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 Requirements / Training 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 Requirement / Annual 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 treated / Pernicious or other macrocytic anaemias
Criteria for inclusion / Any adult (i.e. any person aged 16 years or over) who has received initial treatment following diagnosis and now requires maintenance doses.
Criteria for exclusion / Patients 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/action / Consent not given
Excluded patients: refer to GP
Suspected hypersensitivity reactions: refer to GP
Pregnancy and breastfeeding: refer to GP
Recommended treatment, route and legal status / Hydroxocobalamin by intramuscular injection into the deltoid muscle
Prescription Only Medicine (POM)
Dosage / 1mg in 1ml
Storage / At or below 25oC and protected from light
Frequency of administration and maximum dosage / Normally 1mg every 3 months
Follow-up & advice
Side effects & their management / Local 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 medication / Response to Hydroxocobalamin reduced by Chloramphenicol. Discuss with GP

Clinical Aspects

The following will be required:

1.  Patient specific directions – written by the General Practitioner or other authorised prescriber

2.  Patient identification - required prior to the administration of medication (confirmed by the patient declaring his or her name, date of birth and home address).

3.  Consent – informed consent must be obtained from the patient.

4.  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

5.  Signature of person administering

6.  Patient assessed as not appropriate for injection and any alternative action taken

7.  If the patient has declined injection and any alternative action taken

8.  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

1)  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

2)  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.

3)  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 ……………………………………………….. ..

Protocol for Hydroxocobalamin

Agreement for general practice Health Care Assistants

This protocol is to be read, agreed and signed by all Health Care Professionals it applies to:

Practice: ______

Staff Name: ______

Designation: ______

Signature: ______

Date: ______

Approved by ______

Lead GP:

Date: ______

The Health Care Professionals should retain a copy of the document after signing and the original retained in their personal file.