Administration of Subcutaneous Fluid

Hampshire Community Health Care Version 1.00

Administration of Subcutaneous Fluids Guidelines Page 1 of 28

ADMINISTRATION OF SUBCUTANEOUS FLUIDS (HYPODERMOCLYSIS) TO ADULT

PATIENTS IN COMMUNITY SETTINGS GUIDELINES



Title: GUIDELINES FOR THE ADMINISTRATION OF SUBCUTANEOUS FLUIDS (HYPODERMOCLYSIS) TO ADULT PATIENTS IN COMMUNITY SETTINGS

Summary:

To provide guidance to registered nurses on the safe administration of subcutaneous fluids to adult patients in the community for the management of symptoms of dehydration

Policy Reference Number: HCHC/CLI/95/V1.00

Version Number: 1.00

Target Audience: All employees of the Hampshire Community Health Care (HCHC)

Review Date: March 2014

Approved by: Policy Management Group

Date of meeting:

16/03/11

Ratified by:

Quality and Governance Committee

Date of meeting:

05/04/11

Date Issued: April 2011

Author: S Coopey (Adapted from the Leeds PCT guidelines)

Custodian: Sue Harriman

Signed Chief Executive

Date:



Document Control Change Record

Date Author Version Reason for Change

Reviewers/contributors Name Position Version Reviewed &

Date Steve Mennear Lead Pharmacist Veresion2 (1/2/11) Tina Baker Veresion2 (1/2/11) Carol Mayl Veresion2 (1/2/11) Michelle Morron-Ryan Community Matron Veresion2 (1/2/11) Janet Holden Modern Matron Veresion2 (1/2/11) Vicky Melville Community Matron Veresion2 (1/2/11) Debbie Wakeford Community Matron Veresion2 (1/2/11) Suzie Ingram Clinical trainer Veresion2 (1/2/11)

Distribution

Name Position Version Distributed & Date

Community matrons Veresion2 (1/2/11) Modern Matrons Veresion2 (1/2/11) Community Care Teams Veresion2 (1/2/11)



POLICY DEVELOPMENT DOCUMENT CONTROL PANEL

Title: GUIDELINES FOR THE ADMINISTRATION OF SUBCUTANEOUS FLUIDS (HYPODERMOCLYSIS) TO ADULT PATIENTS IN COMMUNITY SETTINGS Version Number: 1.00 Date of Issue: April 2011 Review Date: April 2014 Policy Developer (Author): S Coopey Policy Developers designation: Practice Development Nurse Specialist Policy Developers contact details: Mobile 07876136718 email: [email protected] (including email address) File name and document pathway: (i.e. P\general\.....) Is this a New Policy? Yes If Yes, why is it required? (i.e. new legislation necessitating HCHC compliance)

If No, name of current Policy under review : (if different from above) If No, reason for reviewing current policy: (i.e. Policy review date expiring, change in legislation necessitating policy amendment)

Who has been involved/consulted in order to develop this Policy? This policy has been developed from the Leeds PCT policy How does the Policy link to: Standards for Better Health identify which Standard: National Service Framework for Older People to avoid age discrimination and promote positive attitudes to older people:

Have you considered in your Policy development the impact of your Policy on: Health and Safety at Work etc. Act 1974 Yes Sex Discrimination Act 1975 Yes Race Relations Act 1976 Yes Human Rights Act 1998 Yes Disability Discrimination Act 1995 Yes Freedom of Information Act 2000 Yes Environmental Information Regulations 2004 Yes Re-use of Public Sector Information Regulations 2005 Yes Race Relations (Amendment) Act 2000 Yes Civil Contingencies Act 2005 Yes Mental Capacity Act 2005 Yes Other (please specify): Policy Ratification Joint Staff

Committee

Professional Executive Committee

Trust Board

Date submitted to: Date re-submitted (if applicable): Date approved:



Contents page

1 Introduction 6 2 Status 6 3 Scope 6 4 Definitions 6 5 Ethical issues 7 6 Resources and equipment 7 7 Rehydration in older people 8 8 The Use of Fluids Licensed for Intravenous Use 8 9 Advantages 8 10 Disadvantages 8 11 Sites 9 12 Choice of cannula 9 13 Fluids 9 14 Use of Hyaluronidase 11 15 Monitoring the infusion 11 16 Documentation 11 17 Training 12 18 Audit and Monitoring 12 19 References 12

Appendix

1. Procedure for the administration of subcutaneous fluids 14 2. Infusion record 16 3. Competency tool 17 4. Training needs analysis 21 5. Equality Impact tool 22



1. Introduction

This guideline identifies the principles and procedures for the management of subcutaneous fluids to adult patients for the management of symptoms of dehydration.

2. Status

This is a clinical guideline

3. Scope

The contents of this document apply to all Registered Nurses working within Hampshire Community Health Care (HCHC).

4. Definitions

Hypodermoclysis Hypodermoclysis is a technique used for the subcutaneous administration of large volumes of fluids and electrolytes in order to achieve fluid maintenance or replacement in mildly dehydrated patients for whom intravenous access may be difficult to obtain, or who cannot tolerate sufficient oral intake

Hypodermoclysis can be considered for use in patients with:

Life-limiting conditions Difficulty maintaining oral hydration Mild to moderate dehydration Difficult venous access Stroke, palliative care and cognitive impairment

Hypodermoclysis should not be considered for the following:

Children Patients experiencing severe dehydration (where IV fluids are required) Severe Renal Failure Severe Hepatic Failure Hypercalcaemia Shock or poor tissue perfusion Any patient for whom fluid balance management requires accurate and intensive monitoring If > 3 Litres fluid to be administered over 24 hours



5. Ethical issues

Patients who are in the last few days or weeks of life are often unable to tolerate oral hydration. The prime goal of any treatment towards the end of life must be the comfort of the patient. Considerations around how to approach the issue of hydration at the end of life are complex and involve not only physical, psychological and social concerns, but also ethical dilemmas. (Salt, S. 2007). A review of the literature continues to give conflicting views as to the role and effectiveness of hypodermoclysis and a comprehensive reading list is provided in this guideline for those interested in further information regarding these views. In summary there are two schools of thought those who believe artificial hydration for this group of patients is unnecessary, not beneficial and potentially harmful, whilst others contend that dehydration in patients who are dying can be extremely distressing and should be given the same priority in terms of symptom control as is given to the control of pain, nausea and vomiting etc.

Whilst it is important that clinicians have information about the latest evidence base regarding hypodermoclysis so that they can contribute to the decision making process about whether or not to use subcutaneous hydration for a dying patient, the purpose of this guideline is to support clinicians in the safe delivery of subcutaneous fluids.

In order for the patient to give their informed consent (which can be written or verbal), they need to have a clear understanding of:

What the subcutaneous fluids are being used for (with particular reference to them being used off license)

The purpose of administering them How the decision will be made to stop the infusion (if appropriate)

It is important that the practitioner understands the reasons behind the decision for each individual patient so that she (he) is able to discuss this with the patient/carers/family as required. It is also important that the situation is constantly reassessed in terms of whether the hydration regime is helping to relieve symptoms.

Where a patient may lack capacity to consent to hypodermoclysis and the treatment is considered in their best interests practitioners will need to refer to the guidance contained in the Mental Capacity Act 2005 Code of Practice.

6. Resources and Equipment

Fluids for infusion Administration sets Drip stands Butterfly/ cannula Semi-permeable film dressing Sharps bin Documentation/infusion record



7. Rehydration in Older People

Dehydration can be a common problem in older people. Acute problems such as mild infections, vomiting and diarrhoea, temporary confusion due to change in medication could all precipitate dehydration because an adequate fluid intake cannot be maintained (Ferry et al, 1999). For older people with mild dehydration or at risk from mild dehydration subcutaneous fluids are a safe intervention that could potentially prevent the need for hospitalisation.

8. The Use of Fluids Licensed for Intravenous Use

The solutions outlined in these guidelines are only licensed for use intravenously. Therefore the use of these subcutaneously is an unlicensed procedure (or being used off-license). The effective use of infusion fluids in this way has been well documented and the prescriber will be conversant with such evidence. It is important that the patient is made aware of this issue as it forms part of the consent required for the procedure.

As the fluids are to be used off license, only a medical prescriber can prescribe these fluids. A Clinical Management Plan (CMP) will be developed for use by Independent Non Medical Prescribers (NMPs).

9. Advantages

The infusion is usually easier to set up than intravenous (IV) fluid therapy and can be set up by a nurse in almost any setting

It does not cause thrombophlebitis It is often better tolerated by the patient It can be discontinued and commenced with no ill effects, as part of the patients management

plan (e.g. where patients are mobile and active) It can be administered in the patients own home or nursing and residential care homes, thus

possibly preventing hospital admission or enabling speedier discharge

10. Disadvantages

It is not appropriate in severe dehydration A limited volume or range of fluids can be administered There is a small risk of inflammation Local oedema can occur and be associated with a feeling of tightness and discomfort. This

normally clears within a few hours and causes no permanent ill effects The infusion can dislodge easily



11. Sites

The site for placement of the cannula should be chosen with consideration to the following:

Limiting the potential for jostling of the cannula in situ Loose subcutaneous tissue will allow for the ease of administration of large volumes of fluid Patient comfort and safety The need to mobilise Lucidity/confusion of the patient

The abdomen, chest and lateral aspects of the upper arm or thigh are recommended sites. The following areas should be avoided:

Areas of lymphoedema or ascites as absorption will be restricted and breaches in skin integrity could increase risk of infection

Bony prominences Recently irradiated skin sites Joints and skin folds Sites of tumour Areas of broken skin Areas of inflammation or infection Areas where medication patches or other topical applications are in place

The subcutaneous needle should be changed every 48 hours.

If resiting and need to use same area, the needle must be at least 3cm away from problem site.

12. Choice of Cannula

Choice of cannula should take into account the specific needs of the patient.

A cannula with a safety system such as BD saf-T-Intima should be used.

13. Fluids

Fluids that can be administered by hypodermoclysis:

Sodium chloride 0.9% or 0.45% Dextrose (Glucose) 5% Dextrose saline (Glucose 4% with sodium chloride 0.18%) Potassium infusion of no more than 20mmol/L (pre-prepared infusion e.g. potassium chloride and sodium chloride infusion)



When administering the above fluids under no circumstances should any medications be added to them.

Under no circumstances should any other fluids (other than those mentioned) be administered via the subcutaneous route.

Special precautions:

Sodium chloride infusion: Maximum 3 litres in 24 hours Maximum 2 litres using a single site

Dextrose (Glucose) 5% infusions: Maximum2 litres in 24 hours Regular monitoring of the site to look for early signs of irritation and inflammation due to acidic pH of glucose

Potassium infusions: Maintain strict site observation because of risk of irritation Do not exceed recommended concentrations

Sodium chloride 0.9% would normally be used where the patient is suffering electrolyte losses such as gastro-enteritis.

Dextrose (Glucose) 5% is more commonly used where dehydration is present due to fluid losses exceeding intake such as coma and dysphagia.

Regimens using both Dextrose (glucose) 5 % and saline in combination or saline 0.18% and glucose 4% (Dextrose saline), can be used where patients need both electrolyte and fluid replacement. Injudicious use of the latter may cause hyponatraemia in the elderly.

The rate setting for 1 Litre over 12hrs will be 28 drops per minute (when using an administration set that delivers at 20 drops /minute).

Volume of fluid (ml) x set value (drops/ml) /minutes = Flow rate (drops/min) duration (hr)

Fluids may also be infused more slowly, for example 1 Litre over 24 hours in which case the rate would be 14 drops per minute.

The drip rate should be as per fluid prescription chart Advice should be sought from the pharmaceutical advisor if asked to administer any other

fluid/or if asked to administer more quickly.

Fluids must be gravity fed and regulated (i.e. using a drip stand, giving set and calculating the drip rate) and NOT infused using a pump (Hypodermoclysis working Group 1998)



14. Use of Hyaluronidase

Hyaluronidase is an enzyme, which assists and speeds up the absorption of subcutaneous fluids. Hyaluronidase may be of benefit to patients in whom sites become quickly oedematous (often those with cachexia).

The use of Hyaluronidase is not routinely necessary and can cause local irritation or systemic allergic reactions.

A daily dose of 1500 units is administered subcutaneously into the site before starting the infusion. It can be used if more than two litres of fluids are infused over 24 hours or an infusion rate of more than one litre in 8 hours (2ml/min).

15. Monitoring the Infusion

The infusion site must be checked every shift/ on each visit. The infusion must be checked to ensure it is maintaining a continuous regular fluid flow at each nursing intervention. Observations of the infusion site as well as ensuring that the infusion is running to time must be recorded in the patients notes at each visit. The site must be checked for signs of redness, swelling, tenderness or leakage around the entry site and the infusion site should be renewed if these symptoms occur. If reactions occur, consider the following;

Change the infusion cannula to non-metallic type Change the type of site dressing

Although it is anticipated that patients with an infusion of subcutaneous fluids in situ will be receiving frequent visits from clinicians over a 24 hour period, there are some exceptions to this. It is not necessary for clinicians to visit specifically to check the infusion if the patient does not require more frequent visits for whatever reason. Monitoring can be delegated to a carer provided they are given the appropriate training/information. Clinicians should use their professional judgement to decide frequency of monitoring and visits and ensure, where appropriate, that relatives and carers are advised on how to detect any problems with the infusion and given contact numbers for reporting these. Relatives and cares should be provided with written information/ leaflet to support the nurse instructions.

16 Documentation

Documentation in the patients nursing record should contain complete information regarding infusion therapy (INS 2000; ICNA 2000), and should comply with the guidelines for record keeping (NMC 2008). This should include:

evidence of consent (or other measures taken where a patient lacks capacity) date and time of insertion/commencement of therapy and site rate of infusion, and fluid being infused evidence of consequent monitoring to include report on site check, rate of infusion, patients

tolerance of therapy



discontinuation of therapy(including date/time and volume infused) and document the reason for discontinuation - either due to completion, adverse reaction, patient decision/choice or if the infusion is considered to be no longer beneficial.

signature and printed name

Staff should use the infusion record for the administration of subcutaneous or intravenous fluids (Appendix 2)

17. Training Needs

Hypodermoclysis can be commenced by any registered nurse who is capable of administering subcutaneous injections and insertion of a subcutaneous needle. There is no formal training within HCHC for this area of practice as it is considered unnecessary. This is because the clinical skills staff need to site a subcutaneous needle and to care for an infusion site are covered in existing training provision (syringe driver training). Additional knowledge requirements are covered within this policy.

However, it is recognised that this is a new area of practice for many staff so to support staff in gaining confidence a competency framework has been developed (see Appendix 2). This can either be used as a self assessment tool or to support colleagues within the team to gain competence.

Any registered nurse required to administer subcutaneous fluids to a patient should ensure they have the knowledge, skills and competence. Staff are encouraged to support less experienced colleagues to gain skills and competence where necessary This may include visiting the patient in hospital/ hospice prior to discharge or another community team to learn from colleagues.

18. Audit and Monitoring

Adherence to this guideline will be monitored through incident reporting within HCHC. The above measures will not only inform of any potential training needs but may also contribute to ongoing research into the ethical issues surrounding the use of this treatment.

19. References

Hypodermoclysis working group. Hypodermoclysis : guidelines on technique.1998. Wrexham: CP Pharmaceuticals (111)

Intravenous Nurses Society (INS,2000) Standards for Infusion Therapy. Cambridge, MA ins AND Becton Dickinson (III)

Infection Control Nurses Association (ICNA, 2000) Guidelines for preventing intravascular catheter-related infections. Fitwise Publications (III)



Nursing and Midwifery Council (2008) The Code - Standards of conduct , performance and ethics for nurses and midwives

Nursing and Midwifery Council (2008) Standards for Medicines Management

Nursing and Midwifery Council (2008) Record Keeping Advice Sheet

Salt, Susan. (2007) When a terminal patient is no longer able to eat or drink. End of Life Care, 2007, Vol1, No. 3

The Mental Capacity Act 2005 Code of Practice

Reading List

Campbell, C. Partridge, R. (2007) Artificial Nutrition and Hydration Guidance in End of Life Care for Adults. National Council for Palliative Care. London

Dunphy K, Finlay I, Rathbone G & Hicks F (1995) Rehydration in palliative care: if not - why not? Palliative Medicine 9: 221 - 228

Fasinger RL, MacEachern T, Miller MJ, Bruera E, Spachyski K, Juehn N & Hanson J, (1994) The use of hypodermoclysis for rehydration in terminally ill cancer patients. Journal of Pain and Symptom Management 9 (5); 298-302.

Ferry M, Daradire V & Constans T (1999). Subcutaneous infusion of hypodermoclysis : a practical approach. Journal of the American Geriatrics Society;47:93-95.

Gill S, Daspupta M & Rochon P(2001) Hypodermoclysis for dehydration. American Family Physician;64:9,1516-1518.

Lanuke, K. Fasinger, R.L. (2003) Hydration management in palliative care settings a survey of experts. Journal of Palliative Care. 19 (4): 278-9

Morita, T. Hyodo, I. Yoshimi, T. et al (2006) Artificial hydration therapy, laboratory findings, and fluid balance in terminally ill people with abdominal malignancies. Journal of Pain and Symptom Management 31(2): 130-9

Steiner,N , Bruera,E (1998) Methods of Hydration in Palliative care patients. Journal of palliative care,14 (2) 6-13 Summer.

Jilek R. (1999) Subcutaneous Fluid Administration: An effective alternative to intravenous therapy. Geriatrician; 17 (1) 16-18.



Appendix 1

Procedure for the administration of subcutaneous fluids

Action Rationale 1. Identify the patient correctly using name, date of birth, NHS number and wristband

To identify the right patient

2. Explain the procedure to the patient and/or carer, allowing time for any questions. Ensure they understand the use of IV fluids for subcutaneous use is unlicensed but best/accepted practice and have the required information for monitoring.

To ensure the patient/family are fully informed and to gain valid consent where appropriate

3. Assess the patient for a suitable site. (See 11.0 above)

To provide a comfortable and safe area for fluid absorption

4. Before administering any prescribed fluid check that it is due and has not already been given.

To protect the patient from harm.

5.Check the fluid against the prescription chart and ascertain and record the following: a) prescription is valid b) fluid name, strength and volume c) batch number and expiry date d) infusion route and rate.

To ensure that the correct type and quantity of fluid are administered by the correct route To protect the patient from harm (NMC May 2008) Standards for Medicines Management (NMC 2008)

6. Check expiry date and integrity of the fluid container to be used. Check infusion fluid for discolouration/ crystalline or particulate matter.

Prepare the fluid for infusion by inserting line into infusion bag and priming line with fluid

To prevent an ineffective or toxic compound being administered to the patient. To check that no contamination has occurred

7. Clean the injection site with swab saturated with 70% Isopropyl alcohol for 15 30 seconds and allow to dry.

To reduce the risk of site contamination

8. Introduce the Butterfly needle/ peripheral cannula at the angle recommended by the manufacturer bevel up. Technique gently pinch a well-defined amount of tissue between the index finger and thumb and insert the needle into the base of the pinch.

To ensure the needle lies in the subcutaneous space

9. If blood appears in the line on insertion of the needle, withdraw immediately and repeat the process in a different site.

To prevent infusion into a blood vessel

10.Coil the tubing and secure with a semi permeable film dressing e.g. Tegaderm

N.B If the patient is also receiving subcutaneous medication via a syringe driver, it is advisable to mark the lines to differentiate between the two infusions

To prevent kinking. To secure the line and prevent contamination

11. Set the infusion at the prescribed rate To ensure the fluid is infused correctly

12. Dispose of sharps safely in yellow Sharps bin.

Prevention of needle stick injuries

13. Monitoring at each visit: To identify signs of infection / prevention of



Check infusion site for signs of redness, swelling, tenderness or leakage around the entry site and record that you have checked.

Check volume remaining is (approximately) correct for the prescribe volume and administration rate i.e. is running to time, and record that you have checked.

Check for any signs of blood in the administration set, plastic cannula or butterfly needle.

If any of the above are present and infusion incomplete, stop the infusion and remove the cannula/needle.

Re-site the infusion in a different area using a new cannula/needle. If sites are restricted for any reason, re-site in the same area but at least 3cm from the original site of entry.

complications

To achieve the rate prescribed

14. Record details of infusion in patient record / medical notes to include- date and time commenced observations of infusion site signature date & time discontinued signature on the appropriate record (see App. 2) and in the patients patient held records as necessary.

To maintain accurate records. To provide a point of reference in the event of any queries. To prevent any duplication of treatment



Appendix 2 Infusion record



Appendix 3

Administration of subcutaneous fluids clinical competencies

Name:

Role:

Base:

Date initial training completed:

Competency Statement: The participant demonstrates clinical knowledge and skill in the administration of subcutaneous fluids without assistance and/or direct supervision (level 3) See page 5 for level descriptors.

Performance Criteria Assessment Method

Level achieved

Date Assessor/self assessed

The Participant will be able to:

1. Demonstrates practical skill in the safe and effective administration of subcutaneous fluids, via a Butterfly needle/soft set and ongoing monitoring of the site

a) Explain the procedure to the patient and/or carer, allowing time for any questions. Ensure they understand the use of IV fluids for subcutaneous use and have the required information for monitoring

Direct observation

b) Assess the patient for a suitable site.

Direct observation

c) Before administering any prescribed fluid check that it is due and has not already been given

Direct observation

d) Check the fluid against the prescription chart and ascertain and record the following: 1. Prescription is valid 2. Fluid name, strength and volume 3. Infusion route and rate

Direct observation

e ) Check expiry date and integrity of the container of the fluid to be infused

Prepare the fluid for infusion by inserting line into infusion bag and

Direct observation



Performance Criteria Assessment Method

Level achieved

Date Assessor/self assessed

priming line with fluid

f) Ensure site is cleaned Direct observation

g) Introduce the Butterfly needle/ peripheral cannula at the angle recommended by the manufacturer, bevel up.

Direct observation

h) Take appropriate action if blood appears in the line on insertion of the needle by withdrawing immediately and repeating the process above in a different site

Questioning / Direct observation

i) Coil the tubing and secure with a semi permeable film dressing

Direct observation

j) Set the infusion at the prescribed rate

Direct observation

k) Dispose of sharps safely in sharps bin

Direct observation

l) Record details of infusion to include: observations of infusion site signature date & time discontinued signature on the HCHC infusion record (see App. 2) and in the patients patient held records as necessary

Direct observation



Date all elements of Competency Tool completed to level 3_______

I confirm that I have attended initial training on _________and that I am confident and competent in administration of subcutaneous fluids

Registered Nurse ______________ Signature _______________ Status ___________ Date _______

I confirm that I have assessed the above named Registered Nurse and can verify that he/she demonstrates competency in administration of subcutaneous fluids

Verifier _______________Signature _______________Status ___________ Date ____

Review Dates:

Competent Yes / No

Registered Nurse Signature

Verifier signature Comments



Levels of competency Rating Scale

Level of achievement Level Novice Cannot perform this activity satisfactorily to the

level required in order to participate in the clinical environment

0

Can perform this activity but not without constant supervision and assistance

1

Can perform this activity with a basic understanding of theory and practice principles, but requires some supervision and assistance

2

Competent Practitioner

Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision

3

Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision, at an appropriate pace and adhering to evidence based practice

4

Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision, at an appropriate pace and adhering to evidence based practice. Additionally demonstrating initiative and adaptability to special problem situations.

5

Expert Can perform this activity with understanding of theory and practice principles without assistance and/or direct supervision, at an appropriate pace and adhering to evidence based practice. Demonstrate initiative and adaptability to special problem situations, and can lead others in performing this activity

6

Adapted from: Herman GD, Kenyon RJ (1987) Competency-Based Vocational Education. A Case Study, Shaftsbury, FEU, Blackmore Press, cited in Fearon, M. (1998) Assessment and measurement of competence in practice, Nursing Standard 12(22), pp43-47.



Appendix 4 - Learning & Development Training Needs Analysis

Type of

Training

Target Audience (by

division) Frequency Length Delivery Method Trainer Recording

attendance Strategic responsibility Operational

responsibility

What type of training

is required

?

Identify specific staff groups who

need to attend from each

Business Unit

How often will staff need to

attend?

How long will the training take?

How will the training be delivered?

Who will deliver the training?

Where are they held, who records

attendance?

Who has ultimate responsibility for the

training? Who makes it happen?

Adult BU: All staff (i.e. registered/qualified clinical staff and unregistered clinical support staff)

Within this template below you will have to clearly identify and describe which staff group require which training and at what frequency. So do consider all options - for example qualified clinical: such as nurses, dental nurses, AHPs (OTs, physios & other therapists) including clinical managers, unqualified/unregistered support workers, non clinical managers, other non clinical versions of the staff in the groups already listed, corporate staff including senior staff such as Directors, plus administrative, clerical & estates etc. and contact L&D as soon as possible to agree training needs and to consider whether this is a trust wide training requirement or whether this training is restricted to a local requirement. This must all be completed and agreed with L&D prior to submission the policy board.



Equality Impact Assessment Tool

Name of policy

GUIDELINES FOR THE ADMINISTRATION OF SUBCUTANEOUS FLUIDS (HYPODERMOCLYSIS) TO ADULT PATIENTS IN COMMUNITY SETTINGS

Directorate/ Department

Adult services

Date Impact Assessment Completed

Name of person / department who is accountable for this Impact Assessment? S Coopey

SCREENING

1 Identify the Main Aims of the Proposal

1.1 What is the purpose of this proposal? Provide a brief overview of the proposal including the background, its purpose and scope, and legal factors impacting on the policy. What does it try to achieve?

This policy sets out the standards and procedures for any member of staff , irrespective of age, race, colour, religion, disability, nationality, ethnic origin, gender, sexual orientation or marital status, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or trade union membership

To provide guidance to registered nurses on the safe administration of subcutaneous fluids to adult patients in the community for the management of symptoms of dehydration

1.2 Who will be affected by the outcomes of the proposal? Who is the policy aimed at? How will they benefit?

The contents of this document apply to all Registered Nurses working within Hampshire Community Health Care (HCHC). The policy will be available to other staff independently contracted to the trust



COLLECT INFORMATION It is important to have as much up to date and reliable information about the different groups the proposal is likely to affect.

2.1 What data has been used to inform this Impact Assessment?

2.1a First Level Data If the main impact of the proposal is employees include demographic data. Also detail in terms of age, gender, race, religion or belief, sexual orientation, disability. If the main impact is patients and public, demographic data should be collated.

Second Level Data (e.g., Grievances, disciplinaries, Complaints, risk events, consultation papers, feedback, national guidelines, other impact assessments, local studies)

Monitored through Datix

2.2 Which stakeholders have been involved / consulted in the development of the proposal? (Those who are directly affected by the policy or external bodies with an interest in this proposals impact.)

Community Care teams and Community hospital staff

2.3 How was involvement / consultation carried out?

Virtual discussion and via policy group

2.4 Summary of data/responses

No equality issues raised

A summary of all data is required here. Specific data relating to each equality strand will be required within each equality review in the Full Assessment.



DECIDING WHETHER THE PROPOSAL IS RELEVANT TO THE GENERAL DUTY

If an impact is anticipated a Full Assessment for the relevant equality strand will need completing.

If no impact is anticipated go to section 7.

Based on the data given will this policy / procedure:

Eliminate discrimination?

Promote equality of opportunity?

Promote good relations between people of the same or of different groups?

Race

yes yes yes

Religion and belief

yes yes yes

Disability

yes yes yes

Gender

yes yes yes

Age

yes yes yes

Sexual Orientation

yes yes yes



4 Race Equality Review (including Religion and Belief)

4.1 State specifically which minority community are affected (or state all)?

travellers refugees immigrants asylum seekers religious and faith groups homeless people people for whom language is a barrier

those involved in the criminal justice system

People from different racial or ethnic groups

those on low incomes Other please state

4.2 What solutions have been implemented to mitigate or reduce this impact?

4.3 What is the anticipated impact of the proposal on the identified minority communities?

What further data has been used? Results of involvement and consultation events, focus groups etc that have been implemented to gain further understanding of this impact.

4.4 List the stakeholders involved in the development of these solutions

4.5 How was this involvement carried out?



FULL ASSESSMENT

5 Disability Equality Review

5.1 Consider which disabilities are affected?

learning or development difficulty mental health conditions mobility disabilities sensory disabilities progressive long term health

conditions older people

those on low incomes Other please state

5.2 What is the anticipated impact of the proposal on those people with a disability?

5.3 What solutions have been suggested to eliminate this impact?






FULL ASSESSMENT

6 Gender (include transgender issues), Age and Sexual Orientation Review

6.1 State specifically which people are affected (or state all)

men women boys girls lesbian gay bi-sexual transgender pregnant women people with caring responsibilities

those on low incomes other please state

6.2 What is the impact of the proposal on gender, age and sexual orientation issues?

6.3 What solutions have been suggested to eliminate this impact?






7.1 Proposed Actions

It is proposed that the policy is implemented and disseminated to all managers and staff at the earliest opportunity

7.2 How will the proposal be monitored?

The policy will be monitored through the Learning Management System.

The policy is to be reviewed routinely every three years or sooner in response to technical amendments or as a result of changes in national / local guidance and/or legislation changes

7.3 What is the time frame for monitoring?

Every three years

7.4 Person/s responsible for proposed actions and review

Policy Group

7.5 Include a Glossary of Terms relating to this EQIA

7.6 Summary for Board Paper

This paper does not have any impact however will be monitored by Datix

Impact assessing this proposal will be an ongoing process As more data becomes available it will be added to the Assessment as appropriate

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