DOCUMENT CONTROL:

Version: 4

Ratified by: Clinical Policies Review and Approval Group

Date ratified: 3 March 2020

Name of originator/author: Chief Pharmacist

Name of responsible committee/

individual:

Executive Medical Director

Unique Reference Number: 150

Date issued: 27 March 2020

Review date: March 2022

Target Audience Community Nursing Staff

Description of changes Review

Administration of Drugs via the CME Medical T34

Syringe Driver

Standard Operating Procedure

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1. Aim This Standard Operating Procedure (SOP) represents current recommended good practice and will ensure the proper action to take regarding the setting up and management of the CME Medical T34 Syringe driver by clinical staff in the Community setting.

2. Scope All registered nurses using the CME T34 Syringe Driver must be personally competent and accountable in the use and operation of the device by attending bespoke training. Evidence of training will be recorded on each staff member’s training matrix, annual updates will be provided. The training could be completed on a 1-1 basis using CCast assessment. An assessor will accompany the registered practitioner and complete the CCast documentation alongside some medicine management training around calculations/drugs etc. The results will then be recorded on the staff members training matrix.

3. Link to overarching policy and/or procedure This SOP is overarched by a n d to be used in conjunction with the Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) Safe and Secure Handling of Medicines Policy.

4. Procedure 4.1 General Information

The McKinley T34 Syringe Driver is used across RDaSH in line with the requirements of the National Patient Safety Alert entitled ‘Safer Ambulatory Syringe Drivers’ (NPSA/2010/RRR019) (2010).

4.2 Safety The McKinley T34 is a small battery operated machine, designed to give a continuous subcutaneous infusion in milliliters (ml) per hour over a given period. This method of symptom control, used predominantly in palliative and end of life care provides relief of multiple symptoms e.g. pain, nausea and agitation via a single route. The safe use of the syringe driver requires comprehensive knowledge in order to maintain patient safety. Caution: If a patient is discharged or transferred into RDaSH services with a different make of syringe driver, this should be changed to a McKinley T34 device as soon as possible. Lock boxes will fit syringes up to 30ml and should always be used with the CME Medical T34. Lock boxes reduce the risk of accidental or intentional interference with the syringe driver and protect from damage caused by normal daily use or drops within the range of one metre.

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4.3 Decontamination and Maintenance All staff must follow standard infection prevention and control precautions including hand hygiene, use of personal protective equipment, decontamination of reusable medical devices, sharps management and disposal of healthcare waste. The device must be decontaminated between patients, daily when in use and as and when it becomes dirty or contaminated using a 2 in 1 antimicrobial wipe. The current Trust approved product is Clinell universal wipes. To prevent fluid ingress to the syringe driver it is recommended that wipes from the smaller packs of Clinell universal are used and that any excess liquid on the wipe is squeezed out before use. Always turn the syringe driver off before decontaminating. Also clean the actuator screw thread and guiding rods to remove debris or other particles. Do not clean the syringe pump with chemicals such as xylene, acetone, or similar solvents. These chemicals can cause damage to components and labels. Do not soak or immerse any part of the syringe driver in any solution. Immersing the pump in liquid will cause damage to components and this will void the guarantee. It is recommended that Clinell universal wipes are also used to decontaminate the lock box. All syringe drivers will require routine annual maintenance and service as a minimum or when syringe driver warning is indicated on individual syringe drivers. Key Health Solutions will provide maintenance work. Devices due for maintenance can be returned to the designated person for the clinical area, who will then forward the devices onto Key Health Solutions. A declaration of decontamination status form will need completing and attaching to the device prior to sending it for repair or service.

4.4 Storage It is essential that all syringe drivers are accounted for at all times. Hospice Syringe drivers and locked boxes will be stored in a designated place within the hospice. Each syringe driver will have its own case. It will be the responsibility of the nurse who last used the device to clean the syringe driver and lock box. Community All Community Nursing Teams (Planned and Unplanned) are required to

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keep an up to date list of the exact location of the syringe drivers. (See appendix 1) Syringe drivers will be stored at the four planned locality bases and a designated place for Unplanned Care. They will be stored in lockable cases and each device will have its own case. It will be the responsibility of the nurse who last used the device to clean the syringe driver. The case will be refilled ready for further use and stored in a safe place within the base point. Hospice and Community The syringe driver should be tagged as clean by wrapping the green ‘I am clean’ label around the device and storing in the lockable case.

4.5 Equipment Required

Syringe driver McKinley T34 and Lock Box. Ensure within maintenance date. Obtain a new syringe driver if out of date.

9-volt alkaline battery Duracell Procell. The average battery life is 3-5 days depending on usage e.g. key presses or backlight use.

Winged infusion set Saf-T-Intima24Gx0.75 FSP318Yellow.

Administration set CME McKinley Micro set 100-172S (Anti-siphon valve and female luer lock. Length approx. 100cm, priming volume approx. 0.5ml).

BD Plastipak luer lock syringe 20ml or 30ml. N.B. luer lock syringes must always be used to ensure secure connection of the infusion set. The pump is calibrated to luer lock and failure to use may result in under or over infusion due to variation in syringe dimensions.

Combi-stopper to cap the syringe or administration set

Transparent adhesive dressing

Drugs and diluent prescribed

Safety or blunt needle (to draw up drug)

Drug additive label

Patient’s Syringe Driver Prescription and Observation Chart.

Sharps bin

Disposable carrying pouch (only if patient is mobile)

Instruction procedure manual and equipment, as documented on syringe driver check list.

Signing in and out sheet completed with the syringe driver serial number date, time, patient name and address (see appendix 2)

Battery must be removed when device is not in use. Syringe driver to be stored in cases provided by Trust.

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4.6 Hospital admission/discharge A reciprocal agreement is in place between RDaSH and Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust (DBTHFT) for the safe return of syringe drivers to their respective bases. The syringe driver must be returned to base after use. If the patient is admitted to hospital, then it is the responsibility of the nurse who is allocated to the visit to ensure that they retrieve the syringe driver. The responsible nurse will contact the Community Support Manager via e-mail using the relevant form. (See appendix 2) An agreement is in place with DBTHFT for devices that turn up with patients that have been admitted to hospital. These devices will be returned to the medical devices unit at DBTHFT. The medical devices unit will then return the device to the Community Support Manager. If DBTHFT devices are sent home with patients into community RDaSH services, these will be returned by the Community Support Manager to the medical devices unit at Doncaster Royal Infirmary (DRI). Hospice Admission/Discharge

If a patient is admitted to the hospice with a community syringe driver, the device must be changed to a hospice device within 24 hours and returned to the designated base via the RDaSH shuttle the next working day.

If a patient is discharged home from the hospice with a syringe driver, the device should be swapped to a community device within 24 hours and returned to the hospice via the RDaSH shuttle the next working day.

All Hospice device serial numbers are recorded on a database and tracked by the Hospice Ward Clerk. Transfer out of RDaSH Services The registered nurse must:

Record the details and serial number of the syringe driver on the district nurse referral form or on the transfer letter if the patient is discharged to a care home, other hospital or hospice

Place a copy of the form in the patient’s notes

Request that care home, hospital or hospice return the syringe driver to Medical Technical Services RDaSH

Inform Medical Technical Services of the transfer

Caution: If a patient is discharged home from a neighbouring hospital (other than DBTHFT) with a different make of syringe driver, this must be changed over to the McKinley T34 as soon as possible and the other syringe driver returned to the hospital in question. The nurse changing the

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syringe driver should liaise with the transferring/discharge ward to arrange this.

4.7 Administration Procedure It is good practice for two staff members, one of which must be a registered nurse, to undertake the procedure; however, in community settings where there may not be another health professional available, the patient’s relative/carer may act as a second signatory to check relevant aspects of the procedure. E.g. Stock levels. See appendix 3 for indications, advantages and disadvantages of syringe driver

4.8 Involving the patient and family/carers Communication and consultation with the patient and family is essential. Before starting a subcutaneous infusion, the reasons for using this method of administration should be explained to the patient and family. Informed consent for administration should be obtained, in accordance with the Mental Capacity Act 2005 Policy. The discussion must then be recorded in the patient’s clinical records. Attention should be paid to both the physical and psychological aspects involved in accepting a new way of receiving medication. Some patients feel that this method of drug delivery is a last resort and that their activities will be restricted and that death may be imminent. It is necessary to listen to and answer the patient’s questions, acknowledge their concerns and then give explanations and reassurance as appropriate. I n community settings the patient and family/carers must be informed that the syringe driver device is on loan to them and it must be returned as delivered after use. A signature will be required from the patient or family after discussion. (See appendix 5) Staff will make all reasonable attempts to reclaim equipment which is not returned (e.g. following a death). If non-return of equipment is shown to be malicious (e.g. re-sale), an IR1 should be completed, and a discussion held with the Team Manager concerning reporting the incident to the police. The explanation should include the following:

The reasons for using a syringe driver

How the syringe driver works

The siting procedure and site care

How the dose of medication can be adjusted to manage symptoms

Encouragement to describe symptoms

4.9 Procedure for setting up the syringe driver

A registered nurse must calculate the volume of drug that needs to be drawn

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up from the concentration of the preparation to be used and the prescribed dose. When preparing medicines and disposing of waste materials, the registered nurse must adhere to the following guidance:-

Controlled Drugs (RDaSH Care Groups Community Services (Physical Health))SOP

Controlled Drugs St John's Hospice SOP

Infection Prevention and Control Manual

NMC Standards of Medicines Management The Medicines Act (1986)

Waste Policy A registered nurse must:-

Ensure the prescription has been completed correctly, perform the calculation and check the medication (where the calculation is complex community staff may consider checking with a colleague before going out).

Confirm the previous opioid dose, formulation and frequency.

Ensure the medication prescribed and the doses are clinically appropriate based on the patient’s previous requirements (NPSA, 2008).

Ensure the relevant diluent has been prescribed. The diluent will be prescribed on the patient’s Syringe Driver Prescription Chart For McKinley T34 feature recognition please see appendix 4 Sterile water for injection Advantages

Appropriate for most medicines

More supporting compatibility data

Reduces the risk of precipitation if using cyclizine lactate Disadvantages

Large volumes are hypotonic and can cause infusion site pain Sterile 0.9% Sodium chloride Advantages

Recommended with certain drugs e.g. octreotide

Less infusion site pain and fewer skin reactions than water for injection Disadvantages

Incompatible with cyclizine

Increases likelihood of precipitation when more than one drug is used

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There is a potential for interaction between drugs in a syringe driver. The compatibility of the drugs and the diluent to be drawn up must be checked prior to mixing. The Palliative Care Formulary (Twycross et al, 2017), The Syringe Driver, Continuous subcutaneous infusions in palliative care (Dickman A and Schneider J, 2011) suggest suitable combinations of drugs. If there are any concerns regarding compatibility:

Firstly refer to the compatibility and stability tables for a subcutaneous infusion in a McKinley T34 Syringe pump. Click here for compatibility and stability tables.

Contact the prescriber

Contact the Specialist Palliative Care Triage

If any further concerns out of hours (after doing all of the above) call the out of hours GP service for advice, if they are unable to answer the question the GP has access to the on-call Consultant in Palliative Medicine via DRI switchboard.

Ideally syringe driver prescription reviews should take place in working hours only (08:30 – 16:30 7 days per week) Routinely in RDaSH a combination of no more than 3 drugs should be prescribed on the prescription form or drawn up into a syringe. If more than 3 drugs are required, 2 prescription forms and 2 syringe drivers will be needed. Please seek advice from the Specialist Palliative Care Team. Exceptionally 4 drug combinations may be appropriate on an individualised basis only, the rationale and compatibility must be clearly documented in the patient’s clinical record. N.B. Ampoules containing a liquid solution may contain an amount in excess of the volume stated on the label. Therefore, measure the volume of liquid as it is drawn up to ensure accuracy of the dose.

Select the appropriate syringe size 20ml or 30ml

Draw up the prescribed medication

Add the diluent up to the required volume

Complete the label, including:

Patient name and NHS number Medicine name and dose Batch numbers Diluent used Route of infusion Date and time prepared Initials of the registered nurses preparing the syringe

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Attach the label to the syringe ensuring that it is flat and not folded. Leave the scale visible so that it can still be read.

Skin site selection for subcutaneous infusions. Where possible involve the patient in the choice of a suitable site. Areas suitable for subcutaneous infusion include those with a good depth of subcutaneous fat, towards the trunk of the body, particularly if the patient’s peripheral circulation is compromised

Following completion of the procedure, document the following in the patient’s electronic records: -

The prescribed medication

Dose

Dilutant

Site of the syringe driver

Alongside the amount of prescribed medication remaining. (see appendix 2).

Note when using Appendix 2: The CME Medical T34 ambulatory syringe pump is calibrated to operate with BD Plastipak Luer lock syringe brands and sizes. It is programmed to recognise both the brand and the size of syringe being used (commonly 20ml. and 30ml). It will be defaulted using a Prime and Load (Lock – on) Programme of a 24 hour delivery system. Fill volume Medication and diluents should always be drawn up to the following volumes

20ml syringe draw up to 17ml

30ml syringe draw up to 22ml Acceptable sites

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Sites to avoid

Oedematous areas, including areas affected by lymphedema or ascites (poor absorption, increased risk of infection)

Sites over bony prominences (discomfort and poor absorption)

Joints or skin folds (discomfort and movement may displace cannula)

Previously irradiated skin (may have poor perfusion - affects drug absorption)

Upper abdomen in a patient with an enlarged liver (risk of puncturing the liver capsule)

Upper chest wall in a very cachectic patient (risk of pneumothorax)

Infected, broken, inflamed or bruised skin

Sites of tumour

Inserting BD Saf-T- Intima Decontaminate hands using alcohol rub or soap and water or for community settings soapy hand wipes can be used followed by alcohol hand gel.

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Clean the site with a 2% chlorhexidine/70% alcohol skin preparation wipe and allow to dry for 30 seconds

Apply the clamp to the line

Grasp the “pebbled” side of the wings of the cannula, pinching the wings firmly together. This “locks” the needle and prevents it from retracting during insertion

Ensure that the needle is point down and bevel uppermost, to guide the cannula through the tissues. This prevents kinking of the cannula. If the needle is not already orientated with the point down open the wings and gently twist the white shield until the needle is correctly positioned

Insert the cannula subcutaneously at an angle of less than 45 degrees, lowering the initial angle of the cannula to a level more parallel to the skin (caution on the chest wall) and advance to the hilt of the cannula

Open the wings (pebbled side down) flat against the skin

Apply transparent adhesive dressing over the insertion site and the cannula wings

Apply firm finger- tip pressure over the wings of the cannula (avoiding the centre where the needle retracts) simultaneously grasp the pebbled end of the coloured/white cylinder shield and pull in a straight continuous motion until the needle has fully with drawn into the cylinder and pops off

Gently remove cylinder from the cannula port, if it has not released spontaneously, exposing the adapter with the rubber bung

Place the needle shield in the sharps bin

Decontaminate hands

Change the site every 7 days or as necessary depending on the condition of the site.

Exceptionally, where a patient is in the last hours of life consideration should be given to the disruption of the patient against the clinical benefit from changing the Saf-T

N.B. The Saf-T-Intima cannot be primed when using the McKinley T34. When setting up the syringe driver the primed extension line is connected directly to the un-primed Saf-T-Intima The registered nurse must prepare the syringe and confirm the patient’s identity as on prescription

Check the battery life by pressing the INFO Key twice ***

Prepare syringe and contents and cap the syringe.

Press STOP

Press and hold INFO key to deactivate keypad lock

If the infusion complete alarm has activated, press YES to confirm end of infusion

Switch syringe driver OFF

Clamp Saf-T-Intima

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Raise the barrel clamp arm

Remove old syringe

Follow instructions on page 18 Power on and pre-loading

When “Start infusion?” screen displays, connect the infusion line to the syringe, release the clamp on the Saf-T- Intima and press YES

In community settings the battery must be changed when the device registers at 40% battery life left. Bolus dose of medication If the patient has uncontrolled symptoms prior to setting up the McKinley T34, it may be necessary to give a PRN dose of medication. A separate Saf-T- Intima 24Gx0.75 FSP318 Yellow should be inserted for the purpose of giving PRN doses. A Swan Lock needle free device should be attached to the Saf-T- Intima port. Administer medication slowly (30 seconds – 1 min) dependent on volume and comfort. If using more than one drug, flush with 0.3mls saline between medications and always flush at the end, do not use a pre-flush at the start, do not mix the medications in one syringe. No more than 2mls (including flush) to be administered in one episode (per device). If more than one drug is to be used, ensure they are compatible. If not compatible use a separate Saf-T intima device and label it per PRN medication. It is normal to have a small swelling immediately after administration of medication (advise the patient and family of this to alleviate anxiety). Temporary interruption to the infusion – Hospice This is not normal practice in a community setting and should only be used in exceptional circumstances e.g. showering or bathing. N.B. Stopping the infusion will delay the end time of the infusion Stopping the Infusion

Press STOP – unlock the keypad and turn the syringe driver OFF.

Clamp the Saf-T- Intima

Disconnect the syringe driver. DO NOT REMOVE THE SYRINGE FROM THE PUMP

Cap the Saf-T-Intima and infusion line to minimize cross infection.

Record time and reason why infusion stopped on Syringe Driver Observation Chart

Resuming the Infusion

Check that the prescription, syringe label and patient details are correct

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Reconnect the line to the syringe on the pump maintaining asepsis

Press and hold ON button

The screen will request confirmation of size and brand of syringe

Press YES to confirm

The screen will display “Press YES to Resume” “NO for New Syringe”

Press YES to resume

The screen will display remaining volume/ duration/ rate of infusion

Ensure information is correct as prescribed

Press YES to confirm

Unclamp Saf-T-Intima

Screen will display “Start Infusion?”

Press YES to start infusion

Press and hold INFO key to lock the keypad

Replace the Lock Box

Record on the Syringe Driver Observation chart the time the infusion was recommenced

N.B. If “NO for New Syringe” is pressed the remaining infusion will be reset to deliver over the next 24hrs at a different rate, and the infusion will be incorrect. If “NO for New Syringe” has been pressed in error. Discard the remainder of the syringe contents, prepare, and set up a new syringe. In a community setting the following procedure should not be applicable as staff will check the battery status before commencing each 24 hour regime. Changing the battery during an infusion

When near the end of the battery alert sounds, it indicates that the battery should be changed within the next half hour

Press STOP and apply clamp to Saf-T-Intima

Insert new battery

Restart the syringe driver

Reconfirm syringe size and brand

Press YES to resume

Reconfirm volume and duration and rate of infusion

Press YES to recommence the infusion

Lock the keypad Following completion of the procedure all patient records must be updated and signed by the registered nurse. (For paper documentation see appendix 2). Records will also include those accessed on SystmOne. What to do if there is an occlusion in the extension line

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Check that the Saf-T-Intima is not clamped Check the extension line and Saf-T-Intima for any kinking – straighten if

kinked Check the syringe, extension line and Saf-T-Intima for any signs of

crystallization of the solution. If crystallization detected – prepare and fit new syringe, extension line

and change Saf-T-Intima site If no physical reason for the occlusion is detected – resite the Saf-T-

Intima If occlusion is still present – change the site, extension line and syringe N.B. During an occlusion the pump’s Post Occlusion Reduction System will reverse the operation of the motor and drive the actuator backwards, otherwise the pressure build up could cause a surge of fluid into the patient on release of the occlusion. When the pump is resumed/restarted following the backward movement of the actuator, time will be added to the time remaining to protect the original calculated rate. Procedure for releasing a trapped foreign object from the actuator (See appendix 6) WARNING: IF A FOREIGN OBJECT IS TRAPPED IN FRONT OF OR BEHIND THE ACTUATOR DURING PRE-LOADING (AUTOMATIC ACTUATOR MOVEMENT) OR WHEN MANUALLY ADJUSTING THE ACTUATOR, THE USER SHOULD: Ignore screen prompts as the prompt that may display will be in relation to

alarm activation and NOT the trapped object Turn the syringe driver OFF Raise the barrel clamp arm and turn it to the left or right to keep it in the

raised position Turn the syringe driver ON Turn and lower the barrel clamp arm Use the FF key (or BACK key) to move the actuator in order to release

the object 4.9 Faulty device

If the syringe driver is faulty: it needs to be changed for a non-faulty device as above, an IR1 may need completing is treatment delayed – seek advice from line manager. The faulty device must be cleaned and labeled as cleaned using the green ‘I am clean’ label. The designated syringe driver coordinator for each area e.g. in the Hospice it is the ward clerk, registers the device out of action and sends to the Trust’s designated repair contractor.

4.10 Incident Reporting Systems are in place within RDaSH to report and manage incidents, near

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misses and serious untoward incidents involving syringe pumps. Staff should be familiar with the reporting process and the Incident Reporting Policy.

4.11 Acknowledgements McKinley T34 Ambulatory Syringe Pump Operations Manual (2011) Illustrations courtesy of CME McKinley Medical CME McKinley UK Ltd Kincraig Business Park, Kincraig Road, Blackpool, FY2 0PJ Tel: 01253 894646 www.cmemedical.co.uk

5 Links to Associated Documents

Healthcare Record Keeping Policy

Corporate Records Policy

Medical Devices Policy

The Medicines Act (1968)

Mental Capacity Act 2005

Incident Management Policy

Consent to Care and Treatment Policy.

Controlled Drugs (RDaSH Care Groups, Community Services (Physical Health)) SOPS

NMC Standards of Medicines Management

Waste Policy

Infection Prevention and Control Manual

6 References and Literature review

Dickman, A, and Schneider, J 2011. The Syringe Driver. Continuous subcutaneous infusions in palliative care 3rd ed. Oxford: University Press Oxford Medicines Act 1986. HMSO: London Mental Capacity Act (2005) DOH: London National Patient Safety Agency 2010. Rapid Response Report NPSA/2010/RRR019: Safer ambulatory syringe drivers. National Patient Safety Agency. Available at: https://www.ukmi.nhs.uk/filestore/ukmiaps/NPSA-RRR19(2).pdf Twycross, R, Howard, P and Wilcock, A 2017. Palliative Care Formulary 6th ed. Nottingham: palliativedrugs.com Ltd.

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6.1 Bibliography

Mitten, T. (2001) Subcutaneous drug infusions: a review of problems and solutions. NMC (2015) The Code: Standards of conduct, performance and ethics for nurses and midwives, Nursing and Midwifery council, London NMC (2015) Standards for medicines management, Nursing and Midwifery Council, London Perdue, C. (2004) The syringe driver – an aid to delivering symptom control. Nursing Times, 100, 13. pp32-35. Wilson J. (2019) Infection Control in Clinical Practice. Updated Third Edition. Elsevier, London.

7 Appendices

Appendix 1 Syringe Driver base information Appendix 2 Subcutaneous syringe driver instruction and observation chart for McKinley T34 and continuation sheet Appendix 3 McKinley T34 Feature Recognition Appendix 4 Procedure for releasing a trapped object from the actuator Appendix 5 Form for the patient regarding loan of syringe driver

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Appendix 1

SYRINGE DRIVE BASE INFORMATION

SYRINGE DRIVER IDENTIFICATION CODE

CLUSTER AREA

IN USE/NOT IN USE NB. IF IN USE PLEASE REFER TO THE RECORD SHEET

STAFF SIGNATURE

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ADMINISTRATION & OBSERVATION DETAILS [for completion by administering clinician] WARD OR BASEPOINT NAME

The patient will be reviewed by the attending clinician at each attendance and, where there has been a change of circumstances, will refer to the prescriber for any necessary treatment changes or need for review.

ADMINISTRATION1 Day and Date OBSERVATIONS2

Time [HH:MM]

DA

ILY

SET

UP

Start time of infusion:

MO

NIT

OR

ING

PR

OG

RES

S

Site appearance6 :

Syringe size used 20ml or 30ml

17ml infusion in 20ml syringe 22ml infusion in 30ml syringe

Syringe/line contents clear3 - OK to continue? [Y/N]

Infusion rate setting – as at set up? [Y/N]

Syringe Driver serial No.: Battery Status [%]: Infusion time remaining [HH:MM]

Infusion rate [ml/hr]: Volume still to be infused (vtbi) [ml]

Site used5: Site Appearance6: Is the VTBI correct for time remaining [Y/N]

Drawn up by: Checked by: Volume infused [ml]

Details of any problems & actions taken:

If syringe contents discarded: Volume discarded: Date & time: Discharged by: Checked:

Battery status [%]4

Is the key pad locked? [Y/N]

Observer’s initials

1. To be completed each time syringe driver is loaded 4. Change battery when less than 10% (ward ) or 40% (community) 2. WARD - Completed 30 minutes after loading and then every 4 hours 5. Document insertion site of winged

infusion COMMUNITY – Complete at set up, at each subsequent visit and at syringe change 6. Appearance: Use code below 3. If contents of syringe look cloudy, precipitation has occurred. STOP infusing and contact NP (no problem) P (pain) I

(inflammation) prescriber. Refer to policy for guidance on checking compatibility SW (swelling) B (bleeding) H ardendin(hardening)

Page 1

Appendix 2

SUBCUTANEOUS SYRINGE DRIVER INSTRUCTION AND OBSERVATION CHART FOR MCKINLEY T34

PRESCRIPTION DETAILS [for completion by the prescriber] – a separate form must be completed for each syringe driver DRUG DOSE DILUENT PHARMACYa

ALLERGY STATUS

PATIENT DETAILS [Affix label if available]

Date 1. Please circle

Water for injection

or Normal Saline

NHS Number: ……………………………………………….. Surname: ……………………………………………………… Forename(s): ………………………………………………… Address: ………………………………………………………..

………………………………………………………. DOB: ……………………..

Route SC 2.

Duration of flow

Please circle 12 hours 24 hours

3.

4.

The patient will be reviewed by the attending clinician at each attendance and, where there has been a change of circumstances, will refer to the prescriber for any necessary treatment changes or need for review. If, as the prescriber, you wish to review the patient on a particular date, please stipulate below -

Review date: ………………………..

Prescriber name: ………………………………………… Signature: ………………………………………………… Practice: ……………………………………………..

a. Pharmacy: Only complete if this form is used on a ward. NOT required for community use.

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SUBCUTANEOUS SYRINGE DRIVER CONTINUATION SHEET

ADMINISTRATION & OBSERVATION DETAILS WARD OR BASEPOINT NAME

The patient will be reviewed by the attending clinician at each attendance and, where there has been a change of circumstances, will refer to the prescriber for any necessary treatment changes or need for review.

ADMINISTRATION1 Day and Date OBSERVATIONS2 Time [HH:MM]

DA

ILY

SET

UP

Start time of infusion:

MO

NIT

OR

ING

PR

OG

RES

S

Site appearance6 :

Syringe size used 20ml or 30ml

17ml infusion in 20ml syringe 22ml infusion in 30ml syringe

Syringe/line contents clear3- OK to continue? [Y/N]

Infusion rate setting – as at set up? [Y/N]

Syringe Driver serial No.: Battery Status [%]: Infusion time remaining [HH:MM]

Infusion rate [ml/hr]: Volume still to be infused (vtbi) [ml]

Site used5: Site Appearance6: Is the VTBI correct for time remaining [Y/N]

Drawn up by: Checked by: Volume infused [ml]

Details of any problems & actions taken:

If syringe contents discarded: Volume discarded: Date & time: Discharged by: Checked:

Battery status [%]4

Is the key pad locked? [Y/N]

Observer’s initials

ADMINISTRATION & OBSERVATION DETAILS WARD OR BASEPOINT NAME

The patient will be reviewed by the attending clinician at each attendance and, where there has been a change of circumstances, will refer to the prescriber for any necessary treatment changes or need for review.

ADMINISTRATION1 Day and Date OBSERVATIONS2 Time [HH:MM]

DA

ILY

SET

UP

Start time of infusion: M

ON

ITO

RIN

G P

RO

GR

ESS

Site appearance6 :

Syringe size used 20ml or 30ml

17ml infusion in 20ml syringe 22ml infusion in 30ml syringe

Syringe/line contents clear3 - OK to continue? [Y/N]

Infusion rate setting – as at set up? [Y/N]

Syringe Driver serial No.: Battery Status [%]: Infusion time remaining [HH:MM]

Infusion rate [ml/hr]: Volume still to be infused (vtbi) [ml]

Site used5: Site Appearance6: Is the VTBI correct for time remaining [Y/N]

Drawn up by: Checked by: Volume infused [ml]

Details of any problems & actions taken:

If syringe contents discarded: Volume discarded: Date & time: Discharged by: Checked:

Battery status [%]5

Is the key pad locked? [Y/N]

Observer’s initials

1. To be completed each time syringe driver is loaded 2. WARD - Completed 30 minutes after loading and then every 4 hours

COMMUNITY – Complete at set up, at each subsequent visit and at syringe change 3. If contents of syringe look cloudy, precipitation has occurred. STOP infusing and

contact prescriber. Refer to policy for guidance on checking compatibility 4. Change batter when less than 10% (ward ) or 40% (community) 5. Document insertion site of winged infusion 6. Appearance: use code below

NP (no problem) P (pain) I (inflammation)

SW (swelling) B (bleeding) H (hardening)

Page …

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SUBCUTANEOUS SYRINGE DRIVER CONTINUATION SHEET

ADMINISTRATION & OBSERVATION DETAILS WARD OR BASEPOINT NAME

The patient will be reviewed by the attending clinician at each attendance and, where there has been a change of circumstances, will refer to the prescriber for any necessary treatment changes or need for review. ADMINISTRATION1 Day and Date OBSERVATIONS2 Time [HH:MM]

D

AIL

Y S

ET U

P

Start time of infusion:

M

ON

ITO

RIN

G P

RO

GR

ESS

Site appearance6 :

Syringe size used 20ml or 30ml

17ml infusion in 20ml syringe 22ml infusion in 30ml syringe

Syringe/line contents clear3- OK to continue? [Y/N]

Infusion rate setting – as at set up? [Y/N]

Syringe Driver serial No.: Battery Status [%]: Infusion time remaining [HH:MM]

Infusion rate [ml/hr]: Volume still to be infused (vtbi) [ml]

Site used5: Site Appearance6: Is the VTBI correct for time remaining [Y/N]

Drawn up by: Checked by: Volume infused [ml]

Details of any problems & actions taken:

If syringe contents discarded: Volume discarded: Date & time: Discharged by: Checked:

Battery status [%]4

Is the key pad locked? [Y/N]

Observer’s initials

ADMINISTRATION & OBSERVATION DETAILS WARD OR BASEPOINT NAME

The patient will be reviewed by the attending clinician at each attendance and, where there has been a change of circumstances, will refer to the prescriber for any necessary treatment changes or need for review.

ADMINISTRATION1 Day and Date OBSERVATIONS2 Time [HH:MM]

DA

ILY

SET

UP

Start time of infusion:

MO

NIT

OR

ING

PR

OG

RES

S

Site appearance6 :

Syringe size used 20ml or 30ml

17ml infusion in 20ml syringe 22ml infusion in 30ml syringe

Syringe/line contents clear3 - OK to continue? [Y/N]

Infusion rate setting – as at set up? [Y/N]

Syringe Driver serial No.: Battery Status [%]: Infusion time remaining [HH:MM]

Infusion rate [ml/hr]: Volume still to be infused (vtbi) [ml]

Site used5: Site Appearance6: Is the VTBI correct for time remaining [Y/N]

Drawn up by: Checked by: Volume infused [ml]

Details of any problems & actions taken:

If syringe contents discarded: Volume discarded: Date & time: Discharged by: Checked:

Battery status [%]5

Is the key pad locked? [Y/N]

Observer’s initials

1. To be completed each time syringe driver is loaded 2. WARD - Completed 30 minutes after loading and then every 4 hours

COMMUNITY – Complete at set up, at each subsequent visit and at syringe change 3. If contents of syringe look cloudy, precipitation has occurred. STOP infusing and

contact prescriber. Refer to policy for guidance on checking compatibility 4. Change batter when less than 10% (ward ) or 40% (community)

5. Document insertion site of winged infusion 6. Appearance: use code below

NP (no problem) P (pain) I (inflammation)

SW (swelling) B (bleeding) H (hardening)

Page …

Page 21 of 23

Appendix 3

McKinley T34 Feature Recognition

Barrel clamp arm….secures syringe and detects brand and size Collar sensor……… detects correct loading of syringe collar Plunger sensor…… detects correct loading of the syringe plunger Actuator drives the syringe plunger to deliver the syringe contents Info key (a) shows infusion summary, protocol parameters, battery level

(b) when pump is paused, access the main menu

(c) activates/deactivates keypad lock UP arrow key (a) scrolls between options

(b) increases infusion parameters Down arrow Key (a) scrolls between options

(b) decreases infusion parameters during programming/ titration Yes/Start Confirms selection and starts infusion No/Stop (a) stops infusion

(b) takes the user back a step during programming FF (Forward) (a) moves actuator forward when no syringe in place and barrel

clamp arm is down (b) accesses purge function (if enabled)

Back (Reverse) moves actuator backward when no syringe is in place and barrel clamp arm is down

On/Off key Switches the pump on and off Infusion LED light. A green indicator lights:

(a) during system self-test

(b) intermittently to indicate infusion delivery A red indicator light:

(a) continuously to indicate an alarm state

(b) when pump paused/on stand-by mode

Page 22 of 23

Appendix 4

Page 23 of 23

You have been loaned a syringe driver by Rotherham Doncaster and South Humber NHS Foundation Trust.

Make and Model...........................................................................................................

Serial Number...............................................................................................................

This syringe driver will be cleaned, maintained and tested to ensure it is, and remains fit for purpose by the Nursing team.

We have included an instruction manual for the unit that you have been given.

Please ensure that;

• The driver is kept dry

• It is handled with care Delivered by (Print name)................................................................RDaSH Employee

Instruction given - Date.............................Signature.....................................................

Syringe driver accepted by (print name)...................................................Patient/carer

Date accepted..................................................................

By accepting this machine I agree to the above.

Signature...................................................................................................

Patient/carer Advice available from............................................................

Please contact .............................................................................. for any issues or to return the unit.

The equipment specified remains the property of Rotherham Doncaster and

South Humber NHS Foundation Trust. When no longer required it must be

returned to the contact above in the condition it was received in when no

longer required.

Appendix 5