UCL Hospitals Injectable Medicines Administration Guide E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 111

Veröffentlichungsjahr: 2013

Beschreibung

"I would definitely recommend this book to all staff with an interest and involvement in intravenous drug therapy." 
—The Pharmaceutical Journal

"There is no doubt that nurses will find this small book useful.  It should be available for consultation in any clinical area where drugs are administered to patients by the injectable routes."
—Journal of Clinical Nursing

The safe administration of injectable medicines is key to patient safety.  The NPSA recognises the use of injectable medicines is a high risk activity and recommends written information about injectables to be available at the point of preparation. 
 
 The UCL Hospitals Injectable Medicines Administration Guide is a practical, accessible guide covering many important aspects of administering medicines by injection.   It provides clear, concise information on the preparation and administration of over 245 injectable medicines for adults, paediatrics and neonates.  It is an essential resource for nurses and other healthcare professionals: it provides the key information and advice needed for the safe and effective administration of injectable medicines.

The Guide’s introductory section provides a concise yet comprehensive overview of injectable therapy, including the risks and benefits of IV administration, infusion devices, and pharmaceutical aspects of injectable therapy.

For each drug the alphabetically tabulated monographs provide:

• A practical method of preparation and administration via the IV, IM and SC routes, with risk reduction in mind at every step
• Expert advice from the team of specialist pharmacists at UCLH to ensure safe and pragmatic use of each medicine
• Monitoring advice for the management of reactions that may occur during administration
• Y-site and syringe driver compatibility data
• Minimum infusion volume data for fluid restricted patients
• Extravasation warnings, pH, sodium content, displacement values, stability and flush data

New to this edition:

• 40 new monographs including recently marketed, unlicensed, rarely used and specialist medicines
• Detailed advice for the administration of high risk medicines such as heparin, with access to UCLH’s medicine related guidelines at www.wiley.com/go/UCLH
• A colour-coded NPSA risk assessment for every mode of administration for every medicine, to highlight the safest method of administration
• A user guide and tutorial to give new readers confidence in using and understanding the Guide
• Revised chapters on administration methods and devices, aseptic non-touch technique, and latex allergy
• Fully revised and expanded Y-site compatibility section
• Spiral binding to allow the book to be left open at the relevant page

The Guide is also available electronically at www.uclhguide.com.

Leseprobe

Contents

Third edition editorial board

Contributors

Acknowledgements

Preface

Section A

1 Introduction

2 Overview

2.1 Organisation of information in the Guide

2.2 Sources of information and disclaimer

3 UCLH policies

3.1 Responsibilities of professional staff at UCLH

3.2 Preparation of injectable medicines on wards, clinics and departments at UCLH

4 An overview of intravenous therapy

4.1 When is intravenous therapy appropriate?

4.2 Drug factors that influence the choice of route

4.3 Disadvantages of intravenous administration

4.4 Routes of intravenous administration

5 Factors affecting patency of intravenous sites

5.1 Factors increasing failure of intravenous sites

5.2 Factors decreasing failure of intravenous sites

5.3 Occlusion of central venous catheters

6 Methods of intravenous administration

6.1 Intravenous bolus

6.2 Intermittent intravenous infusion

6.3 Continuous intravenous infusion

6.4 Preparation and administration of intravenous medicines

6.5 Aseptic non-touch technique (ANTT)

7 Extravasation of injectables: overview and management advice

7.1 Patient factors affecting extravasation

7.2 Medicine factors affecting extravasation

7.3 Administration factors affecting extravasation

7.4 Overall risk for extravasation

7.5 Treatment of extravasation

8 Flushing cannulae, catheters and administration sets

8.1 Flushing between medicines

8.2 When not to flush

8.3 Flushing catheters and cannulae not in use

8.4 Flushing with heparin

9 Infusion pumps

9.1 Pumps used at UCLH

9.2 Volumetric pumps

9.3 Syringe pumps

9.4 Pumps for ambulatory use

9.5 Patient-controlled analgesia (PCA) pumps

9.6 Target-controlled anaesthesia (TCI or TIVA) pumps

10 Administration of injectables in primary care

10.1 Self-caring patients

11 Formulation and presentation of injectables

11.1 Medicines that require reconstitution

11.2 Preparations in solution requiring further dilution before use

11.3 Preparations available ‘ready to use’ without further dilution

11.4 Preparations available ‘ready to administer’

12 Pharmaceutical aspects of injectable administration

12.1 Displacement values

12.2 Sodium content

12.3 Drop size

12.4 Layering

12.5 Fluid restriction

13 Factors influencing medicine stability and compatibility of injectable medicines

13.1 Degradation

13.2 Precipitation

13.3 Binding of medicines to plastics

13.4 Destabilisation of parenteral emulsions

13.5 Leaching of plasticisers

13.6 Blood and blood products

14 Allergic reactions to injectables

14.1 Latex allergy

15 Compatibility of drugs in a syringe driver for subcutaneous use

16 Risk assessment of injectables and risk reduction

16.1 Risk assessment

16.2 Risk reduction

17 Useful resources

17.1 Websites

17.2 Further reading

Section B

User guide

Monographs in alphabetical order

Index of monographs

Quick User Guide

Users of the UCL Hospitals Injectable Medicines Administration Guide should be familiar with the terminology used in the monographs. A full explanation of the terms is found in the User Guide and Tutorial in Section B. For quick reference, the key abbreviations are listed here.

Method of administration

Description

IV bolus

Intravenous bolus

(I) IV infusion

Intermittent intravenous infusion

(C) IV infusion

Continuous intravenous infusion

SC bolus

Subcutaneous bolus

(C) SC infusion

Continuous subcutaneous infusion

IM

Intramuscular injection

Diluent

Definition

NS

Sodium chloride 0.9%

W

Water for injections

G

Glucose 5% (dextrose monohydrate)

G10

Glucose 10%

G20

Glucose 20%

H

Compound sodium lactate

(Hartmann’s or lactated Ringer’s)

GS

Glucose 4% and sodium chloride 0.18%

Infusion device

Description

Volumetric pump

A device which pumps fluid from a reservoir, such as an infusion bag or bottle, through an administration set at a preset rate

Syringe pump

A device which delivers fluid from a syringe into an administration set at a preset rate

Syringe driver

A portable device which delivers fluid from a syringe into an administration set at a preset rate

Term

Definition/Explanation

Reconstitute

Add fluid to a dry powder to produce a solution or suspension

Dissolve

Add fluid to a dry powder to give a solution

Diluent

The fluid used to either reconstitute a powder, or to further dilute a drug solution or suspension

Dilute

to

XmL fluid

Add fluid to the container so the final volume is X. For example, if the instruction says "dilute dopamine 200 mg/5 mL to 20 mL water", the user should take the dopamine and mix it with water so that the final volume is 20 mL. The final concentration is dopamine 200 mg/20 mL, or 10 mg/mL.

Dilute

with

XmL fluid

Add XmL to the container. For example, if the instruction says "dilute dopamine 200 mg/5 mL with 20 mL water" the user should take the dopamine and add 20 mL water, so that the final volume is 25 mL (20 mL from the water, 5 mL from the drug). The final concentration is dopamine 200 mg/25 mL, or 8 mg/mL

Understanding the NPSA risk rating: a full explanation of the risk rating scale is provided in the User Guide. The number bar indicates the complexity of the adjacent preparation and administration method. It is colour coded to give a visual indication of the risk: low risk tasks are green, moderate risk tasks are amber, and high risk tasks are red. The user should take additional time to plan and prepare medicines with a high risk rating, ensuring local protocols are adhered to, and appropriate safety measures and patient monitoring are in place.

This edition first published 2010

© 1998, 2007, 2010 Pharmacy Department, University College London Hospitals

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Library of Congress Cataloging-in-Publication Data

UCL Hospitals injectable medicines administration guide/Pharmacy Department, University College London

Hospitals. – 3rd ed.

p.; cm.

Other title: Injectable medicines administration guide

ISBN 978-1-4051-9192-0 (pbk.: alk. paper)

1. Injections–Handbooks, manuals, etc. 2. Drugs-Handbooks, manuals, etc. I. University College London Hospitals Foundation NHS Trust. Pharmacy Dept. II. Title: Injectable medicines administration guide. [DNLM: 1. Pharmaceutical Preparations–administration & dosage–Handbooks. 2. Injections, Intramuscular–methods–Handbooks. 3. Injections, Intravenous-methods–Handbooks. 4. Injections, Subcutaneous–methods–Handbooks. QV 735 U17 2010]

RM170.U26 2010

615’.6–dc22

2010003288

A catalogue record for this book is available from the British Library.

Third edition editorial board

Editor

Mr Kenneth Mole, MPharm, Dip Clin Pharm, MRPharmS

Sub-editors

Dr Robert Shulman, BSc, DHC, MRPharmS

Dr Anthony Grosso, BSc, MSc, PhD, MRPharmS

Dr Robert Urquhart, BPharm, PhD, MRPharmS

Mr Robin Offord, BPharm, MSc, MRPharmS

The UCL Hospitals Injectable Medicine Administration Guide, Third Edition, is produced by the UCLH Pharmacy Department on behalf of the Trust Use of Medicines Committee.

Contributors

Ms Fiona Maguire, BPharm, Dip Clin Pharm, MRPharmS

Mr Neil Tickner, MPharm, Dip Clin Pharm, MRPharmS

Mrs June Minton, BPharm, Dip Clin Pharm, MRPharmS

Ms Carolyn Gates, BPharm, MSc, MRPharmS

Mr Shahid Gani, MSc, MRPharmS

Ms Preet Panesar, BPharm, MRPharmS

Ms Emma Riches, Dip Clin Pharm, MRPharmS

Ms Kerstin von Both, MPharm, MSc, MRPharmS

Ms Hannah Wilton, MPharm, Dip Clin Pharm, MRPharmS

Mrs Shola Ajibodu, BSc, Dip Clin Pharm, MRPharmS

Ms Sheetal Sumaria, BSc, MRPharmS

Ms Evelyn Frank, MPharm, Dip Clin Pharm, MRPharmS

Mr Balram Malhotra, BSc (Hons), MSc, MRPharmS

Ms Rina Kundi, MRPharmS

Ms Aoife Sheilds, Dip Clin Pharm, MRPharmS

Mrs Ravijyot Saggu, MPharm, Dip Clin Pharm, MRPharmS

Acknowledgements

The UCL Hospitals Injectable Medicines Guide is the result of an extensive team effort, some members of which have changed since the book was published within UCL Hospitals. The editors would like to acknowledge the contribution of Sarla Drayan, Robert Shulman, Simon Badcott, Mark Harries and Denise Hoare for their extensive work on the first edition.

We offer our sincere thanks to the above contributors for their detailed feedback; their in-depth knowledge and attention to detail ensures the monographs are both authoritative and representative of current practice. Furthermore, the editors would like to thank the nurses of Ward T9 at University College Hospital for road testing some of the new monographs and for providing their frank and honest opinion of the content. Nursing feedback has allowed us to make this an altogether more user-friendly guide. We would also like to thank Mr Ronny Jahne for his constructive advice regarding the format of the new style monographs.

Furthermore, we acknowledge the UKCPA Critical Care Group for their Minimum Infusion Volume document (third edition). We would also like to recognise the contribution of the Pharmacy Department of Imperial College Healthcare Trust, Susan Keeling, and the pharmacists from the many different hospitals from around the UK who have contributed to the National Injectable Guide website. Information on the IV Guide site can be obtained from Gill Bullock ([email protected]) who is based in the pharmacy at Charing Cross Hospital.

Preface

The UCL Hospitals Injectable Medicines Administration Guide, Third Edition, is a fully revised and updated version of the previous editions published in 1997 and 2007. The general structure and format remain unchanged. The positive feedback we have received from nurses, pharmacists and doctors across the globe demonstrates that the Guide is a winning format. As computer-based systems are being introduced to manage all aspects of patient care, including patients’ medicines, an internet version of the Guide has been launched. In 2009 the UCLH Guide online went live (www.uclhguide.com) to meet the demand for up-to-date information in the digital age.

Healthcare is a rapidly evolving field, and in recent years patient safety has become an NHS priority. There is great interest in reducing the risk associated with injectable medicines, particularly since the publication of the National Patient Safety Agency alert Promoting Safer Use of Injectable Medicines. The injectable practices within the UCLH have been thoroughly scrutinised; every identifiable practice has been risk assessed and risk reduction strategies introduced. At UCLH we believe we are now working in a safer environment: we have rationalised the injectable products we use, expanded the range of ready-to-use injectables on our formulary, introduced guidelines to support those who prescribe, dispense and administer high-risk injectables and improved the training package for new staff who give injectables. Many of the risk reduction strategies have resulted in amendments to the monographs that form the core of this publication. Staff in the pharmacy department of UCLH are proud in the knowledge that their hard work is protecting patients through the safer use of injectable medicines, and we are happy to share the progress we have made through the Guide.

The opening chapters of the Guide have been revised to reflect recent changes in the use of injectables. Many concepts in the introductory chapters have been expanded to give the reader a more comprehensive overview of injectable therapy. Examples from current practice have been given so that readers can relate their own experiences to the text. A tutorial and example monograph has been added to make it easier for new users to get to grips with the Guide. This edition features over

40 new monographs, ranging from abatacept to zoledronic acid. A large number of unlicensed medicines have been added to support those administering medicines for which there is a paucity of information. The existing monographs have been overhauled to ensure they include all methods of administration, whether licensed or unlicensed, widespread or specialist. In many cases bold decisions have been made in order to give the user the best possible advice, which may differ from the drug manufacturer’s recommendations. The compatibility section now includes much more detailed information about possible compatibilities. This means that those caring for critically ill patients, who often require multiple concurrent infusions, now have a greater range of options when medicines need to be co-infused.

Finally information to support the use of injectable medicines in paediatric and neonatal patients has been included wherever possible. When these patients require special dilutions or infusion rates, this is highlighted. Advice about the preparation of low volume medicines for administration to neonates, and the use of displacement values to ensure accurate dosing in children, is embedded in the monographs.

In short, this is the safest and most comprehensive UCLH Injectable Medicines Administration Guide to date.

We trust that you will be satisfied with the Guide;