CLINICAL GUIDELINE FOR THE ADMINISTRATION OF NEBULISED PENTAMIDINE 1. Aim/Purpose of this Guideline

Transcription

1 CLINICAL GUIDELINE FOR THE ADMINISTRATION OF NEBULISED PENTAMIDINE 1. 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 prophylais 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 Equipment Required: Prescription Prescribed Pentamidine for inhalation Prescribed Salbutamol for inhalation Salbutamol nebulizer kit Pentamidine nebulizer kit (Sidestream Plus) Gloves, goggles and disposable apron Face mask Nebulizer Door Sign Do Not Enter Glass of water 2.3. Procedure: Obtain verbal positive patient identification and secure hospital identity bracelet Eplain 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 All patients must be treated in a room equipped with negative pressure filtration, and ensure the windows are closed Ensure patient is sitting comfortably on bed/chair and can be observed from outside the room with a glass of water within reach As Pentamidine can cause bronchospasm - Blood Pressure, Pulse and Oygen 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 Administer salbutamol nebulizer as per Royal Marsden Manual 8 th edition Chapter This will take approimately mins. Page 1 of 7

2 Once complete, dispose of equipment in clinical waste bin, and allow 5 minutes rest before administering the Pentamidine Ensure negative pressure air filter to the room is switched on Staff must put on face mask, and wear goggles, gloves and apron 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 Instruct patient to place lips firmly over the mouthpiece Instruct patient to switch on the nebulizer machine once the door is closed The patient should be encouraged to breathe in and out through their mouth until all the solution has been nebulized (25 45 minutes) 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 The door must be kept closed at all times with a visible Do Not Enter sign on the door Staff and relatives should remain outside of the room while Pentamidine is being administered unless there is a clinical need Once the procedure is complete the patient should be instructed to turn off the nebulizer and eit the room closing the door behind them Staff should allow at least 5 minutes before entering the room to minimize the risk of pentamidine inhalation Equipment must be disposed of in accordance with RCHT Waste Management policy Sign, date and record procedure 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 recommendations and Lead(s) Change in practice and lessons to be shared 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 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 Page 2 of 7

3 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendi 2. Page 3 of 7

4 Appendi 1. Governance Information Document Title Date Issued/Approved: 6 th November 2013 Date Valid From: 6 th November 2013 Date Valid To: 1 st November 2016 Clinical Guideline for the Administration of Nebulised Pentamidine Directorate / Department responsible (author/owner): Sarah Johns, Wendy Aynsley Contact details: Brief summary of contents Suggested Keywords: Target Audience Eecutive Director responsible for Policy: Date revised: This document replaces (eact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Eecutive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key eternal standards Related Documents: Training Need Identified? Clinical guidance on the safe administration of inhaled Pentamidine Pentamidine RCHT PCT CFT Medical Director New document New document Haem/Onc Speciality Group Sally Rowe Not Required {Original Copy Signed} Internet & Intranet Clinical/Haematology Intranet Only Governance Team can advise Royal Marsden Manual 8 th edition RCHT Waste Management Policy COSHH Guidance: Pentamidine (BOHS 2006) No Page 4 of 7

5 Version Control Table Date Versio n No Summary of Changes Changes Made by (Name and Job Title) V1.0 Initial guideline written Sarah Johns 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 epiry. 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 epress permission of the author or their Line Manager. Page 5 of 7

6 Appendi 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: CSSC, Is this a new or eisting Policy? Eisting Headland/Haematology Clinic Name of individual completing Telephone: 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 / Eisting Evidence Age Se (male, female, transgender / gender reassignment) Page 6 of 7

7 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 Seual Orientation, Biseual, Gay, heteroseual, 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 ecludes 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 eplain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the 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 A summary of the results will be published on the Trust s web site. Signed Date Page 7 of 7