Title Clinical Guideline for the Administration of medication via an Intradermal / Subcutaneous / Intramuscular Injection. Guideline reference number Reference Number: 136 Aim and purpose of guideline / policy To provide guidance for staff who administer medication by injection within Liverpool Community Health Author Quality Lead for District Nursing. Type New Guideline Reviewed Guideline √ Review date November 2017 Person/group accountable for review Clinical Policies Working Group Type of evidence base used C: Evidence which includes published and/or unpublished studies and expert opinion (limited scientific evidence) Issue date December 2015 Authorised by Clinical Policies Group Clinical Policies Working Group Equality Analysis Undertaken Yes √ collated √ No 1
Preparation Step Procedure Rationale 1 Verbally confirm patients date of birth and full name Explain and discuss the procedure with the patient. Obtain valid consent for the administration of the drug via injection and record consent in the patient’s healthcare record. To ensure the patient understands the procedure and gives informed consent. 2 Verify the patients name and date of birth with the prescription sheet. Check the prescription sheet or pharmacy dispensary label for drug name, form, specific directions, time due, dosage, batch number and route of administration. Check drug and dosage are appropriate to the patient’s condition(s) / age / weight, if in doubt consult the British National Formulary and / or the prescriber. Check that there are no contraindications to the administration of the drug, including allergies. To ensure the medication is given safely to the correct patient, at the correct time, at the correct dose and route. 3 Check drug information leaflet to see if there are any injection sites that are recommended or any that are to be avoided. To ensure absorption of the drug. 4 In the case of unfamiliar medicines refer to the package insert for manufacturer’s information or a current British National Formulary ( BNF ) If the dose is not within usage ranges contact the prescriber or pharmacist for advice To reduce the possibility of medication error To reduce medication errors
Read the patients care plan and know its current contents and check that the medicine is due for administration at that time. Ensure dose has not already been given by checking previous entries in the health record and drug administration sheets. To prevent patient from receiving duplicate dose 5 Select appropriate injection site, based on manufacturer’s information and individual patient assessment. Consideration should be made to patient’s comfort and dignity. To ensure absorption of the drug. Maintain patient comfort and dignity. Prevent pain and discomfort to the patient. 6 Select appropriate sized safer sharp needle for administration, based on selected injection site, route and individual patient assessment. To ensure absorption of the drug. Prevent pain and discomfort for the patient. 7 Ensure all the equipment and the drug to be administered is within its expiry date and is sterile, including anaphylaxis kit. To ensure no adverse reaction or infection. 8 Re-check prescription and carry out any calculations relating to dosage. To prevent overdose of drug. 9 Prepare syringe and needle for drawing up and the reconstitution of powder utilising sterile safer sharp needle and aseptic technique. A 23G (Blue) safer sharp needle should be used for drawing up from a glass ampoule, unless a needle is provided for drawing up from a glass ampoule by drug manufacturer Draw up prescribed amount of the drug aseptically into the syringe Remove the needle used for drawing up and apply the attached safety cover. Dispose into a sharps container. Replace with a new, safer sharp needle of the appropriate size for administration To ensure that the drug remains aseptic, without glass fragments and to prevent contamination. To prevent accidental sharps injury. To ensure smooth insertion of needle and to minimise pain and discomfort.
COMPETENCY FRAMEWORK FOR ADMINISTRATION OF DRUGS VIA AN INJECTION 1 Underpinning knowledge PRACTICE OUTCOME/ SKILL SUPPORTING EVIDENCE Assessor Nurse 1.2 Demonstrates knowledge of drugs, possible side effects and contraindications of the drug to be administered by the injection. DATE PASS FAIL COMMENTS 1.3 Demonstrates a clear understanding of the procedure used to report any adverse drug reactions (LCH policy and yellow card system). Assessor Nurse DATE PASS FAIL COMMENTS
COMPETENCYFRAMEWORK FOR ADMINISTRATION OF DRUGS VIA AN INJECTION 2. Preparation PRACTICE OUTCOME/ SKILL SUPPORTING EVIDENCE Assessor Signature Nurse Signature 2.0 Before any activity is undertaken, obtains the patient’s consent and documents this in the patient’s notes. DATE PASS FAIL COMMENTS 2.1 Explains the principles and procedure of injections in a manner appropriate to patient and / or carer. Assessor Nurse DATE PASS FAIL COMMENTS
COMPETENCYFRAMEWORK FOR ADMINISTRATION OF DRUGS VIA AN INJECTION 2. Preparation PRACTICE OUTCOME/ SKILL SUPPORTING EVIDENCE Assessor Nurse 2.2 Uses additional patient / carer information resources where appropriate and available for example leaflets. DATE PASS FAIL COMMENTS 2.3 Able to identify and assemble all appropriate equipment / supplies for the procedure, including anaphylaxis kit. Assessor Signature Nurse Signature DATE PASS FAIL COMMENTS
COMPETENCY FRAMEWORK FOR ADMINISTRATION OF DRUGS VIA AN INJECTION 3.Procedure PRACTICE OUTCOME/ SKILL SUPPORTING EVIDENCE Assessor Nurse 3.0 Draws up solution appropriate amount of drug aseptically using appropriate equipment. Leaves needle cover in place as long as possible. Ensures area for injection is socially clean. DATE PASS FAIL COMMENTS 3.1 Changes the needle prior to injecting, expelling any air bubbles. Checks volume of drug prior to administration. Monitors the condition of the patient throughout the procedure. Assessor Signature Nurse Signature DATE PASS FAIL COMMENTS
COMPETENCYFRAMEWORK FOR ADMINISTRATION OF DRUGS VIA AN INJECTION 4. Infection control 4.3 Following completion of the clinical procedure ensure all waste materials are disposed of in an appropriate manner in accordance with local trust policy. Assessor Signature Nurse Signature DATE PASS FAIL COMMENTS