MM-0003 Procedure for the Administration of Oil-Based ...



ADMINISTRATION OF OIL-BASED DEPOT AND OTHER LONG-ACTING INTRAMUSCULAR ANTI-PSYCHOTIC INJECTIONS TO ADULTS PROCEDUREThe key messages the reader should note about this document are:This procedure aims to guide practitioners involved in the administration of oil-based depots and other long-acting anti-psychotic medication to ensure that safe and effective care is delivered.Deep Intramuscular Injections form part of a wider care plan.Importance of clear and transparent documentation.Consent to treatment should be obtained before each administration.It is considered good practice, where additional practitioners are available, for a second check to be made in order to minimise the risk of error. Furthermore, individual teams should ensure a robust system is in place to identify when service user’s injections are due in the event of staff sickness or annual leave.NB: The second checker – This does not need to be performed by a qualified member of staff. However the second check needs to performed by someone who is competent to do so and is able to understand the following:Name of the depot injection (drug name) againt the depot prescribed on the prescription _ both need to be the sameAppropriatly strength vial to ensure the least volume of depot is administered to the service usersFeel confident to escalate or request advice regarding any issue related to the checking process This policy/procedure may refer to staff as qualified/registered/professional or other such term to describe their role. These terms have traditionally referred to individuals in a clinical role at band 5 or above. Please note that the use of these terms may or may not include nursing associates or associate practitioners (band 4). For clarification on whether a nursing associate or associate practitioner is an appropriate person to take on the identified roles or tasks in this policy/procedure please refer to the job description and job plan for the individual, or local risk assessment.DOCUMENT SUMMARY SHEETALL sections of this form must be completed. Document titleAdministration of oil-based depot and other long-acting intramuscular anti-psychotic injections to adults procedureDocument Reference NumberMM-0003Key searchable wordsDepot, injection, administration, competence, training, safety, documentation.Executive Team member responsible (title)Medical DirectorDocument author (name and title)Rob EdwardsClinical Lead Nurse and Non-Medical Prescribing Lead (Nursing)Approved by (Committee/Group)MOG – Medicines Optimisation GroupDate approved14 December 2017Ratified byPolicy & Procedure GroupDate ratified21 December 2017Review date11th December 2020Frequency of reviewAt least every three yearsAmendment detailVersionAmendmentReason2.0Placed into new procedural formatUpdated documentation2.0Record keeping sectionAdded detail required to reflect current practice.2.0Safe disposal of sharps sectionAdded detail required to reflect up-to-date information.CONTENTSSectionDescription Page1The content of the procedural document 1.1Flow chart of procedure41.2Description of procedure/process 52Appendices included as relevant Appendix A – Standard Operating Procedures11Appendix B – Maximum volume for oil-based depot administration into a single site 17Appendix C – Training18Appendix D – Glossary of Definitions191.THE PROCEDURE-4260858718551.1 Flow chart of procedure 1.2 Description of procedure General Preparation for the Deep IM InjectionDepot preparations should be a treatment option where a service user expresses a preference for such treatment because of its convenience, or as part of a treatment plan in which the avoidance of covert non-adherence with antipsychotic drugs is a clinical priority (NICE, 2009).The administration of any medication is an opportunity for assessment and information exchange with the service user and carer(s), where appropriate. Preparation should include assessment to ascertain if the physical and/or mental health of the service user has changed since the previous contact. Any beneficial effects or side-effects experienced since the last injection should be considered and questions asked of the service user and their carer (where appropriate) to elicit any concerns or information needs.Prior to administration, the service user’s prescription should be checked to ensure that it is legal and valid. Allergy status should be checked. The LYPFT Medicines Code (MM-0004) outlines the required standards and the responsibilities of registered practitioners in prescribing, dispensing and administering medication.If administering Olanzapine depot injection the elearning must be completed prior to prescribing or administering the medication for the first time. Registration is required for access to the elearning which can be found at .Dose calculationsSome drug administrations require complex calculations to ensure the correct volume of medication is administered. Appendix B illustrates the maximum volume for oil-based depot administration into a single site. If a greater volume is required, the practitioner should consider whether an alternative strength of the product is available. strength available (mg/ml) x required dose (mg) = volume required (ml)e.g. To give a dose of Zuclopenthixol Decanoate 350mg using the 200mg in 1ml ampoule (1 ÷ 200) x 350 = 1.75Volume required = 1.75mlWhen preparing for the administration of medication, it is considered good practice, where additional practitioners are available, for a second check to be made in order to minimise the risk of error. This second check may be undertaken by another registered practitioner or ‘medicines competent’ member of staff (see LYPFT Medicines Code (MM-0004).Choice of syringe and needleWhere the product is provided in a pack with a syringe and needle for administration (i.e. Risperdal Consta, Xepilon or ZypAdhera) the syringe and needle provided should always be used and the manufacturer’s instructions followed.Practitioners should ensure that all needles used for the administration of depot medication incorporate a ‘sharp safe’ mechanism. Where the practitioner has to select an appropriate syringe and/or needle, it is necessary to consider the following: Needle length is indicated on the needle pack in inches and/or millimetres. An assessment of the length of needle required to reach the appropriate muscle should be made, taking into account any subcutaneous fat. If the chosen needle is not long enough to reach the muscle, consideration needs to be given as to which needle to use. Advice should be sight from the prescribing practitioner and also pharmacy. The gauge of the needle refers to the outer diameter of the needle. A smaller number indicates a larger outer diameter. 21 gauge needles (green hub) are most commonly used for intramuscular injections. The narrowest needle which complies with the product licence should be used. Where needles are supplied with an injection, only those needles should be employed. The smallest possible size of syringe should be used to accommodate the volume of the product given. Hand hygieneThe Trust’s Hand Hygiene Procedure (IC-0002) describes the hand cleansing technique which should be adhered to. WHO (2010) recommends that non-sterile, well-fitting, single-use gloves must be worn if the practitioner’s or service user’s skin is not intact (e.g. through eczema, burns or skin infections) or when there is a likelihood of coming into direct contact with a service user’s blood or other potentially infectious materials. See the Standard Infection Control Precautions Protocol (IC-0004). It should be noted that gloves do not provide protection against needle-stick injuries and all sharps should be handled with caution. Preparing and drawing up medicationMedication should be prepared immediately prior to its administration and practitioners should ensure all necessary equipment is available before proceeding. Practitioners must ensure that the expiry dates of all equipment are checked prior to use.Where medication requires reconstitution this should be carried out in line with manufacturer’s guidance.Blunt drawing-up needles with an internal filter are available to prevent the accidental drawing up of contaminants from glass ampoules. However, the viscosity (thickness) of the oil and size of the molecules in some oil-based depot injections may make drawing up through a filter needle difficult and could result in some of the product being discarded with the draw up needle when it is changed to the needle for administration. They are therefore NOT recommended for such injections (Hunter, 2008; Feetham & White, 2010)It is common practice to change the needle used for drawing up to a different needle for administration, however, this is only necessary where there has been a risk of blunting the needle (e.g. by perforating a rubber bung or by scratching it on the inside of an ampoule, Feetham & White, 2010).Choice of injection siteMost oil-based depot antipsychotic injections must be administered only into the gluteal muscle by deep intramuscular (IM) injection. The exceptions to this are flupentixol and zuclopenthixol depots which are also licensed to be administered via the lateral thigh.Other long acting injections permit administration into either the deltoid or gluteal muscle. It is good practice for the prescriber to stipulate the muscle where the depot is to be given on the prescription, not just ‘I.M’.Appendix A illustrates the most common injection techniques. Further information regarding each technique can be found within the Royal Marsden Handbook of Clinical Nursing Procedures and video tutorials produced by the University of Hull can be found here: reach4resource.co.uk. The Summary of Product Characteristics for each anti-psychotic injection contains full details of the sites for which each injection is licensed and can be accessed online from the Electronic Medicines Compendium: .uk/emc. Where, according to the product licence, a choice of injection site exists, this should be discussed with the service user. A joint decision on the preferred site should be made and recorded in the service user’s clinical record.Whichever site is selected, the registered practitioner must rotate the site and alternate between the left and right side of the body on each occasion the injection is administered. The site used on each occasion must be documented accordingly.The service user should be assisted into the chosen position for administration of the injection, according to the appropriate chosen site. Privacy and dignity should be maintained at all times.It is important to evaluate the injection site both pre and post injection observing for any signs of swelling, pain, inflammation, infection or tissue damage. If any of these signs are present or there are any other concerns, advice should be sought from an appropriate member of the care team before continuing with the procedure. Practitioners should ensure that an accurate reflection of any discussions that may take place is recorded in the service user’s clinical record.The site may be cleaned prior to injection using an alcohol swab. A period of 60 seconds must elapse before the injection to ensure the alcohol has dried on the skin.Z-Track Administration Technique (See Appendix A: SOP 2)Z-tracking is the recommended technique for all deep IM injections as it creates a broken injection pathway (the Z track), containing the medicine in the intended target muscle and preventing it from moving back up the track to leak out at the skin surface. This has the advantage of achieving the correct plasma concentration whilst minimising the risk of pain or lesions at the injection site. The injection site should not be massaged as this may interfere with the absorption rate of the depot and cause irritation by forcing the medication into subcutaneous tissue.Safe disposal of sharpsSharps should be disposed of at the point of use in a secure sharps bin. Needles should never be re-sheathed and the ‘safe sharp’ mechanism should be engaged as directed and discarded appropriately. In the event of a needlestick injury, the directions included within the Trust’s Blood Borne Viruses; including Sharps, Inoculation and Needle stick injury Protection and management procedure (IC-0003) must be followed. Sharp-safe needles are now commonplace in practice.Record keepingGood record keeping is essential for safe service user outcome, transparent practice and clinical audit. The clinical record should reflect the registered practitioner’s full, chronological account of assessment, planning and care and provide information relevant to the procedure at the time of the administration of the injection. No action or omission by the registered practitioner must compromise patient safety; records must demonstrate this duty of care. The Nursing and Midwifery Council (NMC) Record Keeping Standards clearly outline expectations in detail and should be referred to. As a minimum, the date and time of the injection, the name of the medicine and dose administered, the site of administration together with the registered practitioner’s signature and, where applicable, a signature from a second registered practitioner should be recorded on the service user’s prescription and administration chart. If a student administers the injection under supervision then their signature must be countersigned by the supervising registered practitioner. These will normally be recorded on the prescription and administration record.Ensure that the assessment of the patient’s capacity to consent is assessed and the legal requirements of the Mental Health Act are met and both must be recorded. Record the clinical intervention and specific references to any patient or carer concerns chronologically. A template for the assessment of mental capacity is available on paris. A link to assessment of mental capacity is also available on the LYPFT Staffnet at: Capacity Act/MCA - Forms/MCA1 - Capacity Assessment.doc. The practitioner should calculate when the next injection is due and arrange a convenient appointment with the service user. The next due date should be recorded in the service user’s clinical record and diarised where appropriate.Individual teams should ensure a robust system is in place to identify when service user’s injections are due in the event of staff sickness or annual leave.This can include a second practitioner who has already met the service user and where possible already administered the depot injection. Practitioners should ensure they adhere to the NMC (2010) Recordkeeping Standards, recording an accurate reflection of any discussions and decisions made. Any deviation from normal practice must be clearly recorded in the service user’s clinical record with the rationale for the clinical decision to do so.Any incidents, errors or near misses must be reported as described in the Trust’s Management of Incidents, Including Serious Incidents Procedure (RM-0002).Monitoring and reviewImmediately following administration the service user should be observed for adverse effects. Any special instructions for post-injection monitoring in the product licence must be planned for and followed. For example, after the administration of olanzapine long-acting injection the service user must be monitored for at least 3 hours for signs and symptoms consistent with olanzapine overdose.All service users must have their long-acting antipsychotic treatment reviewed by the clinical team on a regular basis. Such reviews should consider efficacy, including any changes in symptoms and behaviour, side effects, adherence and physical health (NICE, 2009).Regular monitoring of side effects should be carried out using a validated tool, such as the Glasgow Antipsychotic Sidee Effect Scale (GASS). The GASS assessment tool is available on PARIS. Clinical reviews must be undertaken at least every six months in discussion with the service user, carer (where appropriate) and the care team, and will usually take place as part of the Care Programme Approach review. This should be a minimum of annualy but best practice is for the care plan to be reviewed based on needs and clinical presentation. Shared care guidelinesPractitioners should ensure they are aware of the Leeds Health Pathways shared care guidelines which relate to the prescribing of depot medications and transfer of care to primary care.These can be found at: . Test doseFor oil based depot IM anti-psychotic injections it is necessary to give a test dose before treatment is initiated to assess for tolerability to both the active ingredients as well as the oily vehicle. Occasionally a service user with a nut allergy may react to the oil and if a full dose is given from the outset then the service user may experience more severe, protracted discomfort. For this reason it is important to check the summary of product characteristics and the service user’s allergy status prior to administration. Full details of test doses for the oil-based depot injections are given in each individual Summary of Product Characteristics (SmPC) as well as in the British National Formulary (BNF).Missed appointmentsMissed appointments or changes to the planned injection due date should be communicated with the prescriber and documented appropriately in the service user’s clinical record. Some depot injections have information in their product literature which can be found at .uk about what action to take if the dose is missed e.g. if missed paliperidone monthly depot by more that 6 weeks since the last dose extra doses need to be given.2.APPENDICESAppendix A SOP 1Standard Operating Procedure 1General Preparation for Deep Intramuscular (IM) InjectionApplicable to:Registered nurses required to administer oil-based depots and other long-acting intramuscular antipsychotic injections in the course of their practice.Process 1Read the prescription and check that the prescription is for that service user. Establish the identity of the service user using two sources of information e.g. visual/ wristband and date of birth. Process 2Check to see if the service user’s physical or mental health has changed since the previous contact, including the health of any previous injection sites.Process 3Ask about perceived benefits and any side effects experienced since the last injection (if this is not the first).Process 4Check the prescription to ensure:It is legal and validThe dose is due and has not already been administeredThere are no contra indications or allergiesProcess 5Locate the medication and check:The expiry date of the medication to be administered has not passedIt is the correct formulationProcess 6Confirm that the service user has the capacity to consent and gives their consent to the procedure. Record the assessment of capacity clearly in thr clinical casenotes. Process 7Wash your hands according to procedure and put on disposable gloves.Process 8Prepare the injection, making any necessary dose calculations and using the correct equipment.Process 9Carry out a final check of all items in processes 4, 5, 6 & 8. Where possible get a second practitioner to double check.Process 10Chose the site of administration according to the licensed indication for the injection and in collaboration with the service user.SOP 2Standard Operating Procedure 2Z-Track Administration TechniqueApplicable to:Registered nurses required to administer oil-based depots and other long-acting intramuscular antipsychotic injections in the course of their practice. This technique should be used for all IM injectionsProcess 1Pull the skin in the target area taut and to one side with either the thumb or side of the non-dominant hand and maintain firm traction of the skin throughout the procedureProcess 2Insert the needle with a darting motion at a 90 degree angle to the skin surface to an adequate depth to allow the needle to penetrate the muscle. Keep the graduation markings on the syringe barrel visible at all timesProcess 3For dorsogluteal injections onlySteady the barrel of the syringe with the remaining fingers of the non-dominant hand and pull back on the plunger with the dominant hand to aspirate. Should blood appear in the syringe all the equipment must be discarded and the whole procedure started again. If no blood appears it is safe to continue.(Where injections are to be administered into sites where there are no major blood vessels below the injection site this step is unnecessary)Process 4Depress the plunger slowly (1ml per 10 seconds) to allow the muscle fibres to expand to accommodate the drugProcess 5Wait a further 10 seconds before removing the needle and once it has been removed , only then release the traction on the skinProcess 6If necessary the injection site may be wiped with a dry gauze swabProcess 7A plaster may be applied if this is the patient’s choice and if they have no known allergy to latex, iodine or elastoplast?SOP 3Standard Operating Procedure 3Administration Technique for the Deltoid SiteApplicable to:Registered nurses required to administer oil-based depots and other long-acting intramuscular antipsychotic injections in the course of their practice. Process 1Ask the service user to sit down and loosen their clothes so their arm and shoulder are exposed. Ask them to place their hand on their stomach and relax the arm Process 2Follow processes 1-10 in SOP 1 Process 3Palpate the upper arm and find the landmarks of the acromion process and the axilla. The target injection site can be found by visualising an inverted triangle which extends from the acromion process and down to a point level with the axilla. Form a rectangle within the original triangle by placing two fingers below the acromion process to form the top edge of the rectangle and with the bottom edge level with the axilla. The side edges of the rectangle should be parallel to the arm. The injection site is in the middle of this visualised rectangle.Process 4Clean the skin, if necessary with an alcohol swabProcess 5Administer the injection using a Z-track technique (SOP 2)Process 6Dispose of all equipment immediately with safe disposal of sharps into an appropriate, puncture proof, correctly labelled sharps bin. Do not re-sheath needleProcess 7Remove gloves and wash your hands according to Trust procedureProcess 8Document on the prescription/administration chart and in the clinical record the date, time and dose of medication administered, injection site and side of the body plus any deviation from standard practice with a rationale for the clinical decision to do so.Process 9Exchange information about monitoring arrangements, how to manage common side effects and what to and what to do if the service user experiences any change to their mental or physical health status before the next clinical contactSOP 4Standard Operating Procedure 4Administration Technique for the Dorsogluteal SiteApplicable to:Registered nurses required to administer oil-based depots and other long-acting intramuscular antipsychotic injections in the course of their practice. Process 1Follow processes 1-10 in SOP 1Process 2Ask the patient to lie down and loosen their clothes so one buttock is exposed. Ask them to either lie on their front or side with the femur internally rotated to minimise pain on administration. The service user may prefer to stand or bend over a chair rather than to lie down. In such cases the service user should be asked to take the weight off their foot on the side where the injection is to be administered.Process 3If a syringe and/or needle is provided in the product pack by the manufacturer this must be used. If not select an appropriate needle length to reach the gluteus muscle. Consider the Body Mass Index (BMI) and gender of the service user. In obese service users with a BMI of 30 or more, a 50mm needle may be required.Process 4Draw an imaginary cross onto one buttock and identify the upper outer quadrant. Divide this first quadrant into quarters. The injection site is located within the upper outer quadrant of the upper outer quadrant, approximately 5 to 7.5cm below the iliac crest.Process 5Clean the skin if necessary using an alcohol swabProcess 6Administer the injection using a Z-track technique (SOP 2)Process 7Dispose of all equipment immediately with safe disposal of sharps into an appropriate, puncture proof, correctly labelled sharps bin. Do not re-sheath needleProcess 8Remove gloves and wash your hands according to Trust procedureProcess 9Document on the prescription/administration chart and in the clinical record the date, time and dose of medication administered, injection site and side of the body plus any deviation from standard practice with a rationale for the clinical decision to do so.Process 10Exchange information about monitoring arrangements, how to manage common side effects and what to and what to do if the service user experiences any change to their mental or physical health status before the next clinical contactSOP 5Standard Operating Procedure 5Administration Technique for the Ventrogluteal SiteApplicable to:Registered nurses required to administer oil-based depots and other long-acting intramuscular antipsychotic injections in the course of their practice. Process 1Follow processes 1-10 in SOP 1Process 2Ask the patient to lie down and expose their hip. Where the service user prefers to stand they should be asked to take the weight off their foot on the side where the injection is to be administered.Process 3Palpate the greater trochanter. Place the heel of the opposite hand to the service user’s leg on the greater trochanter (i.e. your left hand on their right leg or vice versa). Locate and place index finger of on the anterior superior ileac spine and travel along it until your index finger is in line with the vertical axis of the body. Your thumb should be pointing towards the front of the leg. Spread the middle finger to form a ‘V’. The injection site is in the middle of this ‘V’ level with the first knuckles of your fingers.Process 4Visualise the site and remove your hand to prevent needlestick injuryProcess 5Clean the skin if necessary using an alcohol swabProcess 6Administer the injection using a Z-track technique (SOP 2)Process 7Dispose of all equipment immediately with safe disposal of sharps into an appropriate, puncture proof, correctly labelled sharps bin. Do not re-sheath needleProcess 8Remove gloves and wash your hands according to Trust procedureProcess 9Document on the prescription/administration chart and in the clinical record the date, time and dose of medication administered, injection site and side of the body plus any deviation from standard practice with a rationale for the clinical decision to do so.Process 10Exchange information about monitoring arrangements, how to manage common side effects and what to and what to do if the service user experiences any change to their mental or physical health status before the next clinical contactVideo tutorials of these procedures can be found at: reach4resource.co.uk Appendix BMaximum volume for oil-based depot administration into a single siteGeneric NameBrand/Trade nameMax. VolumeFlupentixol decanoate 20mg in 1mlDepixol Injection2mlFlupentixol decanoate 100mg in 1mlDepixol Concentrate2mlFlupentixol decanoate 200mg in 1mlDepixol Low Volume Injection2mlFluphenazine decanoate 25mg in 1mlModecate InjectionNot specified in SPCFluphenazine decanoate 100mg in 1mlModecate Concentrate injectionNot specified in SPCHaloperidol decanoate 50mg in 1mlHaldol Decanoate 50mg in 1ml3mlHaloperidol decanoate 100mg in 1mlHaldol Decanoate 100mg in 1ml3mlZuclopenthixol decanoate 200mg in 1mlClopixol Injection2mlZuclopenthixol decanoate 500mg in 1mlClopixol Concentrate Injection2mlAs cited in:Guidance on the administration to adults of oil-based depot and other long-acting intramuscular antipsychotic injections: Fourth Edition (2014)Appendix CTRAININGThere is a requirement that all registered practitioners involved in prescribing, preparing, administering and monitoring oil-based depot and other long-acting intramuscular anti-psychotic injections receive training in order to be able to meet the expected level of competency and standards outlined to prevent harm to patients through safe practice (NPSA, 2007).All registered nurses must complete the Trust’s Medicines Calculations and Medicines Administration for Nurses (available on iLearn) in order to evidence their competency in this area. Medicines calculations are also available on iLearn and needs to be completed annually. Nurses wishing to refresh their skills and knowledge may do so by accessing classroom based training or e-learning (also available on iLearn), details of which can be found on the Staffnet iLearn page.Practitioners should recognise and work within the limits of their competence, seeking advice and support from an appropriate source where required.Appendix DGLOSSARY OF DEFINITIONSDefinitionMeaningDeltoid siteThe location for administration of injection into the deltoid muscle.DepotIn mental health, this is the term used for oil-based long acting intramuscular (IM) antipsychotic injections designed to be given by deep IM injection. They consist of the antipsychotic esterified to a decanoate or palmitate dissolved in an oily vehicle. The volume to be injected is deposited deep into the gluteal muscle and forms a depot from where it leaches over time according to its oil:water partition co-efficient into the blood stream. This, together with the time taken for circulating enzymes to hydrolyse the ester back to its base, is responsible for the prolonged length of action of these formulations.Dorsogluteal siteThe location for administration of injection into the gluteus maximus. Often referred to as the “Upper Outer Quadrant of the buttock”. This the most common site for administration of an oil-based antipsychotic depot injection. There is currently discussion as part of the rapid tranquilisation procedure update regarding the use of ventro-gluteal site as an alternative administration site, depending on the license of the drug.Long Acting Injection (LAI)In mental health, this is the term preferred for non oil-based long-acting intramuscular antipsychotic formulations such as risperidone (Risperdal Consta), paliperidone (Xeplion) and olanzapine (ZypAdhera) long-acting injections. The same careful injection technique is required to administer these products but their release characteristics are very different to each other as well as to oil-based formulations.Safer sharp The term ‘safer sharp’ means medical sharps that incorporate features or mechanisms to prevent or minimise the risk of accidental injury.Test doseAn initial low dose of an oil-based depot antipsychotic injection which must be given to assess for tolerability to both the active ingredient and its vehicle or any other excipient.Vastus lateralisThe lateral quadriceps muscle.Ventrogluteal siteThe location for administration of injection into the gluteus medius and gluteus minimus. Colloquially referred to as the “Hip site”.Z-trackingThis is the recommended technique for all deep IM injections. it displaces superficial layers of skin and tissue creating a broken injection pathway (the z-track) containing the medicine in the intended target muscle and preventing it from moving back up the track to leak out at the skin surface. This has the advantage of achieving the correct plasma concentration whilst minimising the risk of pain or lesions at the injection site.PART B 3.IDENTIFICATION OF STAKEHOLDERSThe table below should be used as a summary. List those involved in development, consultation, approval and ratification processes.StakeholderLevel of involvementMedicines Optimisation GroupDevelopment & ConsultationOperational ManagersConsultationPolicies and Procedures GroupConsultationInfection Prevention and Control TeamConsultationLead NursesConsultation4.REFERENCES & EVIDENCE BASECQC (2008) Nurses, the Administration of Medicine for Mental Disorder and the Mental Health Act 1983 The Care Quality Commission: LondonCrowley J, Griffiths M, Hardy S et al (2008) Mental Health Practice Essential Guide: Administration of Depot and Long Acting Antipsychotic Injections Mental Health Practice 12 (2): 1-18Dougherty L & Lister S. Eds (2011) The Royal Marsden Manual of Clinical Nursing Procedures, 8th Edition. Wiley-Blackwell: ChichesterGreenway K (2004) Using the Ventrogluteal Site for Intramuscular Injection Nursing Standard 18 (25): 39-42HSE (2012) EU Directive on preventing sharp injuries in the hospital and healthcare sector Health and Safety Executive: BootleHunter, J (2008) Intramuscular Injection Techniques Nursing Standard 22 (24): 35-40Mental Capacity Act 2005 Mental Health Act 1983 (as amended by the Mental Health Act 2007)NICE (2009) Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (CG82) National Institute for Health and Clinical Excellence: LondonNPSA (2007) Promoting Safer Use of Injectable Medicines: Patient Safety Alert, National Patient Safety Agency: LondonFeetam & White J (Eds.) (2011) Guidance on the administration to adults of oil-based depot and other long-acting intramuscular antipsychotic injections: Third Edition available at hull.ac.uk/injectionguide.Guidance on the Administration to Adults of Oil-based Depot and other Long-Acting Intramuscular Antipsychotic Injections 4th Edition, (2014) [online]. Available at: [accessed 16th November 2017].NICE clinical guidelines for psychosis and schizophrenia (CG 178). NICE. Feb 2014.NMC (2010b) Recordkeeping Standards Nursing and Midwifery Council: LondonNMC (2010a) Standards for Medicines Management. Nursing and Midwifery Council: LondonPrescqipp Community interest Company. Antipsychotic drugs. (2014) [online]. Available at: antipsychotic-drugs/send/113-antipsychotic-drugs/2876-bulletin-135-antipsychotics-update [accessed 16th November 2017].Rodger M & King L (2000) Drawing up and administering intramuscular injections: a review of the literature Journal of Advanced Nursing 31(3): 574-582Schizophrenia: aripiprazole prolonged-release suspension for injection, (2014) [online]. Available at: .uk/advice/esnm39/chapter/key-points-from-the-evidence [accessed 16th November 2017].Taylor D, Paton C & Kapur S (2012) The Maudsley Prescribing Guidelines in Psychiatry: 11th Edition Wiley-Blackwell: LondonWHO (2010) Best practices for injections and related procedures toolkit World Health Organisation: GenevaWorkman B (1999) Safe Injection Techniques Nursing Standard 13 (39):47-53Zabak A, Gunes UY, Tamsel S et al (2007) Does obesity prevent the needle from reaching muscle in intramuscular injections? Journal of Advanced Nursing 58 (6):552-556.5.ASSOCIATED DOCUMENTATION LYPFT Medicines Code (MM-0004) LYPFT Non-Medical prescribing Procedure (MM-0001)LYPFT Hand Hygiene Procedure (IC-0002) LYPFT Standard Infection Control Precautions Protocol (IC-0004)LYPFT Blood Borne Viruses; including Sharps, Inoculation and Needle stick injury Protection and management procedure (IC-0003) LYPFT The Management of Incidents, Including Serious Incidents Procedure (RM-0002)6.Standards/key performance indicatorsThe key performance indicators below are monitored by the assurance framework outlined in the table below:safe administration of depot medication;compliance with professional and good practice standards for medicines management;compliance with the Trust’s Medicines Code.7.EQUALITY IMPACT The Trust has a duty under the Equality Act 2010 to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations between people from different groups. Consideration must be given to any potential impacts that the application of this policy/procedure might have on these requirements and on the nine protected groups identified by the Act (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, gender and sexual orientation).Declaration: The potential impacts on the application of this policy/procedure have been fully considered for all nine protected groups. Through this process I have not identified?any potential negative impacts for any of the nine protected groups.Print name: Rob EdwardsJob title: Clinical Lead Nurse and Non-Medical Prescribing Lead (Nursing)Date: 7th December 2017If any potential negative impacts are identified the Diversity Team must be contacted for advice and guidance: email; diversity.lypft@. CHECKLIST To be completed and attached to any draft version of a procedural document when submitted to the appropriate group/committee to support its consideration and approval/ratification of the procedural document. This checklist and is part of the working papers. Title of document being newly created / reviewed:Yes / No/1.TitleIs the title clear and unambiguous?YesIs the procedural document in the correct format and style? Yes2.Development ProcessIs there evidence of reasonable attempts to ensure relevant expertise has been used?Yes3.ContentIs the Purpose of the document clear?Yes5.ApprovalDoes the document identify which committee/group will approve it? Yes6.Equality Impact AssessmentHas the declaration been completed?Yes7.Review DateIs the review date identified?YesIs the frequency of review identified and acceptable?Yes8.Overall Responsibility for the DocumentIs it clear who will be responsible for co-ordinating the dissemination, implementation and review of the document?YesName of the Chair of the Committee/Group approvingIf you are assured this document meets requirements and that it will provide an essential element in ensuring a safe and effective workforce, please sign and date below and forward to the chair of the committee/group where it will be ratified.NameE WestonDate14/12/17Name of the chair of the Group/Committee ratifyingIf you are assured that the group or committee approving this procedural document have fulfilled its obligation please sign and date it and return to the procedural document author who will ensure the document is disseminated and uploaded onto Staffnet.NameC HillDate21/12/17 ................
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