FREEDOM OF INFORMATION ACT

FOI REF: 18/298 6 th June 2018 FREEDOM OF INFORMATION ACT I am responding to your request for information under the Freedom of Information Act. The answers to your specific questions are as follows: Please may I request a copy of the trust s current Peripheral Intravenous Cannulation Policy. Please see the attached East Sussex Healthcare NHS Trust s Multi Professional Practice Guideline for Peripheral Intravenous Cannulation Competency policy. If I can be of any further assistance, please do not hesitate to contact me. Should you be dissatisfied with the Trust s response to your request, please write to Lynette Wells, Director of Corporate Affairs, East Sussex Healthcare NHS Trust (lynette.wells2@nhs.net) quoting the above reference. Yours sincerely Jo Shoesmith Freedom of Information Manager

Multi Professional Practice Guideline for Peripheral Intravenous Cannulation Competency Version: V1.0 Ratified by: Date ratified: March 2015 Name of author and title: Date Written: March 2015 Name of responsible committee/individual: Trust Infection Control Group IV Team Lead Nurse (EDGH) IV Team Lead Nurse (Conquest) Director of Nursing Date issued: December 2015 Issue number: 2015227 Review date: March 2018 Target audience: CQC Fundamental Standard: Compliance with any other external requirements (e.g. Information Governance): Associated Documents: Nursing and midwifery staff, registered operating department practitioners, radiography staff, IV team and clinical support practitioners, doctors who have received appropriate training, health care assistants working in acute unit with support from the unit manager Epic 3, NICE, RCN Guidelines Did you print this yourself? Please be advised the Trust discourages retention of hard copies of procedural documents and can only guarantee that the procedural document on the Trust website is the most up to date version Page 1 of 24

Version Control Table Version number and issue number Date Author Reason for Change V2 2009253 November 2009 Update Description of Changes Made V1.0 2015227 December 2015 Update Monitoring safety devices Consultation Table This document has been developed in consultation with the groups and/or individuals in this table: Name of Individual or group Title Date Director of Nursing Infection Prevention & Control Team Medical Device Educators District Nurses Lead/Educators This information may be made available in alternative languages and formats, such as large print, upon request. Please contact the document author to discuss Page 2 of 24 V1.0

Table of Contents 1. Introduction... 4 2. Purpose... 4 2.1. Rationale... 4 2.2. Principles... 4 2.3. Scope... 5 3. Accountabilities and Responsibilities... 5 4. Procedures and Actions to Follow... 6 4.1. Preparation... 6 4.2. Insertion... 6 5. Equality and Human Rights Statement... 8 6. Training... 8 6.1. In-house training... 8 7. Monitoring Compliance with the Document... 8 8. References... 10 Appendix A - Multi-Professional Intra-venous Cannulation of Adult Patients- Learning Outcomes Competency Based Assessment Tool... 11 Appendix B - Application to undertake cannulation training... 14 Appendix C - Intravenous Cannulation Procedure Competency Assessment Record 15 Appendix D DEHRA Form... 21 Page 3 of 24 V1.0

1. Introduction It is likely that patients admitted to hospital will need to have an insertion of a peripheral intravenous cannula or vascular access device (VAD) for the delivery of treatment or in the anticipation of treatment being required via an intravenous route. Increasingly the insertion of peripheral intravenous cannulae is being delegated to key competent practitioners including registered nurses, radiographers, operating department practitioners, support practitioners and midwifery staff to ensure that patients receive timely and effective treatment. At East Sussex Healthcare Trust staff who are deemed competent to carry out this procedure must adhere to the Royal College of Nursing (RCN) Standards for Infusion Therapy 2011. 2. Purpose 2.1. Rationale Intravenous cannulation, although a routine procedure is an enhanced practice when carried out by registered nursing, midwifery staff and clinical support practitioners. All practitioners undertaking this procedure must maintain their practice in line with Trust policy and the NMC Code of Professional Conduct (2011) or relevant professional body. The minimum requirement of the Trust is that practitioners who have attended the Intravenous cannulation study session within the last two years but who have not performed this procedure within the last twelve months will undertake the Trust s Competency Based Assessment authorised by a designated supervisor, together with at least ten supervised cannulation procedures recorded on the appropriate Trust documentation. For practitioners commencing with the Trust who have previously undertaken training and practice of intra-venous cannulation with another employer within the last two years, evidence of the training should be provided together with supporting evidence, for example competency records, reflective journals etc to the practitioner s line manager who will authorise, where deemed appropriate, further training. However, all new Trust employees wishing to practice this procedure will undertake ten observations of cannulation procedures authorised by a designated assessor and recorded on the Trust documentation. Sodium Chloride 0.9% injection is a prescription only medicine. However, where practitioners have successfully undertaken additional education in either IV drug administration or cannulation, they may administer sodium chloride 0.9% as part of this practice. The use of prefilled 0.9% sodium chloride following cannulation to maintain patency is available for Trust wide use; a prefilled flush is a medical device which is supported by the MHRA. 2.2. Principles Nurses, midwives, doctors, clinical support practitioners, radiographers and operating department practitioners, and health care assistants have the right to refer cannulation to a more experienced practitioner or to a suitably qualified doctor, where they feel that on initial assessment, referral will prevent unnecessary attempts at cannulation. Page 4 of 24 V1.0

After two unsuccessful attempts to carry out intravenous cannulation the practitioner will refer to a more experienced practitioner within the clinical team. Where it is identified that clinical circumstances predispose to unsafe cannulation by experienced nursing or midwifery staff, the procedure will be referred to the IV Nurse specialists or Senior House Officer for the responsible medical team, with a view to discussing alternative vascular devices available Intra-venous cannulae are single use devices and one cannula should be used for each attempt to cannulate in line with (MHRA) Medical guidance. The Trust is in compliance with the EU Directive in lieu with safety sharps. All insertions should be documented in adherence with the RCN Standards for Infusion Therapy (2011). Practitioners will use appropriate cannula dressings as approved by the Product Procurement Group in adherence with Trust policy. Recently best practice dictated that intravenous cannula should be replaced after 72 hours. However, the latest epic3 guidelines state that the duration can be extended as long as the VIP score is less than one. All cannulae inserted by the Paramedics must be re-sited within 24 hours when the patient condition is stable. However, if intravenous treatment is no longer required, the cannula should be removed as soon as possible. 2.3. Scope This policy applies to all registered nurses and midwives, registered operating practitioners, radiographer staff, IV team and clinical support practitioners, doctors who have received appropriate training, healthcare assistants working in acute unit with support from the unit manager/matron. 3. Accountabilities and Responsibilities All practitioners who have attended the Trust s intravenous cannulation study session will undergo a Competency Based Assessment using the Trust s documentation and Competency Assessment tool. The Competency Based Assessment tool will be authorised by a designated assessor (from the appropriate area) who is competent in intra-venous cannulation practice and is qualified to assess staff, preferably holding a recognised assessors qualification, for example, Managing Learning through Mentorship/ENB998 or Vocational Assessors Award-D32/D33. The unit manager/matron or equivalent will identify those practitioners who will carry out intravenous cannulation procedures and will also be responsible for maintaining training and competency records for designated staff. The unit manager/matron will also be responsible for sending copies of records of cannula training and assessment to the IV Team Lead at EDGH site for entry on to the Trust s database. In circumstances where despite training and continued support, the practitioner has not achieved competency, this should be discussed with and reviewed by the relevant manager for appropriate action. Page 5 of 24 V1.0

Doctors in training are required to complete a competency-self assessment within one week of commencing with the Trust for (CNST) Clinical Negligence for Trust and risk management purposes; intra-venous cannulation is included as a core skill. Where additional training needs are identified, for example, at appraisal, doctors may apply via the Learning and Development services route and should be practically assessed at the discretion of their Educational Advisor or Lead Consultant. Both IV Team Lead Nurses and or IV Specialist Nurses/Practitioners will conduct teaching sessions via Learning and Development as an in house training on alternate basis. It comprises of the legal aspect of the practitioner, infection prevention and control, health and safety measures, anatomy and physiology of the veins, arteries and nerves, site selections and cannulation techniques. The candidate will be provided with monitoring compliance documents and a contract to carry out cannulation procedure. Candidates must practice, complete the record supervised practice and submit the completed form to IV Team Lead at EDGH site to enter in the ESR. It is advisable that the professionals who are skilled with their practice will attend updates every three years. 4. Procedures and Actions to Follow 4.1. Preparation Step 1 Adhere to hand hygiene best practice. Step 2 Verify patient s identity and obtain their consent for the procedure. Step 3 Apply a tourniquet. Best practice dictates a disposable single use only tourniquet should be used. Step 4 Examine patient s arms and select the most appropriate vein for cannulation Step 5 Remove tourniquet Potential Risks if step 1 not done or To minimize the risk of cross infection. Potential Risks if step 2 not done or Verbal consent should be obtained, in the case of patients who are unable to give consent; it should fall under the clinician s discretion in relation to patients best interest. Potential Risks if step 3 not done or Potential Risks if step 4 not done or Potential Risks if step 5 not done or 4.2. Insertion Step 1 Open all supplies and drop onto a clean field/clean sharps tray Step 2 Apply gloves Potential Risks if step 1 not done or Potential Risks if step 2 not done or PPE and so as protecting patient from Page 6 of 24 V1.0

Step 3 Place absorbent pad under patient s arm, apply the tourniquet. It is best practice to use a disposable tourniquet. Step 4 Clean 10-15 cm around the intended insertion site with Chlorhexidine Gluconate 2% w/v and Isopropyl Alcohol 70% for at least 30 seconds. Allow the skin to dry. (For patients who are known allergic to Chlorhexidine, Iodine Povidone is a good alternative or seek advice from pharmacist). Step 5 Angle 10 degrees 45 degrees, for vein depth Step 6 Insert cannula and observe for the initial blood in the flashback chamber. Step 7 Lower angle of cannula and stylet and advance 2 mm. Step 8 Advance cannula, note secondary flashback along the cannula Step 9 Release tourniquet Step 10 Apply digital pressure beyond cannula tip. Step 11 Remove stylet and dispose in sharps container. Step 12 Attach needle less connector. Step 13 Flush cannula with 5-10mls 0.9% Sodium Chloride in a 10 ml syringe Step 14 Secure the cannula with appropriate Trust potential risk of cross infection. Potential Risks if step 3 not done or Potential Risks if step 4 not done or Decontamination of the skin prior to cannula insertion will minimize the risk of systemic bacterial infection. Potential Risks if step 5 not done or Potential Risks if step 6 not done or Potential Risks if step 7 not done or Potential Risks if step 8 not done or Potential Risks if step 9 not done or Potential Risks if step 10 not done or Minimizing blood spillage. Potential Risks if step 11 not done or Risk of needle stick injury Potential Risks if step 12 not done or Close system technique and so as potential risk of bacterial infection can be avoided. Potential Risks if step 13 not done or Maintaining patency of the device and minimizing potential occlusion. Potential Risks if step 14 not done or Page 7 of 24 V1.0

recommended IV dressing. Step 15 Document the procedure on the Peripheral Vascular Access Documentation (PVAD) form or Vital Pac and document how many attempts and any bruising on insertion Potential Risks if step 15 not done or As part of monitoring compliance and assessment tool in early detection of any signs of complications. Step 16 No pre signed or pre stamped photocopied PVADs are acceptable. Potential Risks if step 16 not done or 5. Equality and Human Rights Statement Both IV Team Lead Nurses and or IV Nurse Specialist Nurses/Practitioners will conduct teaching sessions via Learning and Development as an in house training on alternate basis. It comprises of the legal aspect of the practitioner, infection prevention and control, health and safety measures, anatomy and physiology of the veins, arteries and nerves, site selections and cannulation techniques. The candidate will be provided with monitoring compliance documents and a contract to carry out cannulation procedure. 6. Training It is imperative that the candidate will practice and complete the record supervised practice and submit the completed form to IV Team Lead at EDGH site to enter in the ESR. It is advisable that the professionals who are skilled with their practice will attend every three years updates. 6.1. In-house training The Trust currently provides an in house training conducted by the IV Team Lead and IV Specialist Practitioner with the manufacturers support. The benefits of this synthesised approach are that practitioners receive training which complies with both (MHRA) Medicines and Healthcare Products Regulatory Agency and manufacturer s instructions together with current evidence based practice guidance from the Department of Health. 7. Monitoring Compliance with the Document Audit carried out by the IV team in collaboration with ICLF basing on the PVAD and Vital pack. In the event of a vascular access device related bacterial infection a root cause analysis will be carried out by the IPC nurse specialist together with the IV nurse specialist practitioners. Training and education competencies should be monitored by ward matrons or equivalent to make sure that staff are up to date with intravenous cannulation skills. Taking data from learning and development the number of competencies entered into ESR on annual basis. Page 8 of 24 V1.0

Monitoring Table Element to be Monitored Potential source of infection Needle stick Adhering to best practice Lead IV Team/IPC Tool for Monitoring RCA, audit and report Frequency On going On occurrence Every 3 years updates Responsible Individual/Group/ Committee for review of results/report Occupational Health Team Learning and development Responsible individual/ group/ committee for acting on recommendations/action plan Responsible individual/group/ committee for ensuring action plan/lessons learnt are Implemented IV Team and IPC Ward matrons, unit managers or equivalent Page 9 of 24 V1.0

8. References epic3: (2014) National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. DH. 2001. Standard principles for preventing hospital-acquired infections. Journal of hospital infection 74 (supplement), S21-S37. (111). DH. 2002. Reference guide to consent for examination or treatment. London: DH. (111) Dougherty. L. 2000. Venepuncture. In Mallet,J and Dougherty, L. The Royal Marsden manual of clinical nursing procedures. 5 th ed. Oxford: Blackwell Science. (111). ICNA. 2003. Reducing sharps injury- prevention and risk management, Infection Control Nurse Association. February. (111). MDA. 2000. Single use medical devices: Implications and consequences of reuse DB 2000 (04) (111). 2 nd ed, London: Bailiere Tindall NICE. 2012. Infection control: prevention of healthcare-associated infection in primary and community care (clinical guidelines 2). London: NICE. (1) NMC. 2004. Guidelines for records and record-keeping. London: NMC. (111). NMC. 2004a Guidelines for the administration of medicines. London: NMC. (111) NMC. 2004b. Code of professional conduct. London: NMC. (111) Rowley. S 2001 Aseptic Non Touch Technique (ANTT) Nursing Times Feb 15 th Vol 97 No 7 2001: Infection Control Supplement V1-V111 RCN. 2011. Standards for infusion therapy. London:RCN Woodward.S. 2004 Achieving a safer health service: Part 1. Making safety a way of life. Professional Nurse 19 (5): 1 st Jan 2009 Links to; www.nmc.org.uk www.nice.org.uk Page 10 of 24 V1.0

Appendix A - Multi-Professional Intra-venous Cannulation of Adult Patients- Learning Outcomes Competency Based Assessment Tool This list of key competencies is designed as a tool for the designated assessor who will supervise and assess individual practitioners. The Practitioner is required to pass each of the identified competencies in order to complete their assessment and be deemed competent to practice independently. Key: C-Clinical, P-Professional Performance Criteria-Knowledge, Skills and Attitudes 1. Training and Specific Knowledge The practitioner 1a. Has attended the relevant mandatory training session P 1b. Demonstrates relevant knowledge of Anatomy and Physiology of the C arms, hands, feet, vascular and integumentary systems 1c. Demonstrates knowledge of appropriate cannula selection including C gauge/flow rates etc. 1d Demonstrates knowledge of correct usage of disposable tourniquet C 1e Demonstrates knowledge of site assessment tools including Vascular C Infusion Phlebitis Score and Infiltration Scale 2. Role of the practitioner 2a. Demonstrates a flexible and adaptable approach to their work P 2b. Understands the need to maintain and develop working practice in line P with Code of Professional Conduct (NMC 2015) or relevant professional body 2c. Understands the importance of liaison and co-operation with other P members of the multi-disciplinary team 3. Accountability, Behaviour and Attitudes The practitioner 3a. Understands and observes patient confidentiality P 3b. Communicates and cares for patients in a professional manner P 3c. Understands the need to seek consultation following a second P unsuccessful attempt to perform intra-venous cannulation 3d. Has an awareness of the implications surrounding accountability issues P and consent of patients and an awareness of the mental Capacity Act 2005 3e. Demonstrates care and sensitivity to patients throughout the procedure to P ensure minimal discomfort and anxiety 3f Demonstrate non judgemental attitude to patients with mental/physical disability and treat patients with utmost respect regardless of age, race, religious belief, gender and sexual orientation. 4. Infection Control and Risk Management (including Health and Safety) The practitioner 4a. Understands ESHT universal precautions policy and other relevant P infection control policies and guidelines 4b. Understands ESHT sharps injury policy P 4c. Understands the need for effective hand hygiene techniques, the use of C gloves and other Personal Protective Equipment (PPE) as appropriate 4d. Demonstrates an effective sterile non touch technique during intra-venous cannulation procedure C Page 11 of 24 V1.0

4e. Demonstrates effective skin preparation techniques and understands the C importance of appropriate skin preparation 4f. Can state the correct procedure in the event of blood spillage in line with C Trust policy 4g. Can demonstrate the correct use of the tourniquet and the risks C associated with incorrect use 4h. Disposes of materials and sharps safely in adherence with ESHT policy C 4i. Demonstrates knowledge of cannula in-dwell times and records C information relating to cannula insertion in line with RCN Standards for Infusion Therapy (2005). 4j. Can discuss the risks and hazards/complications of IV cannulation and C take appropriate action 4k. Recognises when it is inappropriate to perform IV cannula insertion and C seeks assistance where necessary 4l. Demonstrates knowledge of Trust Incident Reporting procedure P 5. Intra-venous cannulation procedure The practitioner 5a. Demonstrates correct identification of the patient in accordance with P ESHT policy 5b. Obtains appropriate consent prior to performing procedure P 5c. Prepares patient and performs assessment as appropriate including C assessment of the patients veins 5d. Selects and prepares the correct equipment for the procedure C 5e. Demonstrates clean and safe skin preparation and the application of local C and topical anaesthetics where prescribed 5f. Applies and releases single use only disposable tourniquet correctly C 5g. Performs intra-venous cannula insertion safely in accordance with the C manufacturers instructions 5h. Secures cannula,` dates and dresses the site appropriately C 5i. Obtains venous samples from cannula only on insertion in line with RCN C Standards 2011 5j. Flushes cannula with 0.9% Sodium Chloride and administer correct C volume (5 10 mls) using pulsated push-pause and positive pressure method using a 10 ml syringe 5k. Despatches venous samples to the laboratory in adherence with Trust C policy and procedure 5l. Document procedure correctly on the PVAD document in patient s P prescription chart 5m. Uses needle-less connectors and needle free systems as appropriate in C line with manufacturers instructions 5n. Is aware that only one single use cannula shall be used for each C cannulation attempt 5o. Performs removal of IV cannula in adherence with RCN Standards, applies the appropriate occlusive dressing and records in patient s notes and on the PVAD form C 6. Effective Troubleshooting and Risk Management 6a. States the correct procedure for managing severe bruising or haematoma C 6b. Understands how to recognise and manage a punctured artery C 6c. Is able to recognise and manage a collapsed vein C 6d. Is aware of the differences between infiltration and extravasations and C knows the appropriate action to take in relation to both incidents 6e. Is aware of the implications of nerve contact C Page 12 of 24 V1.0

6f. Understands how to encourage venous filling C 6g. Is able to recognise the signs and symptoms of phlebitis and take C appropriate action 6h. Is aware of the need to carry out regular site observations in line with C RCN Standards using the appropriate assessment tools 6i. Is able to confirm patency and take appropriate action in the event of transfixation or occlusion C Page 13 of 24 V1.0

Appendix B - Application to undertake cannulation training Application to undertake cannulation training Please print the following details Date requested : Venue: Name: Role Title: Clinical Area and Division: Line Manager/Clinical Matron: Candidates responsibilities: I agree to undertake all the required cannulation competency following attendance of the above practice and theory study session, and complete this within 5 month period following the training session date. Line Manager responsibilities: I agree to provide advice, help and support for the above applicant to achieve all the required cannulation competency. I agree to liaise with practitioners competent in cannulation in my clinical area, and members of the IV Team to support competency for the above named applicant Signature of Candidate. Date Signature of line Manager/ Clinical Matron Date Copy to be kept by Applicant Copy to be kept by Clinical Matron Copy to be kept by Cannulation Trainer Please send or email completed forms to: Workforce Development, Duncan House, Eastbourne, DGH BN21 2UD Fax : 01323 438239 Page 14 of 24 V1.0

Appendix C - Intravenous Cannulation Procedure Competency Assessment Record Intravenous Cannulation Procedure Competency Assessment Record (Part One) Record of supervised practice Name: Ward/Unit: Theory session date: Hosp/Dept: Date: Signature of Trainer: Designated Supervisor: The section below should be used to maintain a record of the practitioner s skill on intravenous cannulation. It should be completed for every occasion when the relevant skill is performed throughout the competency assessment phase. According to Trust guidelines the practitioner should undertake five observations with their assessor/mentor together with a minimum of ten supervised practical procedures prior to verification of competency to be recorded on parts one and two of the Trust s Competency Based Assessment record. A copy of the completed records should be held in the practitioner s file within the department and one copy should be sent to the IV Team Lead Nurses on the appropriate site for entry on to the Trust s database. The original records should be held within the practitioners PDP. Practitioners who have not performed this procedure within the last twenty-four months will undertake a further Competency Based Assessment authorised by a designated supervisor, together with ten practical cannulation procedure assessments recorded using the Trust records (parts one and two). The practitioner should be able to provide sufficient evidence that they are maintaining their skills and this will be reviewed during their annual appraisal at the discretion of their manager. Page 15 of 24 V1.0

1 DATE Procedure Details (Site/ Gauge /Age of Patient/ other relevant information) Comments Witnessed by Assessor/Mentor (Print) 2 3 4 5 6 7 8 9 10 Page 16 of 24 V1.0

Name: Ward/Unit: Theory session date: Hosp/Dept: Date: Signature of Trainer: Designated Supervisor: Competency Statement: The practitioner will be able to consistently demonstrate competence in both clinical and theoretical knowledge regarding safe practice, technical skills and rationale for procedure in the use of cannulation procedures. The aim of this competency is to provide consistency in conjunction with a high standard of knowledge and practical skills across ESHT. Evidence of competence: Practitioners must be able to provide evidence to support claims of competence. This evidence may take a number of forms including: 1. Supervision/observation conducted by other competent practitioners. 2. Supervision/observation conducted by the Designated Supervisor. 3. Learning logs of practice/procedures undertaken. 4. Reflective journals. I confirm that the practitioner has Undertaken the minimum supervised procedures required Completed the relevant written documentation Is competent to perform intravenous cannulation without further supervision. Signature of supervisor: Print Name: Date: I feel competent in performing this procedure. Having received relevant training and completed the appropriate written documentation successfully, I accept full accountability for my own practice and have discussed this role with my supervisor. Signature of Practitioner: Print Name: Date: Performance Criteria-Knowledge, Skills and Attitudes. Signature of Supervisor Date achieved 1. Training and Specific Knowledge The practitioner: a. Has attended the relevant mandatory training session b. Demonstrates relevant knowledge of Anatomy and Physiology of the arms, hands, vascular and integumentary systems c. Demonstrates knowledge of appropriate cannula selection including gauge/flow rates etc Date of reassessment: Page 17 of 24 V1.0

d. Demonstrates knowledge of site assessment tools including Vascular Infusion Phlebitis score and Infiltration score 2. Role of the Practitioner a. Demonstrates a flexible and adaptable approach to their work: b. Understands the need to maintain and develop working practice. c. Understands the importance of liaison and co- operation with other members of the multidisciplinary team. 3. Accountability, Behaviour and Attitudes The Practitioner: a. Understands and observes patient confidentiality b. Communicates and cares for patients in a professional manner c. Understands the need to seek consultation following a second unsuccessful attempt to perform intravenous cannulation d. Has awareness of the implications surrounding accountability issues and consent of patients. e. Demonstrate non judgemental attitude to patients with mental/physical disability and treat patients with utmost respect regardless of age, race, religious belief, gender and sexual orientation Performance Criteria-Knowledge, Skills and Attitudes. Signature of Supervisor Date achieved Page 18 of 24 V1.0

4. Infection Control and Risk Management (including Health and Safety) The Practitioner: a. Understands the ESHT universal precautions policy and other relevant infection control policies and guidelines b. Understands ESHT needlestick injury policy c. Understands the need for effective hand-washing techniques, the use of gloves and any other Personal Protective equipment (PPE) as appropriate d. Demonstrates an effective aseptic non touch technique during intravenous cannulation procedure e. Demonstrates effective skin preparation techniques and understands the importance of appropriate skin preparation f. Can state the correct procedure in the event of blood spillage in line with Trust policy g. Can state the correct use of the tourniquet and the risks associated with incorrect use h. Demonstrates knowledge of cannula in-dwell times and records information relating to cannula insertion in line with RCN Standards for Infusion Therapy (2003) i. Can discuss the risks and hazards/complications of IV cannulation and drug administration and take appropriate action j. Recognises when it is inappropriate to perform IV cannula insertion and seeks assistance where necessary: k. Demonstrates knowledge of Trust Incident Reporting procedure 5. Intravenous cannulation procedure The Practitioner: a. Demonstrates correct identification of patient in accordance with ESHT policy b. Obtains and records appropriate consent before procedure c. Is able to prepare patient and perform assessment as appropriate including assessment of patients veins d. Is able to prepare the correct equipment for the procedure e. Is able to demonstrate clean and safe skin preparation and the application of local and topical anaesthetics where prescribed Page 19 of 24 V1.0

Performance Criteria-Knowledge, Skills and Attitudes Signature of Supervisor Date achieved f. Is able to apply and release tourniquet correctly g. Is able to perform intravenous cannula insertion safely in accordance with the manufacturers instructions h. Is able secure cannula and apply appropriate dressing i. Is able to safely obtain venous samples from the cannula only on insertion in line with RCN Standards 2003 j. Is able to flush cannula with appropriate prescribed solution and administer correct volume using pulsated push-pause and positive pressure method k. Is able to despatch samples to the laboratory in adherence with Trust policy and procedure l. Is able to administer flush according to RCN Standards 2003 m. Documents procedure correctly on the PVAD form n. Uses needless connectors and needle free systems as appropriate in line with manufacturers instructions o. Is aware that only one single use cannula shall be used for each cannulation attempt p. The practitioner will remove the intravenous cannula in adherence with RCN Standards, applies appropriate occlusive dressing and records on PVAD 6. Effective Troubleshooting, Risk Management and general cannula care The Practitioner: a. Is able to state the correct procedure for managing severe bruising or haematoma b. Is able to understand how to recognise and manage a punctured artery c. Is able to recognise and manage a collapsed vein d. Is aware of the implications of nerve contact e. Understands how to encourage venous filling f. Is aware to carry out regular site observation in line with RCN Standards using the appropriate assessment tools g. is able to confirm patency and take appropriate action in the event of transfixation or occlusion Page 20 of 24 V1.0

Appendix D DEHRA Form Equality and Human Rights Analysis (EHRA) Full guidance is included at the end of this form or by clicking the Help links Help Title(s):Multi Professional Practice Guidelines for Peripheral Intravenous Cannulation Competency Aims / Objectives: It is likely that patients admitted to hospital will need to have an insertion of peripheral intravenous cannula or vascular access device for the delivery of treatment and so as for diagnostic purposes. Increasingly the insertion of peripheral cannula is being delegated to key component practitioners including registered nurses, midwives, radiographer operating department practitioners, IV Team support practitioners staff to ensure that patients receive timely and effective treatment. Completion Statement: I have reviewed the evidence with rigour and an open-mind and am satisfied there has been due regard to the need to eliminate discrimination; advance equality of opportunity and foster good relations, and there is compliance with Section 149 of the Equality Act 2010. Analysis Lead(s) Sign-off: Ignacio Atillo Date: 01/05/2012 Quality Assessor (Office Use): Equality Duty Impacts Help Describe how the work may impact people with particular protected characteristics positively or negatively to meet the three aims (a-c) of the Equality Duty. If the work is not relevant, explain why. Write in the spaces below referencing any evidence e.g. clinical guidance / research; admission / incident data; patient / staff engagement. Describe who is impacted (e.g. young carers with learning difficulties) and classify the protected characteristics putting an X in the boxes (e.g. Age and Disability and Carers ) I.D. a. Eliminate discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act Describe how the work protects people from less favourable treatment or being disadvantaged by the Trust because of their characteristics In order to protect patients with special needs, patients who can not give verbal consent, and patients with mental and physical disability. Getting involved and giving information to the patients carer regarding patients treatment and progress. Treating patient equally regardless of colour and ethnic background. Patients with English as second language or unable to communicate in English that will require an interpreter to send the message across and will gain consent and compliance. Protected characteristics (Mark X) Age Disability and Carers Gender Reassignment Pregnancy & Maternity X Race X Religion or Belief Sex Sexual Orientation + Insert more rows if necessary Page 21 of 24 V1.0

b. Advance equality of opportunity between people with different characteristics Describe how the work: Addresses disadvantage suffered by those people (e.g. access / outcomes) Meets the different needs of those people (e.g. within assessment and care) Encourages participation where it is disproportionately low (e.g. therapies) Challenging and difficult situation such as dealing with paediatric patients regarding gaining consent, child behavioural traits should be considered and so as child s parents or carer who are dealing with anxiety. Very interesting subject of argument as some treatments could be tailored for a specific biological origin basing on some blood test or dose for treatments. Protected characteristics (Mark X) Age X Disability and Carers Gender Reassignment Pregnancy & Maternity X Race Religion or Belief Sex Sexual Orientation Treating patient as a human being and non judgemental regardless of sexual references and orientation. X + Insert more rows if necessary c. Foster good relations between people with different characteristics Describe how the work: Tackles prejudice (e.g. therapist training to increase cultural competency) Promotes understanding (e.g. nursing guidance on different patients needs) Staff should treat patients in a professional manner and maintains patients dignity. Protected characteristics (Mark X) Age Disability and Carers Gender Reassignment Pregnancy & Maternity Race Religion or Belief Sex Sexual Orientation + Insert more rows if necessary Monitoring Arrangements Help Describe how and when the work (and any impacts) will be monitored: (e.g. annual policy / incident data review) Every 3 years. Human Rights Help Describe how the work promotes human rights values of: Fairness, Respect, Equality, Dignity and Autonomy: A practitioner/clinician will undertake the task should treat patient with utmost respect regardless of age, race, religious belief, disability (mental/physical), sex and sexual orientation, and should maintain patients dignity. Staff should be given the opportunity to perform the procedure regardless of the above mentioned, provided that they have been trained and signed as competent and following the Trust policy. Mark X where the work impacts potentially positively and / or negatively on a person s rights + Article.2Right to life (e.g. Pain relief, DNAR notices, staff competency, suicide prevention) Article.3Prohibition of torture, inhuman or degrading treatment (e.g. Informed consent) X Page 22 of 24 V1.0

Mark X where the work impacts potentially positively and / or negatively on a person s rights + Article.4Prohibition of slavery and forced labour (e.g. Safeguarding trafficked people) Article.5Right to liberty and security (e.g. Deprivation of liberty protocols, security policy) Articles.6-7Rights to a fair trial; and no punishment without law (e.g. Legal services policy) Article.8Right to respect for private and family life, home and correspondence (e.g. Confidentiality, records, patient letters, patient visitors or staff leave) Article.9Freedom of thought, conscience and religion (e.g. Last offices, prescribing, uniform) Article.10Freedom of expression (e.g. Patient information or whistle-blowing policies) Article.11Freedom of assembly and association (e.g. Trade union recognition) Article.12Right to marry and found a family (e.g. Fertility, maternity services) Article.14Prohibition of discrimination with respect to human rights (e.g. Illiteracy and Article 8) Protocol.1.A1 Protection of property (e.g. Patient property, last offices policies) Protocol.1.A2 Right to education (e.g. Staff crèche or student nurse agreement policies) Protocol.1.A3 Right to free elections (e.g. Foundation Trust elections) Outcome Help Complete this section and copy it into the: Policy Ratification Cover Sheet or Trust Board Front Sheet Mark with an X the outcome(s) of this analysis (A-D), then explain the reasons why and score any risk: A. Continue the work Reasons: B. Change the work X Added in the Competency Assessment Tool, under accountability, behaviour and attitude. C. Justify and continue the work Professional Demonstrate non judgemental attitude to patients D. Stop the work with mental/physical disability and treat patient with utmost respect regardless of age, race, religious beliefs, gender and sexual orientation. Consequence score: 1 x Likelihood score: 1 = Equality and Human Rights Risk Score: 1 X Equality and Human Rights Improvement Plan Help Identify any actions (including dates, leads and related plans) to address the findings from this analysis: Remove any unlawful discrimination or human rights interferences Advance equality of opportunity for people with protected characteristics: 1.1..1. Remove or minimise disadvantage; meet people s different needs and encourage participation 1.1..2. Take account of disabled people s disabilities where their needs are different Foster good relations (tackle prejudice and promote understanding) Actions (Reference the findings within previous sections to show cause and effect) Target Date Lead Person Which action plan will this be built into? Page 23 of 24 V1.0

Actions (Reference the findings within previous sections to show cause and effect) Target Date Lead Person Which action plan will this be built into? 7.1 Promote diversity and tolerance. 7.2 Treat patients with utmost respect and maintains patients dignity. 7.3 7.4 + Insert more rows if necessary Append this form to the main paperwork. Once approved or ratified send it to equality@esht.nhs.uk Page 24 of 24 V1.0