Administration of IV Medication in the Community by the Children s Community Nursing Team Standard Operating Procedure DOCUMENT CONTROL: Version: 1 Ratified by: Clinical Quality and Standards Group Date ratified: 6 October 2015 Name of originator/author: Clinical Quality and Standards Lead Name of responsible Clinical Quality and Standards Group committee/individual: Date issued: 1 December 2015 Review date: September 2018 Target Audience All Trust Staff
CONTENTS SECTION PAGE NO 1. AIM 3 2. SCOPE 3 3. LINKS TO OVERARCHING POLICY and/or PROCEDURE 3 4. PROCEDURE 3 Pre administration 4 Procedure for IV bolus administration 5 Administration 6 Post Administration 7 Procedure for IV intermittent infusion 7 Procedure (as for Bolus Injection) Action until Administration Point Removal of peripheral Cannula 8 Removal of Unwante4d or part used medication 9 5. Definitions 9 7 Page 2 of 9
1. AIM To ensure safe and consistent practice in the administration of intravenous medication in the community To support the drive to deliver care closer to home through the facilitation of reduced in-patient length of stay and earlier discharge. (UK DH, 2004, 2008, 2010, 2011) 2. SCOPE Children s community nursing team within Doncaster Children Young People and Families Services 3. LINK TO OVERARCHING POLICY AND/OR PROCEDURE Safe and Secure Handling of Medicines Policy 4. PROCEDURES The CCN/registered children s nurse will have undertaken anaphylaxis training and will carry an anaphylaxis kit at all times when delivering IV medication. The CCN/registered children s nurse administering the IV medication will ensure they have the knowledge and understanding of the medication to be administered prior to the home visit. Prior to administration the CCN/registered children s nurse is responsible for checking. Page 3 of 9
PRE ADMINISTRATION Action Check the patient s name, address, date of birth, NHS number. Check the patients allergy status and drug sensitivities Check date treatment is to commence and review/completion date Check the name, form and strength of medication against the prescription / kardex Check that the prescription is correctly completed and contains the necessary information (specifies the substance to be administered, using its generic name and its stated form, together with the strength, dosage, timing, frequency of administration, start and finish dates, route of administration, flushes and diluents as necessary and final infusion volume) Check the date and time of administration Check the route of administration Check the type and volume of diluent (if required) against an agreed reference source eg Medusa Check the dose & correct calculations including weight related dosage and infusion rates. Medication will be checked by 2 qualified nurses on initial visit and in case of dose changes or vial changes. Check the type, volume and availability of flush Assess for a PAWS score of patient at time of visit (PAWS score does not replace clinical experience or acumen Rationale To ensure we have the RIGHT person To ensure it is safe to give this medication To ensure that the medication is still required To ensure that it is the RIGHT drug To ensure that the drug will be given in the correct major at the correct time To ensure that the drug is given at the RIGHT time. To ensure that it is been given by the RIGHT route To ensure that the medication is made up correctly To ensure that the RIGHT dose will be given in the RIGHT way To ensure the RIGHT flush is given and the right amount to ensure patency To ensure the child s condition has not deteriorated and it is still appropriate to give the medication Page 4 of 9
and should not be relied upon for such purposes). Compare to previous two scores - any concerns should be escalated to paediatric registrar on call at local hospital Use clinical judgement to assess the cannula site and patency of the cannula prior to administration of medication and report/act upon any concerns (ideally use the VIP score) and record that they have checked and observed Explaining the procedure to the child/young person, and /or parent/guardian Obtaining verbal consent To ensure that it is safe to use the cannula and that there are no signs of phlebitis, extravasation or signs of infection starting. To ensure that they fully understand what is going on to help reduce anxiety and fear and to help inform consent. To ensure the child and family are consenting to the treatment commencing PROCEDURE FOR INTRAVENOUS BOLUS ADMINISTRATION Gather all equipment Patients prescription chart Consent documentation Dressit Pack Tray for prepared medication Patient s prescribed medicines and diluent if required Flushing solution Chlorhexidine based cleaning wipe (2% CHG/70% IPA solution) syringes 10ml or 20ml Needles for drawing up solution (filter needle if glass vials required) Label for identifying medicines Sharps bin Handwashing kit To prevent delays and ensure that the nurse is ready and able to give the medication Wash hands using effective hand washing technique in liquid soap and water dry hands using clean towels Prepare a clean area/tray. Carry out procedure using ANTT Open all equipment and place in tray taking care not to contaminate key parts. Open needle(s) and connect to To reduce the risk of infection and contamination To reduce the risk of infection from contaminated surfaces To be prepared for the procedure and reduce the risk of infection Page 5 of 9
syringe(s). N.B ensure filter needles used for glass ampoules Using ANTT to draw up all medication(s) with diluent(s) in a different size syringe from the flush(s), required for the procedure Prepare the medicine as per manufacturer s instructions and prescription. Inspect insertion site for signs of Infection using VIP score To be prepared for procedure To ensure the medicine is given as the manufacturer intended and stability To detect signs of inflammation, infiltration or extravasation. If present take appropriate action ADMINISTRATION OF BOLUS INJECTION Clean the needleless system with a 2% chlorhexidine in 70 per cent isopropyl alcohol wipe (eg Clinell ) using friction for 30 seconds Allow the port to dry naturally; do not fan or blow dry To reduce the number of potential pathogens introduced by the syringe at the time of insertion To prevent re-contamination of the port Inject the prescribed volume of sodium chloride 0.9% into needle free bung and observe for resistance and pain Inject the medicine at the rate recommended by the manufacturer and prescription. To detect extravasation of cannula and blockage To detect early signs of an allergic reaction and complications around the insertion site Observe the child/young person and injection site whilst administering the medicine If more than one medicine is to be given, flush with 5-10ml sodium chloride 0.9% injection (or compatible solution) between each medicine After final administration flush the cannula with 0.9% sodium chloride (or compatible solution) under positive pressure with a suitable amount for the device used To prevent medicine incompatibility occurring in the line and reduce the risk of phlebitis To prevent occlusion and blood backflow into the line Page 6 of 9
POST ADMINISTRATION Once the injection has been administered, place all sharp items and syringes into sharps container. Needles should not be re sheathed Other waste should be placed into the appropriate plastic bags Ensure the patient is able to recognise complications and who to contact for further advice To promote infection control measures and reduce the risk of needle stick injuries To detect early signs of complications and ensure the therapy continues as planned Record the administration on the prescription chart and enter the visit in the child/young person s electronic medical record. Record Batch number and expiry of all solutions used. Amend the care plan if any changes occur which affect the treatment and/or care of the patient Place an alert on System 1 to highlight to other members of staff the change in care plan To maintain accurate records, provide a point of reference in the event of any queries and prevent duplication of treatment PROCEDURE FOR INTRAVENOUS INTERMITTENT INFUSION Equipment: As bolus with the addition of:- Luer-lock syringe for infusion (required size) Giving set PROCEDURE (AS FOR BOLUS INJECTION) ACTION UNTIL ADMINISTRATION POINT Connect the giving set to the infusion bag or syringe containing the medicine. Prime the line and use a non-touch, aseptic technique. To reduce the risk of infection Use the tray to transport flushes and To reduce the risk of infection Page 7 of 9
medicines to patient, where possible prepare medicines next to the patient Commence the infusion at the prescribed rate using appropriate infusion device (Mckinley T34/60) Observe the patient during the infusion is in progress On completion of infusion flush through extension set with 5-10mls Sodium Chloride 0.9% or compatible solution To detect early signs of adverse reactions To ensure no medication is left in the line or cannula Disconnect the giving set and discard in a sharps bin Continue with post administration care and record keeping as with Bolus administration PROCEDURE FOR THE REMOVAL OF A PERIPHERAL CANNULA There are five possible reasons for removal of the cannula: 1. extravasation and infiltration 2. intravenous access no longer required 3. it may no longer be functioning effectively 4. it may be causing the child excessive discomfort 5. a VIP score of two or above Collect the required equipment on a previously cleaned tray that has been wiped with a Chlorhexidine based cleaning wipe (2% CHG/70% IPA solution) Always employ an aseptic, non-touch technique Explain the procedure to the child and family To prevent cross infection To prevent cross infection To gain their confidence and trust. Page 8 of 9
Remove the bandage and splint Perform a hygienic hand wash Put on personal protective clothing and ensure that assisting staff are similarly attired Inspect the exit site and assess for phlebitis or infection, utilising the VIP scoring system. To gain access to the cannula To prevent cross infection To prevent cross infection and possible contamination of clothing To determine if a course of antibiotics is required If there is cause for any concerns these should be escalated to paediatric registrar on call at local hospital REMOVAL OF UNWANTED OR PART USED MEDICIATION A Pharmaceutical waste bin should be provided for the family at the start of treatment. Empty and part used or unwanted should be disposed of in this bin. When full or no longer required this bin should be removed from the house to the base point for onward collection via waste contractor 5. DEFINITIONS ANTT Aseptic Non Touch Technique Rdash- Rotherham, Doncaster and South Humber NHS trust CCN Community Children s Nurses PAWS- Paediatric Advanced Warning Score GOSH Great Ormond Street Hospital IV - Intravenous ml Millilitres NMC Nursing and Midwifery Council PICC Peripherally Inserted Central Catheter RCN Registered Children s Nurse SOP Standard Operating Procedure VIP Score Visual Infusion Phlebitis Score Page 9 of 9