Healthcare Assistants in General Practice
Health Care Assistants
(General Practice employed)
Guidance & Framework
Reviewed December 2019 By South London Nursing Network- Sector Lead nurses for Training Hubs or CCG for practice nursing
Liz Sherlock who produced the original version of this document and on which this is based. Croydon PCT guidelines for Health care assistants (Francine Hyatt- written permission obtained)
Acknowledgements for contributions: update 2015
Fiona White- Nurse Consultant in primary care
Julie Simpkins- Education & Development Consultant
Clare Schumacher- Assistant Director of Nursing
Sue McCandlish- PDF representative
Helen Batchelor- Practice nurse manager
Marie Edwards-PDF representative
Pamela Ward- PDF representative
Helen Batchelor – PN Manager
Karol Selvey – PN Manager
Carolyn Moore – Infection Control Advisor
Debra Hutchings – Diabetes Specialist Nurse
Amended December 2019 by Julia Billington- Kingston, Catherine Wallace- Croydon, Fiona White- Merton, Jennie Morrison- Sutton, Alison Epton- Wandsworth,
Review December 2020
Contents
Page
- Employing an HCA 3
- Job Description 9
- Person Specification 12
- Core Competencies 13
- Training themes 14
- Clinical Guidance 17
- Blood pressure monitoring 19
- Blood Glucose monitoring 21
- Cleaning instruments 24
- Form Completion 24
- Hand Washing 25
- Measuring Weight 26
- Measuring Height 27
- Ordering and re-ordering drugs and vaccines 28
- Phlebotomy 29
- Record Keeping 31
- Re stocking of consultancy rooms 32
- Results Giving 33
- Spillages 34
- Storage of Drugs/Vaccines 35
- Urine Analysis 37
- Administering Vaccines/Injections & sample protocols 38
- Appendix A- Patient specific guidance
Employing an HCA
Introduction
CCG’s and Educational Hubs supports local GP practices who are increasingly looking at ways to create capacity. The employment of Health Care Assistants (HCAs) to cover an expanding diversity of roles is one such development. This document aims to provide guidance for practices who are considering or have employed an HCA to help ensure that the quality of service delivered by HCAs meet acceptable standards.
Assessing whether an HCA is right for your practice
The first step for any practice when considering employing a Health Care Assistant is to assess whether the role that needs to be undertaken is suitable for a HCA. A review of the skill mix in the nursing team and consideration of whether the practice is able to offer the support and development needed for an HCA is essential. An alternative to an HCA may be a Band 5 treatment room nurse or a Nurse associate. The existing Practice Nurse team will need to have the resources to develop and supervise the HCA and the HCA be willing to be accountable for him/her. Broadly there would need to be a team of at least 2-3 nurses to ensure supervision is adequate and there should be one who agrees to be the designated supervising RGN. HCA’s can not work autonomously.
A practice risk assessment should be undertaken to assess which roles it would be safe to delegate to a HCA. Systems for recording significant events should be in place. All HCA’s must undertake the Care Certificate within three months of commencing Practice at your Surgery if they do not already hold the certificate.
Range of Roles
The range of accepted role for HCAs in General Practice and promoted in historic DH papers Liberating the Talents (2002) and the NHS Plan (2001) and more recently Department of Health (2012) Compassion in Practice, Cavendish C (2013) The Cavendish Review. An Independent Review into Healthcare Assistant and Support Workers in the NHS and Social Care Settings.
The tasks have diversified from simple tasks such as new patient registration and NHS health assessments, ordering and stock control of supplies including vaccines. To undertake clinical tasks such as blood pressure monitoring, ECG, phlebotomy/ venepuncture and removal of sutures. The HCA JD now includes roles with specific training in wound care , ear irrigation , Doppler and leg ulcer treatment, giving injections ( These are Vitamin B12, Influenza (over 18 years for IM), Shingles, Nasal flu (for under 18 years olds ) and pneumonia injections) using Patient specific directive ( PSD) – see appendix A for guidance. The list of clinical guidelines in this document on page 14 is a list of those roles currently accepted as being suitable for HCAs.
Accountability
Many staff will be concerned with the issue of professional accountability. Guidance from the Royal College of Nursing is as follows:
*Always assess the needs of the patient – their needs should define ‘who does what'.
* Always delegate roles to an appropriate COMPETENT carer, e.g. the HCA, who through their NVQ award / Care certificate / Diploma will have demonstrated competence in a variety of skills.
* The professional (nurse / doctor) is accountable for DELEGATION, and if done correctly (above) then the professional will not be called to account if something untoward happens. You will be called to account however, if you delegate work to someone who has not demonstrated competence in that work.
*Develop a corporate agreement as to what you want the HCAs to do in your practice, there is nothing worse for the HCA, the patients, and all other staff when it is not clear who does what.
* Care Assistants (HCAs) and Assistant Practitioners. The role, challenges and employer responsibilities for the HCA in general practice. HCAs have a duty of care and therefore a legal responsibility with regards to the patients they see. Although they are not registered with a professional body, HCAs are accountable to their employer to follow their contract of employment. In turn, employers have a responsibility to ensure the HCAs they employ are trained and supervised properly until they can demonstrate competence. Employers accept vicarious liability for their employees; they are accountable for the actions and omissions of the employee. It is therefore vital that employers ensure that employees only work within the limits of their competence. If a registered nurse is responsible for delegating tasks to an HCA, the registered nurse is responsible under the Nursing and Midwifery Council (NMC) Code of Conduct for the safe delegation of that task.
The potential isolation of the primary care environment presents different challenges for HCAs who may have previously worked within larger teams in social care or hospitals. The scope and nature of the HCA’s responsibilities vary between practices and depends on the individual needs of the practice. Tasks may include blood pressure management, venepuncture, recording ECGs and health promotion.
Regardless of the task being undertaken, the principles of delegation remain the same:
• the HCA should have been trained and assessed as competent
• the HCA’s job description should specify their role
• the practice should ensure they have appropriate medical indemnity for the HCAs they employ and that the cover provided is sufficient to cover their scope of practice.
Although the nature of general practice means that HCAs will be carrying out care for patients independently, they should have access to a registered nurse or GP who can provide advice and support when necessary. The level of supervision required will depend on the task being undertaken. The key is that the degree of risk must have been assessed because ultimately the patient has a right to the same standard of care, whoever delivers it.
Tasks
Administration of vaccines
HCAs can administer vaccines to patients in certain circumstances and are a valuable part of the team, especially for example during the annual flu vaccination campaign. Specific training and assessment of competence must have taken place.
The Royal College of Nursing (RCN) supports the role of HCAs in administering specific vaccines to adults and the nasal influenza vaccine to children, providing they are appropriately trained and have the support of a registered health care professional (GP or nurse in primary care). The RCN does not support HCAs administering other vaccines such as the remainder of the childhood vaccination programme or travel vaccines. This is due to the clinical decision-making involved.
In all cases, Patient Specific Directions (PSD) should be in place. A PSD is a specific, written order by a qualified prescriber who retains responsibility for the safe administration of the vaccine.
Only registered health care professionals can administer vaccines under a Patient Group Direction and they are therefore not appropriate for HCAs.
See:
• Public Health England updated guidance on minimum training standards for HCAs administering vaccines
*Rigorous protocols need to be drawn up which clearly define the HCA's role within a clinical activity. (The latter half of this document has a range of guidelines that you can adapt for use in your practice).
Liability Issues and indemnity
Whist the practice is liable for the actions of its employees and should have appropriate liability insurance so too are the individual HCAs and Practice Nurses and should be encouraged to join a Union. Some examples of unions that have HCA members are:
Medical Defense Union: Cover is provided under vicarious liability, if the Health Care Assistant is working within guidelines. Cover can be provided as part of a Group Practice Scheme
MDU Contact No: 0800 716 376
Unison Indemnity Insurance Scheme:
The policy covers all members employed in health care (but not members who are self employed). Applications are on an individual basis:
Unison Contact No: 0161 832 5625
Royal College of Nursing
Will accept as members (and thus provide indemnity) HCAs who have achieved NVQ level 3
Tel. 0845 77226100
Insurance and indemnity when you’re working as a GP in England
If you work in England as a GP, trainee GP or locum under a medical services contract (GMS, PMS or APMS) you will receive indemnity (for claims arising from incidents which took place on or after 1 April 2019) through the Clinical Negligence Scheme for GPs (CNSGP), which is administered by NHS Resolution. More information about the scheme is available on the NHS Resolution website.
Are GP practices covered? GPs, whether fundholders or not [and who are not employed by Health Authorities as public health doctors], are independent practitioners and therefore they and their employed staff are not covered by NHS indemnity. Appendix B
You will need to maintain membership with an MDO or other indemnity provider or insurer to retain cover in respect of activities and services not covered by CNSGP or GMPI – including non-NHS or private work, inquests, regulatory and disciplinary proceedings, employment and contractual disputes, and non-clinical liabilities.
Training and Supervision
Training for HCAs it crucial to enable the development of competence. Locally there is a programme of induction, training and life long learning and it is important that the practice supports their HCA accessing ongoing training. The current benchmark for HCAs is the minimum of the care certificate and NVQ level 3 or HCA diploma . The Health care certificate measures the competency of the HCA within their role. The Education Hubs/CCG provide HCA Forums, HCA education updates, clinical supervision and preceptorship programs by means of on going support
Ongoing regular supervision by the designated supervising nurse to assess competence on an annual basis is advised as good practice.
Occupational Health
It is important that there is an assessment of the occupational health requirements of this post. For example if a newly appointed HCA has come from an administration position she will usually require Hepatitis B, MMR, Whooping cough and Influenza (annually unless contraindicated) prophylaxis.
Use of the title ‘nurse’
Under the Nursing and Midwifery Order 2001 (Act of Parliament) it is an offence for anyone to use a title to which he/she is not entitled to or to falsely represent him/herself to possess qualification in nursing. Thus it is the view of the CEPN/Educational Hubs that the use of the title of nurse for a health care assistant should be prohibited. To avoid confusing patients the following measures should be taken.
* Use of a name badge that clearly states the name and job title of the wearer.
* Staff in the practice to be advised not to use the title of nurse when referring to a HCA.
* The uniform worn by the HCA to be clearly different to that of the qualified nurses in the practice and conform to good practice ( no false nails, high shoes( above 2 inches or jewellery apart from wedding ring with no stones) .
Guidance on HCAs administering injectables
The development of the HCA role to include the administration of injectables is a relatively new area. In order for general practice to enable HCAs to safely administer the Vitamin B12/ influenza /pneumococcal /Shingles , Nasal influenza vaccines, certain conditions need to be met in relation to the prescribing and administration of the vaccines. These are as follows:
*The HCA must have completed their care certificate and have worked as a HCA for at least 2 years in their role ( or 1 year if on the nursing associate pathway).
*With regard to the written instruction required for the supply and administration of medicines by non-professionals, HCAs can only administer medicines under a Patient Specific Direction (or Order) Medicines Matters (2006). Unlike a Patient Group Direction this needs to be written for each individual patient. PSDs are a direct instruction and therefore do not require an assessment of the patient by the health care professional instructed to supply or administer the medicine. There is nothing in legislation to prevent PSDs being used to administer medicines to several named patients e.g. on a clinic list or a The recommended READ code for use when authorising PSDs is: 9NgM – Has authorisation for medication under PSD
The HCA should not administer any part of the Childhood immunisation programme (joint statement by the RCN and Health Protection Agency) or Travel vaccinations.
*The HCA should never administer injections without supervision (i.e. a nurse in the next room)
Cervical Smear Taking
HCA ‘s under no condition can perform a Cervical Smear and this is supported by the position of the Royal College of Nursing which is as follows:
Following discussions in 2005 with the DOH, NHS Cancer Screening Programme (NHSCSP), the RCN is currently recommending that HCAs do not take cervical smears. Nursing associates who have been trained will be able to undertake smears.
Care Certificate
From April 2015, all employers appointing HCAs should incorporate the standards contained within the Care Certificate into the induction process. An independent review by Camilla Cavendish in February 2013 investigated how care assistants and support workers in health and social care could be better valued and supported. Since then, Health Education England, Skills for Care and Skills for Health have developed the Care Certificate which contains 15 standards and outlines what health and social care workers should know and be able to deliver in their daily jobs. It aims to address inconsistencies in training and competencies so that all staff have the same introductory skills, knowledge and behaviours to provide safe, high quality and compassionate care of the highest standards. For HCAs employed since April 2015, we expect to see evidence of how the Care Certificate standards are being included in induction programmes. See: Care Certificate: Skills for Life website
CQC inspections of GP practices
When we inspect GP practices we check that staff have the skills, knowledge and experience to deliver effective care and treatment, as part of considering how effective a GP practice is. GPs should therefore be prepared to demonstrate how they have trained HCAs for all aspects of their role and assessed their competence, both when they initially undertook the task and throughout their employment. This could be achieved by a range of methods and could involve a combination of directly-observed and recorded clinical encounters, external training events / updates and in house reflection on practice with a practice supervisor/assessor mentor who has appropriate expertise.
JOB DESCRIPTION
This is a sample job description that may assist you in developing your job description within your employing area of work
JOB TITLE: Health Care Assistant
GRADE:
SALARY SCALE:
HOURS: per week plus training
RESPONSIBLE TO: Practice Manager
ACCOUNTABLE TO: Practice nurse/ GP
LENGTH OF CONTRACT:
JOB SUMMARY
To be a member of the practice based nursing team. You will provide high quality care to the practice population. You will be supervised by members of the nursing and medical team, at all times working to your job description and within your capabilities.
MAIN DUTIES AND RESPONSIBILITIES
1. TRAINING AND DEVELOPMENT
1.1 All health care assistants will be expected to undertake Mandatory Training. Opportunities to undertake additional training will be provided. You will be closely supervised by relevant nursing, medical staff throughout your term of employment. You will have an identified supervisor within your practice.
2. You will carry out all duties with regard to protocols and guidelines in use at ……….
……………………………(name of practice)
2. CLINICAL DUTIES
Performance of clinical duties is dependent on the candidate’s aptitude and are strictly at the discretion of the post holder and practice nurse/ Medical supervisor.
2.1 Carry out health assessments on newly registered patients and NHS health checks e.g. testing urine, blood pressure checks, heights, and weights and taking simple document medical history.
2.2 Report all matters pertaining to patient’s care – changes in condition/circumstances to a relevant member of the nursing or medical team as a matter of priority and ensure that a document record is kept in the Electronic medical record (EMIS).
2.3 Ensure that the clinical rooms are at all times kept in a clean and orderly manner and that relevant equipment is ready for use by nursing and medical staff during clinic sessions.
2.4 Assist in clinic sessions as directed by members of the nursing and medical staff ensuring that all equipment is present.
2.5 Ensure that the drug refrigerator is at correct temperature and this is recorded on a daily basis and that drugs are within their expiry dates and used in correct sequence. Order drugs and other supplies as directed ensuring that adequate levels of stock are available in the surgery. Maintain the ‘cold chain’ when drugs are delivered to the surgery.
6. Make sure that health promotion materials are available within the surgery ordering new stock as required
.
7. Assist member of the team when required: Chaperoning, Moving and Handling, Patient and offering support. Depending on appropriate training.
8. Phlebotomy (If required by the employing practice).
2.9 Injections (If required by the employing practice after two years in this post and only following an approved training course).
3. CONFIDENTIALITY AND RECORD KEEPING
3.1 You will act at all times with regard to the confidentiality and sensitivity of issues to do with patients, their care and treatment. Completing the mandatory training associated (GDPR).
3.2 All contacts that you have with patients must be recorded in the electronic patient records ( EMIS).
4. GENERAL AND CLERICAL DUTIES
Performance of clerical duties are dependent on the candidate’s aptitude and are strictly at the discretion of the post holder and practice Supervisor.
4.1 Carry out relevant clerical and reception duties as required in relation to nursing services e.g. completing relevant templates, answering the telephone, making appointments, entering data onto the computer system, carry out computer searches and summarise patients’ notes.
4.2 Participate in audit as required e.g. note sampling, data input and information gathering.
4.3 To function as an integral part of a developing team.
4.4 Attend relevant meetings/ training events as required.
4.5 Have knowledge of and act at all times within the boundaries of health and safety legislation and data protection acts.
4.6 Have basic understanding of all practice policies and be able to access and refer to them.
5 ADDITIONAL RESPONSIBILITIES
1. The employer can determine any additional duties that may be required so long as they do not exceed the level of responsibility expected for the grade of post.
2. To comply with the following:-
a) Practice Policies and Procedures.
b) Health, Safety and Fire Regulations.
This is not an exhaustive list of duties and the post holder may be required to undertake any other duties, as required, to meet the needs of the practice.
PERSON SPECIFICATION
Health Care Assistant Grade ‘B’
| | | |
| |ESSENTIAL |DESIRABLE |
| |X | |
|Well developed verbal and non verbal communication skills | | |
|Completed Care Certificate |X | |
| |X | |
|Ability to prioritise work | | |
| |X | |
|Multi-cultural and LGBT identity awareness | | |
| |X | |
|Ability to work under pressure | | |
| | |X |
|Previous experience of working in a Health Care | | |
|environment | | |
| | |X |
|First aid skills | | |
| |X | |
|Basic computer/typing skills | | |
| |X | |
|Flexibility | | |
| |X | |
|Professional attitude | | |
| |X | |
|Ability to demonstrate a commitment to team working | | |
CORE COMPETENCIES
Health Care Assistant
|Area |Task |
| |Height, Weight, BP measurements (routine) |
| |Nutrition / Hydration Advice |
|Clinical Skills to be determined as skills and |Urinalysis, Pregnancy Testing , |
|training permit |Chaperoning |
| |Measurement of ECG’s, Phlebotomy,24 Hrs BP/ECG monitoring |
|Audit |Data input |
| |Information gathering |
| |Note sampling |
| |Confidentiality |
|Ordering and maintenance |Checking review dates |
| |Cleaning and storage |
| |Equipment |
| |Immunisations |
| |Infection control |
| |Preparing for clinics |
| |Stocks |
|Information |Data input |
| |Templates |
| |Notes summarising |
| |Searches |
| |Confidentiality |
|Health Promotion |Co-ordinating activities |
| |Ensuring adequate supply of materials |
| |Organising displays |
|The HCA must at all times work within her ability |Additional Skills may include: |
|and be supervised by a professional clinician |Dressings, wound care, Dopplers, Leg Ulcers |
| |Blood glucose monitoring |
| |New patient checks , NHS health checks |
| |Advice on medical devices i.e. Inhalers |
| |Injections |
| |Measurement of PERF AND OR Spirometry recordings. (This must be under guidelines |
| |with reporting structures in place after March 2020 must be on the ARTP register)|
TRAINING THEMES - HEALTH CARE ASSISTANT
CONTENT
• The Structure of the NHS
- General Practice
- The NHS ten point plan/ Capital Nurse
- Primary Health Care Teams
• Roles
• Responsibilities
- Other agencies
• Communication skills
- Documentation
- Confidentiality/ GPDR
- Team working
- Customer care
- Change management
- Clinical terminology
- Consent
• Health Promotion in General Practice
- Data collection
- Guidelines/Protocols
- Resources
- Boundaries
• Anatomy and Physiology and theories of
- Urine testing
- Taking and recording blood pressure
- Weight and height
- Blood Glucose Monitoring
- B.L.S. (Basic Life Support)
• Infection Control
- Principles – universal precautions
- Handling specimens
- Types of infection
- How they are spread
• Nutrition and Hydration
- What constitutes a healthy diet
• Patients Rights
- COSHH
- Accountability
- Boundaries
- Levels of practice
- Health and Safety
- Child Protection
- Moving and Handling
• Injections
- legal issues
- setting standards for good practice
- medical defence organisations and insurance cover
- delegation to health care assistants - a guide for general practice
- education, training and competence assessment
- sample protocols /checklists for influenza and pneumococcal vaccine administration
- sample B12 protocols and treatment plans
• Diabetic Foot Checks
- legal issues
- setting standards for good practice
- medical defence organisations and insurance cover
- delegation to health care assistants - a guide for general practice
- education, training and competence assessment
- Sample protocol/checklist for foot checks
- Appropriate access to equipment and supervision
- Reporting systems in place for abnormal results that protect patient safety
• NHS Checks
- setting standards for good practice or use of templates
- medical defence organisations and insurance cover
- delegation to health care assistants - a guide for general practice
- education, training and competence assessment
- sample protocol/checklist for NHS checks
- appropriate access to equipment and supervision
- Reporting systems in place for abnormal results that protect patient safety
• Spirometry
- setting standards for good practice or use of templates
- medical defence organisations and insurance cover
- delegation to health care assistants - a guide for general practice
- education, training and competence assessment
- sample protocol/checklist for Spirometry checks including reversibility
- appropriate access to equipment ( cleaning & descaling schedule before & after use, annual PACT testing and servicing) and supervision and supervision
- Reporting systems in place for abnormal results that protect patient safety
- Compliance with ARTP
It is best practice for those performing or interpreting diagnostic spirometry in general practice to be on the National Register. This demonstrates they have achieved the standard of practice set out by the Association for Respiratory Technology and Physiology (ARTP).
CQC expects practices to be able to demonstrate:
- how they ensure spirometry equipment is cleaned and maintained according to the manufacturer’s guidance (KLOE S3 – reliable systems, processes and practices).
- that all staff who perform spirometry tests or interpret results are competent (KLOE E3 - staff skills, knowledge and experience). They can demonstrate this if the staff are on the National Register.
• Ear Syringing
- setting standards for good practice or use of templates (Rotherham Ear Care Centre)
- medical defence organisations and insurance cover
- delegation to health care assistants - a guide for general practice
- education, training and competence assessment
- sample protocol/checklist for ear examination and syringing
- appropriate access to equipment ( cleaning & descaling schedule before & after use, annual PACT testing and servicing) and supervision
- Reporting systems in place for abnormal results that protect patient safety
NB
- Continuous assessment of skills should take place in practice area supervised by a Practice Supervisor
- I.T. Training will be practice based
CLINICAL GUIDELINES GUIDANCE CONTENTS
• Blood Pressure Checks 18
• Blood Glucose Monitoring 17
• Cleaning Instruments 20
• Form Completion 22
• Hand washing 23
• Measuring Weight 24
• Measuring Height 25
• Ordering and Re-Stocking of Drugs & Vaccines 26
• Phlebotomy 27
• Record Keeping 29
• Re-Stocking Consulting Rooms 30
• Results Giving 31
• Spillages 32
• Storage of Drugs & Vaccines/ 33
Cold Chain Maintenance
• Urine Analysis 35
• Administration of vaccines 36
• Sample protocols for vaccines 38
GUIDELINES FOR HEALTH CARE ASSISTANTS
Blood Pressure Check
AIMS
1. To take an accurate blood pressure reading.
2. To communicate result to appropriate professional on duty and record it in The EMIS records using appropriate Templates.
3. To have basic knowledge as to what constitutes a high/low blood pressure and use appropriate practice / local BP guidelines.
4. To ensure that all results are communicated to the appropriate member of nursing/medical staff on duty – with emphasis on those results outside normal ranges.
OBJECTIVES
1. Ensure understanding of the need to take blood pressure reading in the prescribed way, to ensure accurate result. (Do not use electronic BP on pregnant women or patients with AF)
2. To understand the need to communicate what is going on to the patient, thus ensuring the patient remains relaxed and an accurate result is therefore obtained.
3. To have understanding of what constitutes a normal blood pressure reading.
METHOD
1. Explain to the patient what you are going to do, and how you are going to do it. Ensure the patient understands that the procedure may be uncomfortable – without alarming them.
2. For pregnant women or patients with AF Place the patient in a position that is comfortable to them, that does not impede achieving an accurate result and that is also comfortable to you i.e. does not put any strain on your back.
3. Place sphygmomanometer at patient’s chest level.
4. Palpate the brachial pulse.
5. Put on the cuff.
6. Place the diaphragm of the stethoscope over the brachial pulse.
7. Close valve of the sphygmomanometer.
8. Inflate Cuff.
9. Ensure that you are at eye level with the meniscus of mercury in the sphygmomanometer.
10. Start controlled release of the valve of the sphygmomanometer (2-3mm/Hg per second).
11. Listen for first (Korotkoff) sound – note level of mercury on the scale of the sphygmomanometer.
12. Listen for the point when sound stops – note level of mercury on the scale of the sphygmomanometer.
13. Record and chart the result in appropriate media. If an abnormal result is obtained, wait for 1-2 minutes and repeat the procedure; if the result remains abnormal, inform a member of nursing or medical staff.
14. Record in patient’s notes, clinical system and report immediately if outside range agreed by practice mentor.
15. Agreed range is: BP Diastolic Systolic
16. Ensure that all results are given to appropriate member of nursing/medical staff.
These guidelines refer to the use of mercury sphygmomanometer. Refer to practice manual if using an electronic model.
Reference: Torrance C. Semple M. 2000 Blood pressure Measurement Procedure Nursing Times; Practical procedures No2.3
Approval- on completion of an approved course
Training requirements: Introduction to Blood Pressure Recording
Protocols- use CCG or SWL Hypertension Guidelines- refer to GPTeam net
Practice assessor/supervisor: by practice supervising RGN/ RN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Capillary Blood Glucose Monitoring
AIMS
1. For the Health Care Assistant to perform capillary blood glucose monitoring accurately, safely and appropriately with minimum discomfort to patients.
2. To obtain an accurate a result as possible.
3. The Health Care Assistant must understand the rationale and have basic knowledge of the principle needs for this test to be performed.
4. To have a good understanding of the importance of a quality control programme.
OBJECTIVES
1. To have a basic level of knowledge about Diabetes and its treatments.
2. To understand the need for a blood glucose level to be checked.
3. To understand how to carry out the procedure in such a way as obtains a result that is as accurate as possible
4. To be able to demonstrate a good understanding of the use of the surgery’s blood glucose monitoring system (meter and single use lancing device) inline with the manufacturers Standard Operating Procedures.
5. To be aware of variables leading to inaccuracies when measuring blood glucose levels. (4.11.)
6. To carry out the procedure in a way that ensures that as little trauma as possible is experienced by the patient.
7. To have knowledge of the principles of infection control, and how they may be applied to this procedure.
8. To have the ability to report and record results accurately
RATIONALE
1. Capillary blood glucose monitoring is a vital part of the care and management of patients with diabetes. (1.2.11.12.13)
2. Treatment is often initiated or changed on the basis of blood glucose measurements, therefore accuracy is vital. (1.2.11.12.13)
3. Incorrect technique, faulty or incorrect use of meters can lead to misleading results, which may compromise the health and safety of the patient. (1.2.6.7.8.9.10.)
4. It will ensure that all practitioners are trained and understand that they should participate in a quality assurance program. (1.2.).
METHOD
1. Ensure that you have all the equipment you will need close to where the procedure is to be carried out.
2. Prepare the patient for the procedure by explaining what you are going to do and why.
3. Ask the patient to wash their hands using soap and water, and to dry their hands using a paper towel.
4. Wash your hands using the same method as the patient, put on disposable gloves.
5. Follow instructions according to the single use lancing device used within practice.
6. Follow instruction according to the blood glucose meter in use within the practice.
7. Select a site to lance avoiding the thumb and forefingers
8. On the finger to be used, massage with an upward motion towards the finger tip.
9. When you are satisfied that the finger is ready i.e. there is enough blood in the finger tip, lance the side of the fingertip using the sterile lancet. Wait for a few seconds, and then squeeze the finger from the bottom in an upwards motion ”milking the finger”, until you have sufficient blood.
10. Apply the blood to the blood glucose strip as recommended in the manufacturer’s instructions and in accordance with the meters instructions.
11. Read off results according to manufacturer’s instructions.
12. Discard sharps directly into a sharps container (which must comply with current UN and British standards) immediately after use to reduce the risk of exposure to blood-borne viruses. Always take extreme care when disposing of sharps.
13. Record the result in the appropriate medium.
14. Report any changes, adverse results to nurse in charge and with reference to your patients care plan.
Clinics will only be scheduled at times when there will be a GP/ Practice Nurse on the premises - in the unlikely event that all the doctors/ practice nurses are called away from the practice, the clinic will be suspended pending their return
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. pp7 & 14
Approval: Each HCA should have an induction programme covering Glucose monitoring
Training requirements: Local training programme
Protocols- practice developed using local guidelines
Supervision by practice RGN (named nurses)
PERSONAL NOTES:
References and Further Reading
|Hazard Warning Blood Glucose Measurements: |1987 |Department of Health and Social Security |
|reliability of results produced in | | |
|extra-laboratory areas | | |
|Guidelines on the use of blood glucose monitoring |1987 |Royal College of Nursing, Diabetes Nurses Forum |
|equipment by nurses in clinical areas. | |Publication |
|The Code of Professional Conduct |2002 |NMC publication June |
|Safety Notice, Extra-Laboratory use of Blood |1996 |Medical Devices Agency Adverse Incident Centre, |
|Glucose Meters and Contra-Indications, Training | |Safety Notice MDA SN 9616 |
|and Advice to the User | | |
|The Hazards and Safe Practice of Capillary Blood |1990 |Dr M Weinbren |
|Sampling from an Infection Control Point of View | |Consultant Microbiologist, Queen Mary’s Hospital |
| | |Roehampton. |
|Lancing Devices for Multi-Patient Capillary |1990 |Dept. of Health, Medical Devices Directorate |
|Sampling: Avoidance of Cross Infection by Correct | |Safety Action Bulletin No. 65 November |
|Selection and use | | |
|A code of practice for the Safe Use and Disposal |1990 |British Medical Association |
|of Sharps | | |
|Collection of Capillary Blood Samples |1990 |Dr J Fyffe |
| | |Consultant Biochemist, Queen Elizabeth II |
| | |Hospital, Welyn Garden City |
|Self Monitoring of glucose by people with |1997 |Gallichan M. BMJ Vol. 314 March 29 |
|diabetes: evidence based practice | | |
|Capillary blood glucose monitoring |1992 |Guilding L. British Journal of Nursing Vol. 1, No.|
| | |9 |
|Blood Glucose Monitoring – Why Test |1989 |Cradock S. Diabetic Nursing 1 (2): 5-6 |
|Diabetes Control and Complications Research Group.|1993 |New England Journal of Medicine 329, 977-86 |
|The effect of intensive treatment of diabetes on | | |
|the development and progression of long-term | | |
|complications in insulin dependent diabetes | | |
|mellitus. | | |
|The United Kingdom Prospective Diabetes Study |1998 |Turner et al, BMJ 317, 703 -720 |
GUIDELINES FOR HEALTH CARE ASSISTANTS
Cleaning Instruments
*It should be noted that all GP surgeries should be using disposable (single use) This section will no longer be necessary.
GUIDELINES FOR HEALTH CARE ASSISTANTS
Electronic Template Completion within EMIS
AIMS/OBJECTIVES
1. The health care assistant will be able to complete all Electronic templates within EMIS – whatever their destination – with all relevant sections completed,
METHOD
1. All Templates to be completed
2. All relevant sections of the Template to be completed.
3. To be completed within the consultation.
4. If there a form that needs to accompany a specimen, the health care assistant must ensure that the patient’s details are on both the container and the request form via the printed T Quest form. The container must be placed in a plastic transport bag and the request form placed into the separate pouch provided.
5. Ensure specimen ready for collection and transportation to the laboratory.
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. Pp14
Approval- Each HCA should have an induction programme covering record keeping,
Documentation and clinical system data entry. All HCA should have their own password and
Computer entry ID.
The HCA will have signed a confidentiality agreement with the practice.
Training requirements:
All HCAs should complete a CCG Information governance seminar or e-learning
package at induction
Protocols- practice developed
Supervision- by practice RGN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Hand Washing
AIMS
1. To ensure that cross infection to patient from a care assistant and vice versa does not occur.
OBJECTIVES
1. Ensure a basic knowledge of the principles and practice of infection control procedures, with particular regard to hand washing
METHOD
Technique is more important than the solution used. Keep nails short and clean. Remove hand and wrist jewellery where possible to help reduce bacterial counts. Do not wear false nails or nail varnish, as they may harbour micro-organisms and become detached. Expose the wrists and forearms. You must include all parts of the hands in the process (ICNA 1997, Larson 1995).
1. Wet hands under running warm water.
2. Apply soap or antiseptic solution. (Preferably from wall mounted liquid soap dispenser)
3. Without applying more water, vigorously rub all parts of the hands for 10 – 15 seconds
4. Rinse hands thoroughly under running water.
5. Dry thoroughly using disposable paper towels or a sterile towel for surgical hand washing.
6. OR apply 5ml of alcohol hand rub to socially clean hands for routine hand washing – then rub until dry.
This latter technique is only suitable if the hands are not visibly soiled – alcohol is ineffective in the presence of dirt.
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. Pp2
Approval: Each HCA should have an induction programme covering Hand washing
Training requirements- all HCA should attend a seminar on infection control in
General practice delivered by the PCT’s infection control advisor and updated according to the CCG’s Mandatory training policy.
Protocols- Local Infection Control Policy
Supervision- Supervising RGN
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Measuring Weight
AIMS
1. To take an accurate weight measurement.
2. To understand what is normal/abnormal weight ranges.
3. Communicate results effectively to nursing/medical staff on duty.
OBJETIVES
1. To ensure that as accurate a weight as possible is recorded.
2. To ensure that the patient understands what is to happen prior to the procedure beginning.
METHOD
1. Assess patient for appropriate scales (if a choice is available).
2. Explain the procedure to the patient; ask them to remove their shoes and heavy coat.
3. Switch on the machine (if appropriate) and ensure that it is calibrated.
4. Ensure patient positioned correctly.
5. Record weight in kilograms in appropriate media and inform the patient of the weight recorded.
Approval- delegated task
Training requirements-as part of induction course or practice induction
Protocols- practice developed
Supervision-by the practice supervising RGN.
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Measuring Height
AIMS
As for weight.
OBJECTIVES
As for weight
METHOD
1. Assess patient for ability to stand and ensure height measure is correctly fitted.
2. Stand patient against height measure, heels against the wall.
3. Ask patient to take a deep breath and hold it: bring down marker to horizontal position on top of patients head.
4. Ensure the patients nose is within level of a straight line to ear lobes
5. Ask patient to breath out, bend knees, move away – read measurement.
6. Record result in appropriate media.
Approval- delegated task
Training requirements-as part of induction course or practice induction
Protocols- practice developed
Supervision-by the practice supervising RGN /RN
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Ordering and Re-stocking of Drugs and Vaccines
(Omitting controlled drugs)
AIMS
The Health care assistant will be responsible for ensuring:
1. Adequate stocks of drugs used in the practice are maintained to ensure that the appropriate level of drugs are available.
2. All drugs are stored correctly and safely, within manufacturer’s instructions to ensure their efficacy is maintained.
OBJECTIVES / METHOD
1. All drugs should be stored within manufacturers/community pharmacist’s recommendations. Some drugs may need to be refrigerated, this must be a purpose built drugs refrigerator (see protocol for storage of vaccines and drugs).
2. Drugs and vaccines that do not require refrigeration must be stored in a locked cupboard. The keys to the drug cupboard will be stored in a safe place i.e. cupboard/box, in a safe place away from the drugs cupboard itself.
3. Stocks of drugs should be maintained at a level appropriate to their use within the practice and therefore ordered on a regular basis, using the forms supplied by the manufacturers/community pharmacist. On-line ordering as per practice/supplier arrangement.
4. Manufacturer’s recommendations on storage/expiry dates should be adhered to at all times.
5. Care should be taken to avoid over/under ordering; employing a method of stock rotation will help this.
6. Regular stock checks should take place of doctors and nurses stocks, and those that are past their expiry dates removed, and disposed of appropriately.
Approval- delegated task
Training requirements-as part of induction course or practice induction
Protocols- practice developed
Supervision-by practice supervising RGN (named nurse)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Phlebotomy
AIMS
1. To obtain sample in efficient manner with minimal discomfort.
2. The health care assistant should carry out the phlebotomy in a way that ensures that the test is accurate as possible.
OBJECTIVES
1. To understand how to carry out the procedure in such a way to obtain a result that is as accurate as possible.
2. To carry out the procedure in a way that ensures that as little trauma as possible is experienced by the patient.
3. To have knowledge of the principles of infection control, and how they may be applied to this procedure.
METHOD
1. Health care assistant to have had appropriate immunisations available to protect themselves from infectious disease.
2. Explain to the patient what you are going to do, and how you are going to do it. Ensure the patient understands that the procedure may be uncomfortable – without alarming them.
3. Place the patient in a position that is comfortable to them, that does not impede achieving an accurate result and that is also comfortable to you i.e. does not put any strain on your back.
4. Ensure that you have all the equipment you will need close to where the procedure is to be carried out.
5. Wash your hands using the same method as the patient, put on disposable glove.
6. Clean the antecubical fossa using a Chlorhexidine 70% and alcohol wipe for 30 seconds and then
7. Blood will be taken from the antecubital fossa only – in the event of difficulties, the phlebotomist can, at their discretion, make one further attempt. If venous access remains problematic then the GP/Practice Nurse will be asked to attend as soon as practical (i.e. before seeing their next patient).
8. There will be no re-sheathing of needles and the “vacutainer” or “butterfly needle” system will be used - both needle and holder will be immediately disposed of safely into a yellow sharps bin.
Notes
1. Clinics will only be scheduled at times when there will be a GP/ Practice Nurse on the premises - in the unlikely event that all the doctors/ practice nurses are called away from the practice, the clinic will be suspended pending their return
2. Only patients over 16, who have previously had blood taken, will be referred.
3. A GP/Nurse will document the tests required in the notes and complete the request form. The phlebotomist will complete the blood bottles as each patient is seen and subsequently make a note to confirm that the procedure has been undertaken.
4. Nurse supervision will be ongoing.
5. In the event of a needle-stick injury the phlebotomist will immediately inform the duty GP/Senior Practice Nurse who must make local arrangements with an occupational health service and A& E department for post-exposure prophylaxis after an inoculation injury involving possible exposure to HIV or hepatitis B (Department of Health 1993, 1996). You will need to run the injury site under cold water and encourage blood flow from the site. Any blood spills will be dealt with immediately by an appropriate method (e.g. Haz Tabs/bleach solution as per practice Health & Safety procedures).
6. The protocol will be reviewed annually/updated as necessary.
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. Pp18
Approval- delegated task
Training requirements-a CCG approved training programme with a competency assessment.
Protocols- practice developed
Supervision-by practice RGN (named nurse) or a PDF/training practice
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Record Keeping
Record keeping is an integral part of general practice. It is one, which should help the care process. It is not separate from this process and it is not an optional extra to be fitted when circumstances allow.
AIMS
1. The health care assistant will understand the principles of record keeping; and their importance as legal and communication documents.
OBJECTIVES
1. To understand the role that document records play in patient care.
2. To understand the legal status of document records.
3. To understand the process of communication in patient care and within the primary health care team.
METHOD
1. All records must be documented clearly in the patients EMIS records.
2. All records must be contemporaneous i.e. documented at the time that the events they speak about happened.
3. Matters documented in patient electronic EMIS records must be objective i.e. they must detail patient care only and should not contain comments that are the expressions of the writers opinion.
4. All matters recorded are confidential i.e. they must not be discussed with anyone other that health care professionals directly involved with the care of that particular patient.
Reference: NMC Guidelines for Records and Record Keeping.
Approval- Each HCA should have an induction programme covering record keeping,
documentation and clinical system data entry. All HCA should have their own password and computer entry ID.
The HCA will have signed a confidentiality agreement with the practice.
Training requirements:
All HCAs should complete a CCG Information governance e-learning package at induction.
Protocols- practice developed
Supervision- by practice RGN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Re – Stocking of Consulting Rooms
AIMS
1. The health care assistant will keep the clinical rooms well equipped with all appropriate requirements, as required by the practice.
2. The Doctors/ Nurses rooms must be checked on a daily basis to ensure that they are stocked with all appropriate requirements.
OBJECTIVES
1. To ensure that the Doctors/Nurses rooms are at all times equipped with clean instruments and health promotion materials.
2. To avoid inconvenience to patients and medical/nursing staff through lack of resources and equipment.
METHOD
1. Check all surgery rooms on a daily basis, and re–stock as necessary.
2. Check health promotion displays and materials on a weekly basis, and replenish as appropriate. Re-order supplies of health promotion in a timely way, from the Health Education Department.
3. Keep all cupboards and trolleys clean and tidy and ensure that all examination couches are clean and well stocked with couch roll.
4. Ensure paper towels and liquid soap are available by all hand washing facilities.
5. Ensure sharps bins are not overfull and replace as required.
6. Ensure stock of Patient information leaflets replenished.
7. Ensure adequate stocks of specimen containers are available.
8. Ensure clinical waste bags are not overfull, replace as required and store correctly until collection.
Approval- delegation by the RGN/RN
Training requirements: As part of the induction programme within the practice
Protocols- practice developed
Supervision- by practice RGN/RN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Results Giving (NHS Health Checks- cholesterol when giving advice)
AIMS
1. To ensure that negative results only are given to patients in line with practice guidelines.
2. All results to be given in a clear and professional manner, to the patient concerned ONLY.
OBJECTIVES
1. To have basic knowledge of routine tests carried out in general practice.
2. To have a basic understanding of the implications of routine test results.
3. To be able to communicate test results to patients in a clear and professional manner, and to always refer to nursing or medical staff if patients require information that they are unable to supply.
4. To understand the need for confidentiality when giving the results of tests to patients.
METHOD
1. Ensure that the senior nurse on duty is aware of the results, prior to the information being passed to the patient.
2. When giving the information – either via the telephone, or in person – ensure that:
• You are speaking to the patient whose results you are giving i.e. not a friend or relative.
• Members of the public cannot overhear you. If giving the results in person if a friend/relative is present, ensure that the patient wishes the third party to know the result.
3. If the patient requires to have more information about the result than you are able to give, always refer back to the nurse/doctor on duty. If in any doubt at all – ask.
Approval- Each HCA should have an induction programme covering record keeping,
documentation and clinical system data entry. All HCA should have their own
password and computer entry ID.
The HCA will have signed a confidentiality agreement with the practice.
Training requirements: All HCAs should complete a PCT Information governance seminar or e-learning package at induction
Protocols- practice developed
Mentorship- by practice RGN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Spillages
AIMS
1. To prevent cross infection from potentially infected bodily fluids.
2. To ensure personal protection by wearing appropriate protective clothing and ensuring that all available protective vaccines have been taken.
OBJECTIVES
1. Ensure an adequate and up to date knowledge base of the principles and practice of infection control.
2. To understand what appropriate protective clothing needs to be worn in order to ensure adequate protection.
3. To understand what are the appropriate methods of cleansing and disposal for particular contaminants.
METHOD
1. Put on appropriate protective clothing before attempting to deal with any spillage.
2. Prepare sterilisation fluid as per the manufacturer’s recommendation for the spillage.
3. Using correctly prepared solution, clean spillage using couch roll or other disposable paper towel.
4. Dispose of contaminated paper products in yellow clinical waste plastic bag.
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. Pp6
Approval- Each HCA should have an induction programme covering how to deal
with spillages.
Training requirements: All HCAs should complete a infection control which
Cover’s decontamination training course
Protocols- practice developed
Mentorship- by practice RGN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Storage of Drugs /Vaccines & Cold Chain Maintenance
AIMS
1. The health care assistant will understand the need to store and handle vaccines and other drugs at the correct temperatures, and as recommended by their manufacturers and the community pharmacist; i.e. that vaccines and other drugs do not maintain their properties if not handled correctly, which could have implications for patient safety.
2. They must also understand the need to maintain adequate levels of drug stock within the surgery, and the implications to patient service and practice targets, if this is not achieved.
OBJECTIVES
1. To understand what happens to vaccines and other drugs if they are not handled in such a way as to maintain their optimum temperature; i.e. maintaining the ‘cold chain’.
2. To understand the way in which the different vaccines and drugs used in the surgery should be stored.
3. To understand how to maintain the drug refrigerator to ensure that it works at its optimum level.
4. Ensure understanding of the need to check the temperature of the refrigerator on a daily basis and record findings
5. To have understanding of the procedure for the ordering of all relevant drug stocks.
6. To ensure that drugs are ordered in a timely way that ensures adequate stock levels, but does not lead to over ordering.
7. To ensure that drugs are used in sequence of ordering, so that they are used within their expiry dates.
METHOD
1. The electricity supply to the drug refrigerator should never be interrupted. Switchless sockets must be used, or sockets taped over, and a document warning added to ensure the electricity supply is not interrupted.
2. A minimum/maximum thermometer should be used to monitor refrigerator temperatures. Thermometers incorporated into the door of the refrigerator should not be relied upon.
3. The maximum/minimum temperature should be checked daily, and a document record kept. Fluctuations outside the specified range of 2oC – 8oC should be expected when new stock has been added to the refrigerator, or when a stock check has taken place.
4. Fluctuations noted at other times should be reported immediately to the nurse or doctor in charge – so that they can take action appropriate to maintain safe storage of drugs and vaccines.
5. Manufacturer’s instructions should be followed regarding storage temperatures and expiry dates of all drugs and vaccines.
6. Old stocks should be used up, before new stock i.e. vaccines and drugs should be used taking that stock with expiry date closest to the current date first.
7. Expiry dates should be closely monitored and adhered to.
8. Partly used multi dose vials should be discarded at the end of each session, and NOT returned to the refrigerator.
9. The drugs refrigerator should be defrosted and cleaned on a monthly basis, using appropriate cleansing solution and method. Vaccines should be stored in an alternative refrigerator during this process.
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. Pp16
Approval- Each HCA should have an induction programme covering storage of
vaccines and maintaining the cold chain,
Training requirements: All HCAs should complete a local induction programme.
Protocols- practice developed
Supervision- by practice RGN/RN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Urine Analysis
AIMS
1. To ensure that an accurate test is obtained.
2. To understand what is a normal test result.
3. To communicate all test results to relevant nursing/medical staff – with particular urgency in the case of an abnormal result being obtained.
OBJECTIVES
1. To have a basic knowledge of the variety of need for urine analysis in general practice.
2. To ensure that the patient understands how to give an uncontaminated sample.
3. To understand the principles and practice of infection control procedures and how they may be applied to this procedure.
METHOD
1. Explain procedure to the patient. If the patient is female, ask whether they are – or have recently finished – menstruating.
2. Collect specimen.
3. Wear appropriate protective clothing.
4. Place stick in urine. Wait the correct amount of time before reading the result as per manufacturer guidelines
5. Read off results according to manufacturer’s instructions.
6. Dispose of urine, stick and gloves.
7. Wash hands.
8. Record results in appropriate media, inform relevant member of nursing/medical staff – urgently if the result was abnormal.
Reference: Royal College of Nursing 2001 Good Practice in Infection Control Working well Initiatives. PP 14
Approval- Each HCA should have an induction programme covering urine testing
Training requirements: All HCAs should complete training as part of their practice
induction process
Protocols- practice developed
Supervision- by practice RGN (named nurses)
PERSONAL NOTES:
GUIDELINES FOR HEALTH CARE ASSISTANTS
Administration of vaccines/injections
AIMS
To ensure the HCA is competent to administer vaccine/injections delegated and supervised by a supervising nurse and using a patient specific directive (PSD)
To understand the signs of a localised or systemic drug reaction and act appropriately and seek appropriate assistance
To communicate effectively with patients in order to gain consent
To keep accurate electronic records of administration and consent
OBJECTIVES
1. To have a knowledge administration of vaccines or injections
2. Know in which situation vaccinations should be postponed or omitted and when to seek advice
3. To ensure adequate record keeping and documentation is recorded
4. To understand the principles and practice of infection control procedures and how they are applied to this procedure.
METHOD
5. Explain procedure to the patient and gain consent
6. Preparing the vaccine equipment
7. Clean the skin if dirty-refer to UK Guidance on best practice in vaccine administration
8. Prepare & Administer the vaccine or medication via the appropriate route as per protocol using the correct technique, needle
9. Dispose of sharps safely (be aware of what to do in the event of a needle stick injury)
10. Document in patients electronic notes as per protocol (including completion of pre immunisation checklists
11. Wash hands
12. Report any adverse reaction or event immediately and seek medical help in the event of anaphylaxis reaction or collapse
Reference: Royal College of Nursing 2001 Good Practice in Infection Control. Working well Initiatives. PP 14
RCN: UK Guidance on best practice in vaccine administration 2001 page 33
Approval- The practice should contact the Education and Development department
on current (Approved) training courses (to be funded by the GP practice).
The Professional Development Facilitator aligned to the practice and the co-ordinator of PDFs should be notified (020 8544 2066) should be informed. The allocated practice PDF will help with the assessment process, allocation of a training practice ( via the PCT Education & Training dept.) for final assessment of Injection administration competency.
Training requirements:
A Local approved course and an assessment process. The HCA will always be supervised and never work alone when undertaking injections. An RGN/RN must always be on site and working nearby so that any queries from the HCA can be addressed.
Both the RGN/RN and the HCA will have completed an annual resuscitation & Anaphylaxis training.
Protocols- practice developed (these should be available for inspection on request
by the CQC.
Supervision- by practice RGN (named nurse facilitator)
Further resources:
PERSONAL NOTES:
General Guidance for the Administration of Vaccines
General
1. The identity of the vaccine must be checked to ensure the right product is used in the appropriate way on every occasion.
2. The expiry date must be noted. Vaccines must not be used after the expiry date on the label.
3. The date immunisation, title of the vaccine and the batch number must be recorded on the recipient’s record. When two vaccines are given together, the relevant sites should be recorded to allow any reaction to be related to the causative site. It may be considered good practice to record all sites of administration.
4. The recommended storage condition must have been observed.
Reconstitution of Vaccines
1. Freeze dried vaccines must be reconstituted with the diluent supplied and used within the recommended period after reconstitution.
2. The diluent must be added slowly to avoid frothing, a sterile 1ml syringe with a 21G needle should be used for reconstituting the vaccine and smaller gauge for injection, unless only one needle is supplied with a pre-filled syringe
3. Vaccines must not be mixed before administration.
Cleaning of the Skin
If the skin is to be cleaned, soap and water are adequate where a HCA skin cleansing is required.
Route of Administration
Adult Intramuscular injection into the deltoid muscle, patients requiring subcutaneous injection should be referred to the nurse.
Recommended Choice of Needle Lengths
Women < 90kg = 25mm needle
Women >90kg = 38mm needle
Men 60-118kg = 25mm needle
Clinical aspects
The following will be required:
1. Patient specific direction – written by the General Practitioner or Independent Nurse 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. Health Care Assistants and Assistant Practitioners are advised to familiarise themselves with the ENTER ORGANISATION NAME Consent Policy
4. Record Keeping – The following should be recorded in the patients notes or on the computer system according to the GP practice system
a. Name of drug, dose, route and site of administration
b. Date administered
c. Batch number and expiry date
d. Signature of person administering – written or electronic.
e. Checklist for influenza and pneumococcal immunisations
f. Patients assessed as not appropriate for vaccination and any alternative action taken
g. If the patient has declined the vaccination and any alternative action taken
h. Any reaction should be recorded in the clinical record
Adverse reactions
Health Care Assistants must ensure that Adrenaline 1:1000 or an Anaphylactic shock pack is available.
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
• Complete Yellow Card if suspected severe reaction
If anaphylactic reaction occurs:
• Give treatment in accordance with ENTER ORGANISATION NAME policy on the Management of Anaphylaxis in the community
• Record in patients notes
• Inform patients general practitioner as soon as possible
Relevant training
1. Health Care Assistants will undertake training covering the following aspects of the administration of inactivated influenza vaccine:
• Appropriate anatomy and physiology
• Correct procedure for the administration of the vaccine via intra-muscular injection
• Vaccine delivery, storage and stock control requirements, maintaining the cold chain
• Cautions and side effects related to the administration of inactivated influenza vaccine.
• Documentation
• Legal aspects of drug administration using Patient Specific Direction
2. Health Care Assistants will have successfully completed a relevant course/qualification. This could be NVQ3 or an accredited course (Foundation or Level1) from an academic institution. They should have completed a course in Basic Life Support.
3. Health Care Assistants will undergo a period of supervised practice and assessment and will be directly observed administering intramuscular injections of inactivated influenza vaccine by the general practitioner or nurse mentor
Assessment of competence
The general practitioner or registered nurse mentor will provide supervised practice and assessment of completion of competencies. Health Care Assistants will be assessed by written assessment.
Competence will be assessed by direct observation and questioning of the Health Care Assistants ability to:
• Prepare the patient for the procedure
• Safely administer the medication (including choice of site, needle size and injection technique) and observation of the patient post procedure
• Correct disposal of clinical waste
• Correct documentation
• Correct procedure followed for delivery, storage and stock control of the vaccine
Significant events
Any significant event which occurs during or as a result of administration of medication must be reported to the Practice Manager / General Practitioner or the Registered Nurse / Manager
and the incident reported via the local 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 document
The following will be required:
Patient specific direction – written by the General Practitioner or Independent Nurse 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. Health Care Assistants are advised to familiarise themselves with the ENTER ORGANISATION NAME Consent Policy
Record Keeping – The following should be recorded in the patients notes or on the computer system according to the GP practice system
o Name of drug, dose, route and site of administration
o Date administered
o Batch number and expiry date
o Signature of person administering – written or electronic.
o Checklist for influenza and pneumococcal immunisations
o Patients assessed as not appropriate for vaccination and any alternative action taken
o If the patient has declined the vaccination and any alternative action taken
o Any reaction should be recorded in the clinical record
Adverse reactions
Health Care Assistants must ensure that Adrenaline 1:1000 or an Anaphylactic shock pack is available.
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
If anaphylactic reaction occurs:
• Give treatment in accordance with the organisation’s policy on the Management of Anaphylaxis in the community
• Record in patients notes
• Inform patients General Practitioner as soon as possible
• Complete Yellow Card if suspected severe reaction.
Relevant training
Health Care Assistants will undertake training covering the following aspects of the administration of the 23-valent pneumococcal polysaccharide vaccine
• Appropriate anatomy and physiology
• Correct procedure for the administration of the vaccine via intra-muscular injection
• Vaccine delivery, storage and stock control requirements, maintaining the cold chain
• Cautions and side effects related to the administration of 23-valent pneumococcal vaccine
• Documentation
• Legal aspects of drug administration using Patient Specific Directions
Health Care Assistants will have successfully completed a relevant course/qualification. This could be NVQ3 or an accredited course (Foundation or Level1) from an academic institution. They should have completed a course in Basic Life Support
Health Care Assistants will undergo a period of supervised practice and assessment and will be directly observed administering intramuscular injections of the 23-valent pneumococcal polysaccharide vaccine by the general practitioner or nurse mentor
Assessment of competence
General practitioner or registered nurse mentor will provide supervised practice and assessment of completion of competency. Health Care Assistants will be assessed by written assessment.
Competence will be assessed by direct observation and questioning of the Health Care Assistants ability to:
• Prepare the patient for the procedure
• Safely administer the medication (including choice of site, needle size and injection technique) and observation of the patient post procedure
• Correct disposal of clinical waste
• Correct documentation
• Correct procedure followed for delivery, storage and stock control of the vaccine
Significant events
Any significant event which occurs during or as a result of administration of medication must be reported to the Practice Manager / General Practitioner (GP employee) or the Registered Nurse / Manager (PCT 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:
ENTER ORGANISATIONs DOCUMENTS AS APPROPRIATE e.g.
• Medicines Policy
• Consent Policy
• Records Management Policy
• Adverse Incident/Reporting & Managing Policy
• Clinical Guidelines
• NMC Guidelines for the Administration of Medication
• NMC Guidelines for Records & Record Keeping
• Immunisation Policy
• DoH Guidance on the Influenza Immunisation Programme
References
Immunisation against Infectious Disease (Green Book) DOH 2006
Liverpool PCT Education Package 2006
UK Guidance on Best Practice in Vaccine Administration. Shire Hall Communications 2000
Protocol for Hydroxocobalamin
Agreement for GP employed Health Care Assistants
This protocol is to be read, agreed and signed by all Health Care Professionals it applies to:
Approved base: __________________________________
Staff Name: __________________________________
Designation: __________________________________
Signature: __________________________________
Date: __________________________________
Signature of Team __________________________________
Leader:
Date: __________________________________
The Health Care Professionals should retain a copy of the document after signing and the original retained in their personal file.
(take out dates and just put expires: )
Protocol for Hydroxocobalamin
Agreement by 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.
PATIENT CARE PATHWAY
|Area of Care |
|B12 ADMINISTRATION |
| |
|(Hydroxocobalamin or Cyanocobalamin Intramuscularly) |
|Patient Population / Incidence |
| |
|Prevalence: |
|20% of Older People in industrialised countries but is often unrecognised |
|Indications / Eligibility Criteria: |
|Megaloblastic anaemias –lack of B12 due to: |
|Food – Cobalamin malabsorption (i.e. dietary deficiency) |
|Cobalamin malabsorption (e.g. total gastrectomy, Crohn’s disease, Celiac disease, Whipple’s disease, chronic pancreatitis, |
|TB etc.) |
|Pernicious anaemia – lack of gastric intrinsic factor |
|Drug induced ( e.g. Prolonged nitrous oxide anaesthesia etc) |
|Hereditary Cobalamin Metabolism diseases (Congenital Transcobalamin II Deficiency etc) |
|Milestones: |Care Pathway: |
|At Referral |Contact GP/ Consultant to verify diagnosis/ rational for B12 Administration |
|At Initial assessment |All patients to receive a Contact and Overview assessment, Care Plan, drug chart and open Care |
| |Package on Epex. |
| |Invasive consent signed by patient |
|Initial Loading Dose (for |Initial administration of Hydroxocobalamin 1mg Intramuscularly, normally 3 times a week for Two |
|newly diagnosed patients) |Weeks or as indicated by prescriber |
|Every 1- 3 months |The Hydroxocobalamin Intramuscularly 1mg can be given at intervals up to 1- 3 Months as indicated |
| |by prescriber |
|Every Six Months |Bloods take to check B12, Folate and Ferritin levels |
|Following Blood Results |Discuss maintenance regimen, including oral administration with GP |
| |All patients received a re-evaluation of overview and care plan. |
|Maintenance |Continue administration of B12 injections to maintain the blood level within acceptable levels |
| |Normal Blood Range areas indicated by Haematology: |
| |B12 = 150-900 Nanograms per litre (pmol/L) |
| |Folate = 2.1 – 20 Micrograms per litre |
| |Ferritin 20 – 300 Nanograms per millilitre |
|Discharge |If B12 injection is no longer required, assess for other nursing needs. |
| |Discharge if appropriate and close care package on Epex |
|What is the evidence to support this care? |
|Library search |
|Pharmacist |
|Haematology |
|BMF/NPF |
|References: |
|Andres E., Loukili N., Noel E., Kaltenbach G., Abdelgheni M., et al, (2004) Vitamin B12 (cobalamin) deficiency in elderly |
|patients. Canadian Medical Association, Aug 3 171 (3) page 251 -259. |
|British Medical Association (2005) Nurse Prescriber’s Formulary for Community Practitioners 2005-2007. BMJ Publishing Group |
|ltd. |
|Elia M. (1998) Oral or Parental Therapy for B12 deficiency. The Lancet. Nov 28th, 352, 9142 p. 1721-1722. |
|Delpre G., Stark P. and Niv Y. (1999) Sublingual therapy for cobalamin deficiency as an alternative to oral and parental |
|cobalamin supplementation. The Lancet. Aug 28th, 354, 9180, p.740-741 |
|Nyholm E., Turpin P., Swain D, Cunningham B., Daly S., Nightingale P. and Fegan C. (2003) Oral vitamin B12 can change |
|practice. Postgraduate Medical Journal. April, 79, 930 p.218-220. |
Appendix A
2019 PSD are available for HCA example of log that needs to be kept.
|Name of PDS |Protocol in place | |
|Acute services – NHS Standard Contract |No |Acute services are covered under CNST |
|Administrative staff / receptionists |Yes |The scheme extends to all staff working for general practice who |
| | |are carrying out activities in connection with the delivery of |
| | |primary medical services or ancillary health services – including|
| | |administrative staff and receptionists – in relation to claims of|
| | |clinical negligence |
|Appraisers |No |Covered under NHS Resolution’s Liabilities to Third Parties |
| | |Scheme (LTPS) – provided that the organisation contracting with |
| | |the appraiser is a member and agrees to accept liability for any |
| | |negligence on the part of the appraiser |
|Coil / implant fitting |Yes |If they are being fitted as part of primary medical services |
| | |under a GMS/PMS/APMS contract or a sub-contract for such |
| | |services, they will be covered under CNSGP |
| | | |
| | |If not, these activities will only be covered if the ‘fitter’ is |
| | |doing so as part of the other types of NHS services provided by |
| | |the general practice that they work for, in which case they would|
| | |be ancillary health services |
|Cross-border GPs |No |CNSGP only covers general practice services carried out as part |
| | |of the NHS in England. Whether or not an individual GP, nurse, |
| | |pharmacist, etc. is covered under CNSGP depends on the contract |
| | |under which they are providing those services |
| | | |
| | |If an individual GP or other person is providing NHS services for|
| | |a GP practice in England under a GMS, PMS or APMS contract or |
| | |sub-contract for such services and provides this service under |
| | |those arrangements then this activity is covered by CNSGP |
| | | |
| | |If the individual is carrying out any other type of NHS services |
| | |for a GP practice in England, then this will also be covered as |
| | |the services will be ancillary health services |
|Dispensing doctors |Yes |These services are provided under a GMS, PMS and APMS contract |
|Educators |Yes |You will be covered under CNSGP in your role as a GP educator. |
| | |The scheme will cover any activity that consists of, or is in |
| | |connection with, the provision of NHS services (primary medical |
| | |services under a GMS, PMS or APMS contract or sub-contract). This|
| | |would include clinical supervision of GP trainees |
| | | |
| | |If a clinical negligence claim were to be brought in connection |
| | |with the diagnosis, care or treatment of a patient, undertaken by|
| | |a GP trainee under your supervision as a GP educator within an |
| | |NHS setting, then both you and the GP trainee will be indemnified|
| | |under CNSGP |
|Emergency treatment |Yes |Under the terms of a GP contract (GMS, PMS or APMS contract or |
| | |sub-contract) medical services must be provided to any person, |
| | |including registered patients and temporary residents, in an |
| | |emergency situation; limited to within core hours and within the |
| | |practice area. For example, a person who has collapsed in the GP |
| | |contractor’s practice area |
| | | |
| | |Emergency treatment provided in these types of circumstances will|
| | |be covered by CNSGP |
| | | |
| | |See also Good Samaritan Acts |
|Good Samaritan Acts |No |Provision of medical services in an emergency situation outside |
| | |of a GMS, PMS or APMS contract or sub-contract is not covered |
| | |under CNSGP. For example, emergency treatment provided to a |
| | |passer-by when off duty |
| | | |
| | |Indemnity cover for Good Samaritan Acts is generally included |
| | |within MDO/Royal College of Nursing (RCN) membership but we |
| | |recommend you check with your MDO /indemnity provider |
| | | |
| | |See also Emergency treatment |
|GP with a Special Interest (GPwSI) |Yes |If the services of the GPwSI are provided under a GMS, PMS or |
| | |APMS contract or sub-contract, they will be covered by CNSGP |
| | | |
| | |If not under one of the above contracts, if you can answer the |
| | |three questions set out below in the affirmative, then you will |
| | |be covered under CNSGP as the services will be ancillary health |
| | |services. If not, then, depending on any indemnity provision in |
| | |your contract, you are likely to need to obtain indemnity cover |
| | |from your MDO or alternative provider |
| | | |
| | |(1) Are you carrying out an activity that consists of, or is in |
| | |connection with, the provision of NHS services? |
| | | |
| | |(2) Are those NHS services being provided by, or under a contract|
| | |with, a person or organisation whose principal activities are to |
| | |provide primary medical services (i.e. the NHS services are |
| | |provided as part of general practice) or under a sub-contracting |
| | |arrangement with such a person? |
| | | |
| | |(3) Is the activity in question connected to the diagnosis, care |
| | |or treatment of a patient? |
|Hospices |Yes |If GPs or other general practice staff are providing NHS services|
| | |to hospices as part of NHS services provided by general practice |
| | |(i.e. primary medical services or ancillary health services), |
| | |these services will be covered by CNSGP |
|Integrated urgent care (IUC) services – NHS Standard|Yes |Integrated urgent care services delivered by general practice |
|Contract with APMS bolt on | |through Schedule 2L of the NHS Standard Contract are covered |
|Requests for information from the Department for |Yes |The provision of information to DWP in support of claims for |
|Work and Pensions (DWP) that GPs are required to | |benefit is covered under CNSGP but only where the provision of |
|provide under a GMS, PMS and APMS contract or | |such information is required to be provided under a GMS, PMS or |
|sub-contract | |APMS contract or sub-contract. |
| | |Please note next entry and also Safeguarding reports/requests for|
| | |information from the Local Authority |
|Medical reports/requests for information from the |No |Providing medical reports and/or information to DWP that are not |
|Department for Work and Pensions (DWP) that are not | |required to be provided under a GMS, PMS or APMS contract or |
|required to be provided under a GMS, PMS or APMS | |sub-contract is not an activity covered under CNSGP as such |
|contract or sub-contract | |provision is not an NHS service required under a GP contract |
| | |See also Safeguarding reports/requests for information from the |
| | |Local Authority |
|Ministry of Defence (MoD) commissioned and provided |No |MoD indemnity arrangements for healthcare professionals are not |
|healthcare | |within scope of CNSGP. You should contact your locum agency and |
| | |MDO or other indemnity provider |
|NHS services following private treatment |Yes |Provision of NHS services arranged by a primary medical services |
| | |provider (Part 4 contractor, subcontractor or provider of |
| | |ancillary health services under an arrangement with a Part 4 |
| | |contractor or subcontractor) for registered patients who have or |
| | |are undergoing private treatment will be covered under CNSGP |
| | | |
| | |For example, suture removal following private cosmetic surgery or|
| | |blood tests as part of ongoing private treatment |
|NHS 111 service |Yes |If the NHS 111 services are provided by general practice they |
| | |would be covered if provided under GMS, PMS or APMS contract or |
| | |sub-contract, or if not, will be covered if the provider’s main |
| | |activity is to provide primary medical services as they will be |
| | |ancillary health services |
|NHS 111 service – NHS Standard Contract |No |These are generally covered by the Clinical Negligence Scheme for|
| | |Trusts (CNST), provided that the main contract-holder is a member|
|Occupational Health tests/injections (including flu |No |Occupational health tests/injections are not covered by CNSGP, as|
|injections) arranged by a GP practice/contractor to | |such tests/injections are the responsibility of the employer as |
|staff for the purposes of their employment | |part of occupational health arrangements. |
| | | |
|Out of hours (OOH)[1] |Yes |Stand-alone out of hours primary medical services are |
| | |commissioned under an APMS contract and so are covered |
|Paramedics |Yes |CNSGP applies to the activities of GPs and others carrying out an|
| | |activity that consists of, or is in connection with, the |
| | |provision of primary medical services under a GMS, PMS or APMS |
| | |contract or sub-contract for such services |
| | | |
| | |Paramedics working in a general practice setting, undertaking NHS|
| | |activities under GP (GMS, PMS or APMS contract or sub-contract) |
| | |contracts, will be covered under CNSGP in respect of such |
| | |activities. They may also be covered in respect of other NHS |
| | |services if the principal activity of the provider who employs or|
| | |engages them is the provision of primary medical services as |
| | |these will be ancillary health services |
| | | |
| | |CNSGP does not however cover the role of a paramedic in the usual|
| | |sense of it being an acute-based role outside of general practice|
|Pharmaceutical services (community pharmacy) |No |These services already have a system of cover |
|Pharmacists |Yes |Pharmacists working in a general practice setting, undertaking |
| | |NHS activities under GP (GMS, PMS or APMS contract or |
| | |sub-contract) contracts, will be covered under CNSGP in respect |
| | |of such activities. They may also be covered in respect of other |
| | |NHS services if the principal activity of the provider who |
| | |employs or engages them is the provision of primary medical |
| | |services as these will be ancillary health services |
|Practice nurses |Yes |If you are a practice nurse who is employed by a general practice|
| | |you will be covered under CNSGP for any NHS services provided by |
| | |you on behalf of your general practice employer |
| | | |
| | |If you are a practice nurse who is employed by a health service |
| | |provider who holds an APMS contract but whose main activity is |
| | |not to provide primary medical services, then only activities you|
| | |carry out for the purpose of the APMS contract services will be |
| | |covered by CNSGP – not any other type of NHS services you carry |
| | |out for that employer |
|Primary Care Network (PCN) – Staff engaged/employed |Yes |Staff carrying out activities for GP practices who are part of a |
|by GP practices to carry out activities for the GP | |PCN, including those engaged under the network direct enhanced |
|practices in a primary care network (PCN), including| |services (DES), which is a variation to the GMS / PMS contract of|
|clinical director | |the organisation and is part of the primary medical services |
| | |contract for the purposes of CNSGP. Cover extends to services |
| | |delivered under these, contracts. |
| | | |
|Public health services |Yes |This includes public health services provided by general practice|
| | |under arrangements with local authorities (where such services |
| | |have been commissioned as part of the NHS) |
| | | |
| | |For example: |
| | |Comprehensive sexual health services (including testing and |
| | |treatment for sexually transmitted infections, contraception |
| | |outside of the GP contract and sexual health promotion and |
| | |disease prevention); |
| | |Health visiting for children aged 0 – 5; |
| | |Dealing with health protection incidents, outbreaks and |
| | |emergencies. |
|Public liabilities and other business or |No |CNSGP will cover clinical negligence claims and will not |
|professional liabilities | |indemnify practices or their staff in relation to other |
| | |liabilities |
|Registrars (GPST) & Trainees (FY2 rotation in |Yes |A GP Registrar or Trainee undertaking a GP placement will be |
|general practice) | |covered under CNSGP for any activity that consists of, or is in |
| | |connection with, the provision of NHS services (primary medical |
| | |services under a GMS, PMS or APMS contract or other NHS services |
| | |that are within the definition of “ancillary health services”). |
| | |Where GP Registrars and Trainees undertake any clinical work |
| | |during their training in organisations which are not part of NHS |
| | |services, such work would likely fall outside the scope of CNSGP |
| | |and CNST |
| | |Indemnity for activities that are out of scope of CNSGP and |
| | |medico-legal support will continue to be provided via Health |
| | |Education England (HEE) |
|Research – design |No |The design risks for clinical trials, i.e. errors in the way in |
| | |which a trial is created, are not covered. We would expect that |
| | |risk to be covered by the trial sponsor, often a drug company. |
| | |This mirrors the position under CNST |
|Research - implementation |Yes |Clinical negligence arising during the course of research |
| | |activities undertaken as part of the NHS services provided by |
| | |general practice is covered. So if, for example, a doctor |
| | |negligently misreads a dose in the trial documentation and |
| | |administers too much of a drug which causes harm to patients, any|
| | |clinical negligence on the part of the doctor is covered |
|Safeguarding reports / requests for information from|Yes |Safeguarding activities pursuant to the duty placed on GP |
|Local Authorities for safeguarding purposes[2] | |practices/contractors under the Children Act 2004 will be covered|
| | |under CNSGP |
| | |See also Medical reports/requests for information from the |
| | |Department for Work and Pensions (DWP) |
|Section 12 of the Mental Health Act (MHA) |Yes |Where these activities are carried out as part of the NHS |
| | |services provided by general practice, for example, GMS, PMS or |
| | |APMS contract or sub-contract, they will be covered. For example,|
| | |where a GP carries out Section 12 activities in connection with |
| | |the provision of primary medical services for their general |
| | |practice work |
| | |Where a mental health professional carries out Section 12 |
| | |activities under an agreement with a general practice, they will |
| | |also be covered |
| | |Section 12 activities carried out for an NHS trust are not likely|
| | |to be covered by the CNSGP but may be covered under CNST, |
| | |depending on the terms of any arrangements with the trust |
|Secure environments (prisons, youth offender |Yes |All services provided in a secure environment that are delivered |
|institutes etc.) | |under the GMS, PMS or APMS contract or sub-contract are covered |
|Temporary residents |Yes |GP practices providing NHS services to temporary residents are |
| | |covered under CNSGP |
|Travel vaccinations (advice) |Yes |Advice (which includes consent) on all travel vaccinations and |
| | |immunisations – regardless of whether the patient pays or not – |
| | |is covered by CNSGP |
|Travel vaccinations (supply and administration – no |Yes |Travel vaccines and immunisations listed in the GMS Contract |
|charge) | |Guidance as funded by the NHS are covered under CNSGP, including |
| | |the supply and administering of these vaccines |
|Travel vaccinations (supply and administration – |No |Separate indemnity cover will need to be arranged to cover the |
|paid for) | |supply and administering of travel vaccinations and immunisations|
| | |to a patient, where the patient is required to pay[3] |
|Vasectomies |Yes |If these activities are being undertaken as part of primary |
| | |medical care services provided under a GMS, PMS, APMS contract or|
| | |a sub-contract for such services, you will be covered under the |
| | |CNSGP |
| | | |
| | |If an NHS trust, commissioned by the Clinical Commissioning Group|
| | |(CCG), is sub-contracting the vasectomy service to a GP practice,|
| | |then the vasectomy service would be viewed as an ancillary health|
| | |service and be covered under CNSGP |
|Volunteers (providing care or treatment under |Yes |A volunteer who is engaged or permitted by a primary medical |
|supervision) | |services provider (Part 4 contractor, subcontractor or provider |
| | |of ancillary health services under an arrangement with a Part 4 |
| | |contractor or subcontractor) to provide care or treatment, which |
| | |is connected to the provision of primary medical services under a|
| | |GMS, PMS, APMS contract or sub-contract, will be covered under |
| | |CNSGP |
|Volunteers (activities not related to care or |No |Activities not related to the provision of primary medical |
|treatment) | |services under a GMS, PMS or APMS contract or sub-contract, (for |
| | |example; making tea for patients), are not covered under CNSGP |
| | |Primary medical service providers should, therefore, ensure they |
| | |have appropriate public liability insurance arrangements in place|
Reference Documents
Royal Pharmaceutical society (2019) Professional guidance on the administration of medicines in healthcare settings.
Buchan J, Seccombe I (2006) From Boom to
Bust? The UK Nursing Labour Market Review
2005/6. (accessed
30 October 2014)
Cavendish C (2013) The Cavendish Review. An
Independent Review into Healthcare Assistant
and Support Workers in the NHS and Social
Care Settings.
(accessed 30 October 2014)
Department of Health (2012) Compassion in
Practice. Nursing, Midwifery and Care Staff,
our Vision and Strategy.
c5lc4n2 (accessed 30 October 2014)
Glasper A (2013) Should a year as an HCA be
compulsory for pre-reg nurses? British Journal
of Healthcare Assistants 7(5): 237–40
Health Education England (2014a) HEE launches
first national consultation on a NHS bands 1-4
workforce strategy.
(accessed 30 October 2014)
Health Education England (2014b) New Care
Certificates Pilots underway.
lmguxs5 (accessed 30 October 2014)
Lepper J (2010) The role and regulation of
healthcare assistants. Independent Nurse. http://
dx.10.12968/indn.2010.14.5.77511
(accessed 30 October 2014)
Francis R (2013) Mid Staffordshire NHS
Foundation Trust Public Inquiry Executive
Summary.
report (accessed 30 October 2014)
Royal College of Nursing (2012) Position
Statement On The Education And Training Of
Health Care Assistants (HCAs). .
com/mbdznfk (accessed 30 October 2014)
• The NHS Plan (2002), Department of Health
• Liberating the Talents (2002), Department of Health
• Medicines Matters (2006), Department of Health
• Immunisation against Infectious Disease (2006), Department of Health
• National Minimum Standards for Immunisation Training (2005), Health Protection Agency
• Core Curriculum for Immunisation Training (2005), Health Protection Agency
• Medical Defence Union (2006) Media Press Release
• Delegation to Health Care Assistants: A guide for general practice
Vaughan, P. and Hughes, A., WiPP
• Introducing a training programme to provide the HCA with the skills, knowledge and ability to deliver influenza & pneumococcal vaccines
Graham, J. and Buchanan, I., Heart of Birmingham teaching PCT
• CHS3: Administer Medication to Individuals' Skills for Health National Occupational Competence
•
• World Health Organisation guidance on Hand Hygiene (Available at )
• Five Moments for Hand Hygiene (Available at )
•
•
•
•
•
•
-----------------------
[1] Out of hours services may include GPs working in A&E departments or urgent care centres, including minor injury units or walk-in centres; teams of healthcare professionals working in primary care centres, A&E departments, minor injury units, urgent care centres or NHS walk-in centres; healthcare professionals (other than doctors) making home visits after a detailed clinical assessment; and ambulance services moving patients to places where they can be seen by a doctor or nurse to reduce the need for home visits. The out of hours period is from 6:30pm to 8am on weekdays and all day at weekends and on bank holidays.
[2] Previous information in this table stated that safeguarding reports/request for information from DHSC were not in scope of the scheme.
The Department of Health and Social Care (DHSC) and NHS England (NHSE) have reviewed the position with regards to safeguarding reports. DHSC and NHSE recognise that GP practices/contractors are under a duty to provide safeguarding information requested by local authorities or the police for safeguarding purposes pursuant to section 16H of the Children Act 2004. Whilst not directly related to GP diagnosis, care or treatment of children, on reflection DHSE and NHSE recognise that these safeguarding activities are related to the care of children and are aimed at ensuring the good health of children (as local authorities rely on this information to act to protect children from harm and ensure their medical needs are taken into account). For these reasons, on balance, DHSC and NHSE consider that safeguarding activities should be considered to be in scope of CNSGP.
We will provide such assistance in relation to any claim for clinical negligence made against you for the provision of reports or information to local authorities for safeguarding purposes from 1 April 2019. General practice staff should contact NHS Resolution to access support for such claims.
[3] Previous information in this table had stated that administration of travel vaccines and immunisations where patients are directly charged is in scope of CNSGP. This information was not correct and the Department of Health and Social Care (DHSC) and NHS England (NHSE) apologise for this error. DHSC and NHSE are committed to ensuring that any general practice staff who were administering travel vaccinations and immunisations (where patients were charged a fee) and who understood themselves to be covered under the CNSGP for such activities, are not financially at a disadvantage as a result of any claim, or potential claim, against them as a consequence of relying on the incorrect information.
In order to mitigate any risk to the health of patients, we will provide such assistance in relation to any claim for clinical negligence made against you for the supply and administration of privately funded travel vaccinations for the period between 1st April 2019 and 31st July 2019. General practice staff should contact us to access support for such claims. Claims relating to the supply and administration of any travel vaccinations or immunisations (where the patient is required to pay) provided outside of this period should be reported to your indemnity provider.
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