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Document name:
Policy for the Pre-loading of Insulin in Syringes for Patients to Administer in their Own Home
Document type:
Policy (with Clinical Procedures Manual and Risk Assessment)
What does this policy replace?
New Policy (Clinical Procedures Manual replaces CWI 2.11)
Staff group to whom it applies:
District Nursing
Distribution:
The whole of the Trust
How to access:
Intranet
Issue date:
January 2015
Next review:
January 2018
Approved by:
Executive Management Team
Developed by:
Diabetes Specialist Nursing Service Practice Governance Coach- Long Term Conditions
Director leads:
Director of Nursing, Clinical Governance and Safety
Contact for advice:
Diabetes Specialist Nursing Service
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CONTENTS
PAGE 1 Introduction 3
2 Purpose 4
3 Definitions 4
4 Duties 5
5 Principles of Practice for Pre-loading of Insulin in Syringes 5
6 Contra- indications 7
7 Training 7
8 Equality Impact Assessment 8
9 Dissemination and Implementation Arrangements 8
10 Process for monitoring compliance and effectiveness 8
11 Process for Review 8
12 References 8
13 Associated Documents 9
14 Appendix A- Clinical Procedures Manual 10
15 Appendix B – Assessing Risk- The Pre-Loading of Insulin 16
16 Appendix C- Safer Sharps Risk Assessment 21
17 Appendix D- Equality Impact Assessment 22
18 Appendix E- Checklist for the Review and Approval of
Procedural Document 25
19 Appendix F - Version Control Sheet
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3
Policy for the Pre-Loading of insulin In Syringes for Patients to Administer in their Own Homes
1. Introduction Diabetes mellitus is a chronic condition. Patients require long-term medication to control blood glucose levels and reduce the risk of associated complications. For some patients the prescribed treatment is regular insulin injections. There are a number of patients with diabetes who cannot convert to using an insulin pen for independent self- administration of insulin because of manual dexterity, lack of strength, personal preference or reluctance to change. As a result many patients are unable to draw up their insulin and need the support of the District Nursing Service, although they may be able to inject independently using a syringe once or twice a day. The preparation of insulin injection by the District Nursing Service for patients to administer in their own homes at a later time has been the practice for many years. In this way each patient can administer their insulin at the correct time in relation to their meals. This not only preserves the individual’s independence, but also reduces the risk of hypoglycaemia and releases nursing time.
The Nursing and Midwifery Council (NMC) Standard for Medicines Management, (2010) Standard 14 “Preparing medication in advance” identifies that “a registrant must not prepare substances for injection in advance of their immediate use or administer medication drawn up into a syringe or container by another practitioner when not in their presence”.
However, the guidance statement identifies an exception would be where “ a registrant has delegated to a named individual for a named patient’s medication, this may be drawn up in advance to enable a healthcare assistant (HCA) or family to administer the medication. The registrant is accountable for the delegation, and a full risk assessment should be documented in the patient’s records ensuring the registrat is aware of the risks before agreeing to delegate. The person to whom they are delegating the task is a ‘named individual’ who has been assessed and documented as competent”.
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (the Sharps Regulations) came in to force in May 2013. The Regulations implement aspects of the European Council Directive 2010/32/EU (the Sharps Directive) that were not specifically addressed in existing legislation within Great Britain. The safer sharps regulations require employers to substitute traditional, unprotected medical sharps with a “safer sharp” where it is reasonably practicable to do so. The use of a safer sharp insulin needle together with the insulin syringe is mandatory for the pre-drawing of insulin in syringes for patients to administer within their own homes. The safer sharps regulations also prevent the recapping of needles after use unless the employer’s risk assessment has identified that recapping is itself required to prevent a risk. The procedure for pre-loading of insulin requires the needle to be re-sheathed after it has been drawn up for later administration by the patient. Although, the insulin
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needle has not been “used” this still poses a potential risk of harm to registered nurses pre-loading the insulin syringe. A risk assessment has been undertaken to mitigate this risk, (Appendix C)
The National Patient Safety Agency (NPSA) “are unaware of any reports where insulin syringes prepared in advance by nurses in the community and given expiry dates of greater than 24 hours have caused serious harm due to infection and contamination issues, (letter cited in Torbay and Southern Devon Health Care NHS Trust policy, recommended as a framework for best practice by the Royal College of Nursing, 2014). However, a Rapid Response Report has been issued for the safer administration of insulin.
This policy is supported by a clinical procedures manual, (Appendix A) and a risk assessment for the pre-loading of insulin for patients to self-administer later, (Appendix B). It stresses the necessary principles of practice including patient assessment and review, ensures other methods of insulin administration have been considered, together with contra-indications, and details appropriate insulin storage requirements and record keeping.
Please note that this policy is for registered nurses only delegating insulin administration to patients and/or family and relates to adult patients within the community setting.
2. Purpose
The purpose of this policy is to:
To promote patient safety
To ensure that Registered Nurses are aware of the potential risks of pre-loading a syringe for later use by a patient
To provide a clear and consistent framework across South West Yorkshire Partnership Foundation Trust for the appropriate assessment and management of a person with diabetes who cannot safely prepare their own insulin dose
To support Registered Nurses to provide insulin therapy as detailed in this policy which is classed as secondary dispensing ( and thus not covered in the Medicines Act, 1968)
3. Definitions Within the context of this policy the definition of “ pre-loading an insulin syringe” refers to insulin that has been withdrawn from a 10ml vial, using insulin syringe that is marked in one or two unit graduations. It is recommended that 8 mm needles are used when using an insulin syringe.
No other type of syringe should ever be used for insulin administration
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4. Duties The following duties apply to this policy: Executive Management Team (EMT)
The Director of Nursing, Clinical Governance and Safety is the lead director for clinical practice within the Trust, supported by the Medical Director and the Diabetes Specialist Nursing Service. The lead director will be responsible for engaging relevant stakeholders in the development of the policy and ensuring appropriate arrangements are in place for managing any resource implications, including dissemination and training and for ensuring that the most current version is in use and obsolete versions have been withdrawn from circulation. The Director of Nursing, Clinical Governance and Safety will also link with the District Directors and the Director of Human Resources to identify any problems with the implementation or monitoring of this policy
Clinical Governance and Clinical Safety Committee - The Clinical Governance and Clinical Safety Committee is responsible for scrutinising the implementation and effectiveness of this policy and providing assurance to the Trust Board.
The District Director - The District Director is responsible for the implementation of the policy with their BDU and ensuring that minimum training standards are being met in relation to the policy. Community Service Managers, Lead Nurse Community Services, Community Practice Teachers – The Community Service Managers, Lead Nurse Community Services, Community Practice Teaches are responsible for ensuring that the policy is implemented and adherence to the standards set within this policy are monitored.
District Nursing Service - All Registered Nurses in the District Nursing Service are responsible for the initial and continued assessment of patients who are self-administering and have a responsibility for recognising and acting upon changes within a patient’s condition with regards to safety of the patient and other.
Diabetes Specialist Nursing Service- The Diabetes Nursing Service is responsible for providing appropriate specialist advice in relation to whether any other alternative methods of insulin administration is appropriate.
5. Principles of Practice for the Pre-loading of Insulin in Syringes Pre-loading of insulin should only be recommended when alternative methods of delivery are not possible and after appropriate risk assessment as outlined in Appendix B.
Registered Nurses should be aware of alternative injection devices available and discuss the patient’s needs and preferred options with the Diabetes Specialist Nurse or the General Practitioner.
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Pre-loading of insulin for injection must only begin following a full written risk assessment, involving the Diabetes Specialist Nurse, and ruling out of alternative methods of administration. A thorough assessment of the patient’s understanding of the insulin regime, their ability to manage it and the support available between District Nursing Service visits, must be undertaken using Appendix A: Clinical Procedures Manual for the assessment of a patient to have insulin prepared in advance of administration followed by completion of Appendix B: Risk Assessment Form.
The risk assessment form in Appendix B should be undertaken every 3 months, or sooner if the patient’s condition changes. The patient should always be consulted about their insulin administration and informed consent obtained regarding the care provided. On completion of the risk assessment the Registered Nurses should decide on the appropriate number of days that the insulin syringes can be prepared for and left with the patient. It is important that the Registered Nurse considers all aspects of social and healthcare for their patient in this decision. The maximum number of days that insulin can be left pre-loaded is 4 days. Please note that if any new insulins become available the stability must be checked for the number of days it can be left pre-loaded before commencing. Advice may be sought from the Diabetes Specialist Nurse. Each pre-loaded syringe must be labelled individually with the patient’s name, insulin name, date of preparation, initials of the Registered Nurse and stored in a wipe-able labelled, sealable, hinge-lidded container.If the patient is having a different type of insulin or dose at another time of the day a different storage container should be used that are either different colours or shapes. The containers must be labelled with the patient’s name, insulin name, insulin dose, time of administration, number of syringes, date and name and signature of the Registered Nurse The following must be clearly documented in the patient’s clinical record each time pre-loaded syringes are prepared:
Name of insulin preparation ( both morning and evening) Pre-loaded dose – before breakfast Pre-loaded dose – before evening meal Number of syringes pre-loaded The number of containers used
The patient’s fridge should be visibly clean and free of debris. The insulin should be store in the fridge door or top shelf to prevent cross- contamination from other food items. It is recommended that insulin is most stable when stored at a temperature of 2 and 8 degree Celsius. Never allow insulin to freeze.
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Unopened insulin can be kept in these conditions until the expiry date. An opened vial of insulin kept in these conditions should be discarded after 28 days. The date that the vial was opened must be written on the vial and in the patient’s clinical records. Patients in residential care must have their pre-loaded insulin syringes stored as outlined in the bullet points of Section 5 above but in a locked fridge. Arrangements must be made to ensure that the monitoring of diabetes control is undertaken. Capillary blood glucose monitoring may be undertaken by the patient themselves, a family member/friend using their own glucose meter. A full written assessment should be undertaken to check the patient or family member is confident and competent to undertake this procedure. The meter should also be checked weekly with the relevant quality control solution that is provided by the relevant meter company to ensure it is accurate. Accuracy can also be checked by comparing a capillary blood glucose result with a venous glucose sample (only if blood tests required at the same time) on a weekly basis. A Hba1c every 3 months is also required to evaluate the level of diabetes control. Liaise with the Diabetes Specialist Nurse as required for advice if circumstances change. 6. Contra-indications
Insulin Lantus (Glargine) must not be pre-loaded into insulin syringes Very variable capillary blood sugar recordings Lack of satisfactory storage conditions in the patient’s home Unpredictable mental state or declining cognitive ability Pre-filled insulin cartridges and commercially available pre-loaded pens must
not be used to withdraw insulin in order to comply with the policy. Only 10 ml vials are permissible to be used.
If any of the points above are found, then this is to be reported to the GP and the advanced preparation of insulin in syringes should cease and arrangements made for the District Nursing team to visit at the required intervals. A Datix (clinical incident form) should be completed. 7. Training All clinical staff should be made aware of this policy at both induction (new staff) and specific medicines management training where appropriate. All community nursing involved in insulin administration will undertake the Medicines with Respect Training.
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8. Equality Impact Assessment This policy has no differential impact on equality, as identified by the equality impact assessment tool, completed in line with the SWYPFT policy for the development , approval and dissemination of policy and procedural documents, see appendix D. 9. Dissemination and Implementation Arrangements Once approved, the Integrated Governance Manager will be responsible for ensuring the updated version is added to the document store on the intranet and is included in the staff brief. If local teams down load and keep a paper version of procedural documents, the manager must identify someone within the team who is responsible for updating the paper version when a policy change is communicated via the staff brief. 10. Process for monitoring compliance and effectiveness Quality assurance that the risk assessment and Clinical Manual Procedure are being completed as outlined in this policy in Appendices A and B, will be undertaken as part of the clinical records audit process. 11. Process for review The policy will be reviewed by the agreed review date, in line with the Trust’s Policy for the development, approval and dissemination of policy and procedural documents. This may be brought forward if earlier review is required, for example because of an identified risk or change in national policy. The Integrated Governance Manager will notify the lead director three months before the policy is due for review. The lead director will check the policy. If no amendment is required, this should be reported to the Executive Management Team for ratification by the review date and the policy will be reissued. If the policy requires minor amendments, the revised policy will be presented to the EMT. If significant amendment is required, the process described in the Trust’s Policy for the development, approval and dissemination of policy and procedure documents should be followed. 12. References
Nursing and Midwifery Council, (NMC) (2010) Standards for medicines management. www.nmc-uk.org/publications
Nursing and Midwifery Council, (NMC) (2008) The Code. Standards fo
conduct, performance and ethics for nurses and midwives. www.nmc-uk.org
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National Patient Safety Agency (2010) Rapid Response Report. Safer
Administration of Insulin. NPSA/2010/RRR013
Royal College of Nursing (2014) Response to enquiry regarding the RCN, (2006) Advance preparation of insulin syringes for patients to administer at one. Email on file
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
(the Sharps Regulations)
Torbay and Southern Devon Health Care NHS Trust, (2012) Policy for the Pre-Loading of Insulin Syringes for Patients to Administer at Home.
13. Associated documents
South West Yorkshire Partnership NHS Foundation Trust, (2012) Care Records Management Policy.
South West Yorkshire Partnership NHS Foundation Trust, (2013) Infection
Prevention and Control Policy
South West Yorkshire Partnership NHS Foundation Trust, (2012) Prevention and Management of Occupational Exposure to Blood Borne Viruses and Post-Exposure Prophylaxis
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Appendix A SOUTH WEST YORKSHIRE PARTNERSHIP NHS FOUNDATION TRUST BARNSLEY BUSINESS DELIVERY UNIT _________________________________________________________________________CLINICAL PROCEDURES MANUAL
_________________________________________________________________________
PRE LOADING OF INSULIN IN SYRINGES REF CWI 2.11 FOR PATIENTS TO ADMINISTER IN THEIR OWN HOMES __________________________________________________________________________________ 1.0 APPLICABLE TO District Nursing
2.0 PERSONNEL Registered Nurse
3.0 RISK FACTORS Incorrect identification of patient. Risk of
Medication error leading to harm
4.0 PURPOSE To promote patient safety. To ensure that Registered Nurses are aware of the potential risk of pre-drawing up insulin. To provide a clear and consistent framework for the appropriate assessment and management of a person with diabetes who cannot safely prepare their own insulin
5.0 PROCEDURE Equipment 1.Plan of care 2.Insulin of prescribed type 3.Insulin Safety Syringes 50, or 100 unit syringes (depending on which is most appropriate for the dose), needle length should be no more than 8 millimetre (8mm) 5.Wipe-able, sealable, hinged, labelled container/s for storage of pre-filled syringes 6.Syringe labels 7.Green insulin medication sheet 8.Sharps container 9. Refrigerator for storage of insulin (available in patient’s own home)
Action – Mental Capacity and Physical Capability 1.Assess the mental and physical capability of the patient/carer to self -administer insulin. The patient should be at Level 3 which is defined as “the patient accepts full responsibility for the storage and administration of the medicinal products”
Rationale Reduce risk of medication error NMC Standards for Medicines Management (2010).
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The level should be documented in the patient’s records Registered nurses should be aware of that the Mental Capacity Act 2005 requires all those working with potentially incapacitated people to assess the individual’s capacity at a particular moment about a particular decision. Any change in the patient’s condition would necessitate a review of their self- administration status e.g. risk of self- harm
Care plan must be updated as a minimum every 3 months to meet needs of patient Reduce risk of medication error
Action- Consent 2. Discuss risks and benefits of self- administration with the patient Support available between community nurse visits Where the patient consents to self-administration of their medicines the following points must be considered
Patients share the responsibility for their actions, relating to self-administration of their medicines. If children have access to the fridge that the patient ensures that the syringes are kept out of reach and/or a child proof fridge lock is in situ
Patients can withdraw consent at any time
Rationale To gain informed consent and document in patient’s records. Patients are empowered to make informed choices Patients are empowered to make informed choices Safeguarding of Children
Action – Ensure most appropriate product has been prescribed 3. Discuss and assess potential alternative insulin preparations with the Diabetes Specialist Nursing team. Contra- indications Are there any contra-indications for the pre-loading of insulin syringes:
Lantus Insulin (Insulin Glargine) must not be pre-loaded up for later administration as it becomes cloudy
Only use 10ml vials to withdraw insulin into syringes. Do not withdraw
Unable to preload/use pen devices due to manual dexterity, poor vision, peripheral neuropathy, physical weakness to deliver insulin does in insulin pen device, patient preference or reluctance to change Risk of deterioration of insulin
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from pre-loaded pens or 3ml cartridges
Is the fridge in working order?
Is the fridge visibly clean?
Is the fridge free from debris?
Patient suffers from an unpredictable mental state or declining cognitive ability
Very variable capillary blood glucose readings
If any of the above points are found, then this needs to be reported to the GP and the advanced preparation of insulin in syringes should cease and arrangements made for the community nursing team to visit at the required intervals. Complete Datix incident report
To ensure appropriate storage conditions There would be a risk to patient safety
Action – Education of Patient 4. Information/education given and supervision should be tailored to meet individual patient need to enable the patient to administer the right dose, at the right time using the correct technique The following information should be provided to the patient before commencing self administration:
The name of the medicine
Why they are taking it, dose and frequency
Re-suspending each pre-loaded syringe between the hands to warm the insulin, at least 20 times prior to injection, if using a cloudy insulin
Inject at a 90 degree angle into sub-cutaneous tissue using a “pinch- up” technique into abdomen, outer thigh or buttocks as decided in the care plan
Rotation with an injection site or between different injection sites
Common side effects and what to do if they occur e.g. hypoglycaemia
Any special instructions
How to obtain further supplies
How to store the medication
Frequency of visits & contact number between visits
Recognition of error and procedure to follow
Correct disposal of sharps at the
To ensure safe administration of insulin To comply with NMC Standards for medicines management (2010) Injecting cold insulin can be painful and it is not absorbed so effectively
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point of use Plan of care documented and agreed with patient and nurse to ensure adequate support, monitoring of diabetes control and wellbeing
To demonstrate partnership working
Action – Preparation of Insulin 5. The minimum nurses should visit to pre-load insulin is twice weekly Document the advanced preparation of insulin on the Green insulin medication sheet, ensuring full details are recorded, including batch number, type of insulin and expiry date are recorded.
To reduce risk of administration errors To comply with Trust documentation record keeping
Read and check plan of care. Check all previous pre-loaded syringes have been administered and safely disposed of. An Datix incident form should be completed if not to investigate why the syringes had not been used.
Explain the procedure to the patient, ensuring consent obtained
Prepare clean working surface
Collect equipment required: check insulin for expiry date and against instructions of care plan
Wash hands and dry thoroughly
Prepare equipment and re-suspend (by rocking back and forth) insulin at least 20 times if using a cloudy insulin. Do not shake as you will damage the insulin suspension. If using a clear insulin there is no need to re-suspend
Swab insulin vial with an alcohol wipe and allow to dry
Draw up insulin in presence of patient as follows for each syringe using a clean procedure to prevent contamination:
Remove needle cover and pull back plunger to measure an amount of air equivalent to the amount of insulin prescribed
With insulin vial standing upright, insert the needle through the centre of the rubber cap and push down the plunger
Invert the insulin vial
Pull back plunger until slightly more
To reduce risk of administration errors To reduce risk of cross infection To ensure safe administration of insulin To comply with NMC Standards for Medicines Management (2010) To ensure best practice in the preparation of insulin prior to injection
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than correct dose is drawn up
Expel any air bubbles back into vial
Re-check correct prescribed does has been drawn up and remove needle from vial
Carefully re-sheath needle ( there is no risk of contaminated needle stick injury as needle is sterile – in event of a needle stick injury the syringe must be safely discarded in a sharps bin, first aid, bleed, wash, cover and report)
Label each syringe with patient name, insulin name, date of preparation, initials of Registered Nurse
Label each container with patient name, insulin name, insulin dose, time of administration, number of syringes, date, name and signature of Registered Nurse
Store pre-filled syringes with needles slightly elevated, within a labelled container as described earlier in main body of the fridge (away from freezer section or the back of the fridge)
Dispose of clinical waste and wash and dry hands thoroughly
Complete nursing documentation ensuring date, time insulin type/dose, batch number and number of pre-filled syringes are recorded
If any pre-loaded syringes have not been used within the designated period, they must be disposed of.
Action – Safe Storage of Pre-Loaded Insulin The needle should be stored approximately at 45 degrees to prevent blockage by suspended substances in the insulin Pre-filled syringes should be labelled and stored in a protective container. If there are different doses then use more than one container. Store in the main body of the fridge ( away from the freezer section of the back of the fridge) between 2-8 degrees. The container should be clearly labelled with the following information
Date
Name of patient
Pre-loaded dose
Number of syringes
Needle blockage by suspended insulin To promote safe storage of pre loaded insulin To ensure best practice To reduce the risk of medication errors
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Number of insulin preparation
Time of insulin administration e.g. before breakfast, before evening meal
Route (subcutaneous) Instructions for administration e.g. just before or 30 minutes before food at times agreed with the patient and document in the nursing notes who has prepared the syringes Separate containers should be used for insulin to be delivered at different times of the day, particularly if the syringe contains a different dosage or type of insulin When each new insulin vial is opened, the date and time must be recorded on the vial and in the patient’s notes Any insulin remaining in vial after 28 days should be discarded Patients should have a vial in use and a back up vial at all times to ensure that vials are used methodically The patient should be advised of the correct storage ( as above) and advised to notify the District Nursing team as soon as possible if their fridge stops working or the fridge freezes
To reduce medication error To meet patients individual needs To promote standardisation of labels used To promote safe storage of insulin
References
1. Nursing and Midwifery Council (NMC) (2010) Standards for Medicines Management
2. NMC, (2008) The Code. Standards of Conduct, Performance and Ethics for Nurses
and Midwives
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Appendix B ASSESSING RISK - THE PRE-LOADING OF INSULIN
The pre-loading of insulin should be considered as a last resort and only following a risk assessment. The aim is to promote independence not as a means of saving nursing time Contra-indications
Insulin which is not suitable for the pre-loading:
Short acting (soluble) insulin
Long acting analogues e.g. Glargine (Lantus)
Unstable diabetic condition
Lack of satisfactory storage facilities
Patient suffers from an unpredictable mental state or declining cognitive ability
Patient resides in a care home without suitable storage facilities If there are no contra-indications to pre-loading then a positive response to all of the following questions are required before the pre-loading of Insulin can commence:
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Risk Assessment for Pre-Loading of Insulin
Patients name
Address
NHS Number
Date of Birth
GP
Type of Diabetes
How long has the patient been insulin treated?
Range of blood glucose readings
Last Hba1c result and date
Date of Risk Assessment completed
Date of Review for risk assessment
Name and Signature of nurse completing risk assessment form
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1. Assessment of Patient’s suitability for Self administration of Insulin
Yes / No
a. Have you assessed the mental and physical capability of the patient/carer to self -administer insulin?
b. Has the patient/carer shown that he/she understands their Insulin regimen?
c. Has the patient/carer shown that he / she is able to administer insulin correctly and independently at the appropriate time?
d. Is the patient at level 3*?= The patient accepts full responsibility for the storage and administration of the medicinal products. N.B The patient should be at Level 3 for this assessment to continue further. (*Level 1= registered nurse is responsible for
storage of insulin and supervision of the administration process ensuring the patient understands the insulin product being administered/ Level 2= registered nurse is responsible for the storage of insulin. At administration time the patient will ask the nurse to open the cabinet/locker. The patient then self administrer the insulin under the supervision of the nurse)
e. Is the level documented in the patient’s records?
f. Risk associated with disability – sensory and or physical?
g. Risk of self-harm?
2. Consent Yes/No
a. Have you discussed the risks and benefits of self administration with the patient?
b. Do children have access to the fridge?
c. If yes, have you advised the patient to ensure that the syringes are kept out of the reach of children?
d. Has a fridge lock been purchased and in situ?
e. Provided information about support available between community visits?
f. Is the patient happy to receive the service?
3. Ensure the most appropriate product has been prescribed
Yes/No
a. Has advice been sought from the Diabetes Specialist Nurses as to a potential alternative insulin preparation/device in order to avoid this situation? NB This discussion must have taken place before the assessment can continue further.
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4. Are there any Contra-Indications for the pre-loading of insulin syringes
Yes/No
a. Is the patient on Lantus Insulin ( Insulin Glargine)?
b. The fridge is NOT working order?
c. The fridge is NOT visibly clean?
d. The fridge is NOT free from debris?
e. Blood glucose showing wide variations?
f. Patient suffers from an unpredictable mental state or declining cognitive ability?
g. Is their current insulin in a pre-filled cartridge or pen
If any of the points a-g are found, then this needs reporting to the GP and the advanced pre-loading of insulin syringes should cease and arrangements made for the district nursing team to visit at the required intervals
5. Education of Patient Yes/No
Has the patient received the following information before commencing self administration:-
a. The name of the insulin?
b. Why they are taking it?
c. Dose and frequency/
d. Shown how to re-suspend each pre-loaded syringe, between their hands to warm the insulin, at least 20 times prior to injection, if using a cloudy insulin?
e. Inject at a 90 degree angle into sub-cutaneous tissue using a “pinch – up” technique into abdomen, outer thigh or buttocks.
f. Shown how to rotate within an injection site or between different injection sites?
g. Educated how to manage hypoglycaemia and what to do if it occurs?
h. How to obtain further supplies?
i. How to store the insulin?
j. Frequency of visits & contact number for between visits?
k. Recognition of error and procedure to follow?
l. Does the patient/carer know how to dispose of the used syringes safely?
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m. Is the plan of care documented and agreed with the patient
n. Nurse to ensure adequate support, monitoring of diabetes control and well-being
6. Summary of Risks Identified
Summarise risks identified, including intuition and patient’s awareness and experience of risk factors
7. Would pre-loading of insulin promote independence & meet patient need?
Yes/No
8. Is there a need for any further assessments? Yes/No
If answered yes to each question proceed to pre- loading of insulin twice weekly unless contraindicated and scan into the patients SystmOne record. If answered no to any question insulin cannot be pre- loaded and seek alternative treatment. Review the risk assessment 3 monthly or sooner if the patient’s circumstances change
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Appendix C
Safer Sharps Risk Assessment
Sharps Type:- Insulin needle safer sharp device Use & Description:- For self administration of insulin using an insulin syringe and
needle by patient in their own home after being pre-loaded by the District Nursing Service
Hazard:- The safer sharps needle will need to be re-sheathed after pre-
loading in order for the patient to self administer at a later date Risks:- Potential for staff to sustain needlestick injury with clean safer
sharps needle during the procedure of drawing up the insulin. Actions:- Safer sharps needle must be used at all times for the pre-loading of insulin Standard precautions:-
1. Pre-loading of insulin for patient self administration must only be undertaken after a risk assessment has been carried out for patient suitability and alternative options for insulin management have been considered in line with the Policy for the Pre-loading of Insulin Syringes for Patients to administer in their Own Home.
2. Extra care must be taken when re-sheathing the needle for later use. 3. If a sharps injury is sustained the following procedure as set out in the Prevention
and Management of Occupational Exposure to Blood Borne Viruses and Post-Exposure Prophylaxis Policy must be followed, (even though the needle is “clean”)
a. Encourage local free bleeding of percutaneous wounds. b. Wash copiously with soap and running water, but do not use a scrubbing
action. Antiseptics and skin washes should not be used, as there is no evidence of their effect on local defences (DH 2008).
c. Dry and apply adhesive dressing. d. Do not suck the wound.
All completed risk assessment forms should be retained locally for reference (in the Health and Safety Risk Assessment file/folder) by the department, ward, team or service manager
Service and area
Department or Team
Manager Director, AD or AMD
Assessor
Assessment Date
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Appendix D - Equality Impact Assessment Tool To be completed and attached to any policy document when submitted to the Executive Management Team for consideration and approval.
Date of Assessment: 17 November 2014 Equality Impact Assessment
Questions:
Evidence based Answers & Actions:
1 Name of the document that you are Equality Impact Assessing
Policy for the Pre-loading of Insulin Syringes for Patients to Administer in their Own Homes
2 Describe the overall aim of your document and context? Who will benefit from this policy/procedure/strategy?
The overall aim of the policy is to describe the Trust’s approach to the pre-loading of insulin in syringes for patients to administer in their own homes. All staff and patients
3 Who is the overall lead for this assessment?
Director of Nursing, Clinical Governance and Safety
4 Who else was involved in conducting this assessment?
Diabetes Specialist Nurses
5 Have you involved and consulted service users, carers, and staff in developing this policy/procedure/strategy? What did you find out and how have you used this information?
No N/A
6 What equality data have you used to inform this equality impact assessment?
N/A
7 What does this data say?
N/A
8 Taking into account the information gathered above, could this policy /procedure/strategy affect any of the following equality group unfavourably:
Yes/No Evidence based Answers & Actions. Where Negative impact has been identified please explain what action you will take to remove or mitigate this impact.
8.1 Race No
8.2 Disability No
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Equality Impact Assessment Questions:
Evidence based Answers & Actions:
8.3 Gender No
8.4 Age No
8.5 Sexual Orientation No
8.6 Religion or Belief No
8.7 Transgender No
8.8 Maternity & Pregnancy No
8.9 Marriage & Civil
partnerships
No N/A
8.10 Carers*Our Trust
requirement*
No N/A
9 What monitoring arrangements are
you implementing or already have in
place to ensure that this
policy/procedure/strategy:-
.
9a Promotes equality of opportunity for
people who share the above
protected characteristics;
The policy is applicable to all patients including all
those within the protected characteristics who are
unable to draw up their own insulin but are able to
administer themselves if pre-loaded by a District
Nurse
9b Eliminates discrimination,
harassment and bullying for people
who share the above protected
characteristics;
As above
9c Promotes good relations between
different equality groups;
As above
9d Public Sector Equality Duty – “Due
Regard”
As above
10 Have you developed an Action Plan
arising from this assessment?
No
11 Assessment/Action Plan approved by
Signed: Date: Title:
12 Once approved, you must forward a
copy of this Assessment/Action Plan
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Equality Impact Assessment Questions:
Evidence based Answers & Actions:
to the Equality and Inclusion Team:
Please note that the EIA is a public
document and will be published on
the web.
Failing to complete an EIA could
expose the Trust to future legal
challenge.
If you have identified a potential discriminatory impact of this policy, please refer it to the Director of Corporate Development or Head of Involvement and Inclusion together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact the Director of Corporate Development or Head of Involvement and Inclusion.
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Appendix E - Checklist for the Review and Approval of Procedural Document To be completed and attached to any policy document when submitted to EMT for consideration and approval.
Title of document being reviewed: Yes/No/ Unsure
Comments
1. Title
Is the title clear and unambiguous? Yes
Is it clear whether the document is a guideline, policy, protocol or standard?
Yes The front cover outlines it is a policy that also contains a procedure as an appendix
Is it clear in the introduction whether this document replaces or supersedes a previous document?
Yes
2. Rationale
Are reasons for development of the document stated?
Yes
3. Development Process
Is the method described in brief? Yes
Are people involved in the development identified?
Yes
Do you feel a reasonable attempt has been made to ensure relevant expertise has been used?
Yes
Is there evidence of consultation with stakeholders and users?
Yes
4. Content
Is the objective of the document clear? Yes
Is the target population clear and unambiguous?
Yes
Are the intended outcomes described? Yes
Are the statements clear and unambiguous? Yes
5. Evidence Base
Is the type of evidence to support the document identified explicitly?
Yes Within the introduction and also listed under references
Are key references cited? Yes
Are the references cited in full? Yes
Are supporting documents referenced? Yes
6. Approval
Does the document identify which committee/group will approve it?
Yes
If appropriate have the joint Human Resources/staff side committee (or equivalent)
N/A
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Title of document being reviewed: Yes/No/ Unsure
Comments
approved the document?
7. Dissemination and Implementation
Is there an outline/plan to identify how this will be done?
Yes
Does the plan include the necessary training/support to ensure compliance?
Yes
8. Document Control
Does the document identify where it will be held?
Yes
Have archiving arrangements for superseded documents been addressed?
Yes
9. Process to Monitor Compliance and Effectiveness
Are there measurable standards or KPIs to support the monitoring of compliance with and effectiveness of the document?
Yes The monitoring of compliance to the policy has been included within the records audit process
Is there a plan to review or audit compliance with the document?
Yes As above
10. Review Date
Is the review date identified? Yes
Is the frequency of review identified? If so is it acceptable?
Yes
11. Overall Responsibility for the Document
Is it clear who will be responsible implementation and review of the document?
Yes
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Appendix F - Version Control Sheet This sheet should provide a history of previous versions of the policy and changes made
Version Date Author Status Comment / changes
1 January 2015
Diabetes Specialist Nursing Service
Practice Governance Coach- Long Term Conditions
Approved
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3
4
5
6
7
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