Essential Syringe Driver Training for T 34 Elaine Bird St Luke s Hospice
Aim For all practitioners to be accountable for their individual competence and capability when caring for a resident with a T34 Syringe Driver.
Objectives Discuss NMC core standards of conduct and practice Discuss standards for medications Understand clinical rationale for commencing and discontinuing a T34 syringe driver in palliative care Understand the importance of clear individualised care plan, incorporating open honest communication & continual holistic assessment. Discuss common medications and guidelines for recommended dose administration Demonstrate the correct procedure for setting up and continual monitoring of the T34 syringe driver.
NMC Code for professional standards of practice & behaviour Prioritise people Practice effectively Preserve safety Promote professionalism & trust
Standards for practice of administration of medicine You must know The identity of the patient & any allergies Understand the therapeutic use of medications, its usual dosage, side effects, precautions and contra indications. The prescription label is clear and unambiguous. The expiry date of the medicine to be administered
Medicine Standards Continued You are responsible for the initial and continued assessment of the patient You must be fully aware of the individual care plan In the event of an error you must take action to prevent harm, report ASAP to the prescriber and document your actions
Clinical reasons for commencing a T34 Syringe Driver in Palliative and End of Life Care
Dysphagia Pain control Relief of nausea & vomiting Control of restlessness or agitation Relief of anxiety Control of convulsions Control of excessive bronchial secretions
Individual Care plan Discuss what should be incorporated in an individual care plan and how/where to document
Advantages of using Continuous Subcutaneous Infusion (CSCI) No peaks or troughs in plasma drug levels 4 Hourly injections CSCI Toxicity Plasma drug level Therapeutic level Time
Disadvantages of using CSCI When the syringe is changed the symptoms for the next 24 hours need to be anticipated If symptoms change, top up injections may be required Machine inefficiency Battery failure Local skin reactions
Infusion sites Lateral aspect of upper arms Anterior aspect of thighs Anterior of chest wall Anterior abdominal wall Scapula region especially if restless
Sites to avoid Areas of lymphoedema Radiotherapy sites Bony prominences or near a joint
Recommended labelling of the Syringe Labels must be applied to the syringe Patient s name NHS Number (D O B if not available) Date and time syringe Driver recharged Drugs And Doses Initial volume of fluid in syringe
Using the T34 Syringe Driver The T 34 in Sheffield is programmed to use a 30ml Luer-Lok BD syringe ONLY Check service expiry date The standard delivery of medication in Sheffield is programmed for 24hours Two registered nurses required to set up the syringe driver Familiarise yourself with the Policy & Procedure Complete the T34 competency form
Maintenance and Cleaning Must have an annual service After each use, thoroughly clean with 70% alcohol wipes including battery holder and cover A declaration of decontamination form must be sent back with the syringe driver after use Any syringe driver involved in a medication incident must be quarantined immediately and sent to BME
After a Patient Dies If RGN is competent with verifying expected death the syringe driver can be stopped removed and drugs disposed of in line with company s policy and procedure If a doctor is required to verify death the syringe driver can be stopped but MUST be left in place until death has been officially verified.
Recommended Drugs, no more than 3 different medications and ensure compatibility Diamorphine Morphine Oxycodone Midazolam Haloperidol Metoclopramide (Maxolon) Levomepromazine (Nozinan) Hyocine Butylbromide (Buscopan)
Starting Dose If opiate naïve- Best practice is to administer PRN S/c injections for 24 hours If taking oral opiates calculate the 24 hr dose administered Divide by 2 to convert oral morphine to S/C Morphine Divide by 3 to convert from oral morphine to S/C Diamorphine
Example Oromorph 5mg qds = 20mg in 24 hours 20mg 2 = 10mg S/C Morphine in 24 hours 20mg 3 = 6.6mg S/C Diamorphine in 24 hours MST 30mg bd = 60mg in 24 hours 60mg 2 = 30mg S/C Morphine in 24 hours 60mg 3 = 20mg S/C Diamorphine in 24 hours Actual dose prescribed would depend on symptoms experienced by the patient
Oxycodone Divide by 2 to convert oral oxycodone to S/C oxycodone Oxycodone 5mg qds = 20mg in 24 hours 20mg 2 = 10mg S/C Oxycodone in 24 hours Oxycodone 20mg bd = 40mg in 24 hours 40mg 2 = 20mg S/C Oxycodone in 24 hours
Guidelines for PRN opiate medications Guidelines for Prn Medications is to divide the 24 hour dose of an opiate medication by 6 For example MST 20mg bd = 40mg morphine in 24 hours 40mg 6 = 6.6mg prn oromorph Syringe Drivers exactly the same 10mg diamorphine over 24 hours 10mg 6 = 1.6mg
PRN medication Actual dose prescribed would depend on symptoms experienced by the patient If sliding scale dose of prn oromorphine, morphine, diamorphine or oxycodone has been prescribed increase frequency of medication before increasing the dose
Dame Cicely Saunders. You matter because you are you. You matter to the last moment of your life and we will do all we can, not only to help you die peacefully, but to live until you die
References NMC The code (2015) Sheffield Palliative Care Formulary 3 rd Ed http://www.intranet.sheffieldccg.nhs.uk/do wnloads/medicines%20management/pres cribing%20guidelines/palliative%20care% 20Sheffield%20Palliative%20Care%20For mulary.pdf