essential syringe driver training for t 34 - s. th driver training t34.pdf · if a doctor is...
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Essential Syringe Driver
Training for T 34
Elaine Bird
St Luke’s Hospice
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Aim
• For all practitioners to be accountable for their
individual competence and capability when
caring for a resident with a T34 Syringe Driver.
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Objectives • Discuss NMC core standards of conduct and practice
• Discuss standards for medications
• Understand clinical rationale for commencing and discontinuing a T34 syringe driver in palliative care
• Understand the importance of clear individualised care plan, incorporating open honest communication & continual holistic assessment.
• Discuss common medications and guidelines for recommended dose administration
• Demonstrate the correct procedure for setting up and continual monitoring of the T34 syringe driver.
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NMC Code for professional
standards of practice & behaviour
• Prioritise people
• Practice effectively
• Preserve safety
• Promote professionalism & trust
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Standards for practice of
administration of medicine
You must know
• The identity of the patient & any allergies
• Understand the therapeutic use of medications, its usual dosage, side effects, precautions and contra indications.
• The prescription label is clear and unambiguous.
• The expiry date of the medicine to be administered
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Medicine Standards Continued
• You are responsible for the initial and continued assessment of the patient
• You must be fully aware of the individual care plan
• In the event of an error you must take action to prevent harm, report ASAP to the prescriber and document your actions
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Clinical reasons for commencing a
T34 Syringe Driver in Palliative and
End of Life Care
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• Dysphagia
• Pain control
• Relief of nausea & vomiting
• Control of restlessness or agitation
• Relief of anxiety
• Control of convulsions
• Control of excessive bronchial secretions
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Individual Care plan
• Discuss what should be incorporated in an
individual care plan and how/where to
document
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Advantages of using Continuous
Subcutaneous Infusion (CSCI)
• No peaks or troughs in plasma drug
levels
Plasma
drug
level
Time
4 Hourly injections CSCI
Toxicity
Therapeutic level
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Disadvantages of using CSCI
• When the syringe is changed the symptoms
for the next 24 hours need to be anticipated
• If symptoms change, top up injections may
be required
• Machine inefficiency
• Battery failure
• Local skin reactions
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Infusion sites
• Lateral aspect of upper arms
• Anterior aspect of thighs
• Anterior of chest wall
• Anterior abdominal wall
• Scapula region especially if restless
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Sites to avoid
• Areas of lymphoedema
• Radiotherapy sites
• Bony prominences or near a joint
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Recommended labelling of the
Syringe
Labels must be applied to the syringe
• Patient’s name
• NHS Number (D O B if not available)
• Date and time syringe Driver recharged
• Drugs And Doses
• Initial volume of fluid in syringe
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Using the T34 Syringe Driver • The T 34 in Sheffield is programmed to use a
30ml Luer-Lok BD syringe ONLY
• Check service expiry date
• The standard delivery of medication in Sheffield
is programmed for 24hours
• Two registered nurses required to set up the
syringe driver
• Familiarise yourself with the Policy & Procedure
• Complete the T34 competency form
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Maintenance and Cleaning
• Must have an annual service
• After each use, thoroughly clean with 70% alcohol wipes – including battery holder and cover
• A declaration of decontamination form must be sent back with the syringe driver after use
• Any syringe driver involved in a medication incident must be quarantined immediately and sent to BME
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After a Patient Dies
If RGN is competent with verifying expected death the syringe driver can be stopped removed and drugs disposed of in line with company’s policy and procedure
If a doctor is required to verify death the syringe driver can be stopped but MUST be left in place until death has been officially verified.
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Recommended Drugs, no more than 3 different
medications and ensure compatibility
• Diamorphine
• Morphine
• Oxycodone
• Midazolam
• Haloperidol
• Metoclopramide (Maxolon)
• Levomepromazine (Nozinan)
• Hyocine Butylbromide (Buscopan)
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Starting Dose If opiate naïve- Best practice is to administer PRN S/c
injections for 24 hours
If taking oral opiates calculate the 24 hr dose administered
Divide by 2 to convert oral morphine to S/C Morphine
Divide by 3 to convert from oral morphine to S/C Diamorphine
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Example
Oromorph 5mg qds = 20mg in 24 hours
20mg ÷ 2 = 10mg S/C Morphine in 24 hours
20mg ÷ 3 = 6.6mg S/C Diamorphine in 24 hours
MST 30mg bd = 60mg in 24 hours
60mg ÷ 2 = 30mg S/C Morphine in 24 hours
60mg ÷ 3 = 20mg S/C Diamorphine in 24 hours
Actual dose prescribed would depend on
symptoms experienced by the patient
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Oxycodone
Divide by 2 to convert oral oxycodone
to S/C oxycodone
• Oxycodone 5mg qds = 20mg in 24 hours
• 20mg ÷ 2 = 10mg S/C Oxycodone in 24 hours
• Oxycodone 20mg bd = 40mg in 24 hours
• 40mg ÷ 2 = 20mg S/C Oxycodone in 24 hours
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Guidelines for PRN opiate
medications
Guidelines for Prn Medications is to divide the 24 hour dose of an opiate medication by 6
For example
MST 20mg bd = 40mg morphine in 24 hours
40mg ÷ 6 = 6.6mg prn oromorph
Syringe Drivers exactly the same
10mg diamorphine over 24 hours
10mg ÷ 6 = 1.6mg
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PRN medication
Actual dose prescribed would depend on
symptoms experienced by the patient
If sliding scale dose of prn oromorphine,
morphine, diamorphine or oxycodone has
been prescribed increase frequency of
medication before increasing the dose
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Dame Cicely Saunders.
• You matter because you are you. You
matter to the last moment of your life
and we will do all we can, not only to
help you die peacefully, but to live until
you die’
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References
• NMC The code (2015)
• Sheffield Palliative Care Formulary 3rd Ed
• http://www.intranet.sheffieldccg.nhs.uk/Do
wnloads/Medicines%20Management/pres
cribing%20guidelines/Palliative%20Care%
20Sheffield%20Palliative%20Care%20For
mulary.pdf