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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Learners Name:

CLINICAL SKILLS COMPETENCY ASSESSMENT

McKinley T34 Syringe Driver Version

1.3 Date ratified

23/4/2020 Review Date

2023

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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.

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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

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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

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Learners Name:

Date Standard number

Areas for development through Formative Practice

Development guide – Formative

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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.

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Question (Q)

Observe practice

(OP)


(/ 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

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Question (Q)

Observe practice

(OP)


(/ 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

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Question (Q)

Observe practice

(OP)


(/ 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)

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Question (Q)

Observe practice

(OP)


(/ 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.

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Question (Q)

Observe practice

(OP)


(/ 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

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Learners Name:

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Question (Q)

Observe practice

(OP)


(/ 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

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Question (Q)

Observe practice

(OP)


(/ 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.

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Question (Q)

Observe practice

(OP)


(/ 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).

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Question (Q)

Observe practice

(OP)


(/ 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

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Question (Q)

Observe practice

(OP)


(/ 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.

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Learners Name:

Date Standard number

Areas for development through Summative Assessment

Development Plan - Summative Assessment

Re-assessment date

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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

http://www.bhsoc.org/

http://publications.nice.org.uk/hypertension-cg127

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