District Nursing Assistant Practitioner Competency Framework

Name……………………………………… Assessor………………………………………………………….

Role / Band………………………………. Level of competency expected of role = 3

Competency: Insulin administration
Competency Statement: To ensure the practitioner can administer insulin safely and correctly in line with the patient’s plan of care
  • Initially please assess your current level of competence in relation to the competency statements outlined, with your registered nurse assessor. With your registered nurse assessor, initial and date where you feel that you are for each statement. This information will help you focus your learning needs.
  • Agree with your assessor a timeframe to complete the competency
  • Once level 3 has been reached for all aspects of this competency, and both you and your registered nurse assessor are confident of your competence, the assessor can sign-off
  • NB. This competency can only be practiced with a specific cohort of patients – see section below entitled “Application of skill for District Nursing Assistant Practitioners” for full details
  • Evidence of ongoing competence must be provided an your annual PDR

Link to KSF dimensions and levels / 1.
Understands basic principles / 2.
Consistently able to demonstrate principles and apply to practice / 3.
Safe to practice unsupervised / Negotiated timeframe for successful completion
Self Assessment
At Induction / Following Training / Following formal assessment
Knowledge required
Shows a clear knowledge and understanding of the individual patient’s care plan and in particular any specific risk assessment issues regarding the administration of injectable medicines
Understands the importance of maximising the patient’s ability to self-care
Understands the nature of diabetes,the difference between Type 1 and Type 2 diabetes, and both the short and long term effects of the disease process
Understands how mental health issues, such as depression and anxiety may affect people with diabetes
Understand the effect current ill heath (ie infection) may affect people with diabetes
Understands the effects of food and medication on blood glucose levels and how this will affect the patient
Understands why insulin is given and its effects on blood glucose levels
Understands the different formulations of insulin (background, mealtime and mixed insulins)
Understands that insulin is administered in ‘units’ and that doses greater than 50 units should be split and administered over two sites
Awareness of different insulin administration equipment available eg. pen devices and insulin syringes, and insulin safety needles
Understands the relevance and reasons for accurateblood glucose testing and recording
Recognises the importance of timely administration of insulin and the implications of deviation from prescribed times
Be able to identify suitable sites for insulin administration and understands the importance of site rotation and inspecting sites for signs of lipohypertrophy
Understands why oral hypoglycaemics are used in conjunction with insulin and the affect these have on blood glucose level
Understands the terms hypo and hyperglycaemia, what can cause them, how to recognise them and how they can affect the patient
Understands the recommended treatments for hypoglycaemia, when they would be required for a patient, and how to administer
Understands the risk of diabetic ketoacidosis (DKA) in Type 2 patients without a history of ketones (see application section below), know how to recognise this and can describe the actions they would take in the event of this
Understands what to do if a needlestick injury is sustained
Understands the importance of accurate and comprehensive documentation and record keeping
Understands the meaning of ‘never events’ and the implications of these
Skills required
Maximises the patient’s ability to self-care in the management of their diabetes, as far as their ability allows
Is able to accurately measure and record blood glucose and ketone levels as per blood glucose and ketone monitoring competency
Is able to use the correct technique for administration according to the insulin device and safety needle used
Can recognise changes in the clinical condition which would contraindicate administration of insulin
Can recognise when escalation and/or emergency action is required
Is able to keep accurate and meaningful records
Attitude/Behaviour required
Is sensitive in approach to patients and family when administering insulin
Is able to discussand explain the contents of the patient information leaflet with the patient and family
Is aware of the accountability and responsibilities for self and others in administering insulin
Is able to identify how the privacy and dignity of the patient can be maintained and promoted whilst administering insulin
Application of skill for District Nursing Assistant Practitioners
DN APs must have attended Oxford Health Diabetes training
DN APs must have attended glucose/ketone meter training and have blood glucose/ketone monitoring competency signed-off
DN AP only to be delegated stable patients who have Type 2 diabetes, and no history of hypoglycaemia in past 12 months, no history of ketosis and live in their own homes (not a care home)
DN APs not to be delegated Type 1 patients or Type 2 patients with history of hypoglycaemia in past 12 months, history of ketosis, or any patients with diabetes living in any type of care home
Pre-requisites for independent visit by DN AP once competency signed off:
  • Named Nurse from DN team must have completed holistic assessment and clear diabetes management careplan and ensure that a clear direction to administer is all present in the patient’s home
  • DN AP must have access to glucose/ketone monitor
  • Joint visit between a registered nurse from the DN and the individual AP to go through care must have taken place
  • Registered Nurse must visit patient weekly as a minimum to review

Suggested learning opportunities to develop skills and knowledge
  • E-learning for diabetes

  • Community Diabetes Specialist Nurses
  • Managing diabetes during intercurrent illness in the community

  • Recognition, treatment and prevention of hypoglycaemia in the community

  • The First UK Injection Technique Recommendations 2nd Ed

  • Fit4safety injection safety in UK and Ireland

  • An Integrated Career and Competency Framework for Diabetes Nursing 3rd edition

  • NPSA alert Insulin passports
  • NPSA Safer administration of insulin alert
  • NICE The Management of Type 2 Diabetes

Related Policies:
Incident reporting policy RMHS1:

Infection Control policy IF1:

Consent to Treatment CP1:

Clinical Risk Assessment and Management CP16

Medical Devices Management Policy and Procedures CP08

Privacy and Dignity CP51:
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The policies identified within this competency framework are not exhaustive and clinicians should have a working knowledge of all relevant polices for required competency Home - Policies & Procedures

Clinicians Comments / Assessors Comments
Signature
Date / Signature
Date
Date of competency/Training review

Subsequent Review Period

Clinicians Comments / Assessors Comments
Signature
Date / Signature
Date
Date of competency/Training review

V2, April 2015

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