CLINICAL GUIDELINE FOR THE ADMINISTRATION OF NEBULISED PENTAMIDINE Summary. 1. Patient requires nebulised Pentamidine Ensure equipment listed is available Ensure HEPA filtered room in Haematology Clinic is available and extractor fan is working and switched on Ensure all external windows are shut and that door to room is shut before administering Pentamidine Follow guideline and administer the prescribed Pentamidine with observations as recommended After use safely dispose of equipment and document procedure Page 1 of 8
Aim/Purpose of this Guideline 1.1. To ensure safe and consistent minimum standards of practice for safely administering nebulized Pentamidine in the hospital setting by appropriately trained nursing staff. This guideline is only to be used for patients >16 years of age being treated within the Haematology Clinic at Royal Cornwall Hospital. A separate risk assessment must be performed for Paediatric patients requiring nebulized Pentamidine. 2. The Guidance 2.1. Nebulized Pentamidine is an antiprotozoal antibiotic, and is used as a prophylaxis for Pneumocystis Carnii Pneumonia (PCP) principally in patients who are immunocompromised and are unable to tolerate oral medication. Nebulized Pentamidine can cause bronchospasm and therefore a Salbutamol nebulizer must always be administered first. As the effect of inhaled Pentamidine is unknown in human pregnancy, staff who are pregnant should avoid handling Pentamidine. 2.2. Equipment Required: 2.2.1. Prescription 2.2.2. Prescribed Pentamidine for inhalation 2.2.3. Prescribed Salbutamol for inhalation 2.2.4. Salbutamol nebulizer kit 2.2.5. Pentamidine nebulizer kit (Sidestream Plus) 2.2.6. Gloves, goggles and disposable apron 2.2.7. Face mask 2.2.8. Nebulizer 2.2.9. Door Sign Do Not Enter 2.2.10. Glass of water 2.3. Procedure: 2.3.11. Obtain verbal positive patient identification and secure hospital identity bracelet. 2.3.12. Explain the procedure to the patient, including the drugs, equipment, why it is necessary and possible side effects. Written patient information will be provided on the first treatment. 2.3.13. All patients must be treated in a room equipped with negative pressure filtration, and ensure the windows are closed. 2.3.14. Ensure patient is sitting comfortably on bed/chair and can be observed from outside the room with a glass of water within reach 2.3.15. As Pentamidine can cause bronchospasm - Blood Pressure, Pulse and Oxygen saturation should be recorded pre and post procedure for the first dose only. Thereafter, this only needs to be repeated if there is a clinical need. 2.3.16. Administer salbutamol nebulizer as per Royal Marsden Manual 8th edition Chapter 16.8. This will take approximately 10 15 mins. 2.3.17. Once complete, dispose of equipment in clinical waste bin, and allow 5 minutes rest before administering the Pentamidine 2.3.18. Ensure negative pressure air filter to the room is switched on Page 2 of 8
2.3.19. Staff must put on face mask, and wear goggles, gloves and apron. 2.3.20. Check Pentamidine against prescription and pour the solution into the Pentamidine nebulizer kit reservoir. Attach the mouthpiece to the reservoir. Attach one end of the tubing to the reservoir and the other to the nebulizer machine 2.3.21. Instruct patient to place lips firmly over the mouthpiece. 2.3.22. Instruct patient to switch on the nebulizer machine once the door is closed. 2.3.23. The patient should be encouraged to breathe in and out through their mouth until all the solution has been nebulized (25 45 minutes) 2.3.24. If the patient requires a break during the pentamidine nebulizer the patient should be instructed to turn the machine off until ready to recommence the nebulizer. 2.3.25. The door must be kept closed at all times with a visible Do Not Enter sign on the door. 2.3.26. Staff and relatives should remain outside of the room while Pentamidine is being administered unless there is a clinical need. 2.3.27. Once the procedure is complete the patient should be instructed to turn off the nebulizer and exit the room closing the door behind them. 2.3.28. Staff should allow at least 5 minutes before entering the room to minimize the risk of pentamidine inhalation. 2.3.29. Equipment must be disposed of in accordance with RCHT Waste Management policy. 2.3.30. Sign, date and record procedure 2.3.31. Do not use room for other patients or procedures for 30 minutes after Pentamidine inhalation is completed 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on Compliance with the Guideline Senior nurse on Headland Unit will take the lead on ensuring that all nursing staff who taking a role in administering nebulized Pentamidine are appropriately trained Monitoring of compliance will be against the Clinical Guideline Staff will be monitored at initial training. Where an issue with compliance is identified this will be reported to the Divisional Governance Committee The senior nurse on Headland Unit and the Divisional Governance Page 3 of 8
recommendations and Lead(s) Change in practice and lessons to be shared Committee will lead on any recommendations in changes of practice Required changes to practice will be identified and actioned. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website. 4.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 4 of 8
Appendix 1. Governance Information Document Title Clinical Guideline for the Administration of Nebulised Pentamidine Date Issued/Approved: 18 th October 2016 Date Valid From: 18 th October 2016 Date Valid To: 31 st October 2019 Directorate / Department responsible (author/owner): Sarah Johns Haemostasis CNS Claire Fullalove Senior Staff Nurse Contact details: 01872 253239 Brief summary of contents Clinical guidance on the safe administration of inhaled Pentamidine Suggested Keywords: Target Audience Executive Director responsible for Policy: Pentamidine RCHT PCH CFT KCCG Medical Director Date revised: October 2016 This document replaces (exact title of previous version): Clinical Guideline for the Administration of Nebulised Pentamidine Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Name and Signature of Divisional/Directorate Governance Lead confirming approval by specialty and divisional management meetings Haem Onc Specialty Group Sally Rowe Not Required {Original Copy Signed} Name: Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): {Original Copy Signed} Internet & Intranet Page 5 of 8 Intranet Only
Document Library Folder/Sub Folder Links to key external standards Related Documents: Training Need Identified? Clinical Haematology None Royal Marsden Manual 8th edition RCHT Waste Management Policy COSHH Guidance: Pentamidine (BOHS 2006) No Version Control Table Date Version No Summary of Changes Changes Made by (Name and Job Title) 21.02.13 V 1.0 Initial guideline issued Sarah Johns Haemostasis CNS 18.10.16 V1.1 Reviewed and inserted into new Trust Guideline template Sarah Johns Haemostasis CNS All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 6 of 8
Appendix 2. Initial Equality Impact Assessment Form Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter referred to as policy) (Provide brief description): CLINICAL GUIDELINE FOR THE ADMINISTRATION OF NEBULISED PENTAMIDINE Directorate and service area: CSCS Is this a new or existing Policy? Existing Name of individual completing Telephone: 01872 253239 assessment: Sarah Johns 1. Policy Aim* Guideline on the administration of nebulized Pentamidine Who is the strategy / policy / proposal / service function aimed at? 2. Policy Objectives* To ensure safe and effective administration of nebulized Pentamidine 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? All staff will administer nebulized Pentamidine safely according to the guideline Assessment of practice against guideline Patients and staff No b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Page 7 of 8
Race / Ethnic communities /groups Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 8 of 8