Procedure for subcutaneous injection of insulin or GLP analogue
Contents
1. subcutaneous injection 90 angle to skin surface Depress plunger all the way down Wait for a count of 6 seconds before removing needle 14 Complete EPMA chart complete nursing documentation Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 2 of 8 15 Patient to remove pen needle from the pen device and dispose of sharp as per infection control policy Needle to be changed at each injection 16 If patient unable to remove pen needle or staff are administering the injection the pen needle needs to be removed using the appropriate needle removing section on the 1 litre sharps bin Eros Code FSL3815 Each patient will need an individual named sharps bin for this method of disposal that is to be stored in the treatment room 17 Insulin GLP analogue that is in use is to be kept out of fridge at room temperature for up to four weeks Please ensure insulin cartridge prefilled pen is dated once commenced 18 Patients pen devices and diabetes equipment should ideally be kept with the patient securely 3 Monitoring compliance and effectiveness Element to be Compliance with the relevant process above for patients seen at a monitored Diabetes Team Review Registered nurse self assessment form for patient self administration of subcutaneous insulin CHA2976 has been completed Ward Pharmacists and DISN team on review of Individual Patients Tool Patient Documentation Registered nurse self ass2. Royal Cornwall Hospitals NHS NHS Trust CLINICAL GUIDELINE FOR PROCEDURE FOR SUBCUTANEOUS INJECTION OF INSULIN OR GLP ANALOGUE USING A PEN DEVICE 1 Aim Purpose of this Guideline The injection is to be performed by patient under supervision of nursing staff in all clinical areas If patient is unable to administer their own injection using a pen device staff can administer the injection using the pen device and correct sharps disposal See procedure number 16 Insulin must not be drawn up from a 3 ml insulin penfill cartridge using a syringe Purpose This procedure applies to all registered nursing staff regardless of grade that are undertaking patient supervision of self administration or administering a prescribed insulin GLP analogue subcutaneous injection within the Royal Cornwall Hospitals Trust The purpose of the document is to ensure that all practitioners perform the procedure in accordance with best practice guidelines Registered staff have a duty of care to supervise the patient in this procedure The individual practitioner must ensure they are competent to supervise or administer the injection undertaking the procedure to the standards within this document If patients are self administering their own Insulin then the registered nurse self assessment form for patient self administration of subcutaneous insulin CHA2976 must be completed by nursing staff and filed in the section seven of the nursing documentation 2 The Gu
3. al interest groups etc around this policy b If yes have these groups been consulted Yes c Please list any groups Diabetes In Patient Specialist Nurses who have been consulted Diabetes Pharmacist about this procedure senior Staff Nurse Endocrine Ward 7 The Impact Please complete the following table Are there concerns that the policy could have differential impact on Equality Strands Rationale for Assessment Existing Evidence Sex male female trans gender gender reassignment Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 7 of 8 Race Ethnic communities groups Disability X For capacity to consent refer to consent form 4 Learning disability physical disability sensory impairment and mental health problems Religion other beliefs Marriage and civil partnership Sexual Orientation Bisexual Gay heterosexual Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted e You have ticked Yes in any column above and e No consultation or evidence of there being consultation this excludes any policies which have been identified as not requiring consultation or e Major service redesign or development 8 Please indicate if a full equality analysis is recommended O ae 9 If you are not recommending a Full Impact assessment please explain why It is not required for this
4. as it is clinical guidance for all the care of all Adults with Diabetes requiring SUBCUTANEOUS INJECTION OF INSULIN OR GLP ANALOGUE USING A PEN DEVICE signature of policy developer lead manager director Date of completion and submission Kim Bull 06 12 13 Names and signatures of 1 Kim Bull members carrying out the 2 Screening Assessment 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 Please sign and date this form Keep one copy and send a copy to Matron Equality Diversity and Human Rights c o Royal Cornwall Hospitals NHS Trust Human Resources Department Chyvean House Penventinnie Lane Truro Cornwall TR1 3LJ A summary of the results will be published on the Trust s web site Signed Kim Bull Date 06 12 13 Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 8 of 8
5. essment form for patient self administration of subcutaneous insulin CHA2976 Frequency Adult in patients with diabetes who are reviewed by the specialist diabetes team Registered nurse self assessment form for patient self administration of subcutaneous insulin CHA2976 Reporting Non compliance will be reported to the responsible ward area arrangements manager Non compliance resulting in an adverse patient event will be reported via Datix Every patient who is self administering their own Insulin needs a Registered nurse self assessment form for patient self administration of subcutaneous insulin CHA2976 to be completed Acting on Ward area managers will undertake subsequent recommendations recommendations and action planning for any or all deficiencies and Lead s and recommendations within reasonable timeframes for their areas The Specialist Adult In Patient Diabetes Team and ward pharmacists will undertake any trust wide recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes Change in Lesson learned or changes to practice will be shared with all the practice and relevant stakeholders lessons to be shared Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 3 of 8 Equality and Diversity 4 1 This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement 4 2 Equality Impact Assess
6. ical section is inside pen Prefilled pen proceed to action number 8 6 Reusable pen put insulin cartridge into the insulin cartridge holder section The screw cap end goes first 7 Reusable pen Screw the mechanical section and the insulin cartridge holder tightly together 8 Take protective tab off the pen needle push and screw onto the screw cap end of the pen device Pull off outer and inner needle caps 9 For cloudy or pre mixed insulin e g Humulin M3 Insulatard Novomix 30 gently roll the pen between your palms 10 times and then turn pen up and down ten times from one end to the other Repeat until liquid is uniform and cloudy 10 Perform air shot for all pen devices except Exenatide Byetta and Lyxumia Lixisenatide where you should refer to the specific pen guide Check the dose selector has returned to zero Dial 2 4 clicks for Novopen 4 disposable Lilly pens and Lyxumia GLP1 analogue pen pull the end injection button out before dialling With needle pointed upward press the plunger all the way in A drop of solution should appear if not repeat procedure until drop of solution appears This procedure needs to be repeated prior to every injection 11 Check that dosage selector is set at zero Dial required dose as prescribed 12 Select injection site e g lower abdomen upper outer arm or upper outer thigh Support injection site for injection These sites should be rotated daily 13 Administer as
7. idance Equipment EPMA Chart e Cartridge of prescribed insulin and appropriate reusable pen device i e NovoPen 3 4 if using NovoNordisk insulin HumaPen if using Lilly insulin Autopen 24 Clikstar is using Aventis insulin Autopen if using C P Pharmaceutical Insulin Or appropriate disposable pre filled Insulin or GLP1 Analogue pen device s Pen needle 6mm or less a Pen user guide supplied with each box of pens e Sharps Box Procedure please refer to individual pen guides for specific instructions 1 Explain procedure to patient and ask patient to wash hands Assemble required equipment as above and take to patient 2 Reusable pen Twist and pull off cap from main body of pen and put to one side Unscrew the insulin cartridge holder which will provide 2 sections Prefilled pen Twist and pull off cap from main body of pen and put to one side Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 1 of 8 3 Reusable pen Identify correct insulin cartridge has been obtained and check expiry date of cartridge Prefilled pen Identify the disposable prefilled pen contains the correct injecatable solution and check expiry date NB Insulin and GLP1 analogue that has been kept out of the fridge expires in four weeks 4 Check cartridge pre filled pen is intact and that it has no crystals 5 Reusable pen Using instruction manual which accompanies pen device ensure piston rod in mechan
8. itals 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 Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 6 of 8 Appendix 2 Initial Equality Impact Assessment Screening Form Name of service strategy policy or project hereafter referred to as policy to be assessed Clinical Guideline for Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Directorate and service area Medical Is this a new or existing Procedure Existing Name of individual completing Telephone 01872253104 assessment Kim Bull 1 Policy Aim To provide detailed guidance on the procedure of Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device 2 Policy Objectives To provide a consistent approach to the management of patients requiring Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device To maintain patient safety and improve outcomes for adult patients with Diabetes 3 Policy intended Consistent management of Diabetes at RCHT sites Outcomes regarding the Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device measure the outcome Datix Reporting Review of nursing documentation as required 5 Who is intended to All adult patients with diabetes who require Subcutaneous 6a Is consultation Yes required with the workforce equality groups loc
9. ment The Initial Equality Impact Assessment Screening Form is at Appendix 2 Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 4 of 8 Appendix 1 Governance Information Clinical Guideline for Procedure for Document Title Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Date Issued Approved 06 12 13 Date Valid From 06 12 13 Date for Review 06 12 16 Medical Directorate Directorate Department responsible Kim Bull Clinical Nurse Specialist author owner Diabetes Contact details 01872 253104 PROCEDURE FOR SUBCUTANEOUS INJECTION OF INSULIN OR GLP Brief summary of contents ANALOGUE USING A PEN DEVICE Suggested Keywords Diabetes Pen Device RCHT KCCG ae ee es ee Target Audience Executive Director responsible for Medical Director Policy Clinical Guideline for Procedure for ae meet Subcutaneous Injection of Insulin or GLP p l Analogue Using a Pen Device Diabetes In Patient Specialist Nurses Approval roure names pI Diabetes Pharmacist Commer Coneritaron senior Staff Nurse Endocrine Ward Divisional Manager confirming Stella Ellis approval processes Name and Post Title of additional Niorreauired signatories q Signature of Executive Director giving Original Copy Signed approval g PY gt 19 Publication Location refer to Policy on Policies Approvals and Internet amp Intranet v Intranet Only Ratification Document Library Folder Sub F
10. older Clinical Endocrine and Diabetes National Patient Safety Alert Safe use of Links to key external standards Insulin 2011 Related Documents e Novo Pen 4 user manual 2008 NovoNordisk Procedure for Subcutaneous Injection of Insulin or GLP Analogue Using a Pen Device Page 5 of 8 e Flex Pen user guide 2006 NovoNordisk e Lantus SoloStar Information For Patients how to deliver Lantus Sanofi Aventis July 2007 e Diabetes UK 2009 www diabetes org uk e Lyxumia pre filled pen guide 2013 Aventis Version Control Table Version Changes Made by a Kim Bull CNS Kim Bull CNS National Patient Safety Alert Safe use of Insulin 2010 recommendations specifically 27 10 10 V2 2 the safe removal of Insulin pen needles oo Addition of GLP1 Analogue medications and devices National Patient Safety Alert The adult patients passport to safe use of insulin 2011 recommendations specifically the registered nurse self assessment form for patient self Kim Bull CNS 06 12 13 V2 3 administration of Diabetes subcutaneous insulin CHA2976 Addition of a further GLP1 Analogue medication device Lyxumia 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 Hosp
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