Neonatal Unit Oral and Intravenous Drug Administration Workbook & Competencies

Transcription

1 Neonatal Unit Oral and Intravenous Drug Administration Workbook & Competencies Copyright Royal United Hospital Bath NHS Trust Version 5 For use in neonatal unit only Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014

2 This book has been issued to.... Date... Ward.... Name(s) of assessor(s) (please print) For audit and verification purposes, please complete the above section. Neonatal Unit staff are required to complete the RUH NHS Trust s Intravenous Therapy Workbook and Competencies in addition to this specialist module. You are reminded that only staff, who have completed the RUH NHS Trust s Intravenous Administration Train the Trainers Course and who are competent in oral and intravenous drug administration in Neonatal Unit should assess you. Please refer to the assessment criteria and process overleaf. Competency forms should be kept in your portfolio when complete. Your manager may require a copy.

3 Safe administration of medicines and fluids to neonates. Emma Trim Practice Development Sister Neonatal Unit The aim of the assessment process is to ensure a registered nurse/midwife becomes competent in the safe administration of intravenous medication and the care and management associated with the equipment. This must be relevant to the patient care within the nurse/midwife s current area of practice. In order to achieve this aim the candidate must undergo final assessment of their underpinning knowledge and their ability to safely administer drugs across a range of circumstances. Criteria for assessment: (Experienced Neonatal staff from other trusts can complete assessment in 1 st month, and must achieve 100% pass in Neonatal Drugs assessment) Assessment Process: Before the final assessment of competence each candidate must: Within 1 3 months: 1. Work through oral drug assessment section within 1 st month 2. Complete the oral drug competency within the 1 st month 3. Complete Volumat MC Agilia / Alaris and McKinley pump competencies within 1-3 months Within 3 6 months: 4. Complete neonatal unit calculations test with practice development sister. Pass mark is 100% 5. Work through IV drug assessments 6. Complete supervised practice with an IV trainer 7. Be familiar with ANTT and IV drug administration policies 8. Complete IV drug competencies & Gentamicin competency 9. Be assessed as competent by the PD Sister or IV trainer. After 6 months of being competent at administering intravenous medicines to a peripheral cannula candidates may undertake the competency assessment for longlines. After 6 months of competent practice at administering intravenous medicines to a longline candidates may progress to undertake the competency assessment for umbilical venous catheters. Candidates who are qualified in speciality and who have completed all competencies of Intravenous management may discuss with the PD sister about arterial line sampling competency assessment.

4 Oral and topical drugs Record of oral drug calculations competency You must complete the oral drugs questions and achieve 100% Within the 1 st month of being on neonatal unit. Date Started: Date completed and assessed as competent:

5 Qualified nurses Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 Calculating oral drugs You may have come to neonates from a different area of nursing and should ensure you are aware of how to calculate medicines and fluids for neonates. Newly Qualified nurses awaiting registration. The transition period from student to qualified nurse can be a difficult time, as you are now accountable for your actions. When you receive your NMC PIN number and statement of entry, you can start checking and administering oral medication on the neonatal unit with another registered nurse. Here are some questions to help test your knowledge of the most common oral medications used within the Neonatal unit and to help build your confidence with drug calculations. Remember the 5 R s: Right Patient Right Medication Right Dose Right Time Right Route You should always check that the prescription is correct. All drugs administered in the neonatal unit should be checked against Western Neonatal Network Prescribing Group Monographs and the BNF for children. The critical care nursery and the stabilisation bay each have a drug folder. Formula for calculating medicines Always remember this: What you want x What it is in = Volume to be given What you have got

6 Vitamins and minerals supplementation and other drugs Neonatal Unit Oral and Intravenous Drug Administration Workbook List the indications for the below and how to administer: Indication for use How to administer Breast Milk Fortifier Gaviscon Dalivit Sodium Iron edetate (Sytron) Sodium Chloride 30% oral solution Glucose 30% Duocal Topical Drugs 1. List indications for the drugs below. 2. Check the prescription, drug and baby and administer the drug. Eye Drops Indications for use Cyclopentolate 0.5% Phenylephrine 2.5% Chloramphenicol Topical creams Daktarin Proshield Cavilon barrier cream Cavilon barrier film

7 Oral Drugs Drug Antibiotics and antifungal treatments Specific information Dose / how to reconstitute PO Flucloxacillin PO Trimethoprim PO Nystatin Drug Specific Information Dose / how to reconstitute PO Phenobarbital PO Chloral hydrate PO Spironolactone PO Chlorothiazide Oral Konakion (Vitamin K) PO Furosemide PO Ranitidine PO Dexamethasone PO Caffeine citrate PO Paracetamol

8 Name: Date commenced: / / Date completed: / / Competency: Oral drug administration in the neonatal unit Aim: The aim of this competency is to provide the individual with the knowledge and skills to perform safe practice. Demonstrating competence in clinical and theoretical knowledge regarding safe practice, technical skill required and rationale for the procedure. Evidence of Competence Individuals need to be able to provide evidence to support their competence. Have read the neonatal unit guidance to calculating Completion of the oral neonatal drug calculations test Learning log of practice and procedures undertaken Evidence of Direct supervision from a registered experience nurse within neonatal unit. Has read the relevant medicines management policies for the RUH trust. I confirm that has been supervised in practice and has completed the neonatal unit oral drugs test and have read the written information for calculating oral medicine in the neonatal unit. They have completed all relevant written documentation and understand the aim of this competency Print name: Signature of Supervisor: Date: I believe myself to be competent in this procedure and understand the competency aim I have received relevant training and completed appropriate documentation successfully. I accept full accountability for my own practice and have discussed this role with my supervisor. Signature of individual: Print name Date:

9 Successful completion of oral drugs calculation test Completion of oral drugs calculations test. Date Individuals signature Practice Development sisters signature Observation of oral drug calculation Observation 1 Date Individuals signature Nurse observing signature Observation 2 Supervised Oral drug calculation and administration Observation 1 Date Individuals signature Nurse demonstrating signature Observation 2

10 Childhood immunisations Date Started: Date completed and assessed as competent:

11 Childhood immunisations 1. List the vaccinations that maybe given while the baby is still on the Neonatal unit. (Though the doctors/annp s administer vaccinations you need to be aware of these). Vaccination Indication Age it should be given Method of administration Specific information 2. Check the prescription, drug, and dose are correct. 3. Can ensure that the necessary documentation and records are made.

12 Intravenous Drug Administration in the Neonatal Unit Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 Intravenous drugs to a peripheral cannula Intravenous Gentamicin competency Date Started: Date completed and assessed as competent: Date started : Date completed and assessed as competent. Intravenous drugs to a neonatal long line Intravenous drugs to a umbilical venous catheter Date started : Date completed and assessed as competent. Date started : Date completed and assessed as competent.

13 Risk Management issues relevant to IV drug therapy Checking and administering drugs is a risky business. As qualified nurses we all have a duty to maintain professional standards and the administration of IV drugs is no exception. Obviously we are all responsible individually but we also have guidelines and policies to support our practice for example the 5Rs and the NPSA Gentamicin prompt charts and the NPSA recommendations for the Prevention of over infusion of intravenous fluid and medicines in neonates. In the arena of risk management we are striving to put in place strategies to prevent errors occurring. Ensuring prescriptions are correctly written Having knowledge of drug therapies to ensure the correct dose is given e.g. using the WNNPG NICU Monograph, BNF for Children, and local formularies. Two trained nurses checking the prescription ensuring that two newly qualified nurses are not checking together, drawing up the medication and then administering with minimum interruptions. (Red Aprons to be worn when checking drugs.) Checking the drugs are being given to the right patient. Ensuring documentation is done correctly e.g. both nurses/dr signing that the medication has been given. However sometimes mistakes occur and we need to consider the cause and effect and hopefully learn from the mistake. We try to encourage reporting so we can monitor any errors and put in to place any changes to help minimise the risk of future mistakes.

14 What to do if an error occurs Inform the senior nurse on duty that you have made or found an error. Inform the Doctor on duty, making sure the baby is safe and if appropriate discontinue the medication or perform any action needed e.g. levels to be taken. Complete an Incident Reporting Form (IRFs) and also photocopy the relevant paperwork e.g. drug charts. Use the Datix reporting system which is found on the desk top dashboard on any network computer. An appropriate person should inform the parents an error has occurred. If three IV errors occur in 12 month period then the individual involved will need to repeat the IV drug calculations test before being allowed to continue to give IV drugs The IRF s will be sent to the line manager for investigation and also sent to the risk management department where they are logged. All of the Incident Reports from the Neonatal unit are then discussed at the Paediatric Risk Forum. The lead sister for the neonatal unit will aim to feedback any action to the individuals involved and to the unit as a whole via the communication book and also through the practice development sister

15 Aseptic Non Touch Technique Definition An Aseptic-non-touch- technique is achieved by preventing direct and indirect contact of key parts by a non-touch method and other appropriate infective precautions. Practising ANTT There are four stages to performing an ANTT 1. Identification of key Parts 2. Assessing the risk of contaminating the key-parts 3. Choosing appropriate infective precautions. 4. Performing the Procedure 1. Identifying the Key Parts The practitioner must know the definition of a key part The practitioner must be able to identify all key parts in any procedure 2. Assessing the risk of contaminating the Key Parts Simply the practitioner must ask, can I perform the procedure without touching/ contaminating the key parts either directly or indirectly`? This will depend on factors such as the technical difficulty of the procedure, the number of key parts, and how long the procedure should take and the cleanliness of the environment.

16 3. Choosing appropriate infective precautions Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 The Practitioner will now tailor the infective precautions to the risks to the risks identified. Essentially, infective precautions can be broken down into 5 components- only two of these actually involve a choice 1. Pre hand wash -compulsory 2. Glove Wearing - sterile compulsory 3. Aseptic Field - simple or involved 4. Non- touch technique - compulsory 5. Post hand wash - compulsory e.g. The preparation of multiple drugs and multiple IV lines for an experienced practitioner would involve a pre hand wash, sterile gloves (multiple key parts can be exposed and protected one at a time in an organised fashion), a large sterilised paper towel on a work surface to hold and organise all the components safely, a non- touch- technique and a post hand wash. 4. Performing the procedure This is self-explanatory but here are some good practice guidelines: - 1. DON T confuse your practice. For example, by trying to keep one hand clean and the other dirty. This will make things more difficult. 2. Important- TOUCH non-key parts with confidence - this will make the procedure easier for you. 3. Concentrate on the key parts. As long as they are not touched or contaminated by you or anything else, you are practising safely. 4. Think ahead. Gather your equipment before starting. Organise your working area, especially your IV tray. 5. Always wait for alcohol cleaned equipment to dry (to become aseptic) before using (usually 30 seconds or so)

17 ANTT gloves in the Neonatal Unit PROCEDURE Peripheral line drugs ± TPN (without disconnecting line) Central line drugs ± TPN (without disconnecting line) Disconnecting peripheral line or central line with TPN (e.g. to add extra port) Disconnecting central line with clear fluids Disconnecting peripheral line with clear fluids Running through non-tpn fluids / infusions peripheral or central (if preparation time less than 5 minutes) All babies less than 1.5 kg or ITU babies with peripheral / central lines STERILE GLOVES

18 Your responsibilities: As a registered nurse you will have met one of the Intravenous trainers for the neonatal unit or the practice development sister and arranged to complete the Royal United Hospital, Intravenous Therapy Workbook. You will have been assessed by someone with the RUH NHS Trust Intravenous Medicines Administration Trainers course. You will have fully completed this package. If you have come from another trust you will show evidence of IV competence/certification. You will read the RUH relevant policies and workbook and self certificate your competence You will complete the Neonatal Unit workbook and the Intravenous Drugs calculations test before being signed off to give intravenous drugs in the neonatal unit.

19 Commonly used abbreviations and units Abbreviations Units mg milligram 1 kilogram (kg) = 1000 grams kg kilogram 1 gram (g) = 1000 milligrams ml millilitre 1 milligram (mg) = 1000 micrograms IV intravenous 1 microgram = 1000 nanograms IM intramuscular 1 nanogram = 1000 picograms SC IO ET subcutaneous intraosseous endotracheal Remember the 5 R s: Right Patient Right Medication Right Dose Right Time Right Route You should always check that the prescription is correct. Resources for this on the unit include drug folder found in the clean utility that has the Western Neonatal Network Prescribing Group Monographs and the BNF for children.

20 Basic Calculations and Formulas What you want in divided by What you have got x What it is in = Volume needed (mg/microgram/nanogram) (mg/microgram/nanogram) (ml of fluid drug is suspended in) (ml) You want to give 10 microgram/kg/hour of Morphine to a 2.5kg baby Morphine infusion labeled as Morphine Sulphate 2.5mg (5mg in 5ml) 2.5ml added to 5% glucose 47.5ml USE WNPIG DRUG FORMULARY 2.5mg of Morphine Sulphate = 2500 microgram 2500 microgram is in 50ml of infusion solution 2500 microgram 50ml = 50 microgram per ml of infusion solution 2.5kg baby x 10 microgram = 25 microgram per hour 25 microgram 50 microgram per ml of infusion solution = 0.5 ml/hour Calculation to work out how many micrograms per kg an infusion is running at. Amount in mgs x 1000 (to change to mcg) divide by weight, divide by amount in syringe (50) x rate = mcg/kg/hour You want to give 20 microgram/kg/minute of Dopamine to a 1.8 kg baby Dopamine infusion labeled as Dopamine 216mg (40mg in 1ml) 5.4ml added to 5% glucose 44.6ml USE WNPIG DRUG FORMULARY 216mg of Dopamine = microgram microgram is in 50ml of infusion solution microgram 50ml = 4320 microgram per ml of infusion solution 1.8kg baby x 20 microgram = 36 microgram x 60 (minutes) = 2160 microgram per hour 2160 microgram in 1 hour 4320 microgram per ml of infusion solution = 0.5ml/hour Remember when calculating for kg/minute you need to multiply by 60 MINUTES to make 1 HOUR infusion pumps run in ml per HOUR. Amount in mgs x 1000 (to change to mcg) divide by weight, divide by amount in syringe (50), divide by 60 (change to minutes) x rate = mcg/kg/minute

21 Intravenous Volumetric Infusion pumps and syringe pumps used within the Neonatal Unit Volumat MC Agilia infusion pump - commonly used for administration of maintenance fluids, TPN and exchange transfusions Alaris Asena GH Syringe pump commonly used for administration of Intravenous medicines such as Morphine, Inotropes and Heparinised saline infusions. Blood and Blood products McKinley T34 Ambulatory Syringe pump can be used for delivery of small drug quantities, such as Vancomycin, Metronidazole etc. Competencies are available through the Intranet and are to be completed prior to assessment. No other Infusion devices should be used within the Neonatal Unit or borrowed from other departments.

22 The following are drugs that are likely to be used on the Neonatal Unit Complete the table below (specific information should include things such as specific nursing care, main side effects, levels, administration method, frequency etc.) Drug - Antibiotics Specific information Dose / how to reconstitute IV Aciclovir IV Amoxicillin IV Amphotericin IV Benzyl penicillin IV Ceftazidime IV Cefotaxime IV Cefuroxime IV Erthromycin IV Flucloxacillin IV Fluconazole

23 Drug - Antibiotics Specific Information Dose / how to reconstitute IV Gentamicin IV Meropenem IV Metronidazole IV Rifampicin IV Teicoplanin IV Vancomycin Drug - Infusions Specific Information Dose / how to make up Dopamine Dobutamine Noradrenaline Morphine Vecuronium 4.2% Sodium Bicarbonate

24 IV Calcium gluconate IV Midazolam IV 30% Sodium Chloride IV 20% Potassium Chloride Intubation Drugs Specific Information How to make up / administer IV Atropine IV Suxamethonium IV Morphine

25 Intravenous Infusion Information for Staff on the Neonatal Unit Intravenous infusions (IVI) are routinely used in the care on neonates in the neonatal Unit. An IVI is used when a baby is nil by mouth, this may be due to their clinical condition or prematurity or gastric instability. Maintaining an accurate fluid balance is important when caring for a sick neonate. Under or over hydrating a baby can be extremely detrimental to the babies condition therefore it is very important to check the fluid prescription chart very carefully at the beginning of each shift. All staff will adhere to the NPSA recommendations for intravenous medicines and fluids and follow the chart below. All staff will have read the report for neonates on the prevention of over infusion of intravenous medicines and fluids. Three way taps are not used in the administration set up. Fluids given by syringe pumps are drawn up into the appropriate size syringe and connected to the main IV access or to secondary IV access as indicated by the nature of the fluid/drug to be infused. Neonatal staff will follow the Neonatal Intravenous Fluid Administration Guideline:- 1. Sterile Aseptic Non Touch Technique should be used in any activity involving the setting up or administration of intravenous (IV) drugs or infusions. 2. Disposable plastic red drug aprons should be worn during the performance of infusion procedures. 3. Clear IV Fluids will be run though a clear IV administration set and have a 96 hour endotoxin filters in the line, the set and filter will be changed every 96 hours. 4. TPN (Vamin) will be run though a light sensitive IV administration set and have a 96 hour endotoxin filter in the line, the set and filter will be changed every 96 hours 5. Clear IV Fluids and TPN: administration sets used must be changed immediately upon suspected contamination or when the integrity of the product or system has been compromised. 6. All IV fluids/drugs (rate and total volume) must be independently checked by two registered nurses (at least one of whom has completed the Neonatal Intravenous Administration competency) prior to administration.

26 7. Check that the appropriate route is available for infusion/drug. i.e. central line or peripheral line. 8. Check that the percent of dextrose to be infused is compatible with the baby s blood glucose level. 9. All IV infusion rates and type of solution must be checked and signed prior to commencement of infusion and at each rate change. 10. The total fluid volume/kg/24 hours, the IV infusion rates, type and concentration of solution must be double checked as part of the handover of each shift. 11. Electronic infusion devices (syringe pumps/infusion pumps) must be used for continuous infusions due to the need for pressure monitoring and rapid occlusion alarms. 12. The IV infusion site must be observed and the assessment site score to be documented hourly (see guideline). 13. The total volume infused must be documented hourly and checked that the correct volume has been administered. 14. All clamps on IV administration sets must be closed before removing the administration set from the infusion pump, or switching the pump off. 15. When using a syringe pump to administer IV fluids or drugs, a bag of fluid should not be left connected to the syringe. 16. The baby must be monitored and observations recorded as indicated by their condition; continuous or intermittent. 17. All discontinued infusions must be disconnected from the baby. 18. All staff must complete infusion device equipment competencies.

27 Immediate checks at time of clinical handover between the nurse going off duty and the nurse coming on duty. Fluid prescription chart and drug chart Check correct fluid is being infused Check fluid is in date Check infusion calculations are correct and labelled correctly Chart is signed and dated Check amount per kg is correct for babies age in days (if different from recommended amount find out why). Review last blood glucose Check NESS score Lines all labelled Chart intravenous and arterial lines on chart. Sign the back of the critical care /special care chart as evidence that this procedure has been adhered to.

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29 Intravenous infusion information for staff on the neonatal unit Pressure limits: Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 Check limits are appropriate. All infusions whether they are longlines or peripheral lines should be set 25 mmhg above the resting pressure. The neonatal unit uses the Volumat MC Agilia infusion pump, the pumps are configured for special care, critical care and 1 for exchange transfusion. Pressure limits for Volumat MC Agilia- Special Care pressure limits Minimum Pressure set = 50mmhg Maximum Pressure Set = 300mmhg Maximum Pressure set when delivering a bolus only = 750mmhg Critical Care Pressure limits Minimum Pressure set = 50mmhg Maximum Pressure Set = 450mmhg Maximum Pressure set when delivering a bolus only = 750mmhg Exchange transfusion Minimum Pressure set = 50mmhg Maximum Pressure Set = 500mmhg A peripheral cannula should not exceed 50mmhg without the certainty that the line is patent, flushes well and there is a clinical indication for the need of pressures greater than 50 mmhg. The Alaris Asena pump is capped at a pressure limit of 400mmhg. This is L4 on the pump pressure bar. L0 = 50mmhg L1 = 100mmhg L2= 200mmhg L3=300mmhg L4=400mmhg

30 Volume to be Infused (VTBI): This method is routinely used to safe guard against accidental over infusing of fluids Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 Set the volume to be infused at your 4 hourly rate, if your rate was 5 ml hourly; then your volume to be infused would be 20 ml hourly. Pumps need to be read hourly. Check the amount infused and record; check the IV site hourly observing any changes using NESS assessment tool. Pumps should be zeroed at 07:00 Changing fluids:- Fluids should be changed in the early evening when possible. (TPN & Lipids come from pharmacy at approximately 16:30 onwards Mon -Fri there should be emergency TPN and Lipid in the fridge (standard bags) for new admissions. This does not apply when changing from prescribed 10% Dextrose to 10% Dextrose and electrolytes when the baby is 24 hours old. IV Lines for clear fluids (10% Dextrose / Vamin (TPN) must be changed every 96 hours (remember to label the filters when they are set up). The lipid line and lipid filter must be changed every 24 hours. NB:- When putting up a bag of TPN (48-hour bag) check the date of the line change. If it needs changing the next day (i.e. 24 hours into the 48-hour bag) then you need to change the line a day before it was due to be changed so as not to interrupt the infusion. If a baby commences oral feeds then you have to deduct the amount from the hourly rate of the intravenous infusion.

31 ACCOUNTABILITY Objective To be able to demonstrate an understanding of: I. The relevant Royal United Hospital Bath policies and hospital standards II. The NMC Scope of Professional Practice Describe / outline the Trust s policies on IV administration How should the NMC Code of Conduct influence the nurse s attitude to the administration of IV drugs? What resources are available to help you when administering IV drugs?

32 ANATOMY AND PHYSIOLOGY Objective To know the reason why the IV route will be chosen / prescribed and the advantages / disadvantages of IV therapy. State 3 reasons why the intravenous route might be chosen in preference to another route of administration State 3 disadvantages of using the intravenous route List the types of intravenous lines currently used in the neonatal unit Discuss the rational for the decision to use central or peripheral venous access.

33 INFECTION CONTROL Objective: To understand the principles, and importance of Infection Control in IV drug administration. List 5 methods of preventing / reducing infection risks when administering intravenous therapy: What are the principles of the ANTT? What is the definition of a key-part? Is it possible to achieve a true sterile IV technique in a typical ward setting? YES / NO Is it possible to achieve an aseptic technique in a typical ward setting? YES / NO

34 Which types of venous-access-device should it be used for? What kind of patients should we use ANTT and when should we use a sterile technique? When should hands be washed? Why is a non-touch-technique important even when practitioners wash their hands and wear sterile gloves? Are sterile gloves required for all procedures? What are the four stages in performing ANTT? What stages are compulsory for all procedures?

35 HEALTH AND SAFETY Objective: To be aware of relevant policies and know what course of action to take regarding: o Safe disposal of sharp objects o Infection risks from body fluids o Accidents, injuries and near misses o Accidental injury from a sharp object Describe how you would ensure the safe disposal of sharp objects that are used in the administration of IV s Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 List seven different administration errors List the 5 R s What is the Trust policy when a needle stick injury has occurred?

36 PRACTICE Objective: To have knowledge of the practical aspects and considerations required for IV administration. Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 Outline the considerations required when preparing a drug for IV administration Describe what is meant by the term displacement. Describe what is meant by the word incompatibility. Name two of the problems caused by incompatibility reaction: If a precipitation occurs what should you do?

37 Why is thorough mixing of drugs into IV fluids important? Give an example of drugs which might be given by the following methods and why? Continuous Infusion Bolus Injection Slow (intermittent) infusion What checks should be made of the peripheral site and line prior to the administration of IV drugs / infusions? What is the life expectancy of an IV line with a filter in situ? What actions can you take to prevent being interrupted when checking IV drugs / infusions?

38 Name: Date commenced: / / Date completed: / / Competency: Intravenous drug administration to a Peripheral Cannula Aim: The aim of this competency is to provide the individual with the knowledge and skills to perform safe practice. Demonstrating competence in clinical and theoretical knowledge regarding safe practice, technical skill required and rationale for the procedure. Evidence of Competence Individuals need to be able to provide evidence to support their competence. Completion of RUH Intravenous & Subcutaneous Therapy Workbook Completion of Neonatal Drug Calculations Learning log of practice and procedures undertaken Has read the RUH trusts Administration of Intravenous Drugs policy I confirm that has been supervised in practice and has completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug Administration in the Neonatal Unit. They have completed all relevant written documentation and understand the aim of this competency Print name: Signature of Supervisor: Date: I believe myself to be competent in this procedure and understand the competency aim I have received relevant training and completed appropriate documentation successfully. I accept full accountability for my own practice and have discussed this role with my supervisor. Signature of individual: Print name Date:

39 Supervised drug administration to peripheral intravenous cannula IV boluses No of attempt Drug Preparation and administration Adherence to correct procedure Action/Side effect discussed Assessee s Signature Assessor s Signature Comments You must have completed 5 supervised drug administrations before being signed off for this competency Supervised drug administration to peripheral intravenous cannula when IV infusions in situ No of attempt Drug Preparation and administration Adherence to correct procedure Action/Side effect discussed Assessee s Signature Assessor s Signature Comments You must have completed 5 supervised drug administrations before being signed off for this competency

40 Competency certificate for the administration of intravenous fluids and medicines to Peripheral Intravenous Cannula Date Individuals signature Nurse demonstrating competency signature Bolus medicines Fluids and Infusions Candidates must be able to answer and demonstrate competence Performance Criteria 1.State intended use of Intravenous Therapy 2. Discuss the hazards & precautions with IV therapy & take the appropriate action 3. Demonstrate how to calculate rates of infusions in commonly used infusions 4. Demonstrate the appropriate checks to ensure a cannula is adequately & safely secured when a cannula is in situ 5.Demonstrate and explain the different signs and symptoms of impending or actual extravasation injury 6.Discuss pressures limits set on pumps & the significance of changes in the pressure 7. Maintains clear and accurate documentation 8. Demonstrates an understanding of the trust policy and unit guidelines on care of infusions/cannula including 5R s 9. Discuss and demonstrate the principles of ANTT 10.Demonstrate running through IV fluids

41 Care and management of long lines Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014

42 Care of a neonate with a longline 1. List three reasons why a neonate may require a longline. 2. List 5 items a doctor / ANNP may require when inserting a longline. 3. Name two common sites for insertion of a long line. 4. Give two reasons why it is important to confirm by X-ray the position of the tip of the long line before commencing fluids? 5. Why do some longlines require radio opaque dye to be administered immediately prior to X-ray? 6. Describe two potential complications for neonates with a long line in situ. 7. What observations would you make when caring for a baby with a long / central line in situ and how frequently would you carry them out? 8. What size syringe should be used to flush central lines and why?

43 9. What would you do if you found a central line difficult or impossible to flush? 10. When would you wear sterile gloves when handling central lines and why? 11. What would make you suspect an infant has a line infection? 12. What are some of the indications for removing a central venous line? 13. Whilst you are supervising the administration of IV drugs you become aware of practices you feel are unsafe. What do you do? 14. The syringe disconnects as you are injecting a drug and it sprays into the bedding. What would you do? 15. When you check the IV insertion site you observe that the area is grossly swollen with blisters. What action would you take? 16. Why must a longline always have fluid running through it until it is safely removed from the infant?

44 Name: Date commenced: / / Date completed: / / Competency: Intravenous drug administration to neonatal longline Aim: The aim of this competency is to provide the individual with the knowledge and skills to perform safe practice. Demonstrating competence in clinical and theoretical knowledge regarding safe practice, technical skill required and rationale for the procedure. Evidence of Competence Individuals need to be able to provide evidence to support their competence. Completion of RUH Intravenous & Subcutaneous Therapy Workbook Competency of Neonatal Drug Calculations and administration to a peripheral cannula Learning log of practice and procedures undertaken Evidence of Direct supervision from RUH NHS Trust Intravenous Medicines Administration Trainers. Has read the RUH trusts Administration of Intravenous Drugs policy I confirm that has been supervised in practice and has completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug Administration in the Neonatal Unit. They have completed all relevant written documentation and understand the aim of this competency. Print name: Signature of Supervisor: Date: I believe myself to be competent in this procedure and understand the competency aim I have received relevant training and completed appropriate documentation successfully. I accept full accountability for my own practice and have discussed this role with my supervisor. Signature of individual: Print name Date:

45 Supervised drug administration to a neonatal longline IV boluses No of attempt Drug Preparation and administration Adherence to correct procedure Action/Side effect discussed Assessee s Signature Assessor s Signature Comments You must have completed 5 supervised drug administrations before being signed off for this competency Supervised drug administration to longline when setting up IV infusions No of attempt Drug Preparation and administration Adherence to correct procedure Action/Side effect discussed Assessee s Signature Assessor s Signature Comments You must have completed 5 supervised drug administrations before being signed off for this competence

46 Competency certificate for the administration of intravenous fluids and medicines to a neonatal longline Date Individuals signature Nurse demonstrating competency signature Bolus medicines Fluids and Infusions Candidates must be able to answer and demonstrate competence Performance Criteria 1.State intended use of Intravenous Therapy 2. Discuss the hazards & precautions with IV therapy & take the appropriate action 3. Demonstrate how to calculate rates of infusions in commonly used infusions 4. Demonstrate the appropriate checks to ensure a longline is adequately & safely secured when a longline is in situ 5.Demonstrate and explain the different signs and symptoms of impending or actual extravastion injury 6.Discuss pressures limits set on pumps & the significance of changes in the pressure 7. Maintains clear and accurate documentation 8. Demonstrates an understanding of the trust policy and unit guidelines on care of infusions/longline including 5R s 9. Discuss and demonstrate the principles of ANTT and longlines 10.Demonstrate running through IV fluids

47 Care and management of umbilical Venous lines (UVC)

48 1 List three reasons why a neonate may require a UVC? 2 Name two things you may do to prepare your patient prior to the insertion of a UVC? 3 Name at least five pieces of equipment a doctor / ANNP will require when inserting a UVC 4 List the two ways in which a UVC can be secured and illustrate the one you may be required to help with. 5 What special precautions in terms of skin integrity may you advocate when helping a doctor secure a UVC? 6 Why is it important to await x-ray confirmation of the position of the UVC prior to commencing infusion fluids? 7 What positions can a baby with a UVC be nursed? 8 If both a UAC and a UVC are in situ, how should the lines be positioned for X-ray?

49 9 Name two potential complications of having a UVC in situ 10 What would you do if you spotted an air bubble in the line? 11 What specific observations would you make when a baby has a UVC in situ and how often would you carry them out? 12 What would be the consequence of a loose connection or a leak in the line and what would be your immediate management? 13 Describe the route the UVC takes when entering the abdomen 14 Where is the recommended position for the tip to lie internally? 15 Describe the two different types of UVC and what situations they are most likely to be used. 16 On X-ray how would you distinguish between a UAC and a UVC?

50 17 Describe why it is important that an aseptic technique is used when changing giving sets and administering drugs and via long/ central venous lines. 18 How often would you change a giving set carrying: Maintenance fluids? Drug infusions? 19 Describe two potential complications of administrating drugs / infusions via a UVC and how you would manage it.

51 Name: Date commenced: / / Date completed: / / Competency: Intravenous drug administration to a Umbilical Venous Catheter. Aim: The aim of this competency is to provide the individual with the knowledge and skills to perform safe practice. Demonstrating competence in clinical and theoretical knowledge regarding safe practice, technical skill required and rationale for the procedure. Evidence of Competence Individuals need to be able to provide evidence to support their competence. Completion of RUH Intravenous & Subcutaneous Therapy Workbook Competency of Neonatal Drug Calculations and administration to a peripheral cannula and neonatal longline Learning log of practice and procedures undertaken Evidence of Direct supervision from RUH NHS Trust Intravenous Medicines Administration Trainers. Has read the RUH trusts Administration of Intravenous Drugs policy. I confirm that has been supervised in practice and has completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug Administration in the Neonatal Unit. They have completed all relevant written documentation and understand the aim of this competency. Print name: Signature of Supervisor: Date: I believe myself to be competent in this procedure and understand the competency aim I have received relevant training and completed appropriate documentation successfully. I accept full accountability for my own practice and have discussed this role with my supervisor. Signature of individual: Print name Date:

52 Supervised drug administration to a Umbilical Venous Catheter IV boluses Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014 No of attempt Drug Preparation and administration Adherence to correct procedure Action/Side effect discussed Assessee s Signature Assessor s Signature Comments You must have completed 5 supervised drug administrations before being signed off for this competency Supervised drug administration to Umbilical Venous Catheter when setting up IV infusions No of attempt Drug Preparation and administration Adherence to correct procedure Action/Side effect discussed Assessee s Signature Assessor s Signature Comments You must have completed 5 supervised drug administrations before being signed off for this competency

53 Competency certificate for the administration of intravenous fluids and medicines to a Umbilical Venous Catheter. Date Individuals signature Nurse demonstrating Bolus medicines Fluids and Infusions Performance Criteria Candidates must be able to answer and demonstrate competence 1.State intended use of Intravenous Therapy 2. Discuss the hazards & precautions with IV therapy & take the appropriate action 3. Demonstrate how to calculate rates of infusions in commonly used infusions 4. Demonstrate the appropriate checks to ensure a UVC is adequately & safely secured when a UVC is in situ 5.Demonstrate and explain the different signs and symptoms of impending or actual extravastion injury 6.Discuss pressures limits set on pumps & the significance of changes in the pressure 7. Maintains clear and accurate documentation 8. Demonstrates an understanding of the trust policy and unit guidelines on care of infusions/uvc including 5R s 9. Discuss and demonstrate the principles of ANTT and UVC s 10.Demonstrate running through IV fluids

54 Name: Date commenced: / / Date completed: / / Competency: Safer administration of intravenous Gentamicin Aim: The aim of this competency is to provide the individual with the knowledge and skills to perform safe practice. Demonstrating competence in clinical and theoretical knowledge regarding safe practice, technical skill required and rationale for the procedure. Evidence of Competence Individuals need to be able to provide evidence to support their competence. Completion of RUH Intravenous & Subcutaneous Therapy Workbook Competency of Neonatal Drug Calculations and administration to a peripheral cannula Learning log of practice and procedures undertaken Evidence of Direct supervision from RUH NHS Trust Intravenous Medicines Administration Trainers. Has read the RUH trusts Administration of Intravenous Drugs Has read the NPSA Safe use of Gentamicin in Neonates (02/2010) I confirm that has been supervised in practice and has completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug Administration in the Neonatal Unit. They have completed all relevant written documentation and understand the aim of this competency; to provide consistency in conjunction with a high standard of knowledge and adherence to the NPSA requirements for the Administration of Gentamicin in the Neonatal Unit Print name: Signature of Supervisor: Date: I believe myself to be competent in this procedure and understand the competency aim I have received relevant training and completed appropriate documentation successfully. I accept full accountability for my own practice and have discussed this role with my supervisor. Signature of individual: Print name Date:

55 1.How frequent should gentamicin be given for: Babies <32 weeks gestation Babies >32 weeks gestation 2. How many mg/kg should be prescribed (according to local policy)? Candidate s signature and candidates answers. Date Competency achieved Signature of Assessor 3. Where should the prescription be prescribed on the drug chart? 4. Which other documentation should be present with the drug chart? 5. With which dose should blood levels be monitored? 6.What is the timing for: The pre level? 7. What is the purpose for monitoring blood levels? 8.What is the correct level for: Pre gentamicin level 9. How may the levels affect future dosage? 10. What are the potential side effects of a Gentamicin overdose? 11. Show evidence of application of the 5 R s prior to administration Taken from: NPSA Safe use of intravenous Gentamicin for neonates (02/2010)