ŠĻą”±į>ž’ ‘“ž’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’ģ„Į5@ šæó$bjbjĻ2Ļ2 \V­X­Xć ’’’’’’ˆjjjjŗŗŗ$|   Pš ¤|Ah¼ĄÄÄČ333ĄĀĀĀĀĀĀ$©‘Rū“Źęŗ3/333ęjjÄČgūķ ķ ķ 3^j8ÄŗČĄķ 3Ąķ ąķ Ķ!*˜‡ü¢ŗ,ŽČ° @ķvĮŃ ‘.”ŠRTŽl0AęŠFŔæŔ¤,ŽŽT2JjjjjŔŗ,Ž(33ķ 33333ęę||$ × ||  Protocol for the Administration of Hydroxocobalamin to adults by Health Care Assistants (HCA) Purpose of Protocol To enable suitably trained Health Care Assistants working for ………………….. SURGERY who have undertaken relevant training (as outlined below), to administer hydroxocobalamin as a duty delegated by the General Practitioner (GP employer) or registered nurse (Trust employee). Characteristics of staff Staff group (s)Health Care Assistants Additional RequirementsTraining and competence in the correct procedure of administering medication via intramuscular injection. Completion of a validated course on Basic Life Support and Treatment of Anaphylaxis. Knowledge of ……………………. Surgery policy on management Anaphylaxis in the Community. Other relevant training (as outlined below) Continuing Training RequirementAnnual updates in Basic Life Support and in the treatment of Anaphylaxis. Demonstration of competence in relation to this medication within the PDP and appraisal process.  Clinical Condition Clinical Condition to be treatedPernicious or other macrocytic anaemias Criteria for inclusionAny adult (i.e. any person aged 16 years or over) who has received initial treatment following diagnosis and now requires maintenance doses. Criteria for exclusionPatients with an unconfirmed diagnosis of pernicious or other macrocytic anaemia. Recently diagnosed patients who are receiving the initial loading doses Any person less than 16 years of age. Circumstances for further advice/actionConsent not given Excluded patients: refer to GP Suspected hypersensitivity reactions: refer to GP Pregnancy and breastfeeding: refer to GPRecommended treatment, route and legal statusHydroxocobalamin by intramuscular injection into the deltoid muscle Prescription Only Medicine (POM)Dosage1mg in 1mlStorageAt or below 25oC and protected from lightFrequency of administration and maximum dosageNormally 1mg every 3 monthsFollow-up & adviceSide effects & their managementLocal side effects: injection site pain Systemic side effects: nausea, headache, dizziness, fever, rash & pruritis Rare side effects: cardiac arrythmias – contact GP, anaphylaxis – see protocol for treatment of anaphylaxis for appropriate management.Special considerations/Concurrent medicationResponse to Hydroxocobalamin reduced by Chloramphenicol. Discuss with GPClinical Aspects The following will be required: Patient specific directions – written by the General Practitioner or other authorised prescriber Patient identification - required prior to the administration of medication (confirmed by the patient declaring his or her name, date of birth and home address). Consent – informed consent must be obtained from the patient. Record keeping – The following should be recorded in the patients notes, either according to the GP practice system, or within the district nursing documentation drug administration records Name of drug, dose route and site of administration Date administered Batch No and expiry date Signature of person administering Patient assessed as not appropriate for injection and any alternative action taken If the patient has declined injection and any alternative action taken Any reaction should be recorded in the clinical record Adverse reactions Health Care Assistants must ensure the availability of an Anaphylaxis shock pack containing Adrenaline 1:1000. If a general adverse reaction does occur: Record in patients notes Inform patients General Practitioner as soon as possible Local reactions should be seen by either the general practitioner or practice nurse or qualified RN within the district nursing team Complete Yellow Card if suspected severe reaction. If anaphylactic reaction occurs Give treatment in accordance with the SURGERY policy on the Management of Anaphylaxis in the community. Record in patients notes Inform patient General Practitioner as soon as possible Relevant training The Health Care Assistants will attend a training session covering the following aspects of the administration of hydroxocobalamin Appropriate anatomy and physiology Correct procedure for the administration of hydroxocobalamin by intramuscular injection Drug storage requirements Cautions and side effects related to the administration of hydroxocobalamin Documentation Legal aspects of drug administration The Health Care Assistant will have successfully completed a relevant qualification. This could be NVQ3 or an accredited course from an academic institution. They should have completed a course in Basic Life Support. The Health Care Assistant will undergo a period of supervised practice and assessment and will be directly observed administering intramuscular injections by the general practitioner or the practice nurse mentor (GP employee) providing this duty has been delegated in writing by the general practitioner or by a registered nurse. Assessment of competence Assessment of competence will be undertaken following the period of supervised practice as outlined above. In the GP Practice, this will be undertaken by the practice nurse/GP providing that this duty has been delegated in writing) in order to comply with the specific requirements of the company providing medical indemnity. If employed by the ……………………………. TRUST, assessment of competence will be undertaken by an occupationally competent registered nurse. Competence will be assessed by direct observation of the HCA’s ability to: Prepare the patient for the procedure Safe administration of the medication (including choice of site and needle technique) and observation of the patient post procedure Correct disposal of clinical waste Correct documentation The Health Care Assistant will also be assessed (via oral questioning) on issues relating to the therapeutics of hydroxocobalamin. Significant Events Any significant event which occurs during or as the result of administration of medication must be reported to the Practice Manager/General Practitioner (GP employee) or Registered Nurse/Manager (Trust employee), and the incident reported via the PCT significant event reporting framework. Audit: Health Care Assistants will be expected to participate in audit in relation to patient outcomes and the development of this role. Health Care Assistants must be familiar with the following documents: Consent Policy Documentation Policy Significant Event Reporting Policy NMC Medicines Management NMC: The Code 2015 Review: It is the responsibility of the lead of the staff group (s) to whom this protocol applied to ensure the review process takes place. This protocol becomes valid on ……………………………………. and becomes due for review on ……………………………………………….. .. 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