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Good Practice Statement for the Preparation of Injections in Near-Patient Areas, including Clinical and Home Environments
EXECUTIVE SUMMARY
The administration of medicines by injection is a hazardous process that should be avoided wherever possible. However, for some patients and medicines there are no alternatives, and these good practice statements have been developed to provide guidance on the standards of practice that should apply in the preparation of injections.
The individual statements are linked (see Appendix 3). Together, they provide a risk- assessment framework which supports the development of policies and procedures to take account of local needs and circumstances. Policies should be applicable to patient groups or categories of medicines, and also to specific situations to decide action in particular circumstances. The good practice statements can be applied by individual clinicians in their practice, by the clinical team and by the organisation.
Locally, Trust Chief Executives, Medical Directors, Directors of Nursing and Chief Pharmacists are responsible for implementing the good practice statements. Regular audit of the local action required that is clearly defined for each of the statements should be undertaken to monitor compliance. Action from national bodies and agencies including the Association of Scottish Trust Chief Pharmacists, NHS Education for Scotland, university schools of medicine, pharmacy and nursing, and further relevant education establishments is also recommended.
The good practice statements
Medicines should only be given by injection when no other route is suitable. Wherever possible, injections that are available in a ready-to-use form should be used. When the injection is available in a ready-to-use form, and there are no health and safety risks to the operator or to the environment, it should be transferred to the administration device in near-patient areas, and used immediately. Where a ready-to-use form of an injection is not available, a multi-professional risk assessment should be completed to determine the most appropriate location for preparation, and any action required to eliminate or minimise hazards. Parenteral nutrition solutions that require to be prepared, and cytotoxic medicines, should be made available through a pharmacy in the final container or device for administration. The preparation of injections in near-patient areas should be carried out by suitably instructed patients, carers or healthcare staff, in a suitable environment, using safe procedures. Injections prepared in near-patient areas should be administered immediately. Regular planned audit of the preparation of injections in near-patient areas in healthcare premises should be undertaken. Where local aseptic dispensing services are required, they must comply with the national standards.
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