COMPETENCIES MCKINLEY SYRINGE DRIVER COMPETENCY FOR THE THEORY AND PRACTICAL ASSESSMENT FOR REGISTERED NURSES (REGISTERED NURSES UPDATE EVERY TWO YEARS)
New Registered Nurses to the Trust COMPETENT TO BE LEAD NURSE: New registered nurses must be competent to be a lead nurse for setting up a syringe driver within 6 months of joining the organisation and have completed the following: Registered nurse to complete self assessment of theoretical syringe driver competency Registered nurse to complete syringe driver numeracy test and 100% pass rate is required Team Leader/ Senior Nurse Practitioner to assess practical aspect of setting up a syringe driver at base Team leader/senior Nurse Practitioner and nurse to sign off syringe driver competency to confirm nurse is competent SECOND CHECKER FOR SYRINGE DRIVER COMPETENCY All new registered nurses to the Trust can be a second checker as follows: Have had a completed local Induction From one month of joining the organisation With a named preceptor for support as required SUBSTANTIVE BANK STAFF Substantive bank staff can set up a syringe driver following completion of syringe driver competencies and be a second checker BANK STAFF Can only be a second checker SYRINGE DRIVER COMPETENCY Registered Nurses currently working for the Trust COMPETENT TO BE LEAD NURSE: Registered nurse to complete theoretical aspect of syringe driver competency every two years Registered nurse to complete syringe driver numeracy test every two years a 100% pass rate is required Team Leader/ Senior Nurse Practitioners to assess practical aspect of setting up a syringe driver every 2 years at base for all registered nurses in the team Team leader/senior Nurse Practitioner and nurse to sign off syringe driver competency to confirm the nurse is competent TEAM LEADERS To peer assess each other to confirm competence of syringe driver competency, and to monitor competence of the team SENIOR NURSE PRACTITIONERS Team Leader to assess Senior Nurse Practitioner to confirm competence of syringe driver competency every 2 years including practical assessment at base Page 2 of 13
The self-rating scale is to be used by the individual practitioner for self assessment of present performance and to help identify any learning needs prior to completion of assessment. Key for Self-Assessment 1 = No knowledge / novice 2 = some knowledge / experience 3 = Competent (minimum expected level of every registered nurse) 4 = Proficient 5 = Very experienced and able to teach others I confirm that I have self-assessed and successfully passed the theory, practical and numeracy test for syringe driver competencies and competent to manage the care of patients requiring a syringe driver Practitioner Full Name Practitioner Base... Job Title Practitioner Signature Date: I confirm I have assessed the above named nurse has successfully passed the theory, practical and numeracy test for McKinley syringe drivers Assessor Name... Signature... Base... Date:... MANDATORY COPIES REQUIRED FOR: - 1. Personal Portfolio 2. Personal File (Whole copies of part one and two) It is the individual nurse s responsibility to maintain and work within this competency, every two years. It is the line manager s responsibility to monitor compliance at Personal Development Reviews and at Managerial Supervision. UPDATES:- Competency is mandatory if practitioner:- Is delivering nursing care to a patient requiring this intervention Has been on long term sickness absence or maternity leave e.g. over 6 months Has identified the need for an update as part of own continuing professional development Has not completed an update within the last two years and needs to care for a patient requiring this treatment Has had this topic identified as a developmental need following a clinical incident investigation or Root Cause Analysis Page 3 of 13
When did you complete your medicines 1 management competency? If not completed what is the expected date of completion? 2 3 4 5 6 7 8 How often do you need to complete the theoretical and practical aspect of the syringe driver competency? Have you successfully completed part two the numerical component of the syringe driver competency? Define the roles of the two nurses when setting up /re-priming a syringe driver and recording the administration? Which type of syringe driver is used within Wirral Community NHS trust? Where would you locate the operator s manual? Identify the relevant documentation required for setting up syringe driver and for checking syringe driver site Identify relevant policies, procedures and SOPs relating to controlled drugs, syringe drivers and incident reporting? Key for Self-Assessment 1 = No knowledge/ novice 2 = some knowledge / experience 3 = competent / 4 = proficient / 5 = very experienced and able to teach others Page 4 of 13
How often does the Patients Medicines 9 Administration Chart (PMAC) need to be rewritten for controlled drugs? 10 11 12 13 14 15 16 How often does the PMAC need to be rewritten for all other drugs (with the exception of Hydroxocobalamin)? How often must the syringe driver checklist be completed? What would you do if you suspected the syringe driver was malfunctioning? How often should a syringe driver be serviced? Where would you send the syringe driver for servicing? What documentation would you need to complete to accompany the syringe driver when sending for servicing? What measures can you put in place for the safe storage of controlled drugs in the patient s home? When counting and checking stock levels of medicines in the home, do you need to open and count the ampoules in unopened boxes? Key for Self-Assessment 1 = No knowledge novice 2 = some knowledge experience / 3 = competent 4 = proficient 5 = very experienced and able to teach Page 5 of 13
What would you do if you discovered the seal 17 on the envopak bag was broken? Or discrepancies in the stock of controlled drugs? 18 19 20 21 22 23 24 Where would you store additional tags for envopak bags in the patient s home? What are the indications/criteria for administering drugs via a syringe driver? What patient information would you give to patients and carers regarding the use of a syringe driver? If a registered nurse had not completed the syringe driver competency can the nurse be a second checker? Who would you contact for advice regarding medication used for symptom management in normal working hours and out of hours? What advice would you give a patient/carer regarding safe disposal of controlled drugs from the home? Would you set up a syringe driver for a patient in a nursing home if nursing home staff were not competent to do so? Page 6 of 13
If you did set up a syringe driver in a nursing 25 home what documentation would you need to complete? 26 27 28 29 30 31 32 Can registered nurses in nursing homes administer as required medication or rescue doses for patients? What is the procedure for checking and administering drugs via cannula? How many staff does this procedure require? Where would you document the amount of flush required for flushing a butterfly? Where would you be able to seek opioid conversion ratios from oral medicines for subcutaneous route? When medicines are prescribed for anticipatory prescribing, should the patient be prescribed a sliding scale? When setting up a syringe driver using a sliding scale what dose is normally recommended to start at? What are the maximum number of drugs that can be safely mixed in a syringe driver? Page 7 of 13
If a patient has a Fentanyl patch and requires 33 a syringe driver for breakthrough doses of analgesia, does the patch remain insitu? 34 35 36 37 38 39 40 For a patient with a fentanyl patch in situ and is also receiving opioids via a syringe driver; how is any increase in the syringe driver dosage calculated? Describe how to titrate the dose of analgesia for a syringe driver when a patient has received additional doses of as required analgesia? When using cyclizine either alone or in combination with other medicines what diluent should you use Are you aware of the different reasons for using water for injection or sodium chloride as a diluent with diamorphine in a syringe driver What diluent would you use for a syringe driver or for as required doses when using medicines other than cyclizine and diamorphine greater than 40mg/ml? When drawing up as required doses of medication for symptom management what is the usual size of syringe to be used? What symptoms are levomepromazine prescribed for and what is one of the main side effects of levomepromazine? Page 8 of 13
What is midazolam prescribed for and what is 41 the usual starting dose for a syringe driver? 42 43 44 45 46 47 48 What symptom is Glycopyrronium prescribed for and what is the usual amount prescribed for an as required dose? What type of patient is Alfentanil prescribed for? If a patient is prescribed Alfentanil for pain relief who would you contact for advice? If Alfentanil is prescribed in a syringe driver over 24 hours for pain relief, what medication is used for breakthrough pain? When Alfentanil is prescribed in a syringe driver, do you always need to seek specialist advice when calculating appropriate rescue doses of Oxycodone? List five main symptom management guidelines in the Wirral Non Renal Care of the Dying Guidelines and the main medicines recommended Would you administer stat doses at the same time as setting up syringe driver if the patient was symptomatic? Page 9 of 13
49 50 51 52 53 54 55 56 What is the maximum amount of medication and flush that can be administered via a subcutaneous cannula for as required medication? What are the exceptions for not removing the syringe driver when death is expected and the patient is on a Liverpool Care Pathway? Are you aware of the process that has to be followed if a patient dies of mesothelioma to provide the right advice for the family? In the event of a serious untoward incident, i.e. drug error or unexpected death, what actions should the nurse take? Describe how to decontaminate the syringe driver? What type and size of syringe should be used with McKinley syringe driver? Describe the correct start up sequence? Prime/load or Load/prime Describe the type of battery to be used, indications for battery change and the average battery life? Page 10 of 13
57 58 59 60 61 62 63 64 Describe the two areas in the pump where you can verify the battery life (%)? Describe the correct infusion line to be used, cannula and why priming the line is important? Describe the functions associated with the individual keys on the keypad? POWER ON AND OBSERVE PRE-LOADING Describe power on and pre loading (automatic actuator movement)? And two key functions Describe how you would align syringe to fitting area and purpose of 3 sensor areas? Describe how to start infusion and confirm the infusion is running? Describe how you would check the volume to be infused and volume infused? Describe how to apply keypad / remove keypad lock? Key for Self-Assessment 1 = No knowledge novice 2 = some knowledge experience 3 = competent 4 = proficient 5 = very experienced Page 11 of 13
What are the implications of pressing Yes and 65 No on the screen Re: yes to resume and no for new syringe? 66 67 68 Why should the infusion not be connected to the patient when placing syringe in pump? Describe how often the extension line and Saf- T-Intima cannula should be changed? Describe what events activate the alert or alarm function? 69 Describe how to access the Info menu? 70 71 72 Describe what the event log is and how it can be used? Describe what to do in the event of an infusion error or device failure, how and who to report incident too? Where would you access the Wirral Care of the Dying Guidelines? Page 12 of 13
What training is available to support 73 community nurses in the care of the dying patient and the use of syringe drivers? 74 75 What would you do if you are unable to access palliative care training? The nurse can demonstrate to the assessing nurse the process for setting up a McKinley syringe driver in the clinical setting? Page 13 of 13