Regional template for syringe pump prescription and administration record (CME/McKinley T34 syringe pump) Welcome to this training session for the regional syringe pump template.

Learning outcomes At the end of the session, you should be able to Know the background to the template Understand how to use the syringe pump prescription and administration record Check you have selected the correct training presentation depending on whether your organisation requires the volume to be stated as part of the prescription or not.

Background to the templates Sub-group of NICaN Supportive and Palliative Care and Pharmacy group developed templates for use in primary and secondary care, distributed in 2009 for local implementation Syringe driver prescription and administration record (primary and secondary care) Continuation record (primary care only) Breakthrough symptoms (primary care only) Templates adapted for syringe pumps with rate based on volume Sub-group of NICaN Supportive and Palliative Care and Pharmacy group developed templates for use in primary and secondary care, distributed in 2009 for local implementation The templates that were developed were for a syringe driver where the rate is based on ‘distance travelled’. These templates have now been adapted for syringe pumps with a rate based on volume.

Two sides of A4 with hole punching on top for filing Regional template for syringe pump prescription and administration record Landscape design Two sides of A4 with hole punching on top for filing Side 1 – allergy box, patients details, prescription, preparation and administration Side 2 – monitoring, patient details and record of disposal The layout is the same as the original templates and we will go through each section in more detail. Say whether you want the record of disposal to be completed as some trusts may alternatively record this in your CD register.

Hand out blank copies of the prescription and administration record Hand out blank copies of the prescription and administration record. You will see that as described, it is double sided A4 with the prescription preparation and administration on one side and the monitoring and disposal on the reverse. Space for an NSV ordering code is as the bottom right hand side of the front page. We will now work through the different sections of the chart to highlight it’s use. Note these presentation slides were made before the name change to CME/McKinley T34

The first section highlighted is the patient details The first section highlighted is the patient details. An addressograph can be used or the details handwritten. In primary care, the hospital and ward will be blank and the GP details entered. The prescription chart serial number will be sequentially printed on the printed copies by the printer and not handwritten as shown on the example. This is required for primary care so that it is linked to the continuation record, which we will come back to later in the presentation. The number of syringe pumps in use will often be one but may be more. The date rewritten is when an existing prescription is rewritten but unchanged. It will usually be used in secondary care where the prescription has to be rewritten after 4 days as continuation charts are not in use and there is only space for preparation, administration and monitoring of 4 syringes. If a prescription is cancelled and a new prescription written with different medicines and/or doses then date rewritten should not be completed.

The next section is the allergy documentation which should be completed according to your organisation’s policy. For example, in some Trusts this must be completed by the prescriber and medicines should not be prescribed or administered except in an emergency unless this is completed. If the patient has no known allergy, a tick is entered as shown. If the patient has allergy, the allergen should be entered and the nature of the reaction if known. The entry must be signed and dated by whoever documents this information.

Note: There is no longer a DHSSPS use and control of medicines (since April 2103) this bullet point has been reworded to reflect this. The standards for prescribing and administration should be followed as stated in Medicine Management Policies/Procedures e.g. prescriptions should be written using the approved name. In addition it is also recommended that the opioid dose is written in both words and figures to minmise the risk of an incorrect dose being administered due to a number being misread or a decimal point not seen. A reminder regarding dose increase is also included. As you will see when we come to the prescription section, there is space to prescribe up to 4 medicines in one syringe pump. Several comments during the consultation felt that this was advocating four medicines being used. However this statement highlights that even two medicines should not be mixed in a syringe without compatibility information. In secondary care, where a Kardex is in use, this chart must be clearly referenced on the main Kardex so that it is clear that the chart is in use. A prompt is included to remind staff of the need to prescribe breakthrough medication either on the main Kardex or in primary care on a separate breakthrough symptoms chart.

The prescription section allows for up to four medicines to be prescribed in one syringe pump, PROVIDED compatibility information exists. Any unused medicine spaces must have a line drawn through them to prevent additions to a previously prescribed syringe pump. The diluent should be prescribed underneath. The rate over which the infusion should be administered should be completed. The signature, printed name and designation should be filled in along with the start date and time.

Now we will look at the preparation and administration section Now we will look at the preparation and administration section. As you will see four syringes can be prepared against this one prescription before in secondary care, the prescription needs to be rewritten. In primary care the continuation chart needs to be started.

You will see the preparation details being completed for preparation on 1.12.11 and again on 2.12.11. The batch numbers are completed in line with the medicine to which they refer. Where a medicine line is not used as part of the prescription, a line should be entered. The expiry dates must be checked and there is space to document that this check has been completed and the medicines are in date. Battery life should be recorded in % and confirmation that the pump is delivering. The ID number of the syringe pump should be recorded whether this be asset number or the syringe pump number. The final volume should be documented here in ml. If the line has been primed from this syringe then answer YES. This will be the same whether you prime then measure or measure then prime. This must be advised as per local policy although some have indicted through consultation that it would be good to have regional consistency on this. Enter the rate setting, the site of administration and whether or not the lock is on. Finally complete the date and time started and the signature(s) of those preparing and administering. Two persons usually in secondary care and one person in primary care.

Next we look at the reverse and the monitoring and disposal record Next we look at the reverse and the monitoring and disposal record. The frequency of monitoring should be conducted according to your policy. Many secondary care organisations conduct a monitoring check at 30 minutes after set up and then four hourly intervals. In primary care, it may be at each visit.

The example here shows monitoring checks being conducted 30 minutes after set-up using a syringe that was measured and then used to prime the line using 0.5ml before the pump was commenced and then 0.3ml is what would be expected to have infused after 30 minutes. That the line has been primed from this syringe is entered in the comments column to highlight that that VTBI, VI and rate are as expected. The VTBI and VI since last check should always be checked to confirm this is what would be expected if the syringe is infusing at the correct rate. The other columns are being completed to indicate that each of these have been checked. If any problems were observed these would be recorded using the codes at the top of the page. There is sufficient space to record 30 minutes after set-up and four hourly with space for additional checks if required following detection of a problem.

Codes as shown

This shows further completion of the checks now that a second syringe has been set up, this time the line was not primed from the syringe so again confirmation that the VTBI and VI are as expected.

Now we return to the prescription and where a prescription is being changed and therefore the current prescription is discontinued. The prescriber puts a diagonal line through the prescription and through the remainder of the administration record and signs and dates the discontinuation section as shown in the bottom left hand corner.

The monitoring record is annotated in the comments section to highlight that the prescription is discontinued. In some organisations disposal is recorded in the CD register. In others, it is recorded on the prescription as shown.

For primary care, once the first four columns on the prescription chart have been used then a continuation record can be used to record further preparation, administration, monitoring and disposal. This is where the prescription chart serial number is essential as it ensures a clear record of which prescription the continuation record is being used with. Note these presentation slides were made before the name change to CME/McKinley T34

Hand out copies of the chart. This highlights the top of this chart Hand out copies of the chart. This highlights the top of this chart. The notes at the top left hand corner do not refer to a Kardex in comparison to the prescription since the continuation record is only for use in primary care and a prompt to check the allergy status on the prescription chart. This shows the serial number of the prescription being completed and that it is the first continuation record. Addressograph is also for community only in that hospital and ward have been removed and only the GP is listed as a doctor. Note these presentation slides were made before the name change to CME/McKinley T34 Note: There is no longer a DHSSPS use and control of medicines (since April 2103) this bullet point has been reworded to reflect this. The standards for prescribing and administration should be followed as stated in Medicine Management Policies/Procedures e.g. prescriptions should be written using the approved name.

This should be completed as for the preparation and administrations section on the prescription chart and the monitoring and disposal section is also the same

The final document for primary care is for the prescription and administration of SC medicines for breakthrough symptoms. Note: There is no longer a DHSSPS use and control of medicines (since April 2103) this bullet point has been reworded to reflect this. The standards for prescribing and administration should be followed as stated in Medicine Management Policies/Procedures e.g. prescriptions should be written using the approved name.

The patient details and allergy box should be completed as for the syringe driver prescription and administration document. During the consultation some had suggested printing both of these on one piece of paper however others commented that it may be difficult to have the syringe driver and breakthrough symptoms rewritten if only the syringe driver was being changed and the breakthrough symptoms were not. Most keep the charts in a file in any case for each patient.

The medicine is prescribed as shown with a maximum frequency and where possible details on what the medicine should be administered for. The administration is then recorded chronologically in the columns alongside the prescription, always checking before you administer a dose that it can be given according to the maximum frequency prescribed.

Ten doses can be administered against this one prescription after which it needs to be represcribed however more importantly the patient should be reviewed to ensure that the need for breakthrough doses does not indicate a need for a change in the syringe driver.

Any questions? Take questions. It may also be appropriate to add local information such as where to find charts, how to order them and filing of old charts.