Download Protocol for the administration of Hydroxocobalamin

Your Surgery Name
Protocol for the Administration of Hydroxocobalamin (B12) to
adults
by Health Care Assistants (HCA)
Purpose of Protocol
To enable suitably trained Health Care Assistants working within Your surgery name
who have undertaken relevant training (as outlined below), to administer
hydroxocobalamin as a duty delegated by the General Practitioner (GP employer) or
registered nurse (PCT employee).
Characteristics of staff
Staff group (s)
Health Care Assistants
Additional Requirements
Completion of relevant training (as
outlined below)
Knowledge of PCT policy on
management Anaphylaxis in the
Community and basic life support.
Training and competence in the correct
procedure of administering medication
via intra-muscular injection.
Continuing Training Requirement
Annual updates in Basic Life Support and
1 yearly updates in the treatment of
Anaphylaxis.
Demonstration of competence in relation
to this medication within the PDP and
appraisal process.
Clinical Condition
Clinical Condition to be treated
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Megaloblastic anaemias –lack of B12 due
to:
o Food – Cobalamin malabsorption
(i.e. dietary deficiency)
o Cobalamin malabsorption (e.g.
total gastrectomy, Crohn’s
disease, Coeliac disease,
Whipple’s disease, chronic
pancreatitis, TB etc.)
Pernicious anaemia – lack of gastric
intrinsic factor resulting from
autoimmune gastritis.
Drug induced - ( e.g. Prolonged nitrous

oxide anaesthesia etc)
Hereditary Cobalamin Metabolism
diseases (Congenital Transcobalamin II
Deficiency etc)
Criteria for inclusion
Any adult (i.e. any person aged 18 years
or over) who has received first dose
following diagnosis and now requires
maintenance doses.
Criteria for exclusion
Patients with an unconfirmed diagnosis
of pernicious or other macrocytic
anaemia.
Recently diagnosed patients who are
receiving the initial two weeks of
treatment.
Any person less than 18 years of age.
Adverse reactions
Health Care Assistants must ensure the availability of an Anaphylaxis shock pack
containing Adrenaline 1:1000.
If a general adverse reaction does occur:
 Record in patient’s notes
 Inform patient’s General Practitioner as soon as possible
 Local reactions should be seen by either the general practitioner or practice
nurse or qualified Registered Nurse within the district nursing team.
If anaphylactic reaction occurs
 Give treatment in accordance with the PCT policy on the Management of
Anaphylaxis in the community, including ensuring patient is transferred to
Accident and Emergency.
 Record in patient’s notes
 Inform patient’s General Practitioner as soon as possible
Relevant training
1) The Health Care Assistants will attend a training session covering the following
aspects of the administration of hydroxocobalamin
 Appropriate anatomy and physiology
 Correct procedure for the administration of hydroxocobalamin by
intramuscular injection
 Drug store requirements
 Cautions and side effects related to the administration of hydroxocobalamin
 Documentation
 Legal aspects of drug administration
2) The Health Care Assistant will have successfully completed and passed the
Injection Training Course.
This includes an assessment of competence at
performing basic life support and underpinning knowledge of consent issues.
3) The HCA will undergo a period of supervised practice and to be directly observed
administering 5x intramuscular injections of hydroxocobalamin either by the general
practitioner or the practice nurse (GP employee) providing this duty has been
delegated in writing by the general practitioner or by a registered nurse (if employed
by Croydon PCT).
Assessment of competence
Assessment of competence will be undertaken following the period of supervised
practice as outlined above. In the GP Practice, this will be undertaken by the general
practitioner (or by the practice nurse providing that this duty has been delegated in
writing) in order to comply with the specific requirements of the company providing
medical indemnity. If employed by the Croydon PCT, assessment of competence will
be undertaken by an occupationally competent registered nurse.
Competence will be assessed by direct observation of the HCA’s ability to:
 Prepare the patient for the procedure
 Safe administration of the medication (including choice of site and needle
technique)
 Correct disposal of clinical waste
 Correct documentation
The Health Care Assistant will also be assessed (via oral questioning) on issues
relating to the therapeutics of hydroxocobalamin.
Clinical Aspects
The following will be required:
1. Patient specific direction – written by the General Practitioner or other
authorised prescriber
2. Patient identification - required prior to the administration of medication
(confirmed by the patient declaring his or her name, date of birth and home
address).
3. Consent – informed consent must be obtained from the patient.
4. Record keeping – The following should be recorded in the patient’s notes,
either according to the GP practice system, or within the district nursing
documentation drug administration records
 Name of drug, dose route and site of administration
 Date administered
 Batch No and expiry date
 Signature of person administering
Significant Events
Any significant event which occurs during or as the result of administration of
medication must be reported to the Practice Manager/General Practitioner (GP
employee) or Registered Nurse/Manager (PCT employee), and the incident reported
via the PCT significant event reporting framework.
Audit: The HCA will be expected to participate in audit in relation to patient
outcomes and the development of this role.
The HCA must be familiar with the following documents or own PCT equivalent:
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Your CCG Medicines Policy
Your CCG Consent Policy
Your CCG Records Management Policy
Your CCG Adverse Incident/Reporting & Managing Policy
NMC Standards for Medicine Management
This protocol has been revised by Francina Hyatt, Clinical Nurse Trainer and
Barbara Adie Principle Pharmacist
Acknowledgement is given to the following people from Salford PCT
Mrs Barbara Jackson
Workforce Modernisation Co-ordinator
Ms Sue Harris
Non-medical Prescribing Lead
Review:
It is the responsibility of the lead of the staff group (s) to whom this protocol
applied to ensure the review process takes place.
This protocol becomes valid on 1st February 2016
Protocol for Hydroxocobalamin
Agreement for Health Care Assistants
This protocol is to be read, agreed and signed by all Health Care
Professionals it applies to:
Approved base:
__________________________________
Staff Name:
__________________________________
Designation:
__________________________________
Signature:
__________________________________
Date:
__________________________________
Signature of Team __________________________________
Leader:
Date:
__________________________________
The Health Care Professionals should retain a copy of the document after
signing and the original retained in their personal file.
Expires 1st February 2018
Protocol for Hydroxocobalamin
Agreement for Health Care Assistants
This protocol is to be read, agreed and signed by all Health Care Professionals it
applies to:
Practice:
__________________________________
Staff Name:
__________________________________
Designation:
__________________________________
Signature:
__________________________________
Date:
__________________________________
Approved by
Lead GP:
__________________________________
Date:
__________________________________
The Health Care Professionals should retain a copy of the document after signing
and the original retained in their personal file.
Expires 1st February 2018
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