Download Injection Preparation and Administration

POLICY DOCUMENT
Document Title
INJECTION PREPARATION AND
ADMINISTRATION
Reference Number
Medicines Policy Handbook / Tab 8
Policy Type
Medicines
Electronic file / location
P:Data/Word/Policies/Use of Medicines Tab
8 Injection Preparation and Administration
Intranet location
Home / policies / Procedures for the Use of
Medicines / Tab 8 Injection Preparation and
Administration
Status
Approved
Version No / Date
Author(s) Responsible for Writing and
Monitoring
Version 2 – October 2010
Version 3 – September 2013
Version 4 – September 2016
Associate Director for Nursing
Medical Director
Associate Director for Pharmacy
Approved By
Medicines Management Group
Approval Date
September 2016
Implementation Date
September 2016
Review Date
September 2019
© North Essex Partnership University NHS
Foundation Trust (2013). All Rights reserved.
Copyright
Not to be reproduced in whole or in part
without the permission of the copyright
owner
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Medicines Policy Tab 8 - Injection Preparation and Administration
Page 1 of 16
SECTION
CONTENTS
PAGE NO
8.1
Introduction
3
8.2
Scope
3
8.3
Caution
3
8.4
Preparation of Injection
3
8.4.1
Equipment Required
3
8.4.2
Single Dose Ampoule – Solution
5
8.4.3
Single Dose Ampoule – Powder
6
8.4.4
Vial – Solutions
7
8.4.5
Vial – Powder
8.5
7&8
Administration of Injection
8
8.5.1
Code of Professional Conduct
8
8.5.2
Intramuscular Injection
8
8.5.3
Needle Size
9
8.5.4
Administering to the Patient (minimum requirements)
10
8.5.5
If needle snaps in situ
11
8.5.6
Subcutaneous Injection
11
8.5.7
Long-acting intramuscular antipsychotic injections or depot
neuroleptic injections
13
(f)
Test doses
14
(g)
Adverse reaction
14
Intravenous (IV) injections / cannulae insertion
15
8.6
Monitoring
15
8.7
References
15
8.8
Compliance Monitoring
16
8.5.8
Medicines Policy Tab 8 - Injection Preparation and Administration
Page 2 of 16
8
INJECTION PREPARATION AND ADMINISTRATION PROCEDURE
8.1
INTRODUCTION
While administering medicines the nurse must meet the requirements set out in
the Administration of Medicines Policy that encompasses the principles detailed
in current Nursing & Midwifery Council Standard for Medicines Management.
Further guidance on clinical procedure please refer to The Royal Marsden Clinical
Nursing Procedures and clinical resources in the IntraNEP.
8.2
SCOPE
This procedure covers administration of injections using: •
•
8.3
Ampoules (powder and solution)
Vials (powder and solution)
CAUTION - This procedure involves the use of sharp instruments and, as such,
the procedures contained within the Trust’s Infection Control Handbook must
be strictly adhered to. Protective clothing is required when handling certain
preparations, as described in a COSHH (Control of Substances Hazardous to
Health) Manual which is kept in every unit. If in any doubt, consult with a
pharmacist.
For infection control and increased protection from needlestick injury it is
good practice to wear well disposable fitting gloves throughout the
procedure.
The EU Directive (2010/32/EU) “The prevention of sharps injuries in the hospital
and healthcare sector” came into effect in May 2013.
In line with this directive sharps products approved for use by the Trust are on the
IntraNEP under Infection Control / Sharps.
8.4
PREPARATION OF INJECTION
8.4.1
Equipment required
It is important to consider prior to administration of the injection the most
appropriate syringe to be used if not using a pre-filled syringe. As needles must
not be re-sheathed, the rule is that the injection must be administered in the
same location (i.e. clinical room) wherever possible. If this is not possible and it
is necessary to change a needle use a blunt fill needle, filter needle, or
SureGuard safety needle to draw up before attaching the needle to be used for
administration. Never carry an unsheathed needle through an inpatient area.
• Clean tray with sharps box attached (for inpatient areas) or receiver in which to
place drug and injection equipment (community)
• Needles – size dependent upon route of administration and physical build of
service user.
Medicines Policy Tab 8 - Injection Preparation and Administration
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•
•
•
•
•
•
•
•
•
Appropriate size syringe for amount of drug to be given.
Drug to be administered.
Service user’s prescription/medicines administration card.(PMAC)
Appropriate diluent (if required, e.g. sterile water).
Gloves
Controlled Drug Recording Book if necessary.
Sharps box (community)
Alcohol swabs/wipes
Ampoule breaker (most modern ampoules should not require an ampoule
breaker)
• Specific needles and syringes if supplied with the product
(a)
Action
Collect and check all equipment.
Rationale
To prevent delays and enable full
concentration on the procedure.
To ensure sterile and in date.
(b)
Check that all equipment packaging is
intact. If seal is damaged, discard.
(c)
Wash your hands/use alcohol gel.
To remove transient organisms.
(d)
Prepare needles and syringe(s) on the
tray/receiver and inspect all
equipment.
Check all details with another
registered nurse when the nature of the
drug demands it.
Consult the service user’s
prescription and administration of
medicines card and ascertain the
following:
To check for damage.
(e)
(f)
To minimise any risk of error.
To fulfil any legal requirements.
To ensure that the service user is
given the correct drug in the prescribed
dose, using the appropriate diluent and
by the correct route, and that the
prescription is valid.
•
•
•
•
•
(g)
Service user’s name
Allergies
Drug
Dose
Date and time of administration/
previous administration
• Route and method of
administration
• Diluent as appropriate
• Validity of prescription
• Doctor’s signature
Select the drug, and diluent if
necessary, checking the expiry date.
Put on gloves Proceed with the
preparation of the drug as injection.
Refer to package insert for preparation
if necessary or contact the pharmacy.
The expiry date indicates when a
drug may be no longer pharmaceutically
effective.
Medicines Policy Tab 8 - Injection Preparation and Administration
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8.4.2
Single Dose Ampoule – Solution
(a)
Action
Inspect the solution for
contamination.
Rationale
To prevent the service user receiving
an unstable or contaminated drug.
(b)
Gently tap the neck of the ampoule.
To ensure that all the solution is in
the bottom of the ampoule.
(c)
Cover the neck of the ampoule with
swab, or use an ampoule breaker.
To protect the nurse from harm when
opening ampoule.
(d)
Inspect the solution for glass
fragments. If present discard.
To prevent contact with the drug,
which could cause a sensitivity
reaction.
To prevent injection of foreign matter
into the service user.
(e)
Remove needle cover, expel air from
syringe and withdraw the required
amount of solution.
To ensure dosage of drug in solution
(f)
Gently tap the syringe to dislodge air
bubbles and then expel the air. Do
not expel fluid into the atmosphere.
To ensure the correct amount of
drug is in the syringe and avoid
injecting air.
(g)
To prevent contact with the drug,
which could cause a sensitivity
reaction.
Change the needle where applicable. To avoid possible trauma to the
Blunt fill and filter needles do not
service user if the needle has
require resheathing to remove.
blunted
SureGuard needles engage the safety Reduce risk of needle stick injury
device. Put immediately into sharps is used for injection.
box.
Medicines Policy Tab 8 - Injection Preparation and Administration
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8.4.3 Single Dose Ampoule - Powder
Action
Gently tap the neck and body of the
ampoule.
Rationale
To ensure that any powder lodged
there falls to the bottom of the
ampoule.
To loosen packed powder.
(b)
Cover the neck of the ampoule with
a sterile swab or use an ampoule
breaker.
To protect the nurse from harm when
opening ampoule.
To prevent contact with the drug,
which could cause a sensitivity
reaction.
(c)
Draw up the correct diluent as
previously described and add it
carefully down the wall of the
ampoule.
To ensure that the powder is
thoroughly saturated before
agitation and is not released into the
atmosphere.
(d)
Agitate the contents by gently
shaking the ampoule then inspect
the contents.
To dissolve the drug.
(e)
When solution is clear, withdraw
the prescribed amount.
To ensure the powder is dissolved
and has formed a solution with the
diluent.
(f)
Gently tap the syringe to dislodge air
bubbles and then expel the air. Do
not expel fluid into the atmosphere.
To ensure the correct amount of
drug is in the syringe and to avoid
injecting air.
(a)
To detect any obvious glass
fragments or particulate matter.
To prevent contact with the drug,
which could cause a sensitivity
reaction.
(g)
Change the needle where applicable.
Blunt fill and filter needles do not
require resheathing to remove.
SureGuard needles engage the safety
device. Put immediately into sharps
Box.
To ensure a sharp uncontaminated
needle is used and to avoid possible
trauma to the service user if the
needle has blunted.
Reduce risk of needle stick injury
.
Medicines Policy Tab 8 - Injection Preparation and Administration
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8.4.4 Vial - Solutions
Action
Inspect the solution for
contamination.
Rationale
To prevent the service user receiving
an unstable or contaminated drug.
(b)
Wipe the top of the vial with an
alcohol impregnated swab.
To prevent dust and dirt
contaminating the drug.
(c)
Inject equivalent amount of air into
the vial as solution being withdrawn,
then withdraw the prescribed
amount of solution.
To facilitate withdrawal of fluid and
prevent the spraying of drug into the
atmosphere.
(d)
Tap the syringe to dislodge any air
bubbles and then expel the air. Do
not expel fluid into the atmosphere.
To ensure the correct amount of
drug is in the syringe and prevent
injection of air.
(a)
To prevent contact with the drug,
which could cause a sensitivity
reaction.
(e)
Change the needle where applicable.
Blunt fill and filter needles do not
require resheathing to remove.
SureGuard needles engage the safety
device. Put immediately into sharps
box.
To avoid possible trauma to the
service user if the needle has
blunted.
Reduce risk of needle stick injury
8.4.5 Vial – Powder
(a)
(b)
Action
Wipe the top of the vial with an
alcohol-impregnated swab and let it
dry.
Rationale
To prevent dust and dirt
contaminating the drug.
Draw up the correct amount of
diluent as previously described.
Inject the diluent into the vial.
Draw up the same volume of air from
vial.
To ensure that the powder is
thoroughly saturated before
agitation and is not released into the
atmosphere.
(c)
Remove the needle and syringe.
Shake the bottle vigorously.
(d)
Inject equivalent amount of air into
the vial as the solution being
withdrawn.
To prevent positive pressure in the
vial
To ensure reconstitution of the drug.
To facilitate withdrawal of fluid and
prevent spraying of drug into the
atmosphere.
Medicines Policy Tab 8 - Injection Preparation and Administration
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(e)
Action
Tap the syringe to dislodge any air
bubbles and then expel air. Do not
expel fluid into the atmosphere.
Rationale
To ensure correct amount of drug in
the syringe and prevent injection of
air.
To prevent contact with the drug
which could cause sensitivity
reactions.
(f)
Blunt fill and filter needles do not
require resheathing to remove.
SureGuard needles engage the
safety device. Put immediately into
sharps Box.
To avoid possible trauma to the
service user if the needle has
blunted.
To ensure the correct size of needle
used for injection.
NB - The nurse may encounter other presentations of drug for injection, e.g. with a
transfer needle, and in these instances should follow the manufacturer’s instructions.
8.5
ADMINISTRATION OF INJECTION
8.5.1 NMC Standards for Medicine 2008 “Clinicians must not prepare substances for
injection in advance of their immediate use or administer medication drawn into a
syringe or container by another practitioner when not in their presence”
8.5.2 Intramuscular Injection
(a) Drugs injected into the muscle are usually absorbed rapidly. There are four sites for
injection:
 Dorso Gluteal – “Upper outer quadrant” Ventro
Gluteal – “Hip site”
 Deltoid – “Upper arm”
 Vastus Lateralis / Rectus Femoris – “Thigh sites”
(b) The practitioner should feel confident that they are competent to
administer drug into the site chosen
(c) A Summary of Product Characteristics (SPC) contains full details of the sites for
which each injectable preparation is licensed for. These are all available online
from the electronic Medicines Compendium: http://www.emc.medicines.org.uk.
(d) The clinician administering the injection have a responsibility to explore the
possible sites of administration with the service user and to discuss and record
their preference in accordance with their capacity to understand information
about the risks and benefits associated with each site.
(e) Where alternative sites of administration are possible, a joint decision on the
preferred site is likely to influence adherence to future treatment and enhance the
Medicines Policy Tab 8 - Injection Preparation and Administration
Page 8 of 16
service user’s perception of safety and dignity.
(f) Whichever site is selected for administration of the injection, the clinician must
rotate the site and alternate between the left and right side of the body on each
occasion the injection is administered. This must be annotated on the PMAC and
recorded in REMEDY.
(g) The Z-track method is recommended for the dorso gluteal, ventro gluteal and
vastus lateralis / rectus femoris.
(h) The Z-track method involves pulling the underlying skin downwards or to one side of
the injection site, inserting the needle at a right angle to the skin, which moves the
cutaneous and subcutaneous tissues by approximately 1– 2cm (Workman 1999).
The injection is given and needle withdrawn, while releasing the retracted skin at
the same time. The manoeuvre seals off the puncture tract. Gentle exercising of the
limb (but not massage to the area) afterwards is believed to assist absorption of the
drug by increasing blood flow to the area (Beyea & Nicholl 1995).
(i) A maximum 4ml can be injected into dorso gluteal, ventro gluteal and vastus lateralis/rectus
femoris sites and 2 ml in to deltoid this is to reduce local tissue damage and facilitate even
drug release.(Hopkins & Arias 2013)
(j) Pabrinex I/M is a 7ml injection. The Medicines Procedure group has recommended to be
mixed and administered as two gluteal injections of 3.5ml each.
8.5.3 Needle Size
Needle gauge for an intramuscular injection is generally a 21 gauge (green hub)
needle. The gauge of the needle refers to the size of the lumen (bore), not the
length of the needle. It is recommended that a blunt fill needle is used for drawing
up change to a 21 gauge for the actual injection.
Needle length is indicated on the needle pack in centimeters. A variety of lengths
are available and an assessment of the length of needle required to reach the
muscle should be made by an assessment of the individual service user, taking
into account any subcutaneous fat and remembering to allow for approximately
1/4 of the needle length to be left outside the skin to allow the needle to be
removed should it break.
Calculating the service user’s Body Mass Index (BMI) will assist in the assessment
of body fat which can affect all injection sites. Women are particularly at risk of
accidental injection into subcutaneous fat as they have more adipose fat in the
buttocks and the deltoid fat pad. This should be recorded 6-monthly on the LAI
prescription and every PMAC.
Medicines Policy Tab 8 - Injection Preparation and Administration
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8.5.4
(a)
(b)
(c)
(d)
Administering to the Patient (minimum requirements)
Action
Confirm the identity of the service
user by checking against the service
user’s prescription and
administration of medicines card.
Warm oily or large volume injections
to body temperature
immediately before use if
possible.
Explain and discuss the procedure
with the service user.
Assist the service user into the
required position
Wash hands / alcohol gel &
Put on well-fitting gloves
Rationale
To ensure that the medication is
given to the correct service user.
To reduce viscosity of oils and to
reduce trauma, shock and pain at
the site of the injection and to
improve absorption.
To ensure the service user
understands the procedure and
gives his/her valid consent.
To allow access to the chosen site
and to ensure the designated muscle
group is flexed and therefore relaxed
To minimise risk of contamination/
infection and reduce infection risk
from needlestick
To minimise damage to tissue.
(e)
Select and expose the chosen site.
(f)
Pull the skin in line with the Z track
method around the chosen site
To facilitate the insertion of the
needle and to displace the
subcutaneous tissue.
(g)
Holding the syringe and needle at a
90 degree angle, quickly plunge it
into the skin, leaving a third of
the shaft of the needle exposed.
To ensure that the needle penetrates
into the muscle.
NB. An appropriate needle should
be used for children and thin or
emaciated service users.
Pull back plunger. If no blood is
aspirated, depress the plunger and
inject the drug slowly. If blood
appears, withdraw the needle and
recommence procedure, explaining
to the service user what has
occurred.
Withdraw the needle rapidly. If any
bleeding occurs, apply alcohol swab
and digital pressure.
To avoid local tissue damage.
Record administration on PMAC and
in REMEDY medicines card.
To maintain accurate and legal
records
(h)
(i)
(j)
(k)
To facilitate removal of the needle,
should it break.
To confirm that the needle has not
entered a blood vessel.
Slow injection prevents pain and
ensures even distribution of the drug.
To prevent haematoma formation.
Medicines Policy Tab 8 - Injection Preparation and Administration
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Action
Rationale
(l)
Dispose of the used syringe and
unsheathed needle, ampoule or vial
into a sharps box.
To ensure safe disposal and avoid
injury to staff.
(m)
Remove gloves and wash hands
To minimise risk of contamination/
infection
(n)
Encourage service user to gently
exercise the limb
To assist absorption and increase
blood flow to the area
(o)
Record which buttock has been
used, on the Prescription/Medicine
Administration card.
To minimise tissue damage.
(p)
Note:
Service users who are detained for treatment under the Mental Health
Act are subject to the provisions of Section 58 - Consent to Treatment.
The Trust Consent to Treatment Policy on obtaining consent must be
followed.
8.5.5 If needle snaps in situ
•
•
•
•
•
advise the service user
circle the area in indelible pen
inform the nurse in charge
inform the doctor
attempt removal with forceps only if the shaft of the needle is visible and able to
be gripped DO NOT ATTEMPT TO REMOVE IF YOU ARE UNCERTAIN
• if not refer to Accident and Emergency Department
• complete a Datix report
• enter into the service user’s health and social care record / REMEDY
8.5.6 Subcutaneous Injection
These are given beneath the epidermis into the fat and connective tissue underlying the
dermis. Injections are usually given using a 25g needle, at a 45º angle. However,
following the introduction of shorter needles the recommendation for insulin injections is
at an angle of 90º. The sites of choice are the lateral aspects of the upper arms and thighs
and the abdomen in the umbilical region. Rotation of the use of these sites decreases the
likelihood of irritation and ensures improved absorption.
Medicines Policy Tab 8 - Injection Preparation and Administration
Page 11 of 16
(b)
(c)
Action
Confirm the identity of the service
user against the service user’s
prescription and administration of
medicines card.
Rationale
To ensure that the medication is
given to the correct service user.
Explain the procedure to the service
user.
To ensure the service user
understands the procedure and
gives his/her valid consent
Wash hands/alcohol gel &
Put on well-fitting gloves
To minimise risk of contamination/
infection and reduce infection risk
from needlestick injury
(d)
Select and expose the site for
injection.
To minimise damage to tissue
(e)
Choose the correct needle size
To minimise the risk of missing the
subcutaneous tissue and causing
pain.
(f)
Hold up a fold of skin between thumb To elevate the subcutaneous tissue.
and forefinger.
(g)
Insert the needle into the skin at an
angle of 45 degrees and release the
grasped skin. Insulin should be
given at an angle of 90 degrees
using a shorter needle.
Injecting medication into compressed
tissue irritates nerve fibres and
causes the service user discomfort.
(h)
Pull back plunger. If no blood
aspirated, depress the plunger and
inject the drug slowly. If blood does
appear withdraw the needle and
recommence the procedure,
explaining to the service user what
has occurred.
NOTE: Not with Insulin pens or other
multi-use devices.
Withdraw the needle rapidly at the
same angle it was inserted. If any
bleeding occurs, apply alcohol swab
and digital pressure.
To confirm that the needle has not
entered a blood vessel.
(j)
Dispose of used syringe and
unsheathed needle, ampoule or vial
into a Sharps box.
To ensure safe disposal and avoid
injury to staff.
(k)
Remove gloves and wash hands
To minimise risk of contamination/
infection.
(l)
Record administration on service
To maintain accurate clinical and
user’s prescription and administration legal records.
of medicines card.
(i)
Slow injection prevents pain and
ensures even distribution of the drug
To avoid contamination.
To prevent haematoma formation
Medicines Policy Tab 8 - Injection Preparation and Administration
Page 12 of 16
(m)
Prefilled insulin pens and devices
Wherever possible the patient should be encouraged to continue to self-administer,
if necessary under supervision by clinical staff. If this is not possible the
multidisciplinary assessment and discussion must be recorded in the care plan.
When clinicians are administering from a pen/prefilled device the pen needle must
be removed using UniGuard pen needle remover to reduce the risk of needlestick
injury.
8.5.7 Long-acting intramuscular antipsychotic injections or Depot
Neuroleptic Injections
Please also refer to the “Antipsychotic long-acting injections guidance” on iconnect/policies/medicines management/guidance, or
http://www.nepft.nhs.uk/professionals/information-about-medication/
(a) Antipsychotic medications available in a depot formulation usually consist of
drugs that are suspended in an oily solution ( for example sesame oil), that
enables the particular drug to be released over a period of days or weeks, except
for risperidone and Paliperidone, which are both aqueous. These injections are
always given by deep intramuscular injection using the ‘Z’ tracking technique.
(b) The antipsychotic drugs currently available in a depot preparation are;
fluphenazine decanoate, flupentixol decanoate, zuclopenthixol decanoate,
haloperidol decanoate and pipothiazine palmitate. All oily injections are for
gluteal administration, NOT deltoid.
(c) Risperidone long-acting injection is the first atypical antipsychotic to be available in
a slow release injectable preparation. It takes 3 weeks to start to work, and peaks at
4-6 weeks. If this medication is used, the manufacturer’s instructions must be
followed closely. A test dose cannot be used.
(d) Paliperidone long-acting injection has the same active moiety as Risperidone, but
is a MONTHLY injection and requires a loading dose into the deltoid muscle
unless it is to replace Risperidone consta or a depot.
•
•
•
•
Unlike other depots, this one should be prescribed in months not weeks,
making a total of 12 injections per year
The patient must have had Risperidone oral or IM before they start
Paliperidone, with no adverse effects
25mg risperidone consta is equivalent to 50mg Paliperidone IM
(37.5 equivalent to 75mg paliperidone, 50mg equivalent to 100mg
Paliperidone). There is also a licensed 150mg dose equivalent to 75mg
Risperidone.
This must be a deltoid injection initially, and should continue to be deltoid
after that, though the gluteal route can be considered if necessary.
Absorption from the deltoid route may be 30% more than from a gluteal
site, and it has a shorter more predictable half-life.
Medicines Policy Tab 8 - Injection Preparation and Administration
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•
•
(e)
Olanzapine long-acting injection (ZypAdhera)
•
•
•
•
•
•
•
(f)
Switching from oral medication, the day 1 dose must be 150mg, the day 8
dose 100mg, then the day 38 dose will be whatever the final dose will be.
Write the first 2 doses on the once-only section of the PMAC, then the final
monthly dose in the long-acting injections section (not 4/52).
Switching from a different depot injection: A loading dose is not required.
The first paliperidone dose should be given on the day the next depot
would have been due. Thereafter it will be monthly, gluteal or deltoid.
This injection is non-formulary because of the high level of nursing input
required at an inpatient address throughout treatment. Consultants must
contact the pharmacy and complete a form B application.The consultant and the staff involved with the care of the patient must
undertake additional training provided by the manufacturer before this
preparation can be prescribed or administered.
A detailed care plan must be agreed by the multidisciplinary team.
Where the functional model is in place this will include the community
consultant as well as the inpatient consultant.
The patient must be monitored for at least 3 hours after every
injection, delivered home safely and checked the following day.
For protocol see
Olanzapine Embonate Injection (ZypAdhera)
Procedure for Prescribing and Administration
Test Doses
Depots are long acting and any adverse effects, which result from injection, are
likely to be long lived, thus a small test dose is essential to avoid severe prolonged
adverse effects. Alternatively, the service user must have been treated successfully
with that medication in oral form. After a test dose it is necessary to wait 4-10 days
before starting titration to maintenance therapy (always refer to product
information for the individual drugs).
(g)
Adverse reactions
Pain may occur at the injection site and occasionally erythema, swelling and
nodules. For specific side effects of the individual antipsychotic drugs refer to
the summary of product characteristics (SPC).
Depot antipsychotics do not produce extra-pyramidal side effects (EPSEs) at the
time of administration. An onset of this type may emerge in a few hours up to
several days for oily depots, and 4-6 weeks for risperidone consta.
The administration of procyclidine, orally or intramuscularly at the time of the
depot injection is illogical as the effects of the anticholinergic drug will have
worn off before the plasma antipsychotic levels peak.
(h)
Rarer adverse effects such as rashes and agranulocytosis are well documented
with antipsychotic drugs, anaphylaxis is not. Hypotension occurring after the
Medicines Policy Tab 8 - Injection Preparation and Administration
Page 14 of 16
administration of a depot injection is not likely to be secondary to anaphylaxis
and the administration of adrenaline in these circumstances could lead to a
further drop in blood pressure. A sudden drop in blood pressure immediately
after administration of a depot is often due to vasovagal attack, which may be
resolved by lying the service user flat and raising their legs.
(i)
8.5.8
Although the risk of anaphylaxis is rare, it is recommended that test doses of
depot neuroleptics are only administered in a ward or day hospital situation or in
a GP Practice by the CPN or with prior agreement, by the Practice Nurse. The
service user should be monitored for 20–30 minutes after the test-dose
medication has been administered to observe for signs of anaphylaxis.
Intravenous (IV) Injections/Cannulae Insertion
(a)
IV cannulae or injections are only to be inserted or administered by medical
staff who are competent to undertake these duties. Issue of supply needs
addressing
(b)
Staff, e.g. crash teams, employed by other Trusts may undertake these duties if
competent, i.e. nurses who are trained to undertake IV cannulae insertion.
(c)
Nurses are responsible for ongoing care in line with Royal Marsden
Guidelines.
(d)
Where a drug is to be given by the IV route, the nurse must seek advice on the
observations and actions required, the duration of action and adverse effects.
8.6
MONITORING
A Registered Nurse’s competency to administer medication will be assessed
following where the nurse has been involved in a serious or repeated medication
errors, or for newly qualified nurses within the first six months of employment
during Preceptorship by the Trust .
8.7
REFERENCES
EU Directive “The prevention of sharps injuries in the hospital and
healthcare setting” (2010/32/EU)
NMC Standards for Medicines management. Latest edition.
Intramuscular injection clinical skills workbook Janssen 3rd edition October 2011
(or current version)
Antipsychotic long-acting injections guidance (NEP) Antipsychotic
high dose guidance (NEP)
Una Hopkins, RN, FNP-BC, DNP; Claudia Y. Arias, RN, OCN - February 22,
2013 Features Large-volume IM injections: A review of best practices
Medicines Policy Tab 8 - Injection Preparation and Administration
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8.8
COMPLIANCE MONITORING
Compliance with this procedure will be against the Trust’s agreed minimum
requirement/standards as detailed in the Auditable Standards and Monitoring
Arrangements.
Medicines Policy Tab 8 - Injection Preparation and Administration
Page 16 of 16