STANDARD OPERATING PROCEDURE ADVANCE PREPARATION OF INSULIN FOR PATIENTS TO ADMINISTER AT HOME First Issued July 08 Issue Version Two Purpose of Issue/Description of Change Planned Review Date To promote safe advanced preparation of insulin for the patient to administer at home 2012 Named Responsible Officer:- Approved by Date Medicines Management Governance Pharmacist Section :- Medicines Management MM N o 10 Clinical Policy Group Medicines Management Group Impact Assessment Screening Complete July 2010 August 2010 Full Impact Assessment Required Y/N UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM NHS WIRRAL WEB SITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION
NAME OF DISCIPLINE : COMMUNITY NURSING OBJECTIVE SCOPE TARGET GROUP CROSS REFERENCE RELATED POLICIES / DOCUMENTS advance preparation of insulin for the patient to administer at home and to prevent needle stick injury To cover all aspects of advance preparation of insulin using vials and syringes (this does not include pens as pens cannot be preloaded with needles left in place due to risk of leakage) All registered nurses employed by NHS Wirral involved in the advance preparation of insulin syringes for patients to administer at home as defined by their job description NHS Wirral Nursing Policies and Procedures including: Safe Handling and Administration of Medicines Policy Sharps Usage and Disposal Policy Record Keeping for Community Nursing Consent Policy Risk Assessment Form Advanced Preparation of Insulin Procedure for Blood Glucose Monitoring Infection Control Policies Standard Operating Procedure Administration of Medicines Clinical Protocol for the Self - Administration of Medicines and Administration of Medicines supported by family/informal carers of patients in community nursing EVIDENCE TO SUPPORT PROCEDURE Royal College of Nursing (2006) Advance preparation of insulin syringes for patients to administer at home. RCN Guidance for Community NMC (2010) Standards for Medicines Management National Patient Safety Agency (2010) Rapid Response Report NPSA/2010/RRR013: Safer administration of insulin PROCEDURE Activity Rationale Responsibility 1. ASSESSMENT OF PATIENT S SUITABILITY FOR SELF ADMINISTRATION OF INSULIN IN ALL CASES COMPLETE A RISK ASSESSMENT FORM ADVANCED PREPARATION OF INSULIN Community nurses must be reminded that the advanced preparation of insulin should only be considered after all other options have been exhausted Patients who require community nurses to prepare their insulin in advance of administration should be suitable for selfadministration and only require physical help due to impaired dexterity Alternatively a carer may be able to take full responsibility for the patient s insulin, but require help due to impaired dexterity It is therefore essential that the mental and physical capability of the patient (or if appropriate carer) is assessed prior to community nurse involvement in the self administration of insulin syringes prepared in advance A risk assessment form-advanced preparation of insulin must be completed The outcome of the assessment must be recorded in the patient s record Any change in the patient s condition would necessitate a review Review Date 2012 2/5 Advanced preparation of insulin is an unlicensed activity and carries a risk of needle stick injury NMC Standards for Medicines Management (2010) Care plan must be updated to meet Caseload manager/
of their self administration status To self administer, the patient needs to be at Level Three (NMC 2010) NMC Definition the patient accepts full responsibility for the storage and administration of the medicinal products 2. ASSESSMENT OF PATIENT S HOME ENVIROMENT When assessing whether a patient is suitable for community nurse involvement in advanced preparation of insulin syringes, the assessment must include the patient s access to a suitable fridge for appropriate storage For patients living in Residential Care Homes, a lockable fridge specifically for the storage of medication should be provided by the Care Home 3. CONSENT Discuss risks and benefits of self administration with the patient Where patients consent to self administration of their medicines the following points must be considered:- Patients share the responsibility for their actions, relating to selfadministration of their medicines Patients can withdraw consent at any time 4. ENSURE MOST APPROPRIATE PRODUCT HAS BEEN PRESCRIBED Discuss potential alternative insulin preparation with a diabetic specialist nurse or prescriber, as advanced preparation of insulin does carry risk of needle stick injury. In some specific cases there may be no alternative, as this may be the only preparation that meets the health needs of the patient a risk assessment must be completed 5. EDUCATION OF PATIENT 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 common side effects and what to do if they occur any special instructions how to obtain further supplies how to store the medication Plan of care documented and agreed with patient and nurse to ensure adequate support, monitoring of diabetes control and wellbeing 6. PREPARATION OF INSULIN should remove the insulin from the fridge personally and not rely on carers or care home staff must not mix different insulins in the same syringe for administration at a later time Review Date 2012 3/5 needs of patient To comply with storage recommendations and to ensure the patient has access to their insulin To gain informed consent and document in patient s record Patients are empowered to make informed choices Patients retain right to withdraw consent Unable to preload some pen devices Once a day administration will reduce risk of needle stick injury administration of insulin To comply with NMC Standards for medicines management (2010) To demonstrate partnership working administration errors There is no longer a need to mix insulins due to the availability of suitable
Insulin must never be withdrawn from an insulin cartridge by a syringe. Insulin cartridges are designed for use with specific pen devices and are therefore unsuitable for advanced preparation. Also failure to use the appropriate pen device can result in an administration error When withdrawing insulin from vials, ensure only insulin syringes are used. Lantus Insulin cannot be pre-drawn up for later administration as it becomes cloudy Pre drawn insulin should be left no longer than 24hours Document the advanced preparation of insulin on NHS Wirral Community Nursing Record Sheets, ensuring full details are recorded, including batch number, type of insulin and expiry date are recorded 7. SAFE STORAGE OF PRE - DRAWN INSULIN The needle should be stored approximately at 45 o to prevent blockage by suspended substances in the insulin Syringes should be stored in a sealable container (provided by patient) Each syringe is required to be clearly flagged with the following information:- date name of patient number of syringes ( e.g. 1 of 1, 1 of 2 if required) name of insulin preparation route (subcutaneous) pre-loaded dose instruction for time of administration drawn up by Pre printed labels are available from Shared business services (SBS) Pre-loaded insulin syringes should be stored in the main part of the refrigerator at 2 to 8ºC. They should not be placed in the freezer or at the back of the fridge Clearly marked separate containers should be used for insulin to be delivered at different times of the day, especially if the syringe contains a different dosage or type of insulin e.g. the containers should be marked with preparation name and time of administration Instructions for administration will be recorded in the care plan for the patient to reference Prior to administration, to re-suspend the insulin, advise the patient to gently rotate the syringe between the hands to warm the insulin. This needs to be done at an appropriate time, before food, and in accordance with manufacturer s instructions 8. DISPOSAL OF SHARPS All sharps to be disposed of in a yellow sharps disposal bin Sharps disposal bin will be provided by Community Nursing if the patient is on a Community Nursing Caseload. Becton, Dickinson and Company safe clip device should be Review Date 2012 4/5 manufacturer s preparations preparation To reduce the risk of Risk of deterioration of insulin To comply with NPSA Alert 20 To comply with NHS Wirral documentation record keeping Needle blockage by suspended insulin To ensure best practice in the administration of medicines To promote standardisation of labels used To reduce To promote safe storage of pre loaded insulin To meet patients individual needs s Injecting cold insulin can be painful and it is not absorbed so effectively To comply with the NHS Wirral policy
used by the patient when away from home to dispose of the needle if appropriate Re-sheathing of needles for disposal must be avoided, needles are to disposed of in the sharps bin 9. GENERAL STORAGE OF INSULIN VIALS Store according to manufacturer s instructions, insulin not in use should generally be kept in the main part of the refrigerator at 2 to 8ºC, not at the back of the fridge. Date of commencement of use must be identified on the vial (Insulin stored out of the fridge must usually be used within 28days refer to manufacturer s literature for further details) Pre drawn insulin should be left no longer than 24hours Expiry dates should be checked 10. DISPOSAL OF EXPIRED STOCK Advise patient to arrange for expired stock to be returned to the community pharmacy needle stick injuries storage of insulin Storage outside the fridge reduces the shelf life of the insulin expired stock being administered disposal of medicines TRAINING SPECIALIST COMPETENCIES OR QUALIFICATIONS CONTINUING EDUCATION & TRAINING RISK ASSESSMENTS ORGANISATION DEPARTMENT employed by NHS Wirral will work to the Standard Operating Procedure, NHS Wirral policies and procedures. All registered nurses will have completed their Competency for Medicines Management within 3 months of joining organisation and update two yearly Staff will have attended Essential Learning Staff will have attended Medicines Management Training every two years Staff will be aware of manufacturers instructions for specific medication and devices Staff have access to specialist nurses, General Practitioners and the Medicines Management Team for ongoing advice as required. Advanced preparation of insulin (on Community Nursing section of web site) NHS Wirral Community Nursing STANDARD OPERATING PROCEDURE DEVELOPED BY FINAL SIGNED COPIES ARE HELD BY LISA KNIGHT. MEDICINES GOVERNANCE PHARMACIST Pharmacist Name: Lisa Knight Position: Medicines Governance Pharmacist Department/ Service Lead Name: Sandra Christie Position: Head of Nursing Authorisation Lead Pharmacist Name: Helen Dingle Position: Prescribing Adviser STANDARD OPERATING PROCEDURE (SOP) PEER REVIEWED BY:- Forum Provider Services Medicines Management Group Nursing and Allied Health Professionals NHS Wirral Nursing Policy Group Medicines Management Team Review Date 2012 5/5