. e) Ensuring that information about the medicines patients are taking is available and understandable. Safe Use of McKinley Syringe Pumps Policy 2

9 f) Ensuring that information is available about the medicines patients are taking in order to prevent ill health. g) Ensuring that medicines are given lawfully In accordance with the national policy and guidance outlined in the Medical Devices Directive 93/42/EEC, Community Care Western Cheshire has a responsibility to ensure that all medical devices are used in a safe and appropriate manner in accordance with both the manufacturers instructions and recognised best practice In line with the Care Quality Commission Registration Requirements Community Care Western Cheshire has a responsibility to take all necessary steps to ensure that patient safety is enhanced by the use of its health care processes, working practices and systemic activities that prevent or reduce the risk of harm to its patients. The development of this policy establishes systems and procedures that aim to protect patients and help to reduce the risks associated with the acquisition and use of medical devices The syringe driver was originally developed in 1979 by Dr Martin Wright for use in treating thalassaemia with infusions of Desferrioxamine (Wright & Galland, 1979). The use of a portable battery operated syringe driver for subcutaneous medications is now a well established technique in palliative care and its use is fully supported by Dickman et al (2005) who suggests "that it is particularly suited to palliative care" The benefits of employing the syringe driver is that it "allows for a minimally invasive route of drug administration, which produces relatively constant levels of medication which avoids peaks that can result in reduced symptom control" (Hunt 2002) Many palliative care patients often present with multiple symptoms that can necessitate the need to use several drug treatments. If the patient's condition deteriorates and the oral route cannot be used, Dickman et al (2005) further suggests "that a continuous subcutaneous infusion via the syringe pump provides a simple and effective way to control symptoms" As a consequence of safety issues highlighted with the Graseby MS26 Syringe Driver, the syringe pump of choice within Western Cheshire Primary Care Trust is now the McKinley T34 Syringe Pump. However, other types are available and may still be in use by neighbouring trusts, including the Countess of Chester Hospital NHS Foundation Trust (See Appendix B and C). NB: If a health professional comes across such a device, they should follow the manufacturer's instruction manual for details of their use Parenteral administration of medicines carries a number of risks which have been well documented (Doyle et al, 1993). These can be attributed to a number of reasons, including user error, maintenance, damage and contamination problems as well as device-related issues such as Safe Use of McKinley Syringe Pumps Policy 3

10 performance, degradation, quality assurance and design and labelling (Medical Devices Agency Device Bulletin 2003(02)) Additionally, it is also recognised that syringe pumps may only be used intermittently and professional competency can be difficult to maintain where its use is infrequent. Furthermore, the introduction of any new medical device brings with it the associated risks of unfamiliarity and the need to develop the required competences. The provision of local guidance on the use of the McKinley T34 Syringe Pump will introduce and establish robust procedures to promote a consistent approach to its use across the Primary Care Trust As such, the main aim of these guidelines is to assist health care professionals administering drugs via the McKinley T34 Syringe Pump and to promote a procedural uniformity across Community Care Western Cheshire This policy aims to: a) Introduce and establish rigorous procedures to ensure a consistent approach to the use of the McKinley T34 Syringe Pump b) Reduce the potential risk of adverse incidents (Medical Devices Agency Device Bulletin 2003(02)) c) Improve patient safety and clinical outcomes d) Provide evidence for the organisation to meet the Standards for Better Health e) Establish key performance indicators to monitor and evaluate the effectiveness of the guidance Safe Use of McKinley Syringe Pumps Policy 4

11 3. DEFINITIONS a) This policy relates to the Safe Use of McKinley Syringe Pumps. In this policy the following terms have been used: Term Accountable Officer Authorised Administrator Definition Ensuring that Community Care Western Cheshire has robust arrangements for the safe and effective management and use of controlled drugs. This role is registered with the Care Quality Commission. A qualified registered medical practitioner, registered nurse or healthcare employee authorised by Community Care Western Cheshire to administer a medicine. Authorised Prescriber Registered Doctor, Consultant, Non-medical Prescriber. Bolus Cannula Care Quality Commission Community Care Western Cheshire Control of Substances Hazardous to Health (COSH) Guidelines Controlled Drug Diluent FP10 Prescription Infusion set McKinley T34 syringe pump The injection of a drug (or drugs) in a high quantity at once, the opposite of gradual administration (as in intravenous infusion). A tube which can be inserted into the body, often for the delivery or removal of fluid. The Care Quality Commission is the independent regulator of health and social care in England. An arm s length provider of services with NHS Western Cheshire retaining overall accountability and responsibility as the statutory body. COSHH is the law that requires employers to control substances that are hazardous to health. Controlled Drugs are those defined in the MDR(2001) and MDR Regulations, An agent used for effecting dilution. FP10 prescriptions are purchased by Primary Care Trusts and Hospital Trusts, and are distributed free of charge to GPs, nurses, NHS dentists and other prescribers. An implantable device consisting of a fine needle and tubing which is attached to a syringe to enable the delivery of drugs via a syringe pump. The McKinley T34 syringe pump is a portable battery-operated infusion pump weighing approximately 210g (excluding the battery) and measuring 169mm by 53mm by 23mm. It is used for the administration of medication subcutaneously over a 24 hour period. Safe Use of McKinley Syringe Pumps Policy 5

12 Medicinal Product or Medicine Medicine Administrator Medicines Management Any substance or combination of substances presented for treating or preventing disease in human beings or in animals. Any substance or combination of substances which may be administered to human beings or animals with a view to making a medical diagnosis or to restoring, correcting or modifying physiological functions in human beings or animals is likewise considered a medicinal product. Council Directive 65/65/EEC A medicine is any medicinal product in any form including tablets, capsules, external preparations, internal preparations, patches, gasses, emergency medicines, medicated dressings, implants, parenteral preparations etc. The definition of administer is to give a medicine either by introduction into the body, whether by direct contact with the body or not (e.g. orally or by injection) or by external application (e.g. application of an impregnated dressing). The clinical and cost effective and safe use of medicines to ensure patients get the maximum benefit form the medicines they need, while at the same time minimising potential harm (MRHA 2004) Medicines Trail Covers all the potential activities that are associated with the medicinal product, from the initiation of the patient treatment through a prescription or Patient Group Direction to the administration of the medicine and the disposal of any waste material. NHS Western Cheshire Nursing and Midwifery Council (NMC) Patient Patient Group Direction An organisation that commissions health services and ensures those services meet the needs of the local population. Organisation set up by Parliament to protect the public by ensuring that nurses and midwives provide high standards of care to their patients and clients. Throughout this document the word patient is used and can include families and carers where relevant. A specific written instruction for the supply or administration of named medicines in an identified clinical situation. It is drawn up locally by doctors, pharmacists and other appropriate professionals, and approved by the employer, advised by the relevant professional advisory committees. It applies to groups of patients or other service users who may not be individually identified before presentation for treatment. Safe Use of McKinley Syringe Pumps Policy 6

13 Prescription pricing Authority (PPA) now known as the NHS Business Service Authority. Registered Nurse Risk Exception(s) Scheme of Reservation and Delegation Secure and controlled stationery Transcribing NHS Business Service Authority which provides the NHS with a range of drug, financial and prescribing information. A Nurse who has met the standards of proficiency for pre-registration nursing education and has been declared as being of good health and good character and has paid the registration fee and whose name is held on the Nursing Midwifery Council Register as a person who is capable of safe and effective practice as a nurse. Risk exceptions are those risks highlighted and reported through the governance structure committee/group function in meeting minutes or any other risk that is identified and escalated within Community Care Western Cheshire. The Scheme of Reservation and Delegation is found in the NHS Western Cheshire Corporate Governance Manual on the NHS Western Cheshire public facing website. It sets out the detail of how the powers are reserved to the NHS Western Cheshire Board of Directors, while at the same time delegating to the appropriate level, the detailed application of NHS Western Cheshire policies. However, the Board of Directors remains accountable for all of its functions, even those delegated to committees, sub committees, individual directors or officers and therefore expects to receive information about the exercise of delegated functions to enable it to maintain a monitoring role. All stationery, which in the wrong hands, could be used to obtain medicines fraudulently. Any act by which medicinal products are written form one form of direction to administer to another is transcribing. This includes discharge letters, transfer letters, copying illegible patient medicines administration charts onto new charts, whether hand written or computer generated. Safe Use of McKinley Syringe Pumps Policy 7

14 4. DUTIES: ROLES AND RESPONSIBILITIES 4.1. The NHS Western Cheshire Chief Executive is responsible for: a) Ensuring that policies are fit for purpose The Community Care Western Cheshire Managing Director has delegated responsibility under the Community Care Western Cheshire subset of the NHS Western Cheshire Scheme of Reservation and Delegation for: a) Ensuring that all Community Care Western Cheshire policies are fit for purpose. b) Delegating the responsibility for ensuring that all Community Care Western Cheshire policies are fit for purpose to appropriate Associate Directors The Associate Director of Governance and Quality is responsible for: a) Ensuring that the Safe Use of McKinley Syringe Pumps Policy meets all legal statutory and good practice guidance requirements Associate Directors are responsible for: a) ensuring that this policy is implemented Community Care Western Cheshire Heads of Services and Managers are responsible for: a) The operational implementation of this policy ensuring only members of staff who have been appropriately trained and assessed as competent undertake any medicine related activities. They are also responsible for taking appropriate action should any breach of this policy occur. b) Auditing a sample of Care Pathway medication documentation and developing action plans where gaps and deficiencies are identified. c) Ensuring that staff involved in medicine related activity have a current registration with the appropriate body. d) Ensuring that members of staff are aware of their roles and responsibilities in relation to controlled drug activities. e) Writing medicines management standard operating procedures where relevant. f) Auditing compliance with medicine management Standard Operating Procedures annually. g) Ensuring that safe and secure annual self-assessment declarations are completed for their service including a nil return. Safe Use of McKinley Syringe Pumps Policy 8

15 4.6. The NHS Western Cheshire Lead Pharmacist Medicines Governance is responsible for: a) Advising Community Care Western Cheshire on systems and process to ensure for the safe and secure handling of medicines The Community Care Western Cheshire Non-medical Prescribing Lead is responsible for: a) Ensuring that medicine management training is in place as set out in the Training Needs Analysis and Local Learning Plans and Continuous Professional Development for Doctors maintaining medicine management related competencies. b) Ensuring that attendance and non-attendance at medicine related training is reported at the Medicine Management Patient Safety Group The Community Care Western Cheshire Accountable Officer is responsible for: a) Ensuring that the organisation has robust arrangements for the safe and effective management and use of controlled drugs. This role is registered with the Care Quality Commission. b) Facilitating the use of the Incident Decision making tree for all Controlled drug incidents. c) Overseeing all of Community Care Western Cheshire Controlled Drug incidents Prescribers and Non -medical Prescribers are responsible for: a) Being clinically and legally responsible for their prescribing actions. b) Prescribing medicines that they are competent to prescribe (knowledge of drug indication, action, dosing, side-effects, interactions). c) Prescribing medicines if they are necessary. d) Prescribing only if benefits of medication outweigh the risks. e) Discussing treatment medicines adherence options with patients. f) Indicating likely/degree of benefit (efficacy), onset and duration. g) Discussing side-effects/tolerability. h) Being accountable for their own actions, being aware of the limits of their skills, knowledge and competence. Safe Use of McKinley Syringe Pumps Policy 9

16 4.10. Medical Devices Coordinator a) Developing and maintaining an up to date Medical Devices Register for their service area The Head of Business is responsible for: a) Receiving syringe pumps that have been involved in an adverse incident. b) Monitoring medical devices and equipment contracts The Medicines Management Patient Safety Group are responsible for: a) As approving group for this policy monitoring the policy key performance indicators six monthly ensuring that action plans are developed, implemented and monitored when gaps in policy implementation are identified. b) Monitoring compliance with this policy and reporting medicines related risk exceptions to the Risk Assurance Sub- committee The Risk Assurance Sub-committee is responsible for: a) Ratifying medicines management related polices b) Receiving medicines related risk exception reports from the Medicines Management Patient Safety Group Staff are responsible for: 5. SCOPE a) Highlighting training needs in regard to the safe and secure management of medicines via a written record of these needs in their personal development review and one-to ones with line mangers. b) Ensuring that specific duties in relation to medicines are undertaken within their competence. c) Adhering to this policy, regardless of role, band, discipline or service area This policy is aimed at all qualified nursing staff working within Community Care Western Cheshire who are currently registered with the Nursing and Midwifery Council and who have completed the relevant in-service training and are deemed competent in the use of the McKinley T34 Syringe Pump. 6. DEVELOPMENT AND CONSULTATION 6.1. This policy has been developed by a District Nursing Task and Finish Group. Safe Use of McKinley Syringe Pumps Policy 10

17 7. MEDICINES MANAGEMENT PROCESSES 7.1. Standard Operating Procedures a) Standard Operating Procedures are required for all medicine related activities. This includes controlled drugs. b) Services Heads are responsible for writing the Standard Operating Procedures for their service. The Lead Pharmacist Medicines Governance will advise on the development of the Standard Operating Procedures. c) Master word versions of all Standard Operating Procedures are stored on a password protected area of the Community Care Western Cheshire shared drive. A paper resource file will be available for all staff at the service location at which they are used. d) Service Heads are responsible for auditing compliance with Standard Operating Procedures annually. e) Standard Operating Procedures must be comprehensive, reproducible and unambiguous and must indicate who is authorised to perform the relevant tasks and must specify any equipment, facilities and data associated with the process. f) The Medicines Management Patient Safety Group will formally approve and ratify Standard Operating Procedures. Standard Operating Procedures will only be fully operational when formal approval has been given. g) Standard Operating Procedures are subject to annual update and review by the Medicines Management Patient Safety Group. h) All Standard Operating Procedures must be dated and the date of review included. i) All Standard Operating Procedures must include the number of years that paper records and electronic records of medicine related activity are retained: 2 years for paper and 7 years for electronic. 8. MCKINLEY T34 SYRINGE PUMP EQUIPMENT a) McKinley T34 syringe pump b) Battery: 6LR61 Duracell MN1604 alkaline or lithium. Plus spare new battery c) 20 ml, 30 ml or 50 ml luer lock syringe, e.g. Becton Dickinson (BD) d) Suitable infusion set e) Alcohol wipe Safe Use of McKinley Syringe Pumps Policy 11

18 f) Transparent adhesive dressing, e.g. TEGADERM g) Prescribed medicines I diluents h) Filter needle to draw up drugs, e.g. Becton Dickinson (BD) filter needle 19G 1 W' - to avoid drawing up glass particles which may cause abscess i) Syringe pump prescription I recording sheet I drug label j) Patient's own electric razor or scissors (for hair removal if necessary) 8.2. Medical Devices and Equipment Asset Register and Maintenance a) A medical devices and equipment asset register is held within Community care Western Cheshire. When new syringe pumps are introduced into the system or syringe pumps are removed from service, the medical devices coordinator must be notified according to process outlined in the Community Care Western Cheshire Policy for the Management of and Training Needs for Medical Devices and Equipment. b) All syringe pumps must be serviced annually, whether they have been used or not. The responsibility for the annual service / maintenance contract lies with the Head of Business; however it is the responsibility of individual Team Leaders (community) / Ward Managers (Ellesmere Port Hospital) to ensure that syringe pumps are serviced annually. c) Additionally, syringe pumps should be sent for maintenance checks if they have been dropped or submerged in fluid or if there is any doubt as to their handling operation whilst out on loan Decontamination of the McKinley T34 Syringe Pump a) Decontamination should be carried out with a damp disposable cloth (use warm water and general-purpose detergent). Dry thoroughly. If any additional cleaning is needed, e.g. the threads of the screws the actuator moves along, contact the Infection Prevention and Control Team for advice. The pump must not be submerged in water: if it is accidentally dropped in water, it must be withdrawn from use immediately and sent for repair. 9. INDICATIONS FOR THE USE OF THE MCKINLEY T34 SYRINGE PUMP 9.1. The policy must be followed on all occasions when a McKinley T34 Syringe Pump is required to administer medication. Safe Use of McKinley Syringe Pumps Policy 12

19 9.2. The McKinley T34 Syringe Pump is used to deliver drugs at a predetermined rate via the subcutaneous route over a 24 hour period. Typical applications include its use in pain and symptom control. Other indications for the use of the McKinley T34 Syringe Pump are: a) Intractable nausea and vomiting b) Intestinal obstruction c) Dysphagia d) Head and neck lesions/surgery e) Semi or unconscious state f) Malabsorption g) Unsatisfactory response to oral drugs (uncommon) h) Stomatitis i) Patient compliance j) Patient not be well enough to take the oral medications they require 9.3. The advantages of using the McKinley T34 Syringe Pump are: a) The ability to infuse a combination of drugs via one route negates the need for repeated injections b) Portable, lightweight and compact, allowing mobility and independence c) Simple calculation of dosages over a 24 hour period d) Avoids or reduces the need for oral medication e) Plasma concentrations remain level, therefore improved symptom control f) Infusion timing accuracy 9.4. The standard delivery period for a continuous subcutaneous infusion is a 24 hour period in palliative care. The McKinley T34 pump may be used with most makes of syringes. The most commonly used syringes have been 10 ml and 20 ml. However, it has been more recently advocated that a 20ml syringe is the recommended minimum (Dickman et al 2002) as this allows a larger dilution to be used, which will reduce both the risks of an adverse site reaction and also any potential incompatibility. In addition, it will also accommodate larger doses of certain drugs (Merseyside and Cheshire Palliative Care Network 2006). It is therefore recommended that 20ml and 30ml syringes should be used and that they have a luer lock facility in order to avoid leakage or accidental disconnection. Safe Use of McKinley Syringe Pumps Policy 13

20 NB: The 50 ml Luer lock syringe is the largest syringe that will fit the McKinley T34 syringe pump. The benefits are that it allows drugs to be diluted up to approximately 34 mls volume for Becton Dickinson (BD) syringes and 44 mls for Terumo syringes. This reduces the risk of reactions at the infusion site and also reduces the need for a further syringe pump when giving larger volume drugs. 10. PRESCRIBING MEDICATION FOR USE IN A MCKINLEY SYRINGE PUMP NB: When patients are commenced on the Final Days Care Pathway the documentation contained within the Care Pathway for prescribing, administering and controlled drug stock sheets must be used. For all other patients who are commenced on a syringe driver the prescribing, administering and controlled drug stock form as set out in the Safe and Secure Management of Medicines Policy (including controlled drugs) must be used Registered Doctors and Consultants are authorised to prescribe drugs for administration via a syringe pump. NB: Controlled drugs must not be prescribed by Non-medical Prescribers working within Community Care Western Cheshire Authorised prescribers of medicinal products are required to check medicinal products for suitability of use, contra-indications and allergies that patients may have Prescribing for Syringe Pumps Anticipation of symptoms and corresponding patient requirements is advocated for at least 24 hours. Appropriate quantities of supplies require to be obtained for patients' foreseeable needs. (For further information, please refer to the Community Care Western Cheshire End of Life Care Pathway) Four groups of drugs are commonly prescribed in syringe pumps: a) Analgesics (usually Diamorphine or Morphine Sulphate or Oxycodone) b) Anti-emetics (Cyclizine, Haloperidol, Levomepromazine, Metoclopramide) c) Sedatives (Midazolam) d) Anti-secretory drugs (Glycopyrronium, Hyoscine hydrobromide) Please refer to the Final Days Care Pathway for further guidance about drug prescriptions and conversions. For further assistance please contact the Macmillan Specialist Palliative Care Team Standard for the accuracy of patient medicine administration charts A Patient Medicine Administration Chart is not a prescription but is a direction to administer medication (NMC 2008). Safe Use of McKinley Syringe Pumps Policy 14

21 It must be signed by an authorised prescriber and authorises the delegation to administer medication on the prescribers behalf. However in so doing the staff administering the medicinal product are accountable for their actions and for raising any concerns about the direction with the prescriber The Final Days Care Pathway Medicine Documentation in use across Community Care Western includes: a) The As Required Sub-cutaneous Drugs Sheet and must contain Patient demographic details: Patient NHS number Date of Birth GP Name Date Drug name Drug dose Route Indication Doctors Signature b) Additional 'as required' bolus doses of analgesia should always be prescribed on the as required prescription sheet and be available for administration by nursing staff as required. c) The Syringe Pump Drugs Sheet must contain all the prescribed medication for the patient: Patient demographic details Patient NHS number Date of Birth GP Name Date Drug name Drug dose Route Safe Use of McKinley Syringe Pumps Policy 15

22 Indication Doctors Signature d) The As Required Sub-cutaneous Injectable Drugs Sheet and the Syringe Pump Drugs Sheet must be completed in full and signed by the Prescriber blank sheets must not be signed Drug Stock Sheet a) A separate Drug Stock Sheet for each drug must be completed and contain: Drug name Patient name NHS Number Date of Birth Date Time Drug (s) Dose Batch No/Expiry Date Stock remaining Signature(s) of staff checking drugs Standard for entries on Care Pathway Medicine Documentation a) The name of the medicine should be written using black indelible ink pens, writing legibly using BLOCK CAPITALS and approved medication names. Proprietary names (i.e. brand names) must not be used. The only exceptions to this rule are multi-ingredient preparations with no approved names or products whose proprietary name defines a specific formulation (e.g. slow-release theophylline preparations). b) Where non proprietary (generic) titles are given they must be used in prescribing. This will enable any suitable product to be dispensed thereby saving delay to the patient. The only exception to this is where bioavailability problems are so important that the patient should always receive the same brand and in such case the brand name or manufacturer should be stated. Safe Use of McKinley Syringe Pumps Policy 16

23 10.7. Use of Decimal Points The unnecessary use of decimal points should be avoided, for example: 3mg not 3.0mg. a) Quantities of 1 gram or more should be written as 1g. b) Quantities less than 1g should be written in milligrams, for example: 500mg not 0.5mg. c) Quantities less than 1mg should be written in micrograms, for example: 100 micrograms not 0.1mg When decimals are unavoidable a zero should be written in front of the decimal point where there is no other figure, for example: 0.5ml not.5ml Use of the decimal point to express a range for example: 0.5 to 1g is acceptable Micrograms, Nanograms and units must not be abbreviated particularly as a poorly written u can be misinterpreted as a number leading to insulin over dosage The term millilitre' (ml or ml) is used in medicine and pharmacy, and cubic centimetre, c.c., or cm3 should not be used Use of Abbreviations a) Only the following abbreviations when prescribing dosage are acceptable: mg milligram g gram kg kilogram l litre ml millilitre mmol millimole Route of Administration use of Abbreviations The following abbreviations are only acceptable when prescribing route of administration: I.M. intramuscular INHAL for inhalation I.V. for intravenous Safe Use of McKinley Syringe Pumps Policy 17

24 I.D Intradermal NEB for nebulised PO or O for oral P.R. for rectal S.C. subcutaneous PV for vaginal S/L for sublingual TOP for topical Routes of Administration a) Other routes of administration must be written in full, for example: Sublingual, Buccal. Only one route of administration may be specified for each medication, for example: METOCLOPRAMIDE O/IV is not acceptable Dosage of Medication a) The dose required must be included by the authorised prescriber. The dose must not be expressed in terms of the dosage form for single ingredient preparations, for example: Zomorph 2 capsules is not acceptable and should be written as Zomorph capsules 20mg. b) When doses other than multiples of 5 ml are prescribed for oral liquid preparations the dose-volume will be provided by means of an oral syringe Dosage frequency a) For regular medication the times of administration must be indicated by the authorised prescriber using the 24 hour clock As required medication a) As required medicines the times for administration must be written by the prescriber, using the 24 hour clock, where relevant, for example: hypnotics the maximum frequency must be stated as well as the maximum dose in 24 hours. In the case of preparations to be taken as required' a minimum dose interval must be specified Discontinued Medications a) A diagonal line must be drawn through the prescription so that cancellation is obvious, but the prescription is not obliterated. This is important to know exactly what was taken by the patient and when. Safe Use of McKinley Syringe Pumps Policy 18

25 Incorrect entries a) Incorrect entries must be scored through and the word cancelled written against it by the prescriber. 11. ADMINSTRATION OF MEDICATION IN MCKINLEY T34 SYRINGE PUMP The definition of administer is to give a medicine either by introduction into the body, whether by direct contact with the body or not (e.g. orally or by injection) or by external application (e.g. application of an impregnated dressing). a) Medications can only be administered via a McKinley T34 Syringe Pump by a competent Registered General Nurse who has undertaken and completed the required training in this procedure. b) Only registered nurses and registered doctors are authorised to prepare medicines for administration. c) In the handling of the medicinal product due regard shall be given to its Control of substances hazardous to health (COSHH) assessment. See d) Substances for injection should not be prepared in advance of their immediate use. e) Medication should not be administered when drawn into a syringe or container by another practitioner when not in their presence. f) All medicines must be prepared in an environment which protects both the medicine and the member of staff from possible contamination. g) All medicines must be prepared in a manner which is suitable for the intended route of administration. h) Manufacturers and / or pharmacists instructions for the preparation of medicines must be complied with. i) Valid consent must be obtained before the administration of a medicine. For consent to be valid it must be given voluntarily by an appropriately informed person. j) No-one can give consent on behalf of an incompetent adult; however such patients can be treated if the treatment would be in their best interest. Please read the Consent to examination or treatment policy in conjunction with this policy. k) The relevant current manufacturers Summary of Product Characteristics (SPC) guidance on route of administration is followed. See for current Summary of Product Characteristics. Safe Use of McKinley Syringe Pumps Policy 19

26 11.2. Key points for authorised administrators are: a) Knowing the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra-indications. b) Being certain of the identity of the patient to whom the medicine is to be administered. c) Being based, whenever possible, on the patient s informed consent and awareness of the purpose of the treatment. d) Being aware of the patient s care plan. e) Checking that the prescription, or label on medicines dispensed by a pharmacist, is clearly written and unambiguous. f) Having considered the dosage, method of administration, route and timing of the administration in the context of the condition of the patient and co-existing therapies. g) Checking the expiry date of the medicine to be administered. h) Checking that the patient is not allergic to the medicine before administering it. i) Contacting the prescriber without delay where contra-indications to the prescribed medicine are discovered, where the patient develops a reaction to the medicine, or where assessment of the patient indicates that the medicine is no longer suitable. j) Making a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient, ensuring that any written entries and the signature are clear and legible. k) Where there is any doubt as to the accuracy, completeness or appropriateness of an individual prescription, or to the quality of the medicine, it is the responsibility of the member of staff to confirm details with the prescriber and/or pharmacist before administering the medicine. Any concerns and the details of the action taken must be recorded in the patient healthcare records. l) Medicines requiring reconstitution must be done in accordance with the manufacturer s instructions. Any product with a shortened expiry date due to its preparation or its packaging being opened will not be stored for future use. m) If a dose calculation is required this information must be included as part of the prescription either by the Doctor or the Pharmacist, so that the person administering the dose is clear about the actual amount to be administered. Safe Use of McKinley Syringe Pumps Policy 20

27 n) If a calculation is required, a formula should be in place to ensure all calculations are recorded. o) Before administration, the following should be checked and any concerns raised with the prescriber before proceeding. patient s name age and weight if appropriate any allergies / hypersensitivities date and time the dose is due name of medicine, dose and frequency time of previous dose if any route of administration p) When selecting the medicine, the following should be checked and any concerns clarified before proceeding. name of the medicine strength form expiry date that the dose has not already been given q) A record of the medicine administered to a patient must be made on the Drug Administration Sheet. This must include: Patient Name Patient NHS number Date of Birth Syringe Pump Serial Number Date and time of administration Drugs administered Dose administered Route/site Safe Use of McKinley Syringe Pumps Policy 21

28 Batch Number/Expiry Date Syringe Pump Rate Volume of Fluid Condition of Injection Site Signature (s) of administrator r) All omitted, refused or wasted doses should be recorded and omissions and refusals should be reported to the prescriber if it is considered that the non-administration may affect the patient s condition and or symptoms. s) Paper and electronic records to be retained for 8 years or in the case of a child until they are 25 years old. t) Disposal of any waste material including sharps should comply with the Safe and Secure Management of Medicines Policy (including Controlled drugs). 12. ACCURACY OF THE CARE PATHWAY MEDICATION DOCUMENTATION A six monthly audit of a sample of medication documentation contained within the care pathway will be completed by Service Heads against the standard set out in section 14 of this policy. This will be supported by the Clinical Audit Team. The Medicine Management Patient Safety Group will receive the completed audit reports. Where deficiencies are identified actions plans will be developed by Service Heads. Implementation of these action plans will be monitored by the Medicines Management Patient Safety Group and the audit repeated in six months or sooner where deficiencies in implementation have been identified. The Audit of End of Life Care Pathway medication documentation is included in the Medicines Management Patient Safety Group Annual Work Programme. 13. PROCEDURES FOR USING THE MCKINLEY T34 SYRINGE PUMP Obtaining informed consent No. Action Rationale 1. Ensure that informed patient consent has already been obtained by the prescribing professional. To enable procedure to commence. 2. Explain procedure to the patient. To ensure that the patient understands the process and has the opportunity to raise any concerns. Safe Use of McKinley Syringe Pumps Policy 22

29 3. Provide the patient information leaflet (Appendix E) with completed contact telephone numbers. To reiterate the information given and to provide the patient / carer with further information and advice (The Mental Capacity Act has been introduced to help people who are unable to make decisions for themselves. For further information, please refer to Appendix D) Preparing the syringe No. Action Rationale 1. Draw up the medication and diluents into the appropriate sized as prescribed (see paragraph 5.4). 2. Complete the details on the drug additive label as per labelling section. To ensure the correct medication is given within the appropriate volume of diluent. To ensure accurate record keeping Labelling No. Action Rationale 1. All syringes containing drug additives must be labelled. 2. If there is any doubt as to the contents of a syringe, the contents should be discarded into denaturing kit. 3. Complete the label details in black ink or other indelible print. The label requires to state: The name of the patient for whom it is intended; The date and time of preparation; The full name of the person preparing the contents; The name and quantity of all drugs; The name of the diluent; The total volume of the contents; The time period over which the contents are to be infused; The intended route of infusion; To ensure accurate record keeping. To ensure that any risks to the patient are minimised and to comply with Western Cheshire Primary Care Trust Policy for the Disposal of Controlled Drugs. To ensure accurate record keeping. Safe Use of McKinley Syringe Pumps Policy 23

30 The date and time the infusion started. 4. Ensure the label does not interfere with the mechanism of the infusion device, i.e. where there is contact with the barrel clamp arm. 5. Attach the label to the syringe. Ensure that the label does not obscure any visual scales. Ensuring safe practice and to prevent malfunctioning of pump. To ensure the visual scales can be viewed during the infusion Connecting infusion set to the syringe No. Action Rationale 1. Use the appropriate infusion set. To ensure the correct infusion set is used for the administration of medication via a syringe pump. 2. Connect it securely to the syringe. To prevent leakage and wastage of medications and disconnection. 3. If it is a new infusion set, gently depress the syringe plunger until the line is just full, e.g. 1 ml for Sims Graseby 100cm infusion set Preparing the McKinley T34 Syringe Pump No. Action Rationale Priming line prevents time delay in patient receiving medication. 1. Install the battery. In order to power the pump. 2. Before placing the syringe into the Pump ensure the barrel clamp arm is down then press and hold the "ON/OFF" key until the "SELF TEST" screen appears. 3. The LCD display will show "PRE- LOADING" and the actuator will start to move. Wait until it stops moving and the syringe sensor detection screen (syringe graphic) appears. (Appendix F) NOTE: During Pre-Loading, the actuator always returns to the start position of the last infusion programmed. 4. If the actuator is not in the correct position to accommodate the syringe, leave the barrel clamp To ensure the pump is working correctly. To ensure LCD display is working properly. The barrel clamp arm needs to be in the down position to enable the FF and BACK buttons to work. Safe Use of McKinley Syringe Pumps Policy 24

31 arm down and use the "FF" or "BACK" buttons on the keypad to move the actuator. Forward movement of the actuator is limited, for safety; therefore repeated presses of the "FF" key may be required when moving the actuator forward. Backwards movement is not restricted. 5. Check the battery Press "INFO" key repeatedly until the battery level appears on the screen and then press "YES" to confirm. 6. Discard the battery if less than 40% life remaining as per Waste Management Guidelines. In order to verify there is sufficient battery power for the programme. (The average battery life, starting at 100%, is approx 3-4 days depending on use.) In order to ensure there is sufficient battery power for the programme Fitting the syringe to the syringe pump ENSURE THE LINE IS NOT CONNECTED TO THE PATIENT (unless repriming only) No. Action Rationale 1. Lift and turn the barrel clamp arm. This will enable syringe to be placed on the pump. 2. Seat the filled syringe collar/ear and plunger so the back of the collar/ear sits against the back of the central slot (ensure correct placement with the syringe scale facing the front). The syringe collar/ears should be vertical. 3. Turn and lower the barrel clamp arm to secure the syringe. To ensure the safe delivery of medication. To ensure the safe delivery of medication. NB: The syringe graphic on the screen ceases to flash at each point as the syringe is correctly seated Confirm that the syringe size and brand match the screen message. Press "YES" key to confirm or scroll with up + down - arrows to view other syringe manufacture choices, select, press Yes to confirm. Safe Use of McKinley Syringe Pumps Policy 25

32 13.7. Setting the infusion parameters New Patient After the syringe confirmation, the first screen that appears is displayed below: Same Patient After the syringe confirmation, the first screen that appears is displayed below: The pump calculates and displays the deliverable volume, duration of infusion (24 hrs) and rate of infusion (millilitres per hour) - Press "YES" to confirm. Pump screen prompts "START INFUSION". Press "YES to Resume". If this is a new infusion - press "NO for New Program". NB: If the original syringe is still in place, pressing "No for New Program" will reset the 24 hour clock, this means that the remaining contents of the syringe will be delivered over the next 24 hours from confirming "start infusion". Check the line is connected to the pump Connecting the infusion to the patient No. Action Rationale 1. Shave or clip excess hair from the selected site. 2. Insert the needle inverted (bevel up) at an angle of degrees into the subcutaneous tissue at the selected site. 3. Secure the needle with a transparent dressing. To enable site to be viewed and to ensure that any dressing used will adhere properly. To ensure needle is placed correctly. To ensure that the site can be viewed at all times. Safe Use of McKinley Syringe Pumps Policy 26

33 4. Include a loop of the infusion set under the dressing. 5. Ensure the patient and carers know that the syringe pump must NOT be placed at a level higher than the infusion site. 6. Record in the appropriate documents, the drugs/diluent administered and the time the infusion commenced. 7. Never take a syringe that is not empty off the pump if it is still connected to the patient. To avoid any direct pull on the needle. To ensure that the contents do not siphon out. To ensure accurate record keeping. To prevent the patient from receiving an accidental administration of medication. NB: It takes 4-6 hours for drugs to reach therapeutic blood plasma levels via the syringe pump, therefore, an additional bolus dose of the medication may require to be administered when the syringe pump is set up if the patient has unrelieved symptoms Starting the syringe pump In order to start the infusion, press YES on the syringe pump When the pump is running, the screen displays the following: a) Top line - infusion duration time remaining; b) Main line - infusion rate in ml/hour; c) Bottom line - alternates between syringe size/brand and the message "««pump delivering". d) The green LED indicator will also flash Keypad lock The T34 allows all users to lock the operation of the Keypad during infusion. This function should be routinely used to prevent tampering with the device. a) Activating the keypad lock With the pump infusing press and hold the "INFO" key until a chart is displayed showing a 'progress' bar moving from left to right. Hold the key until the bar has moved completely across the screen and a beep is heard to confirm the lock has been activated. NB: The following buttons are still active Stop/No, Start/Yes, Information. b) Deactivating the keypad lock Safe Use of McKinley Syringe Pumps Policy 27

34 To turn the lock off, repeat the above procedure. The bar will now move from right (lock) to left (unlock) and a beep will be heard Stopping the infusion and removing the syringe pump No. Action Rationale 1. Removal of the cannula and/or discontinuation of infusion must only be carried out by an appropriately trained health professional. 2. When the infusion is complete and the syringe is empty, it will stop automatically and the alarm will sound. If the syringe pump is no longer required for the patient, press "OFF" and then remove the battery from the syringe pump. 3. If the infusion is to be stopped before the syringe is empty, it should also be disconnected at the syringe end from the patient for safety reasons before the syringe is taken off the pump. A syringe that is not empty must NEVER be taken off the pump while connected to the patient. 4. Clean the pump and the cover (do not immerse pump in water). Dry and replace in packaging if no longer required for use. 5. Temporary Interruption of Infusion, e.g. bathing: Press "STOP". 6. Press and hold "OFF" button until a beep is heard; the screen will go blank. To ensure patient safety and maintain professional responsibility. To ensure the pump is off and the remaining battery life is saved. To ensure there is no accidental administration of drugs to the patient. To comply with infection control guidelines. To ensure pump is off while bathing. To ensure pump is switched off. 7. Do not remove syringe from pump. To ensure pump can reset to original regime. 8. Disconnect the line from the syringe and cap the end of the line and syringe tip. To avoid contamination of line and syringe. Safe Use of McKinley Syringe Pumps Policy 28

35 Resuming the infusion No. Action Rationale 1. Check that the prescription, syringe label and patient details match. 2. Reconnect the line to the syringe on the pump. 3. Press and hold the "ON" button until a beep is heard. 4. The screen will request confirmation of syringe size and syringe brand. 5. The screen will display the remaining volume, duration and rate of infusion. To ensure that this is the correct syringe for this patient. To ensure pump can reset to original regime. To ensure pump is switched on. To ensure the correct rate of infusion is calculated. To confirm the correct amount and duration of infusion remaining. 5. Press "YES" to confirm. If you press "NO" the pump interprets this as a completely new 24hr period. In this case, you would require to set up a completely new prescription from the start. 6. The screen will display "Start Infusion". 7. Press "YES" to confirm. To start infusion. To confirm that the infusion is to be recommenced What to do if the patient dies whilst the syringe pump is running No. Action Rationale 1. Stop the pump. To discontinue the infusion. 2. Press the "INFO" button and record the date, time and amount of solution remaining to be infused in the syringe (ml). 3. If there are doubts about the circumstances of the death, leave the pump in place and contact the Line Manager for advice. 4. In a straightforward situation, following identification of death, remove the needle and line from the patient and discard contents of line and syringe into denaturing kit. To ensure accurate record keeping. To ascertain any legal requirements. To ensure compliance with Western Cheshire Primary Care Trust Policy for the Disposal of Controlled Drugs. Safe Use of McKinley Syringe Pumps Policy 29

36 5. Remove the battery. To protect battery life and pump. 6. Record the signature(s) of person(s) destroying the remaining solution. To ensure compliance with the Health Records Policy Sites for placement of cannula for syringe pump infusion Appropriate sites for continuous infusion of subcutaneous drugs are as follows: a) Anterior chest wall b) Abdomen c) Lateral aspects of upper arms and thighs d) Back (scapula) - particularly suitable for confused patients ii) Areas which should not be used for syringe pump infusion a) Lymphoedematous limbs or trunk b) Sites over bony prominences c) Sites near a joint d) Previously irradiated skin e) Infected skin/skin lesions Care of infusion site No. Action Rationale 1. A transparent dressing must be used. 2. If there is evidence of inflammation or poor absorption (hard subcutaneous swelling), the infusion site should be renewed. 3. The needle site should be changed at least every 3 days. 4. Inspect for leakage at the cannula site and at the connection sites. To permit visible monitoring of site. This may effect absorption of medication and patient comfort. To reduce the risk of irritation / inflammation / cannula displacement. In order to minimise the risk of any malfunction or administration problems. Safe Use of McKinley Syringe Pumps Policy 30

37 Site breakdown No. Action Rationale 1. Further dilute drug if possible. To reduce any site irritation. 2. Change infusion device, e.g. Thalus set if patient has allergy to metal (Unomedical - available through NHS Logistics). To reduce any site reaction and prevent absorption problems. 3. Change type of site dressing. To reduce any site irritation. 4. Change site more often. To reduce any site reaction. 5. Check diluent. To ensure the appropriate diluent is used. 6. Check compatibility of drugs. (Seek advice from a pharmacist on whether an alternative diluent would be appropriate.) 7. Consider the use of an additional pump. 8. Use a filter needle to draw up the drugs Care during infusion No. Action Rationale 1. Explain care of the pump to carers e.g. avoid spillage of liquids on it or avoid dropping. Report if light stops flashing or if alarm should sound. To reduce the possibility of drug interactions. To reduce any possible drug interactions. To ensure that no debris / glass particles can enter the system. Good communication enables better patient/family experience and ensures early intervention of health care professionals if pump malfunctions. 2. Check battery daily. To ensure sufficient battery life. 3. Avoid using mobile telephone nearer than 1 metre to the syringe pump (McKinley Medical UK Ltd). 4. When the patient is mobile, ensure syringe pump is well supported Checks to be made whilst syringe pump is in use No. Action Rationale To ensure there is no interference with the operation of the syringe pump. To ensure the comfort of the patient and also to prevent pump malfunction. 1. Assess symptom control regularly. Individualised care/ good practice. 2. Check site for redness, inflammation, infection or needle displacement. To ensure early detection of site problems. Safe Use of McKinley Syringe Pumps Policy 31

38 3. Check syringe and infusion line for crystallisation, precipitation, cloudiness or colour change of contents or leakage. To ensure early detection of drug / diluent incompatibility. Re-prime pump if this is the case. 4. Check the display - pump is delivering and infusion rate is as programmed. To ensure the pump is delivering the correct infusion rate as required. 5. Record rate setting. To ensure accurate record keeping. 6. Press the "INFO" key to check: single press - VTBI (Volume to be Infused) and volume infused and record. double press - battery life remaining. 7. Visually check fluid remaining in syringe at each check and compare with pump reading Troubleshooting To verify infusion rate and battery life. To verify that contents of the syringe reflect pump reading If fast (running more than 1 hour ahead of expected time). No. Action Rationale 1. Check the rate setting is correct. To ensure pump rate is not set too fast. 2. Check the correct syringe brand or size has been selected. 3. Change the entire syringe pump for a new one and send for servicing. 4. Inform the patient s medical practitioner if the patient's clinical condition gives cause for concern. 5. Report the incident through the Primary Care Trust s incident reporting system. To ensure exact calculation by syringe pump of rate. In order to maintain patient safety and in compliance with Western Cheshire Primary Care Trust Medical Devices Policy. To obtain expert medical advice. To ensure compliance with Western Cheshire Primary Care Trust Incident Reporting Policy. Safe Use of McKinley Syringe Pumps Policy 32

39 If slow (running more than 1 hour behind expected time). No. Action Rationale 1. Check the syringe pump light is on. 2. Check the battery level. (If battery level displays 40% or below, change battery.) To ensure that the pump has power. To ensure the power level is sufficient to complete the safe delivery of drugs over a 24 hour period. 3. Check the rate setting is correct. To ensure the appropriate dose is delivered. 4. Check the correct syringe brand or size has been selected. 5. Check that syringe is inserted correctly into syringe pump. 6. Ascertain if syringe pump has been stopped and restarted for any reason. 7. Check contents of syringe and line - is there any evidence of crystallisation/kinking of tubing? 8. Check needle site - is this red/hard/lumpy/sore? To ensure exact calculation by pump of rate of administration. The pump will not work if the syringe inserted incorrectly. This will affect the functioning of the pump. This may slow delivery of contents. This may affect absorption. 9. Change needle site if necessary. To improve absorption. 10. Consider further dilution of drugs to minimise irritation by setting up a fresh syringe. 11. Consider metal allergy from needle. 12. If the syringe pump continues to run through too slowly, change the entire pump and send for servicing. 13. Check the rate of infusion at regular intervals If the pump alarm activates When the pump detects a problem four things occur: a) The infusion stops; To prevent irritation. Patient may have an allergy to the metal in the needle. To ensure that any problems with the syringe pump are investigated and repaired if necessary. To ensure patient receives correct drug dosage over correct time. To establish that the pump is working correctly. Safe Use of McKinley Syringe Pumps Policy 33

40 b) An audible alarm is activated; c) A message appears on the display screen indicating the cause of the alarm; d) The LED indicator turns RED The following table indicates the appropriate actions should the pump alarm Actions to be taken by the patient / carer in the event that the pump alarms are also outlined in the Patient Information Leaflet (Appendix E). Alarm Possible Cause Action Occlusion or Syringe Empty. Syringe Displaced. Pump Unattended. Near End. Patient access device blocked, kinked, clamped. Occlusion. Actuator has reached minimum travel position. Syringe has been removed or displaced. Pump left or no key presses detected for 2 minutes. 15 minutes from end of infusion. Release clamp. Flush or replace access device. Remove occlusion and restart. End of program, switch pump off. Check and confirm syringe seated correctly and resume. Start infusion, continue programming or switch off. Prepare to change syringe or switch off. End Program. Infusion complete. The pump will either default to KVO, (keep vein open) await nurse, or it will alarm in which case switch pump off Medications No. Action Rationale 1. Protect the syringe from direct light whenever possible. 2. Visual inspection of drug solutions should be made at each monitoring check (at least daily) and discarded if evidence of crystallisation, precipitation, cloudiness or discolouration. Some drugs may be light sensitive. To enable early detection of drug interactions. Safe Use of McKinley Syringe Pumps Policy 34

41 3. Avoid high concentrations of drugs used singly or in combination. 4. Do not infuse contents of syringe pump over a period longer than 24 hours. This will minimise the risk of site irritation. Prescriptions are only issued within Western Cheshire Primary Care Trust for 24 hour delivery It remains the responsibility of each individual practitioner to ensure that the drug(s) prescribed are suitable for continuous subcutaneous infusion, and are stable under these conditions. If in any doubt, seek advice from a Pharmacist or other registered professional Diluents A greater dilution of syringe pump contents reduces: a) The risk of incompatibility b) The impact of priming a line c) Injection site skin reactions 14. PROCEDURE FOR THE SAFE DISPOSAL OF CONTROLLED DRUGS USED IN MCKINLEY SYRINGE PUMPS In cases where the death of a patient is classed as an unexpected death, patient medication including controlled drugs must NOT be destroyed Where a patient has died, the practitioner must determine that the controlled drugs will not be required by the coroner in a further enquiry The supervising police officer in attendance will secure the scene and in collaboration with attending ambulance crew determine whether patient s medication is to be seized or may be retained by medical/ nursing staff for appropriate disposal in accordance with this policy In cases where the circumstances of the unexpected death require further investigation the police may seize patient medication as evidence and take responsibility for appropriate disposal Staff should record within the patient s records the details of the supervising police officer who is responsible for seizing and retaining the medication. The incident should be reported as a serious untoward incident in accordance with the Community Care Western Cheshire Incident Reporting Policy. NB: This includes when the cause of death is attributed to the industrial disease Mesothelioma and therefore reportable as an unexpected death Controlled drugs used in a community setting are the responsibility of the patient for whom they were prescribed. However, if Community Nurses have Safe Use of McKinley Syringe Pumps Policy 35

42 been involved with the administration of these drugs they should also take the responsibility for ensuring the safe disposal of any unwanted Controlled Drugs at the end of a course of treatment or in the event of a patient death. All medicines obtained for a patient via a prescription are the property of that patient. Under current legislation, no patient or carer is entitled to possess a controlled drug once there is no longer a clinical need The patient s carer should be advised to return controlled drugs to the pharmacy that originally dispensed them. (Although all Community/Hospital Pharmacists should accept, patient-returned Controlled Drugs for destruction, even if they did not originally dispense them) Controlled Drugs must not be removed from a patient s home by Community Nurses ONLY in exceptional circumstances should nurses destroy controlled drugs in a patient s house when a patient dies or the drugs are no longer required. Nurses should keep Destruction of old Pharmaceuticals - Denaturing Kits for this purpose If it is considered to be a risk to leave the patient or carer to dispose of the Controlled Drugs, then the controlled drugs should be destroyed in the patient s home in the presence of a witness and documented in the patient care plan and Care Pathway Medication Documentation the Drug Stock Sheet Permission must be sought from the patient, relative or carer to destroy the controlled drugs. This information must be documented in the patient s care plan In accordance with national guidance (NMC 2008) it is good practice for two registered healthcare professionals to witness the destruction of drugs belonging to patients i.e. two registered nurses. However, if there is only one registered nurse on duty, another healthcare professional/unregistered colleague may witness the destruction. A lay person, such as a patient s relative, should not be asked to witness destruction. The destruction must be recorded on the Drug Stock Sheet and signed by the registered nurse and the witness. If it is not possible to obtain a suitable witness at a given time (e.g. at night) then arrangements should be made for the necessary staff to destroy the drugs within 72 hours (e.g. arrange with daytime staff) All controlled drugs routinely administered by community nurses, which have to be destroyed in the patient s home should be destroyed within 72 hours and a record made on the Drugs Stock Sheet including the name, strength and quantity of drugs destroyed Procedure for the Safe Disposal of Controlled Drugs A syringe from a syringe pump that is empty should be disposed of in a yellow lidded waste bin. Safe Use of McKinley Syringe Pumps Policy 36

43 A syringe that is removed from a syringe pump with controlled drug medication left in it for whatever reason must be disposed of using a denaturing kit (section 14) Denaturing Kits can be obtained through NSH Logistics The stock of the drugs for disposal against the last entry on the Drug Stock Sheet must be checked to ensure that no discrepancy has occurred Obtain a Denaturing Kit and follow the instructions provided with the kit (section). This is the only method of controlled drug destruction that should be used The used Denaturing Kit must be disposed by returning to a Local Pharmacy. This must be documented in the patient s care plan Drugs must never be disposed of down the sink or toilet For the disposal of transdermal opioid patches(fentanyl), fold adhesive sides in on themselves and put back in the original pouch if available and then dispose of in a yellow waste bin or Denaturing Kit if available Record on the Disposal of Prescribed Drugs Stock Sheet the: drug name, the form, the strength, the amount destroyed and the method of destruction It must then be signed, dated and timed by the registered nurse and witness destroying the drugs. The Drug Stock Sheet must then be filed in the patient care plan The Drugs Stock Sheet must then be retained for seven years if it contains details of Controlled Drugs disposal. If permission to destroy controlled drugs is refused, the GP must be informed and the refusal recorded in the care plan and on the drug stock sheet. The manger or on-call manager should be informed within 24 hours If nursing staff are unable to gain entry to a patient s home to destroy the controlled drugs held there (e.g. after the patient s death) a Datix Incident Report completed A duplicate set of notes should be made by the community nurses and the lack of entry to a patients home to destroy the controlled drugs must be recorded. 15. ARRANGEMENTS FOR ADVERSE EVENT, ERROR AND NEAR MISS REPORITNG Community Care Western Cheshire actively promotes an open and fair culture that fosters peer support and discourages the attribution of blame. The organisation continually strives work towards a culture where human error is understood to be a consequence of flaws in the healthcare systems, not necessarily the individual. Safe Use of McKinley Syringe Pumps Policy 37

44 15.2. The emphasis for reporting medication errors is the desire to learn from these incidents and to prevent repetition. The over-riding concern is to protect patient safety and identify the immediate clinical action required to reverse or negate any adverse clinical outcome as a result of a medication incident or error Incidents related to the use of the McKinley T34 Syringe Pump should be reported on the Datix Incident Reporting System and Incident Reporting Policy. The following incidents should be reported and investigated: a) Administration of incorrect medication, dose and/or diluent selection b) Incorrect rate setting on syringe pumps resulting in infusions completing ahead of intended time or carrying on beyond intended time of completion c) Device not alarming d) Any other incident or near miss which may compromise patient safety or comfort NB: Any device involved in an adverse incident should be taken out of service and sent to the Head of Business. 16. CENTRAL COMMUNICATION SYSTEM (CAS) DRUG ALERTS Services within Community Care Western Cheshire are required to implement the requirements of the Care Quality Commission Registration Requirements This includes the protection of staff, and others, from any mitigating risks arising from the issue and dissemination of safety alerts, including any medical devices, patient safety and drug alerts, and other safety critical information, issued by the Department of Health, Medicines and Healthcare Products Regulatory Agency and or National Patient Safety Agency, using the Central Alerting System A Community Care Western Cheshire process is in place to cascade and manage Alerts including drug alerts. 17. DISSEMINATION This policy will be disseminated via the Community Care Western Cheshire Policy Cascade system. 18. IMPLEMENTATION Good Corporate Citizen a) This Policy enables Community Care Western Cheshire to learn from issues raised by its implementation, furthering community involvement Safe Use of McKinley Syringe Pumps Policy 38

45 and engagement and employee development (Office for Public Management 2004). 19. MEDICINES MANAGEMENT TRAINING AND MCKINLEY SYRINGE PUMP TRAINING The requirements for safe and secure handling of medicines may change over time. It is therefore essential that all clinicians to keep up to date with current medicine related practice and involves continuing learning Training to support implementation of this policy will be in accordance with Community Care Western Cheshire s Training Needs Analysis and Learning and Development Policy. Staff will be asked in their Personal Development Reviews and one-to one meetings with line managers to identify their training needs in relation to medicines management McKinley Syringe Pump Competency based training and reviews is completed as part of local induction training. Competency based training is provided within Community Care Western Cheshire through a train the trainers scheme. Staff who are involved in the use of Syringe Drivers will have their competencies reviewed annually by a Team Manager or Service Head. An Annual Report of reviews will be received by the Medicines Management Patient Safety Group. This is the responsibility of the Nonmedical Prescribing Lead. Where staff who are involved in the use of syringe drivers have not attended competency based reviews a date for the review will be re-booked Where gaps and deficiencies are identified in staff skills training will be available from a trainer or through advice from the Specialist palliative Care Macmillan Team Medicines Management Training attendance and non-attendance will be monitored by the Human Resources Learning and Workforce Sub-committee and risk exceptions reported to the Human Resources Committee. The Nonmedical Prescribing Lead will ensure training attendance and nonattendance reports are received by the Medicines Management Patient Safety Group six monthly. 20. DOCUMENT CONTROL AND ARCHIVING ARRANGEMENTS Policies/procedures are archived in compliance with the NHS Western Cheshire s Corporate Records Retention Policy. 21. MONITROING COMPLIANCE WITH THE IMPLEMENTATION OF THE SAFE USE OF MCKINLEY SYRINGE PUMP POLICY The Medicines Management Patient Safety Group as approving group for this policy will monitor the Policy key performance indicators six monthly and escalate exceptions in implementation to the Risk Assurance Subcommittee. Safe Use of McKinley Syringe Pumps Policy 39

46 21.2. Action plans will be developed and implemented when deficiencies are identified through monitoring of the policy key performance indicators The content of the policy key performance indicators will be reviewed annually by the Medicines Management Patient Safety Group The Medicines Management Patient Safety Group will ensure that where monitoring identifies deficiencies, recommendations and action plans will be developed and changes implemented accordingly The relevant NHS Litigation Authority Risk Management Standard will be used to monitor implementation of the Safe use of McKinley Syringe Pump Policy. Safe Use of McKinley Syringe Pumps Policy 40

47 22. TABLE 1: RISK MANAGEMENT STANDARD Medicines Management Risk Management Standard Monitoring Compliance How Monitoring Committee Where Frequency of Review When Responsible Lead Who Process for prescribing medicines in all care environments Will be reviewed as part of the update of the policy and will take account of changing roles and tasks and organisational structure Medicine Management Patient Safety Group Minimum 2 yearly or when changes to the policy are made due to guidance, legislation, or organisational changes or as a result of an incident, complaint or claim. Non-medical Prescribing Lead Process for ensuring the accuracy of all prescription charts Audit of sample of Care Pathway medicine administration documentation against the standard set out in this policy. Medicine Management Patient Safety Group Six monthly Service Heads Process for the administration of medication in all care environments Reviews of the administration of medicines related incidents Medicine Management Patient Safety Group Quarterly Non-medical Prescribing Lead Process for patient self administration Procedure for the safe disposal of controlled drugs Not applicable to this policy. Reviews of the safe disposal of medicines related incidents including controlled drugs Medicine Management Patient Safety Group Quarterly Non-Medical Prescribing Lead Training requirements for all staff, as identified in the training needs analysis Report highlighting review of syringe pump competencies Review of the content of Syringe Pump Competencies Medicine Management Patient Safety Group Medicine Management Patient Safety Group Annual Annually Non-Medical Prescribing Lead Non-Medical Prescribing Lead Safe Use of McKinley Syringe Pumps Policy 41 Version 3.0

48 23. KEY PERFORMANCE INDICATORS The number of incidents reported relating to drug errors whilst using the McKinley T34 Syringe Pump The number of untoward incidents reported relating to the performance of the McKinley T34 Syringe Pump The number of staff attending Syringe Pump training annually 24. ACKNOWLEDGEMENTS Thanks and appreciation is for Alison MacRobbie and NHS Highland for allowing us to utilise their own guidelines as a basis for this document: - Wilma Halley, Macmillan Clinical Nurse Specialist, NHS Highland. Chris Magee, Macmillan Clinical Nurse Specialist, NHS Highland. Chrissie Merrick, Sister, Highland Hospice Alison MacRobbie, Palliative & Community Care Pharmacist, NHS Highland Kathryn McCall, Macmillan Clinical Nurse Specialist Graphics reproduced with kind permission from McKinley Medical Ltd. 25. REFERENCES British Medical Journal, 2(6190): 582. Dickman, A. Littlewood, C. Varga, J (2002) The Syringe Driver. Oxford University Press, Oxford. Doyle, D. Hanks, G. Cherry, N. Calman, K. (1993) Oxford Textbook of Palliative Medicine, 3rd Edition, Oxford University Press, Oxford. Hunt, T. (2002) in: Pension, J. Fisher, R. (eds) Palliative care for people with Cancer. London: Arnold. McKinley Medical UK Limited. Ambulatory Syringe Pump Instruction Manual McKinley T34, June Medical Devices Agency (2003). Devices Bulletin: Infusion Systems. Medical Devices Agency, March Merseyside and Cheshire Palliative Care Network Audit Group, 3rd edition (2006). Guidelines for Strong Opioid Substitution in Palliative Care. Safe Use of McKinley Syringe Pumps Policy 42

49 Western Cheshire Primary Care Trust (2008). End of Life Care Pathway. Wright, B.M. & Callan K. (1979) Slow drug infusions using a portable syringe driver. Safe Use of McKinley Syringe Pumps Policy 43

50 APPENDIX A - GOVERNANCE STRUCTURE Safe Use of McKinley Syringe Pumps Policy 44

51 APPENDIX B - PATIENTS BEING ADMITTED TO HOSPITAL WITH SYRINGE PUMP NB The Countess of Chester Foundation Hospital Trust continue to use Graseby Syringe Pumps Action Patient identified as requiring admission to hospital Inform Single Point of Access that the hospital will need to be alerted to the McKinley pump being in situ Rationale To enable the staff to be prepared to change pumps Ensure the transfer of care form is complete with clear lists of drugs (by dosage only not rate of flow) contained in the syringe. To assist the hospital staff in transferring the pump. Enclose the prescription card with details of syringe pump contents. Contact single point of access to determine where patient is to be admitted. Enables the hospital to obtain prescription in timely manner To arrange collection/return of syringe pump via the Macmillan nurses attending the Mulit-Disciplinary meetings. Patients being admitted as an emergency should take the whole health record with them. Safe Use of McKinley Syringe Pumps Policy 45

52 APPENDIX C - DETACHMENT OF SYRINGE PUMPS ON ADMISSION TO/DISCHARGE FROM HOSPITAL Patient discharged into Community Care Western Cheshire with MS26 Graseby syringe driver in situ Patient admitted to Countess of Chester Foundation Trust Hospital with McKinley T34 syringe pump in situ. Discontinue infusion & reprime syringe & load onto Mckinley T34 syringe pump as per prescription sheet. Discontinue as per Syringe Pump Information leaflet and set up syringe driver as per hospital protocol. Return Graseby MS26 syringe driver to Countess of Chester Hospital Request family return McKinley Syringe pump to District Nurses NB: Countess of Chester & Hospice are not currently using McKinley T34 Syringe Pumps. Please do not seek their advice re: these pumps Safe Use of McKinley Syringe Pumps Policy 46

53 APPENDIX D - ASSESSING CAPACITY TO CONSENT Assessing Capacity to Consent (For more information see Mental Capacity Act, Code of Practice, Chapter 4) The Mental Capacity Act (2005) states as one of its central principles that you must presume a person has capacity. If you have reason to believe that a person lacks capacity to consent to treatment then you must assess this formally and document your findings. Remember, refusal to treatment or any other decision that may seem unwise to you does not automatically mean the patient lacks capacity. Under the Act, assessment of capacity is a two-stage process: Stage 1: The Diagnostic Test Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn t matter whether the impairment or disturbance is temporary or permanent.) If so, does that impairment or disturbance mean that the person is unable to make the decision to consent to treatment? Stage 2: The Functional Test The person will be deemed as lacking capacity if they cannot do ANY of the following: 1. Understand information about the decision to be made (the Act calls this relevant information ) 2. Retain that information in their mind 3. Use or weigh that information as part of the decision-making process, or 4. Communicate their decision (by talking, using sign language or any other means) Following assessment, if the patient is deemed to have capacity to consent and refuses a transfusion then it cannot then be given. If a patient has no capacity to consent and refuses the treatment then it may be appropriate to administer the transfusion provided it can be demonstrated it is in their best interests. Assessing Best Interests (For more information see Mental Capacity Act - Code of Practice, Chapter 5). The Act gives a checklist of key factors that you must consider when deciding what is in the best interests of a person who lacks capacity. Safe Use of McKinley Syringe Pumps Policy 47

54 It is important not to make assumptions about someone s best interests merely on the basis of the person s age or appearance, condition or any aspect of their behaviour. You must consider all the relevant circumstances relating to the decision in question. You must consider whether the person is likely to regain capacity, and if so can the decision wait until then? You must involve the person as fully as possible in the decision that is being made on their behalf. You must in particular consider: 1. the person s past and present feelings, in particular if they have been written down 2. any beliefs and values (religious, cultural, moral) that would be likely to influence the decision in question and any other relevant factors As far as possible you must consult other people if it is appropriate to do so and take into account their views as to what would be in the best interests of the person lacking capacity especially: 1. anyone previously named by the person lacking capacity as someone to be consulted 2. carers, close relatives or close friends or anyone else interested in the persons welfare 3. any attorney appointed under a Lasting Power of Attorney 4. any deputy appointed by the Court of Protection to make decisions for the person You must also seek to ascertain if the patient has made a valid advance decision to refuse the treatment that is proposed. The Act will protect you from liability around advance decisions if you: stop or withhold treatment because you reasonably believe that an advance decision exists, and that it is valid and applicable treat a person when, having taken all practical and appropriate steps to find out if the person has made an advance decision to refuse treatment, you do not know or are not satisfied that a valid and applicable advance decision exists. After taking the above steps you must weigh up the factors to determine what decision or course of action is in the person s best interest. If it deemed that a blood transfusion is the best way forward, you should document your decision and how you reached it in the care notes. Safe Use of McKinley Syringe Pumps Policy 48

55 APPENDIX E SYRINGE PUMPS SYRINGE PUMPS Patient Information Leaflet What is a Syringe Pump? This is a small, portable battery controlled pump. It can be carried about in a pouch attached to a belt, on a shoulder holster, or in your pocket. The pump is fitted with a syringe, which gives your medicines through a needle just under the skin. The medicines are absorbed directly into your bloodstream. The pump runs 24 hours a day, avoiding the need for repeated injections. Why do I need one? Sometimes it is easier for you to have some of your medicines this way. This may be because: You have been vomiting, and find it difficult to keep your medicines down. Medicines to help stop vomiting are given in the syringe pump, along with medicines to help other symptoms such as pain. Once the vomiting has settled you may go back to having your medicines by mouth. You have so many medicines to take that you are finding it difficult to manage them all. Putting some of the medicines in the syringe pump can reduce the number of medicines you need to take by mouth. You are unable to swallow medicines. Medicines to help your symptoms can be put into the syringe pump. Starting a syringe pump doesn t mean that your medicines have stopped working or aren t strong enough, only that this is a more effective way of getting them into your body, if you cannot take them by mouth. Who will look after my syringe pump? If you are at home, your community nurse will come in each day to replace the syringe, check that the needle is comfortable and that there are no problems with the medicines. If you are staying in the hospital, hospice or care home the staff there will check your syringe pump regularly to make sure it is working well. The syringe will be changed Safe Use of McKinley Syringe Pumps Policy 49

56 each day by the staff. They will check that the needle is comfortable and that you are not having any problems with the medicines. The medicines in your syringe pump have been prescribed by your doctor to help your symptoms; you do not need to do anything to the syringe pump. The medicines will continue to be absorbed over 24 hours, helping your symptoms round the clock. What does a syringe pump look like? The syringe pump currently in use in Community Care Western Chehsire is the McKinley T34 syringe pump. The pump (actuator) pushes the medicine into the giving set, through the needle and into the tissues under the skin where it is absorbed into your bloodstream. While the pump is running the indicator light will flash to let you know that it is working. The pump is lightweight and about 15cm long by 5cm tall. It may have a clear plastic cover to protect it and may be in a fabric bag, to protect the syringe from light. Your nurse or doctor will be able to show you the syringe pump. Actuator Indicator Light Some dos and don ts The medicines in the syringe pump will flow into your blood stream throughout the 24-hour period, controlling your symptoms. Any adjustments needed will be made Safe Use of McKinley Syringe Pumps Policy 50

57 by your GP or Community Nurse or by the hospital or hospice staff. Do not interfere with the syringe or the pump. You must keep the syringe pump and the infusion site dry. Take care when washing or bathing to keep the syringe pump dry. If you drop it into water contact your nurse, a new syringe pump will be needed to be sure that your medicines are being given at the right rate. The syringe in the pump should not be exposed to direct sunlight you should keep it in the fabric pouch to protect it from light. The syringe pump should not be exposed to extremes of heat. Avoid placing the syringe pump next to a heat pad, electric blanket or hot water bottle. Avoid the use of mobile phones within a metre of the pump if at all possible as they may interfere with the way the pump works. If a call is unavoidable, keep the length of the calls as short as possible. If you notice any of the following contact your nurse/gp: The colour of the medicines in the giving set has changed. There is a cloudiness or sediment in the giving set. The skin around the needle is red, swollen or painful. The alarm on the pump sounds. How will I know the syringe pump is working? The green light on the case will flash so long as there is power in the battery. If the light goes out while the syringe pump is running, the battery will need to be replaced when the next syringe is put in. There is no need to change the battery before then, the rest of the medicine in your syringe will be given. A new battery will last for three to four days. If the alarm sounds it may mean your infusion is complete, or that there is a blockage in the syringe or giving set. Contact your nurse who will check the pump. If I have any worries who should I contact? District Nurse: Hospice Nurse: Hospice Doctors: Community Macmillan Nurse: Safe Use of McKinley Syringe Pumps Policy 51

58 Out of Hours contact: Safe Use of McKinley Syringe Pumps Policy 52

59 APPENDIX F T34 FEATURE RECOGNITION T34 Feature Recognition Syringe Loading 1. Barrel clamp arm - (detects syringe size/width of barrel, secures) 2. Syringe ear/collar sensor (detects secure loading of syringe collar) 3. Plunger sensor (detects secure loading of syringe plunger) T34 Feature Recognition Keypad 1. INFO Key - access event log/set Up (code protected)/battery status 2. UP / DOWN arrow keys - increase/decrease parameters/scroll options 3. YES/START key - confirms selection/starts infusion 4. NO/STOP- step back a screen/stops infusion 5. FF (forward) - moves actuator forward/purge facility 6. BACK - moves actuator back 7. ON/OFF Safe Use of McKinley Syringe Pumps Policy 53