Hospital In-Patient Multi-Disciplinary s1

Pathway for McKinley T34 for staff in nursing homes-v1-00-0296-TRE-DCHS Version No 1.0 Version Date 27/08/13 Review Date 27/08/2015

Surname: ……………………………………… NHS No ______Home

Forename(s): ……………………………………… Date of Birth: ______G.P

Address: …………………………………………………………………………… Male / Female

Pathway for McKinley T34 Syringe Driver

NB: This document is a record of care for each individual patient for which a syringe driver is used. The person making the record entry should print their name and designation alongside the signature, date and time the first time they personally make an entry, after which ALL subsequent entries should be signed, dated and timed at completion

Is the patient using a McKinley T34 Yes  No , If no have you alerted other staff to this Yes  No , Change syringe driver Model to McKinley T34 at next syringe change

Signature:- …………………… Print:- ………………………………….. Designation:- ……………………………

Date the syringe driver was first set up ….. / …./ …….. by whom ……………………………………..

Activity Assessment Yes No Date, Time /NA & Signature

A. Consent Have you discussed the use of the syringe driver and medications with the patient, carer, relatives, explaining the benefits and risk and have they consented to this method of administration?

 Ensure that the medication and diluent been prescribed with the appropriate period to be infused  Check the drug dose and diluent against the prescription.  Complete syringe driver form.  Refer to Symptom Management Guidance to be used with care pathways for last days of life. B. Prescribing &  Complete appropriate incident form for your area of work if drug checking instability or compatibility problems occur (or other problems)  Ensure a label is attached to the syringe without covering the markings and including the following details: - Name of Patient - Date of birth of Patient - Syringe driver contents - NHS number of Patient - Name of nurses who set syringe driver up, date and time set up - Time of when the syringe should expire

 Is there a range of prn medication prescribed?  If the answer to the above is No contact medical or non medical prescriber as appropriate to prescribe prn medication  It is preferable to administer prn medication by subcutaneous injection C. where possible. NOTE other routes that could be used are oral and Breakthrough rectal See Prescribing on Palliative Care in BNF. Medication  If regular breakthrough medication is required, do the contents of the syringe need to be reviewed? Discuss with prescriber  Evaluate and document the effectiveness of the prn medication administered on the appropriate documentation, i.e. pain chart

D. Care and site Ensure that the site of insertion is documented clearly on the syringe of Cannula driver infusion monitoring chart The following areas are not appropriate for cannula positions.  Lymphoedematous limbs  Bony prominences

of 3 Activity Assessment Yes No Date, Time /NA & Signature  Previously irradiated skin  Sites near a joint

The cannula, of 25 gauge or 24 gauge, should be inserted at an angle of 45º and secured with a transparent dressing. This is to enable inspection of the site. (The Royal Marsden, 7th Edition)

The site should be monitored a minimum of four hourly in the care home & community hospital setting and a minimum of daily in the community setting using the appropriate documentation If the skin becomes:  Painful  Red/erythema  Inflamed  Hard  Leaking  Resite the cannula and line, documenting the date and time changed and the new site of the cannula, re label the line  Insert the battery correctly, apply the back cover.  Ensure barrel clamp arm is down and no syringe in place.  Press ON/OFF key to power up, the actuator moves (pre-loading) and the first four screens display automatically. E.  Check battery level: It should be 40% or greater: press INFO key then Commencement YES. Load the syringe. (If necessary, align syringe to sensors and use the FF/BACK keys to move the actuator for syringe placement)  If the syringe size/brand displayed match the one used, confirm by pressing YES.  Infusion summary displays. DO NOT CONFIRM, remove syringe.  Using previously prepared syringe, connect administration set and prime the line.  To prime gently depress the plunger until a bubble can be seen at the end of the administration line.  Clamp the line to minimise the risk of siphoning the contents of the F. syringe into patient. Priming the line NOTE: When the infusion tubing has been primed the Infusion will finish earlier, i.e. in less than 24hrs.

 Attach a label to the line with the following information: - Name of patient - Date of birth of patient - NHS Number of patient - Contents of line - Date of line change  Reload the syringe driver, use the FF key to adjust actuator  If the syringe size/brand displayed matches the one used, confirm by G. pressing YES Reload  Press YES to resume Syringe  Check all settings and confirm by pressing YES  Press YES to start the infusion  To activate keypad lock, press and hold INFO key until the graphic fills H. Keypad left to right and an audible beep is heard Lock on  Place the syringe driver in the lockbox, lock and place the key in the agreed place for your Home

I. Record  Ensure Syringe Driver Prescription Sheet is completed Infusion  Complete Syringe Pump Infusion Chart at the designated time (4 Recommended hourly).

of 3 Do’s and Don’ts

Do  Remove battery for prolonged storage  Ensure pump is kept away from water whilst bathing • ALWAYS USE LOCK ON MODE

Don’t  Drop your syringe pump  Immerse in water • Discard battery in house hold waste

Cleaning: Clean unit with a damp cloth (soapy if necessary) Allow to dry thoroughly before use Care Homes RETURN DRIVER to D/N Team or other provider ensuring you get a signature.

ENSURE DRIVER IS CHECKED ANNUALLY BY MEDICAL PHYSICS

Decontamination as per local policy, including relevant paperwork, E.g. Decontamination Form completion