Contents
1 Aim
The development of the band 3 health care assistant practitioners within the community will incorporate the administration of Insulin, Hydroxocobalamin and low molecular weight heparins.
The administration of Insulin, Hydroxocobalamin and low molecular weight heparins is an important element of health care within the community setting which, for the purpose of this standard operational procedure (SOP), is identified as the patient’s own home or residential care setting.
Because of increasing age, infirmity and complexity of disease pathways patients need the assistance of healthcare staff to administer injectable medications to them; therefore, to meet these service demands it is imperative that staff are utilised and trained accordingly to provide excellent patient care within community settings.
Health care assistants within Doncaster Care Group will be enabled to administer Insulin, Hydroxocobalamin and low molecular weight heparins through the use of this SOP.
2 Purpose
This standard operating procedure (SOP) aims to provide a framework for non-registered practitioners to use in order to administer Insulin, Hydroxocobalamin and low molecular weight heparins.
This SOP will ensure that the delivery of care meets the standards required by CQC and to the professional standards of the NMC as would be the expectation of all competent practitioners.
The non-registered practitioner would be expected to adhere to the policies and clinical skills package relevant to the administration of Insulin, Hydroxocobalamin and low molecular weight heparins.
This SOP is used in conjunction with the:
- safe and secure handling of medicines manual
- infection prevention and control manual
- waste policy
- clinical risk management system policy
3 Scope
The SOP applies to health care assistants (HCA) Band 3 within physical health care group (community teams) who have undertaken training and development in order to attain the knowledge and skills required to safely administer Insulin, Hydroxocobalamin and low molecular weight heparins.
A delegating and accountable registered nurse will identify the patients who are appropriate for this service. Taking into account; stability of disease process, mental capacity, and an identified need for a practitioner to administer the prescribed treatment on behalf of the patient, who has given consent.
3.1 Link to overarching policy or procedure
This SOP is overarched by the safe and secure handling of medicines manual.
4 Responsibilities, accountabilities and duties
4.1. Registered practitioners with delegating responsibility
The registered practitioner is accountable for the delegation of any aspects of the task and to ensure that the individual is competent to carry out the task as identified in the healthcare competency assessment training package, including the assessment and supervision of practice (NMC, 2010). The registered practitioner must complete a comprehensive assessment of the patient and ensure that they are medically stable:
For Insulin and low molecular weight Insulins this should be on a weekly basis. This assessment should indicate whether the patient is suitable for administration of the medication by a HCA. Has the patient been unstable, for example, hypoglycaemic or hyperglycaemic which is outside of the patients agreed acceptable parameters then the registered practitioner should administer the insulin until the patient is deemed stable.
For other items then the frequency of review should be agreed with the registered practitioner.
4.2. Health care assistants
The HCA band 3 will attain competency in all elements of medication administration by:
- attending a HCA band 3 training day delivered by the trusts CPTs
- completion of HCA band 3 competency assessment booklet for which the Band 3 will be assigned a mentor
- completion of the six steps to Insulin safety online e-Learning
- completion of 000 safe use of Insulin located on ESR
- yearly reassessment competencies by a registered practitioner to ensure knowledge and skills are maintained
- ensuring that care plans are set for the next visit
Each individual health care assistant remains responsible for their own actions and omissions as per Rotherham, Doncaster and South Humber Foundation Trust (RDaSH) Code of Conduct for Health and Social Care Support Workers in RDASH. No individual should undertake the administration of Insulin, Hydroxocobalamin or low molecular weight Heparin without the appropriate knowledge and skill. Competency will be assessed by a registered practitioner using an RDASH acknowledged tool for example, CCAST.
It is the health care assistant’s responsibility to check that the patient has been reviewed by a registered practitioner on a weekly basis and the patient is considered of appropriate stability and that circumstances have not changed, allowing the health care assistant to administer the medication. The healthcare assistant to review the last 3 visits prior to administration.
5 Prescribing of medication, Insulin
The Insulin will be prescribed by the patients’ general practitioner, hospital doctor or a trust employed non-medical prescriber.
Relevant data including the prescriber’s signature is visible on SystmOne:
- the patients full name, including aliases
- date of birth
- address
- NHS number
- full name of Insulin
- dose of medication
- the word ‘units’ written in full (for insulin doses)
- time of each injection or required time frame
- route (subcutaneously)
- allergy status
The health care assistant must have attained the appropriate competency level as identified in the healthcare competency assessment training package in order to administer Insulin.
This competency level must encompass community life support and anaphylaxis. The policies aforementioned in 2 must be understood and adhered to.
5.1. Blood glucose monitoring for diabetic patients
An agreed target range for blood glucose will be on the patients care plan within SystmOne.
Targets will differ for individual patients with diabetes, but the following is the recommended guide determined by the Diabetic Specialist team for most patients:
- fasting, 5 to 7mmol/L
- pre-lunch or pre-teatime, 5 to 7mmol/L
- post-meal (1 to 2 hours), less than 10mmol/L
- bedtime, 6 to 10mmol/L
Blood glucose results outside of the patients target range should be reported to the registered nurse responsible for the patients care.
Blood glucose results persistently outside of the patients target range should be reported to the appropriate prescriber to review the patient’s insulin regime.
Day to day blood glucose levels should be stable within patients agreed parameters, injection sites free from Lipohypertrophy (this will need to be assessed by registered practitioner on a weekly basis) HbA1c stable within patients agreed parameters)
5.2. Procedure for administration of Insulin
Ensure prescription of Insulin is completed as per policy. Check both the electronic record and paper copy of the Instruction to administer for the most recent prescribed dose.
Prior to administration the HCA must ensure:
- the correct patient
- the correct drug
- the correct dose
- the correct date and time
- the correct route and method of administration
- the validity and legibility of the prescription
- the signature of the prescription or instruction
- allergy status
The HCA will explain the procedure to the patient and obtain consent.
The HCA will accurately draw up the correct Insulin safely and appropriately.
The HCA will safely and accurately administer the medication by the route intended following infection control and the safe disposal of sharps policies.
The HCA will record batch numbers and expiry dates of medications used within the patient record as per record keeping standards. Also required to record dose of insulin administered and blood glucose level.
The HCA will ensure that current stock levels are checked and arrange further prescription if required.
The HCA will ensure care plan is set for the next scheduled visit.
6 Prescribing of medication, Hydroxocobalamin
The Hydroxocobalamin will be prescribed by the patients’ general practitioner, hospital doctor or a trust employed non-medical prescriber.
Relevant data including the prescriber’s signature is visible on SystmOne:
- the patients full name, including aliases
- date of birth
- address
- NHS number
- full name of Hydroxocobalamin
- dose of medication
- time of each injection or required time frame
- route (Intramuscular)
- allergy status
The health care assistant must have attained the appropriate competency level as identified in the healthcare competency assessment training package in order to administer Hydroxocobalamin.
This competency level must encompass community life support and anaphylaxis. The policies aforementioned in 2 must be understood and adhered to.
6.1. Procedure for administration of Hydroxocobalamin
Ensure prescription of Hydroxocobalamin is completed as per policy.
Prior to administration the HCA must ensure:
- the correct patient
- the correct drug
- the correct dose
- the correct date and time
- the correct route and method of administration
- the validity and legibility of the prescription
- the signature of the prescription or instruction
- allergy status
The HCA will explain the procedure to the patient and obtain consent.
The HCA will accurately draw up the hydroxocobalamin safely and appropriately.
The HCA will safely and accurately administer the medication by the route intended intramuscular injection and follow infection control and the safe disposal of sharps policies.
The HCA will record batch numbers and expiry dates of medications used within the patient record as per record keeping standards.
Hydroxocobalamin can be administered by the HCA Band 3 once the patient is on a stable regular dose. This must be reviewed by the registered practitioner at alternate doses administered by the HCA Band 3 to ensure patient stability and suitability.
7 Prescribing of medication, low molecular weight Heparin
The low molecular weight Heparin will be prescribed by the patients’ general practitioner, hospital doctor or a trust employed non-medical prescriber.
Relevant data including the prescriber’s signature is visible on SystmOne:
- the patients full name, including aliases
- date of birth
- address
- NHS number
- full name of low molecular weight Heparin
- dose of medication
- time of each injection or required time frame
- route (subcutaneously)
- allergy status
The health care assistant must have attained the appropriate competency level as identified in the healthcare competency assessment training package in order to administer low molecular weight Heparin.
This competency level must encompass community life support and anaphylaxis. The policies aforementioned in 2 must be understood and adhered to.
Low molecular weight heparins can be administered by the HCA band 3 once the patient is on a therapeutic dose. This must be reviewed by a registered practitioner on a weekly basis to ensure patient stability and suitability of the HCA administering the medication.
Patients on the bridging protocol for low weight molecular heparin will be required to be visited by a registered practitioner.
The HCA can only administer a full prescribed dose from a prefilled syringe.
8 Procedure for administration of low molecular weight Heparin
Ensure prescription for low molecular weight Heparin is completed as per policy.
Prior to administration the HCA must ensure:
- the correct patient
- the correct drug
- the correct dose
- the correct date and time
- the correct route and method of administration
- the validity and legibility of the prescription
- the signature of the prescription or instruction
- allergy status
The HCA will explain the procedure to the patient and obtain consent.
The HCA will safely and accurately administer the medication by the route intended following infection control and the safe disposal of sharps policies.
The HCA will record batch numbers and expiry dates of medications used within the patient record as per record keeping standards.
9 References
In addition to the above policies the below clinical skills packages are available on the learning and development intranet page:
- administering intramuscular injections
- blood glucose monitoring
- subcutaneous injection
- six steps to safer insulin (login required) (opens in new window)
Document control
- Version: 3.
- Unique reference number: 449.
- Date ratified: 20 December 2023.
- Ratified by: Clinical policies review and approval group.
- Name of originator or author: Community practice teachers (CPT).
- Name of responsible individual: Executive medical director.
- Date issued: 27 December 2023.
- Review date: 31 December 2026.
- Target audience: Physical health care group (physical health community teams).
- Description of changes: Administrative errors, part of the SOP rearranged for better flow of reading, competency tool added. Updated terminology. Allergy status added to bullet points. Bullet points rationalised.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025