McKinley T34 Syringe Driver - Phyllis Tuckwell...flick wrist movement When driver not in use ensure batteries removed for storage Dispose of batteries in line with local policy 8 of
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1 of 18
Learners Name:
CLINICAL SKILLS COMPETENCY ASSESSMENT
McKinley T34 Syringe Driver Version
1.3 Date ratified
23/4/2020 Review Date
2023
2 of 18
Learners Name:
Pre-requisite(s) The learner must have achieved the following pre-requisites before they attempt the formative supervised practice
and then the summative sign off.
UN AP RN AHP
x Unregistered Staff
x Associate Practitioners /
Student AP
Registered Nurse
Adult/child
x Allied Health Professional
(HCPC registered)
1 Completed the mandatory medicines administration training
2
Read and understood following up to date policy
Syringe driver guidance
NMC code of conduct1
Waste disposal policy
Adverse incident reporting
3 Be up to date with infection control training
Name of competency
The competency is for
Responsibilities in Practice Learner
Must only undertake skills within their identified scope of practice and have completed relevant training
and/or knowledge update before presenting for competency assessment.
The Learner should have read, understood, signed and have a copy of the NMC Code (2018)1, or HCPC
standards of conduct, performance and ethics (2016)2, or HCA Code of Conduct (2013) 3 (as appropriate to
position)
Practice Supervisor The Practice Supervisor must have completed Supporting Learning in Practice (SLiP) training or equivalent.
The Practice Supervisor must be competent4 in the standards within this competency.
The Practice Supervisor should have read, understood, signed and have a copy of the NMC Code (2018)1, or
HCPC standards of conduct, performance and ethics (2016)2 (as appropriate to position).
To have read and understood relevant, local and national policy relating to this competency.
Practice Assessor/sign-off For the purpose of this document the Practice Assessor/sign-off is a qualified/registered practitioner
The Practice Assessor/Sign-off should have read and understood the NMC Code (2018)1, or HCPC standards
of conduct, performance, and ethics (2016)2, (as appropriate to position)
To have read and understood relevant local and national policy relating to this competency
Following summative assessment, if learner achieves all standards, complete and sign off the competency
and declaration form. If not then the development plan to be completed.
3 of 18
Learners Name:
Print Name Signature Designation
Practice Supervisor/Practice Assessor sign below if they have signed off any
observations within this competency:
Signature records form
4 of 18
Learners Name:
Date/time Activity Areas for
Development Supervisor’s Name
Supervisor’s Signature
Write w
ithin
table b
elow
Once supervised practices completed (minimum 2) the Practice Assessor can
complete Summative Assessment using the following competency document.
Assess in simulated situation and only after competent work with shadow RN
in patient set up.
Each episode of formative supervised practice relating to this competency must be logged
This is a compulsory activity to obtain competency
Must have evidence of a minimum of 2 formative supervised practices
Multiple Practice Supervisors are allowed until the learner is ready to have summative assessment
completed.
Formative Supervised Practice Log
5 of 18
Learners Name:
Date Standard number
Areas for development through Formative Practice
Development guide – Formative
6 of 18
Learners Name:
Stan
dar
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
Can demonstrate: an understanding of the indications where a McKinley T34 syringe driver may be required.
The information required for the patient and consent. Which charts and documents required
1a
Can identify indications for
using a syringe driver (in a
palliative setting) Q
Persistent nausea and/or vomiting
Dysphagia – intermittent or continuous oral pharyngeal lesions
Intestinal obstruction
Patient too weak to swallow oral medication
Diminishing level of consciousness
Malabsorption of oral medication
Rectal route not appropriate or not available
Can identify other situations
(not palliative) where syringe
driver may be used
Persistent nausea and/or vomiting during chemotherapy
Pain control where absorption problem
1b
Discuss what information
should be communicated to the
patient prior to setting up the
syringe driver
Q
Different route to manage symptoms
Driver will deliver medication over 24hour period with up to 3 medication
Reassure dose is calculated using patients’ current oral doses
Reason for the medications being used & possible side effects
1c How to obtain consent Q Verbal consent (if patient able to give)
If lack of capacity or unconscious: best interest decision
1d
Can explain which
charts/documents should be
completed prior to and during
use of a syringe driver
Q
Syringe driver medication/instruction chart (correctly documented)
Daily administration chart/checklist completed each day
PRN medication chart – may require amending if 24 hour doses are changed
Stock sheet for CD’s in the community
Summative Assessment
Competent: The expectation is that the nurse is able to demonstrate efficiency, is coordinated and has confidence in
his/her actions performing this activity satisfactorily without supervision and/or assistance, displaying high quality of
work with understanding and appropriate application (Benner 1984).
Pass Criteria The Learner must have achieved every standard listed below during the summative assessment in order to be
fully signed off
The Learner must have completed a minimum of 2 formative supervised practice episodes, prior to summative
assessment.
7 of 18
Learners Name:
Stan
dar
d N
o
Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
Can identify all safety pre-checks
2a
Can identify pre-use safety
measures, and considerations
following MHRA/ field reports
on the syringe driver Q
OP
Must only be used on people aged 18+
Can locate the serial number above gold bar
Locate the service sticker and the date last services
Know that yearly servicing is required
Check it is clean and visibly intact
Decontaminate with 70% alcohol wipes, avoid universal Clinell = moisture egress
Understand devices are pre-set ‘Lock-On’ over 24 hours
Check lead screw to ensure no white powder (Field notice 2019)
Can identify actions to be taken
in case of malfunction
Report, complete documentation with clarity of event and send to maintenance team
Ensure it is clearly labelled not in use
Can competently identify all components-key pads of the McKinley T34 Syringe driver, the equipment used in
conjunction with it and the preparation of medications
3a
Can locate and identify all
components on McKinley
syringe driver
OP
On/Off grey (press and hold for action)
Infusion light – Green = running every 30 seconds
Red = No/ Stop
Green = Start/Yes
Blue = Battery, VTBI/VI and Keypad lock
Forward and back arrows to move actuator
Up and Down= for finding syringe type
Identify serial number which needs to be documented on chart
Gold bar – memory of all events (+500) and can be retrieved to identify fault or errors information off for incident analysis
Battery location and safety with foam pad for 2nd edition, unless updated by BD/CME
3b
Can locate, install, remove and
dispose of batteries
Shows knowledge of how long a
battery can be used for 2nd and
3rd edition drivers
OP
Battery life @100% for 3-4 days. When at 30% replace (2nd Edition). 3rd edition= daily change, unless updated by BD/CME.
9v alkaline – Duracell
Removed back cover and placed the batteries correct way (+ve to +ve)
To remove tapped back of driver or swift flick wrist movement
When driver not in use ensure batteries removed for storage
Dispose of batteries in line with local policy
8 of 18
Learners Name:
Stan
dar
d N
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
3c
Can explain what should be
considered when drawing up
from glass ampoule
Q A 23 gauge (blue) needle as bore too small
to draw up glass
Red filter needle
3d
Can describe what type, and size of syringe to be used according to local guidelines Can explain the limitations and risk assessments used if 50ml syringe is required Know how much each syringe should be filled to
Q
20ml, 30ml & 50ml leur lock BD plastipak
Only use 50mls syringe after completing a risk assessment (environment, family, patient safety without lock box) and raised to senior management if larger lockbox cannot be located
Note: Locally BD Luer Lock 20ml and 30 ml (this allows reasonable diluent, reducing the risk of site complications) Fill syringe to the maximum volume that the syringe pump can deliver in 24 hours
18mls in a 20ml syringe
23mls in a 30ml syringe
3e
What considerations need to be addressed: When gathering correct syringe size. Regards medications to be drawn up into syringe?
Q
Total volume of medication from ampoules and diluent should not exceed the volume allowed in the syringe
This calculation should be done before the medication is drawn up, using the appropriate syringe
Compatibility of all medications and diluent
Discuss understanding of manufacturers overfilling of ampoules and the ramifications if this is not adhered to when drawing up medication from an ampoule
Ensure only the volume prescribed is drawn up i.e. 10mg in 2mls
It is not uncommon for ampoules to be overfilled so if you drew up the whole ampoule you are administering more medication than prescribed
3f
Diluents Is aware of which diluents should be prescribed and mixed with what medication. Can state where to find the resources to support this information
Q
Able to discuss the rationale for the following: Diluent – Normal Saline (0.9%) or Water for Injection
Cyclizine must be mixed with water
Refers to specific medicines’ information in organisations Syringe Driver resources, Palliative Care Network Guidelines, hospital pharmacy
3g
Cannula Discuss how to insert a ‘Saf-T-Intima’ cannula Demonstrate how to insert and apply dressing as this can be completed prior to infusion set up.
Q
OP
Skin prep (isopropyl alcohol 70%) as cannula may be inserted for up to 7 days
Aligning bevel up to the position to insert (using white part)
Insert at 45 degrees
Removal of the needle leaving cannula insitu
Apply semi-permeable clear dressing
9 of 18
Learners Name:
Stan
dar
d N
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
Identify appropriate site for cannula insertion and discuss rationale for this choice
Q
Suitable sites: leg, abdomen, arm, scapula
Avoiding: arms if lying on them unless good lateral area, ascites, oedema, bone prominences
Considering: mobility and patient choice
3h
Line Can discuss the features of the McKinley Line When to prime the line Q
Anti-siphon line
PVC
These lines require a +ve pushing force for fluid to flow (when no force the line is shut i.e. no free flow)
0.5mls for priming – which will not significantly affect the prescription delivery
Double wall so no knotting & kinking
Prime before setting driver
Discuss other line options, indicators for use and contraindications for siting
Saflo 90 lines can be used if PVC free line required i.e. Clonazepam use. Cannula and line one-piece, priming line minimal.
Insert at 90 degrees Note: DO NOT insert in chest wall or scapular as could cause pneumothorax
3i
Calculations Can demonstrate how to calculate the correct infusion rate and why this is important
Q
Mls = hrs rate in mls Hours e.g. 18mls =0.75ml per hour 24 hours To ensure the device is set up properly, checking with the rate setting on screen
The Learner can competently and safely demonstrate the ability to set up and operate the T34 McKinley Syringe Driver
4a The learner can discuss and explain the procedure with the patient and gain consent
OP
Use communication that is appropriate and understood to explain the procedure
Identify any previous experiences of syringe drivers and anxieties
Using respect and clarity, ensure patient understands procedure
Valid consent gained, or best interest
Offer leaflet for patient and family to allay anxiety and generate further questions
4b Decontaminate hands Infection control (IC)
OP
Hands to be decontaminated during the 5 moments of patient contact
Decontaminated of hands (in line with organisational IC measures)
10 of 18
Learners Name:
Stan
dar
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
4c
Ensures the syringe driver is correctly prescribed. Accurately calculates the diluent
OP
Ensures syringe driver is correctly prescribed
the right patient
the right drug
the right time
the right dose
the right route Shows written calculation of drugs and diluent
Draw up the medication as prescribed
Uses smaller syringe to draw up from each drug ampoule
Adds medication to diluent into 20/30ml syringe
4d Accurately completes medicines label and applies to syringe
OP
Completes label filling out all required fields
Attaches to back of syringe, revealing mls
Near luer lock; so not to interfere with the clamp sensor
4c
The learner can demonstrate how to connect the infusion set to the syringe including the priming process (taking into consideration 2% margin of error)
OP
Connects the line to the filled syringe
Primes the line (keep the line coiled on the packet for ease), prior to putting the syringe into the driver
NOTE: Always load the pump with the new syringe before attaching the line to the patient, to avoid the pump delivering any inadvertent bolus
Care should be taken when priming the line to keep within the 2% margin of error allowed to ensure delivery of prescription
i.e. 23mls/100 x 2% = 0•46mls
4c Can turn on the device and explain what is happening during the preloading sequence.
OP
Insert battery and turn upside down to check connection of terminals. Attach back
Press On/Off button
The barrel clamp is down; this is to ensure the pre-load can occur, (automatic actuator movement) Important to allow for the driver to erase the last set up memory
Note: Do NOT place syringe into the device otherwise preload cannot function.
4d Check the battery level OP
Press the blue ‘info’ key once
30% for 2nd edition and change daily for 3rd edition.
NOTE: If after starting infusion press blue key twice. No need to check throughout infusion as the device has an alarm facility and you have checked connection of terminals.
11 of 18
Learners Name:
Stan
dar
d N
o
Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
4e Load the syringe and align the 3 syringe sensors to the syringe
OP
Press and hold the BACK key to move the actuator to its full extent. A beep will sound, so that you gain maximum starting length.
Use of forward and back keys to adjust as necessary to align to placement for plunger
Insert the syringe carefully to avoid depressing the plunger and losing medication
The syringe is placed in the 3 detection areas
Barrel clamp arm (clamp that holds the barrel in place)
Groove for the collar of the syringe; recognises size
Actuator, the plunger fits between the teeth. This needs a strong movement.
Observe LCD to confirm correct placement of syringe. Follow instruction i.e. Load syringe or Syringe displaced etc.
4f
Check the syringe driver has correctly identified the syringe brand and size
OP
Checks the LCD screen for the syringe make and size The syringe pump measures the syringe thickness using the sensor clamp as well as the length from actuator to the plunger and will come up with maybe three syringe makes
Scroll up or down to change this if incorrect
Must confirm with the pump which one is right – press yes key
4g Check for correct duration of infusion and rate setting
OP Reviews the summary screen for volume,
rate and duration
4h Attach line to cannula Clean technique, ensure bung removed and
line attached to Saf-T-Intima; not too tight
4i Start the infusion OP Press Yes key on pump
4j Ensure the syringe driver is working correctly
OP Q
Checks that screen displays:
LED indicator light (above the ON/OFF key) flashes every 30 seconds
Rate displayed in ml/hr
‘Syringe size and brand’ alternate with ‘Pump Delivering’ at bottom of the screen
Volume infused- Press the INFO key once
To check the volume infused (VI) and volume to be infused (VTBI)
That the volume in the syringe matches the volume displayed
12 of 18
Learners Name:
Stan
dar
d N
o
Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
4k
Lock the driver and can demonstrate how to unlock. Discuss what keys are still active even when locked. How to protect the driver?
OP Q
Lock
Press and hold the INFO key until a progress bar is moving to the right. Keep holding until it beeps and the bar is completely across.
Unlock
As above but the progress bar moves to the left.
Keys still active
Blue - INFO
Green - YES/START
Red - NO/STOP Insert in lock box and store key for all staff. Ensure driver is kept away from water.
4l
Places the driver in the correct place when in use and know why this is important.
OP
Driver to be placed below site of the needle- to reduce risk of syphoning
In a cover to reduce pharmacological compatibility problems with sun light
Not in a hot place as 2nd Edition have a malfunction where the pump could deliver the contents quicker than set up
4m
Document/ record of actions and observations. Also, be specific about what you would record on the documentation.
OP
Records all information:
On the syringe driver checklist
Patient’s notes regarding assessment and action
Syringe driver medicine instruction/prescription chart
Check includes:
Serial number
Chart number links with instruction charts for reference point
Completion of initial set-up boxes
Expected time of completion
The learner can demonstrate the ability to monitor the infusion progress of the T34 McKinley Syringe Driver
5a
Knows how often the syringe driver should be checked in the community setting or inpatient unit
Q
Inpatient setting
During the first 15 minutes of operation
The driver should then be checked every four hours
Community
At each visit (e.g. twice daily)
At set-up/ syringe change and if assessed as patient has complex needs once more during the 24-hour period
13 of 18
Learners Name:
Stan
dar
d N
o
Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
5b Can name what checks need to be carried out during ongoing monitoring
Q
Patient
Assess that symptoms managed
No adverse effects Site for:
Pain/discomfort
Redness
Swelling
Bleeding Equipment
Correct display information
Light flashing
Delivering to time, or highlight defect of fast or slow and actions
Medication/diluent
Clear
No crystallisation
Volume infused/ remaining
As prescribed and administration chart
5c
Demonstrates how to retrieve information from driver to check the volume infused (VI) and if required the battery level while infusion is in progress
OP
Press the INFO key once to display this information.
Record VI on monitoring chart
If required- Check the battery life Press the INFO key twice to display this information
5d Can discuss and demonstrate (accurately) where are the ongoing observations recorded
OP
On the daily administration chart
On patient records if any changes to situation and assessment and actions
The learner can demonstrate the ability to change the syringe in an ongoing infusion
6a
Identifies assessment and preparation Demonstrates the process for changing a syringe in an ongoing infusion, noting differences from initial setup.
OP
Hand hygiene
Timely review to be able to assess patient, medication effects and dose ranges
Check site
Draw up new syringe and attach label take back to patient on clean tray/dressing pack
T34 pump- Press Red key -NO/Stop
Disable the keypad lock
Hold the OFF key to power off
Remove pump from Lock box
Disconnect the syringe from the patient’s line, mindful of infection control measures
Remove empty syringe from pump Warning: The infusion line must be disconnected from the syringe before removing the syringe from the driver, to prevent free flow and risk of serious harm to the patient.
14 of 18
Learners Name:
Stan
dar
d N
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
Return the barrel clamp to the down position
Turn ON pump
Follow Preload instructions from this stage
The actuator should go back to the last infusion length (remember to press for maximum length)
Check battery % - change if indicated 30% or with 3rd edition every day)
Place syringe in 3 sensors
Check and confirm all information NOTE: To avoid inadvertent administration of a bolus ALWAYS load the syringe onto the driver before connecting to the patient.
Attach to line (remove bung if used for infection control whilst preparing new syringe)
Press YES to start infusion
Read and check information on screen
Keypad lock
Lock box
Documentation
6b
Discuss the rationale for changing the infusion line +/- cannula when the patient’s medication has been changed.
Q
Good practice is to change the SC infusion line and cannula when:
Changes to prescription leads to compatibility issues of medication
No need when there is titration of the same medication. PRN dose may be required following assessment to ensure patient’s symptoms are managed.
Line to be changed in accordance to manufactures guide and rationale ensuring safety and availability (3-5 days)
The learner shows understanding of how to manage an alarm in the event of the Occlusion during an infusion
7a
Can identify what is the best practice when occlusion is apparent on the LCD when pump alarming. Reflect understanding about mechanical slack and implications of this for the patient if not resolved properly.
Q
If alarming and reading occlusion then there is a need to change the site due to the machine identifying pressure within the area.
If there is an internal occlusion the actuator reduces the pressure in the line to protect the patient from bolus dose. Once restarted, the pump takes 15 minutes to build enough pressure try and push through the occlusion (mechanical slack).
15 of 18
Learners Name:
Stan
dar
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
7a
Q
If the occlusion has not been resolved the occlusion alarm will sound again and no medication will be delivered.
Action:
Press NO/STOP key to pause the alarm sounding
Site a new cannula away from occluded site checking area of new site with patient
Apply semi vapour-permeable dressing
Disconnect the line from the old cannula and connect the line to the new inserted cannula
Press YES to confirm syringe brand and size on the driver
Press YES to RESUME existing programme
Document the time the SC infusion line is changed on the monitoring chart, and communicates to the teams. It may be running early due to change, or late but will still need changing within 24 hour of start time.
Explain the difference when using a Saflo 90 and occlusion is highlighted via alarm
Start again with new prescription of medication
Draw up required prescription
Prime a new line (needle attached)
Commence as with new set up for T34
7b
Discuss why it is important to correctly know why to press YES key to Resume and what would happen and what you would need to do if accidently pressed the NO key when managing occlusion
Q
YES will resume current infusion (same patient, same syringe, same infusion)
NO deletes the current programme – it cannot be retrieved, need to prepare new syringe for prescribed medication following assessment for next 24-hour period
The learner shows understanding of the T34 McKinley Syringe Diver Alarms and Alerts and troubleshooting considerations
8a
Define the differences between an alert and an alarm. How the alerts differ with the 2nd and 3rd Edition T34
Q
Q
Alert is a warning - Pump continues to run however bleeps to remind you there is a need to rectify the situation.
The 2nd edition bleeps three times every three minutes and light stays green
The 3rd Edition light goes yellow and the sound varies according to the cause
Alarm stops the driver from delivering until the reason for alarm is resolved. Both 2nd and 3rd edition light turns red
16 of 18
Learners Name:
Stan
dar
d N
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Performance Criteria The learner will be able to:
Question (Q)
Observe practice
(OP)
Demonstrates/mentions Competent
(/ X)
Discuss when the alert will sound and what guidance you would give to the patient/family
LCD screen for causes for an alert to sound:
Near end of battery
Near end of infusion (last 20-30 minutes) Guidance to include:
Patient/ carer should be told about the alert and given information about who to contact to correct the problem
Nurses will have anticipated end time of infusion, however, ring 24/7 to ensure all going to plan
Discuss when an alarm will sound
Causes include:
End battery
Pause too long
End of infusion
Occlusion The alarm sounds continuously until either paused (by pressing NO) or YES to re start. An error message appears on the LCD indicating the cause of the alarm. This is very annoying for the patient and family and no medication is being administered.
Demonstrates how to disable an alert or alarm and action instruction on screen
OP Q
Reads what the indication of the cause on the screen
Follows instruction on screen
All causes explored and resolved
Discusses awareness of what information should be given to patients/carers if the alert or alarm sounds
Q
Educate family/patient that if the alarm is going, to ring the community team and ideally explain what it is reading. Family know expectation of time to be able to rectified. Nurse may know the family and assess if they can press red button to pause alarming once reported whilst waiting a visit for nurse to review.
Educate self-caring patients/family not to press YES after an occlusion alarm as the pump will not deliver if the cannula is still occluded (even though it appears OK for 15minutes) and therefore will delay infusion time and not manage symptoms.
17 of 18
Learners Name:
Date Standard number
Areas for development through Summative Assessment
Development Plan - Summative Assessment
Re-assessment date
18 of 18
Learners Name:
Competency Declarations In signing this form, I confirm that:
Learners Name Designation signature Date
Practice Assessor Name Designation signature Date
.
Learner Declaration I declare that I am competent in performing McKinley T34 Syringe driver and can demonstrate clinical and
theoretical knowledge in this procedure.
I am responsible and accountable keeping my practice up-to-date and will keep my skills up-to-date with
current practice.
I will read updates and change my practice accordingly.
I understand the need to re-educate and complete further assessment can be requested at my manager’s
discretion at any time.
I will seek to update my practice as necessary, but particularly if I do not understand an element of
practice.
Practice Assessor Declaration I declare the Learner is competent and safe to practice McKinley T34 Syringe driver.
I have assessed the Learner named above. They have shown to be competent in the standards outlined
above, in this competency.
They have provided evidence that they fulfil the minimum standards to be able to undertake McKinley
T34 Syringe driver
References 1Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing
associates 2Department of Health (2013). Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England; Published by Skills for Care and Skills for Health 3Health and Care Professions council (2016), HCPC standards of conduct, performance and ethics 4Benner, P. (1984) From Novice to Expert. Menlo Park, Ca: Addison-Wesley
5Marieb, E & Hoehn, K (2010) Human Anatomy & Physiology, 10th edn. San Francisco: pearson Benjamin Cummings 6Dougherty, L & Lister, S ed (2015). The Royal Marsedn Manuel of Clinical Nusring Proceudres. 9t ed. West Sussex: Wiley Blackwell 7BHS (2006) Blood Pressure Measurements Ware: British Hypertension Society. Available at www.bhsoc.org 8NICE (2011) Hypertension: Clinical management of Primary Hypertension in Adults, London: National Institute of Clinical Excellence. Available at: http://publications.nice.org.uk/hypertension-cg127 9Bridges, E & Thomas K (2009) Noninvasive measurement of body temperature in critically ill patient. Critical care Nursing, 29, 94-97
Please scan a copy of this document to your line manager and Learning and development
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