Clinical Guidelines for Subcutaneous Infusion · PDF file · 2017-11-202.4.2 Accepting nursing team 8 ... Diagnosis of mild to moderate dehydration ... On the side of a mastectomy

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Clinical Guidelines for Subcutaneous Infusion (Hypodermoclysis) in the Community Setting

Policy Date e.g. (2017/19) Policy Version e.g. (V2, draft 2.0) Month & Year of Ratification This document remains valid whilst under review

TARGET AUDIENCE (including temporary staff)

People who need to know this document in detail

All clinical staff administering subcutaneous fluids within Sussex Community NHS Trust

People who need to have a broad

understanding of this document

All Sussex Community NHS Trust Managers and staff in clinical teams

People who need to know that this document exists

All Sussex Community NHS Trust employees

Policy Author: Joint Service Lead

Approved by: End of Life Steering Group Date: Nov 2016

Ratified by: Trust Wide Clinical Governance Group Date: April 2017

Date of next review:

April 2019

http://thepulse/our-trust/trustwide-policies-procedures/

Clinical Guidelines for Subcutaneous Infusion (Hypodermoclysis) in the Care Home Setting

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VERSION CONTROL

Record of Changes

Date Version Changes / Comments

01/01/2016 1.0 Final Document

01/11/2016 2 Policy reformatted-no changes to content


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CONTENTS Amend the contents pages in line with the document headings.

Page

1. INTRODUCTION 5

1.1 Background 5

1.2 Scope 5

1.3 Definitions 6

2. MAIN BODY OF DOCUMENT 6

2.1 Indications for the use of subcutaneous fluids 6

2.2 Limitations for the use of subcutaneous fluids 7

2.3 Contradictions for the use of subcutaneous fluids 7

2.4 Referral process 7

2.4.1 Referring GP 8

2.4.2 Accepting nursing team 8

2.5 GP Treatment Regimen and Monitoring 8

2.6 Nursing Procedure for Administration and Monitoring of Treatment

8

2.6.1 Equipment Required 8

2.6.2 Patient Preparation 9

2.6.3 Site Selection for Subcutaneous Infusion 10

2.6.4 Procedure for Administration of Subcutaneous infusion 11

2.6.5 Fluid Infusion Calculation 12

2.6.6 Patient Monitoring 12

3. RESPONSIBILITIES 12

4. ASSOCIATED DOCUMENTS AND REFERENCES

Infection Prevention and Control Policy Waste Management Policy Intravenous Therapy Administration Policy for Adults and Children Health & Safety Policy Medicines Policy Resuscitation Policy Health records Standards Consent for Examination or Treatment Policy Patient Identification Policy

Risk Assessment Policy

13


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5. MONITORING COMPLIANCE 14

6 DISSEMINATION AND IMPLEMENTATION 14

7. CONSULTATION, APPROVAL, RATIFICATION & REVIEW 15

Appendix A 16

Appendix B 17

Appendix C 18

Equality and Human Rights Analysis (EHRA) 19

Ratification Checklist 21


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1. INTRODUCTION 1.1 Background The administration of subcutaneous fluids is a safe, simple and effective method of treating mild to moderate dehydration in elderly patients (Scales 2011; Barton et al 2004) and those entering the last few weeks of life (NICE 2015). It is not suitable for treatment of severe dehydration or electrolyte imbalance. Dehydration can have a detrimental effect on the health of elderly adults and can lead to an increase in morbidity and mortality. As the body ages, its ability to regulate fluid balance deteriorates - kidney function becomes less effective, changes occur in body water composition and the thirst sensation reduces (Faes et al 2007). Additional adverse effects of dehydration in older adults include poor mental function, thrombosis, infection, renal stones and constipation (Scales 2011). Postural hypotension is likely to develop causing dizziness and putting the patient at risk of falling over, a very unwelcome complication for elderly adults who already have a greater vulnerability to fractures following a fall (Campbell 2012). All of these detrimental factors increase the likelihood of a hospital admission to hospital. In people at the end of life clinically assisted hydration should be considered if oral hydration is inadequate or not possible and the person has distressing symptoms or signs that could be associated with dehydration, such as thirst or delirium (NICE 2015). The King’s Fund Data Briefing (Tlan et al 2012) lists ‘dehydration and gastroenteritis’ as one of the leading causes of emergency admissions attributing to 10% of all ambulatory emergency admissions in England in 2009/10. Whilst many of these admissions are unavoidable, a proportion are admitted from care home settings. The intervention of subcutaneous fluid hydration will reduce the number of unnecessary admissions for mild and moderate dehydration, associated acute episodes of illness and secondary effects such as confusion and risk of falls (Barton et al 2004; Walsh 2005; Lybarger 2009). 1.2 Purpose The purpose of this document is to provide clear guidelines for the safe administration of subcutaneous fluids. 1.3 Scope This document covers the administration of subcutaneous fluids by registered nurses to adult patients (over the age of 18) at home, in a community hospital or care home by staff from Sussex Community NHS Trust (SCT) . It does not include children


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1.4 Definitions

Subcutaneous Under the skin; the hypodermis - the lower layer of the skin. With a subcutaneous procedure, a needle is inserted just under the skin, a drug or fluids can then be delivered into the subcutaneous tissues. The drug or fluid moves into small blood vessels and the bloodstream.

Hypodermoclysis Subcutaneous infusion of fluids usually for hydration

Gastroenteritis Inflammation of the stomach and small intestine caused by an infection, usually viral causing abdominal cramps, nausea, vomiting, diarrhoea, resulting in dehydration.

Norovirus Virus - Most common cause of gastroenteritis in humans Known as the ‘Winter vomiting bug’; highly infectious, transmitted by contaminated food or water, person-to-person-contact, contaminated surfaces

2. MAIN BODY OF DOCUMENT 2.1 Indications for the use of subcutaneous fluids

Short term hydration for patients who are unable to take adequate oral fluids to maintain hydration requirements

Diagnosis of mild to moderate dehydration

Patient medically stable, not requiring hospital admission due to associated symptoms of dehydration

Patients at the end of life who are distressed by being dehydrated or thirsty,

2.2 Limitations for the use of subcutaneous fluids

Sodium Chloride 0.9% will be used for subcutaneous infusion.

No other fluids or drug additives will be used

Use of hyaluronidase is not recommended

Hypodermoclysis is not suitable of patients requiring more that 2 litres of fluid in 24 hours (including oral fluid intake)

Patients at the end of life or those with persistent vomiting, usually due to chemotherapy or intestinal obstruction may receive small amounts of fluid on alternate days over a longer period. These patients will usually be known by a specialist palliative care service.

This policy does not apply to any subcutaneous infusion of drugs being given via a syringe driver ( See local syringe driver policy)

2.3 Contraindications for the use of subcutaneous fluids

Patient refusal/poor concordance

Severe dehydration/electrolyte imbalance

Rapid administration of large volumes of fluids is required

Coagulation disorders/low platelets/risk of bleeding at infusion site

Fluid replacement requiring potassium or other additives


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Marked oedema/poor tissue perfusion

Broken/infected skin at infusion sites

Acute Renal failure

Hypernatremia (serum sodium >150mEq/L), not applicable to people at the end of life

Caution in patients with peripheral vascular disease in lower extremities

Caution in patients with pulmonary oedema or cardiac failure

Where precise control of fluid balance monitoring critical to clinical diagnosis 2.4 Referral Process Once a patient has been diagnosed with mild to moderate dehydration, and is suitable for short-term subcutaneous rehydration (check against indications, limitations and contraindications, see sections 2.1, 2.2, 2.3), the patient must be referred for treatment via the relevant call service. Referring GP 2.4.1 The referring GP Clinician

Should:

Complete an FP10 for 3x 1 litre Sodium Chloride 0.9% for infusion, and send/fax to nominated pharmacy

Complete the relevant community prescription chart.

Where required arrange for pre-treatment blood tests to be taken - creatinine, urea, electrolytes, include any additional relevant blood test that may be needed e.g. clotting. .

2.4.2 Accepting Nursing Team The accepting nursing team will:

Visit the patient in their home care setting and confirm suitability for delivery of treatment, including patient consent

Obtain pre-treatment blood samples if relevant

Complete full nursing assessment including baseline physiological observations (blood pressure, pulse, temperature, respirations, and where indicated: oxygen saturations, urinalysis, blood glucose strip test)

Arrange the set up and monitoring of the subcutaneous fluid infusion.. Note: In a care home once the care home staff have agreed the monitoring of the subcutaneous infusion, it is their responsibility to ensure this is carried out safely and appropriately.

It is important to clearly establish the responsibly for the patient’s care for this intervention and ongoing monitoring.


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2.5 GP Treatment Regimen and Monitoring, this may not be applicable to people receiving fluid as part of their care at the end of life.

Day Treatment and Monitoring Complications

Referral Day

- Pre- treatment bloods taken and checked - GP confirms to start treatment - 1 litre Sodium Chloride 0.9% for infusion over 12 hours

- Pre-treatment bloods indicate subcutaneous fluid not suitable intervention e.g electrolyte imbalance - GP to arrange alternative treatment

1 - Post infusion bloods taken and checked - GP confirms to continue treatment - 1 litre Sodium Chloride 0.9% for infusion over 12 hours

- Post infusion bloods indicate subcutaneous fluid not suitable intervention - treatment not continued - GP to arrange alternative treatment

2

- Post infusion bloods taken and checked - GP confirms to continue treatment - 1 litre Sodium Chloride 0.9% for infusion over 12 hours

- Post infusion bloods indicate subcutaneous fluid not suitable intervention - treatment not continued - GP to arrange alternative treatment

3

- Post infusion bloods taken and checked - GP confirms dehydration rectified, treatment completed, patient discharged from service

- Dehydration not rectified - GP to arrange alternative treatment

2.6 Nursing Procedure for Administration and Monitoring of Treatment 2.6.1 Equipment Required Drip stand 1 litre bag Sodium Chloride 0.9% for infusion Intravenous infusion (giving) set Butterfly needle or 21-25g cannula Skin cleanser - 2% Chlorhexidine Gluconate (CHG) ampoule 0.67ml Transparent Semi-Permeable Membrane (TSM) dressing Dressing pack - gloves and apron included Additional non sterile gloves Sharps bin Completed subcutaneous infusion instruction chart (signed by prescriber) Nursing documentation


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2.6.2 Patient Preparation Gain informed patient consent Explain procedure to patient (and carer/s) Prepare patient, environment and necessary equipment Check patient allergies Check expiry date of prescribed fluids Check prescribed fluid is clear and colourless 2.6.3 Site Selection for Subcutaneous Infusion A skin site with an adequate amount of subcutaneous tissue should be selected. Individual assessment of the site areas should be made as the patient’s physical condition may influence site choice. Patient comfort and convenience must be considered in site choice Sites should be rotated every 24-48 hours to decrease likelihood of irritation and to optimize absorption. No more than 2 litres of fluid should be infused at any one subcutaneous site. Suggested subcutaneous infusion sites:

Khan & Younger (2007)


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Places to avoid:

Oedematous limbs

Painful sites - over bony areas, near joints

Broken skin, infected areas, sites with skin rash, bruised or scarred tissue

Previously irradiated skin area

Areas near breast tissue / perineum

On the side of a mastectomy or close to a stoma

Upper arm site in bed-bound patients who require regular turning

Peripheral extremities 2.6.4 Procedure for Administration of Subcutaneous Infusion Prior to carrying out the procedure, ensure patient consent has been obtained (see section 2.6.2), physiological observations have been taken and recorded (see section 2.4.2) and insertion site has been selected (see section 2.6.3) Procedure

Wash hands with soap and water as per SCT hand washing policy

Put on clean non-sterile gloves and apron

Prepare infusion equipment using Aseptic Non Touch Technique (ANTT)

Clean selected insertion site with 2% CHG applicator - check patient allergy to chlorhexidine prior to use. If allergic, use 70% isopropyl alcohol to clean insertion site; clean selected area thoroughly for 30 seconds; allow to air dry (1-2 minutes)

Remove gloves and discard

Wash hands with soap and water as per hand washing policy

Put on clean non-sterile gloves

Insert butterfly/cannula at a 45-degree angle into the subcutaneous tissue (if blood appears in the line, remove device, replace butterfly/cannula, prime and resite)

Loop the tubing and secure with TSM dressing

Commence infusion at the correct drip rate (see section 2.6.5)

Check infusion site to ensure fluid is not leaking from insertion site (if leaking, stop infusion, remove device, replace butterfly/cannula, prime and resite)

Remove gloves and apron and discard

Correctly dispose of equipment and any sharps in accordance with SCT waste policy

Wash hands with soap and water as per SCT hand washing policy

Complete relevant documentation including recording of batch number and expiry date of infusion fluid


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2.6.5 Fluid Infusion Calculation Formula to calculate the drip rate for subcutaneous infusion

Prescribed infusion to be administered: 1 litre Sodium Chloride 0.9% over 12 hours, via standard administration set delivering 20 drops per ml 1000mls x 20 (drops per ml) = 27.77 round up to 28 drops per minute 720 minutes Subcutaneous fluid infusions are administered using gravity only; volumetric pumps must not be used. 2.6.6 Patient Monitoring Regular monitoring of the patient and infusion will need to be arranged depending on the care home staff capabilities. The following must be checked and documented within 30 minutes of commencing the infusion, then rechecked every 4 hours in care home or hospice setting or twice a day in a community setting and at completion of the infusion (see Appendix 2):

Infusion site

Infusion drip rate

Fluid volume infused

Additional oral intake (where able)

Fluid output Monitor patient for adverse reactions, complications and any signs of fluid overload e.g pulmonary oedema, peripheral oedema.

Complication Action

Local oedema

- May be resolved by gently massaging area to aid absorption - Infusion should be re-sited if patient discomfort experienced

Redness, swelling or inflammation at infusion site (may be due to local reaction to cannula)

- A teflon cannula may be used as an alternative to reduce risk of potential nickel allergy - Change infusion site - Adhere to ANTT procedure

Cellulitis - Change infusion site - Adhere to ANTT procedure - Treat cellulitis according to patient’s clinical condition - Perform wound swab if clinically indicated to identify pathogen

Total in mls X Drops per ml (giving set) = drops per minute Minutes


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Pain or discomfort at infusion site

- Adjust/change needle position, needle may have been inserted intradermally (at too shallow an angle) - Slow infusion rate, infusion rate is too rapid

Leakage at site - Adjust/change needle position, needle may have been inserted intradermally (at too shallow an angle) - Slow infusion rate, infusion rate is too rapid

Abscess formation (rare)

- Reassess patient’s clinical condition and need for continued hypodermoclysis, to reduce the risk of further complications - Change infusion site - Treat abscess according to patient’s clinical condition - Perform wound swab if clinically indicated to identify pathogen

Bleeding/bruising at site

- Re-site needle if bleeding occurs on needle insertion; needle may have been inserted intradermally

Pulmonary oedema

- Infusion should be stopped immediately and medical advice sought to ensure patient safety

Peripheral oedema

- Infusion should be stopped immediately and medical advice sought to ensure patient safety

3. RESPONSIBILITIES General Practitioner / Medical Prescriber / The prescriber is responsible for assessing that the patient is suitable for the administration of subcutaneous fluids and prescribing fluids suitable for subcutaneous infusion taking into account the patient’s clinical presentation and involve the patient in that decision following the General Medical Council’s Good Clinical Practice guidance. The referring clinician will have medical responsibility for the patient, view blood results if appropriate. The prescriber must state the name of the infusion fluid, concentration, volume and rate of infusion. No more than 1 litre of infusion fluid prescribed over a 24-hour period. Registered Nurse The registered nurse administering subcutaneous fluids is responsible for checking the prescription is valid, obtaining and recording consent from the patient (if the patient lacks capacity to consent follow Mental Capacity Act Procedures relating to consent), setting up the infusion, monitoring the effectiveness and observing for and acting upon complications arising from the infusion. The registered nurse must be competent in both the theory and practice of administering subcutaneous fluids prior to carrying out the procedure.


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In addition The manufacturers of fluids for infusion applied for and were granted the product specific Product License for the purpose of intravenous infusion only. Therefore, the use of these sterile liquids for the purpose of subcutaneous infusion must be considered as an unlicensed procedure. This must be communicated to the patients / relatives when gaining consent for the procedure. As such, the medical prescriber must take full responsibility for the efficacy of the infusion fluid and any adverse effects resulting from its use. Care Homes There are differences in the staff provision, skills and training in care homes. Some care home employ registered nurses and others do not, depending on the type of care offered to the residents. The administration of subcutaneous fluids is permitted in all types of care home settings with the consent of the care home owner/manager, the prescribing GP and the patient. The process for this must be clear and relevant to the care home. Care Home Trained Staff (Registered Nurses) The registered nurse administering subcutaneous fluids is responsible for checking the prescription is valid, obtaining and recording consent from the patient (if the patient lacks capacity to consent follow Mental Capacity Act Procedures relating to consent), setting up the infusion, monitoring it’s effectiveness and observing for and acting upon complications arising from the infusion. The registered nurse should be competent in both the theory and practice of administering subcutaneous fluids prior to carrying out the procedure. Care Home Non-Trained Staff Where the care home does not employ trained nurses, monitoring of the patient and subcutaneous infusion can be carried out by a non-trained member of staff with the support of the relevant SCT community nursing team but the setting up of the fluids should be undertaken by a trained nurse. The non-trained staff member should receive training in the monitoring and trouble-shooting of subcutaneous fluids prior to carrying out the procedure. They must know how to monitor the patient and what actions to take in the event of any complications. The Chief Executive has ultimate responsibility for the organisation and is supported by the Executive Directors. The policy author is responsible for ensuring the policy follows the appropriate Trust format and complies with the recognised development, consultation, approval and ratification process. Service managers / team leaders are responsible for promoting and implementing the policy. All staff are required to complete in full and as directed any templates or proformas as instructed, for use as part of this policy.


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4. ASSOCIATED DOCUMENTS AND REFERENCES Barton A Fuller R Dudley N (2004) Using subcutaneous fluids to rehydrate older people: current practices and future challenges QJ Med 97:765-768 Last accessed on 20 January 2013 at: http://qjmed.oxfordjournals.org/ Campbell N (2012) Dehydration: best practice in the care home Nursing and Residential Care 14:1 21-25 Faes M Spigt M Olde Rikkert M (2007) Dehydration in geriatrics Geriatrics and Aging 10:9 590-596 Lybarger E (2009) Hypodermoclysis in the home and long-term care settings Journal of Infusion Nursing 32:1 40-44 NICE (2015) Caring for Adults in their last days of life. NHS Sussex (2012) Integrated Strategic and Operating Plan 2012-2015 NHS Sussex Board Meeting 27 March 2012 last accessed on 20 January 2013 at: http://www.westsussex.nhs.uk/ Scales K (2011) Use of Hypodermoclysis to manage dehydration Nursing Older People 23:5 16-22 Tlan Y Dixon A Gao H (2012) Emergency hospital admissions for ambulatory care-sensitive conditions: identifying the potential for reductions The King’s Fund Data Briefing Last accessed on 20 January 2013 at: http://www.kingsfund.org.uk/ Walsh G (2005) Hypodermoclysis: an alternative method for rehydration in long-term care Journal of Infusion Nursing 28:2 123-129

5. MONITORING COMPLIANCE Service managers will be responsible for monitoring compliance within the service through a variety of methods e.g. direct observation of practice, supervision, incident reporting and audit. The number of referrals and treatments for subcutaneous fluid hydration will be monitored and data collected for reporting as required.

6. DISSEMINATION AND IMPLEMENTATION The ratified policy will be disseminated to service managers in the relevant services for further dissemination to staff. The ratified policy will be posted on the Pulse.

http://qjmed.oxfordjournals.org/

http://www.westsussex.nhs.uk/

http://www.kingsfund.org.uk/


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This document will be circulated to all GPs within the North Locality of SCT for information and implementation.

Training sessions for community nursing staff

Training sessions for care home staff

Information guide for patients on pathway (Appendix 3)

Information sessions for GP practices to introduce the pathway Sussex Community Trust is committed to equipping staff with the necessary skills required to undertake their roles competently and confidently. In turn, staff must take responsibility for developing these skills and participating in the lifelong learning process. This policy will be made available on the intranet, and publicised through Contact (the Trust internal electronic newsletter).

7. CONSULTATION, APPROVAL, RATIFICATION & REVIEW Consultation and communication with:

Professional Lead for Nursing

Community Matron for Care Homes

Clinical Service Managers

Medicines Management Committee - SCT

Antimicrobial pharmacist

North Locality Clinical Commissioning Groups

Leads for End for Life Care Approval by Medicines Committee and North Locality Clinical Commissioning Group. Ratification by Patient Safety and Clinical Governance Committee Review of this document will take place every three years or sooner if there is a significant change to practice or new guidance.



Appendix A Title

Name

DOB NHS Number

KNOWN ALLERGIES Instruction Chart valid for

(end date / review date) Maximum 3 Days

SUBCUTANEOUS INFUSION INSTRUCTION CHART

Chart No: ____ of ____

DAY 1

Date Name of Medicine Dose Route Infusion

Rate Prescriber’s Name Prescriber’s Signature

Sodium Chloride 0.9%

for infusion 1000ml SC

Over 12 hours

DAY 2

Date Name of Medicine Dose Route Frequency Prescriber’s Name Prescriber’s Signature



Over 12 hours

DAY 3

Date Name of Medicine Dose Route Frequency Prescriber’s Name Prescriber’s Signature



Over 12 hours

MEDICINE ADMINISTRATION RECORD

Date Time Name of Medicine Expiry Date

Batch No. Dose Route Site Administered by

(signature)




Appendix B

FLUID BALANCE CHART (CARE HOMES SUBCUTANEOUS FLUIDS)

Patient Name………………………………………………… DOB……………………

NHS No………………………..………….... GP…………………...……………………

DATE TIME

(Hours) Use 24

hr clock

INPUT (ML) OUTPUT (ML) SITE

CHECK DRIP RATE

URINE BOWELS VOMIT

00:00

01:00

02:00

03:00

04:00

05:00

06:00

07:00

08:00

09:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

17:00

18:00

19:00

20:00

21:00

22:00

23:00

24:00

TOTAL

Drip Rate and Infusion Site need to be checked as follows:

1st Check within 30 minutes

2nd check at 4 hours

3rd check at 8 hours

4th check at 12 hours (on completion)

Check more often if indicated

Observe the person receiving treatment on a regular basis to ensure their comfort.



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Appendix C

Subcutaneous Fluid Infusion – A Patient Guide

What is a subcutaneous infusion? A subcutaneous infusion is a way to replace lost fluids in the body. It is done when a person is not well enough to drink enough water or eat enough food. A person who may not be well enough because of weakness, or if they have nausea or vomiting which might lead to mild dehydration. How can fluids be replaced in people who can’t eat and drink enough? There are two ways to do this. The first way is to put the fluid right into a vein; this is called Intravenous (IV) infusion. The other way is to put fluid under the skin; this is called subcutaneous fluid infusion. The fluids prescribed for this procedure are the same whether they are for intravenous or subcutaneous use and although these fluids are licensed for intravenous use, it is perfectly safe to use them for subcutaneous use. How safe is a subcutaneous infusion? This way of replacing fluids has been used safely for several decades. Due to the relative ease in setting up and administering subcutaneous fluids the procedure can be carried out in the care home setting by nurses. The infusion does not need close medical supervision and even if dislodges does not cause serious problems. How does the infusion work? A bag of fluid is connected to a plastic tube and to a small needle. The needle is put under the skin and secured in place. The needle is placed usually on the chest, abdomen, upper arms or thighs. There is a drip chamber in the tube (like a little window) that shows the flow rate of the fluid. A roller clamp allows control of the flow rate. The flow rate is how fast the fluid goes into the tube. What to look for when monitoring an infusion: Observe the infusion site, looking for:

redness

swelling

tenderness

bleeding

leakage of fluid

needle dislodgement

If any of the above problems arise or you need reassurance with this procedure contact a member of staff in the care home immediately.

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EQUALITY AND HUMAN RIGHTS ANALYSIS (EHRA) All staff are required by the Equality Act 2010 to assess whether a policy, practice or function has any relevance to equality i.e. could affect people differently according to 1) Age, 2) Disability, 3) Gender reassignment, 4) Marriage and Civil Partnership, 5) Race, 6) Religion or Belief, 7) Sex, 8) Sexual Orientation or access to human rights. Please use the form below to support your assessment

For more information and support on undertaking an EHRA, please visit The Pulse or contact the Equality and Diversity Lead.

1 Name of Policy or Service Clinical Guidelines for Subcutaneous Infusion (Hypodermoclysis) in the Care Home Setting

2 Service and Directorate Clinical Services - ADULT Clinical Guideline and Intervention Pathway

3 Objectives What is the purpose of this policy or service?

The purpose of this document is to provide clear guidelines for the safe administration of subcutaneous fluids.

4 Analysis completed by (Author? Equality Lead? Other?)

a) Name b) Job Title

Author Joanna Stuttaford Joint Service lead

5 Does the policy or service have an effect on Staff and/or the Public? (please )

Staff Yes No

Public Yes No

http://www.legislation.gov.uk/ukpga/2010/15/contents

http://thepulse/our-trust/equality-diversity/

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Equality law protects people on

the following grounds:

Has your policy or

service given due regard to this area of equality or

human rights?

If yes, is the effect positive or negative

Evidence of the effect (e.g. statistics, research, surveys, results of

engagement, etc)

Is further action required?

Yes If No, why not?

Positive effect

Negative effect

*Yes No

Age

Disability

Gender Reassignment

Marriage and Civil Partnership

Race and Ethnicity

Religion and Belief

Sex

Sexual Orientation

Access to Human Rights

Equality Analysis:

Signed Date

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RATIFICATION CHECKLIST

INSERT NAME OF GROUP MEETING INSERT DATE OF MEETING

Agenda Item: The meeting administrator should be able to provide this

Policy Title: Clinical Guidelines for Subcutaneous Infusion (Hypodermoclysis) in the Care Home Setting

Policy Author: Joanna Stuttaford/Sue Dewar

Presented By:

Purpose: Ratification

Checklist for Ratification

1. Reason for Review:

Reason for the Policy review: (please delete as appropriate) a) Revisions to current policy – Minor revision to include subcutaneous fluids at home

b) Review date due or expired - 2016

2. Summary

Please give a brief overview of the following: Purpose and scope of document – to provide clear guidelines for the safe administration of sub

cutaneous fluids

3. Format

Has the standard SCT template been used?

Yes Comments:

4. Consultation

Name: Mags Bunting, Julia Fairhall & Lauren Smith

Group Member – End of Life Steering Group Response Y/N

Please state the consultation who has been consulted in the of this document:

5. Dissemination/Implementation Process

6. Cost/Resource Implications

Does this policy/procedures have any cost and/or resource implications? N

Please provide details of the cost/resource implications: eg training, equipment, additional staff

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Has this been agreed by the accountable Director? N

Name Job Title Date

Richard Quirk

7. Approval

Please state the name of the Group that has approved this document?

Name: End of Life Steering Group

Date of Group Approval: Date: November 2016

8. Equality Analysis

Has the Equality Impact Assessment been completed?

Yes/No (please delete)

Comments

9. Review

Please state the timescale for review:

DECISION OUTCOME AND RECOMMENDATIONS

For completion by the Chair of the Group or Committee considering ratification.

Is the Committee / Group satisfied and assured that due process has been followed in order to produce or review the Policy?

Yes

Comments:

Is the Committee / Group satisfied and assured with the consultation on the Policy?

Yes

Comments:

Does anybody (Group or individual) else need to be consulted prior to ratification?

No

Please state who:

Other Comments

Outcome:

Was the Policy Ratified?

Yes

Other comments:

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Including strengths and good practice.

Additional actions required for ratification:

Must be SMART

Signature of Chair: Richard Quirk

Date: 04.04.17

Documents

Clinical Guidelines for Subcutaneous Infusion · PDF file · 2017-11-202.4.2 Accepting nursing team 8 ... Diagnosis of mild to moderate dehydration ... On the side of a mastectomy