Royal Brompton and Harefield NHS Foundation Trust Nurse training in apheresis
Training for the Clinical Nurse Specialists/Nurse Consultant regarding the use of the Patient Group Direction for the administration of lipoprotein apheresis therapy at HarefieldHospital
Department of Cardiology
HarefieldHospital
July 2014
1. Introduction
HarefieldHospital, part of the Royal Brompton and Harefield NHS Foundation Trust, provides a nurse-led lipoprotein apheresis unit at HarefieldHospital. The unit is run by clinical nurse specialists with supervision from the nurse consultant and consultant cardiologist. Patients attend the unit on a bi-weekly basis for treatment. Treatment is a ‘life-long’ therapy and each treatment session lasts 2-4 hours.
The lipoprotein apheresis service is nurse-led. A variety of medications are required to set up and run the different machines used. In addition there are some intravenous and oral drugs which are required during the treatment process.
This training plan is not exhaustive. It should be used in conjunction with relevant Trust procedures and national legislation and guidelines.
2. Aim
On completion of training, the CNSwill be able to carry out a lipoprotein apheresis treatment without direct supervision.
3. Basic Qualifications
Nurses must have all the following before starting training in administration of lipoprotein apheresis treatment:
- NMC registration
- Experience in carry out the relevant treatment under supervision
- Knowledge of apheresis procedures
- Approval from the lead clinician
- Approval from the lead nurse
4. Training Requirements
The lead nurse and lead clinician or their delegates will act jointly as trainers. The process will be documented by the trainee. Assessment will be by a combination of trainee statement, directly observed practice and structured interview. Evidence of the following will be required:
4.1Working within the PGD.
4.2Competence in carrying out lipoprotein apheresis treatments.
4.3Knowledge of the apheresis procedure.
4.4Understanding of the local protocols for apheresis procedures.
4.5Completion of apheresis competencies.
4.6Knowledge of the basic pharmacology, actions, interactions, side effects, adverse reactions, indications, cautions and contra-indications of all the drugs within the direction.
4.7Knowledge of the legal and professionalimplications of drug prescribing, dispensing and administration, including knowledge of the Supply and Administration of Medicines under Group Protocols as directed by current NHS Executive Health Service Circulars.
4.8Current ILS/ALS certification.
4.9Medicines management training within the previous two years.
4.10A log book of patients treated with lipoprotein apheresis.
4.11Regular meetings between the trainee and trainer to review progress. These should be held at least monthly.
4.12Practical training – this will include;
- Observing and assisting withat least 20 lipoprotein apheresis treatments
- Lead at least 10 lipoprotein apheresis treatments under supervision
- A pass in a viva examination
5. Outcome
The CNS will be assessed by the trainers as competent to lead lipoprotein apheresis treatments without supervision of the nurse consultant/cardiology consultant. Consultation with the relevant consultant will be expected in difficult or unusual cases.
6. Adverse Reactions
Adverse reactions to any of the drugs in the direction must be recorded in the patient’s notes and through the Trust incident reporting system and the ‘yellow card’ system as appropriate.
7. Audit
The number of patients undergoing lipoprotein apheresis therapy and the frequency of use of the drugs included in this direction will be audited annually. The nurse must complete the relevant audit form every time any of the drugs included in the direction are supplied and administered. An annual PGD audit will be carried out and the results submitted to the Trust non-medical prescribing group.
8. Revalidation
Each nurse will require annual revalidation by the lead nurse and lead consultant in order to continue with the supply and administration of the drugs included in this direction. The minimum requirement for revalidation is;
- Carrying out at least 20 lipoprotein apheresis treatments without supervision
Failure to achieve this standard will require a period of supervision which will be individually agreed with the lead clinician.
9. References
- Trust lipoprotein apheresis guidelines available on the H drive
10. Reviewed
Name: has been assessed has achieved the stated objectives and is competent to administer the drugs within this patient group direction.
Signed: ______Consultant CardiologistDate:…..………..
(If delegated to Cardiology SpR must be no less than year 5)
Name in Capitals ______
Signed______PharmacistDate:……………
Name in Capitals ______
Signed:______PractitionerDate:……………
Name in Capitals ______
Name:has been assessed has achieved the stated objectives and is competent to administer the drugs within this patient group direction.
Signed: ______Consultant CardiologistDate:…………….
(If delegated to Cardiology SpR must be no less than year 5)
Name in Capitals ______
Signed:______PharmacistDate:……………
Name in Capitals ______
Signed:______PractitionerDate:……………
Name in Capitals ______
Date of issue: July 2014 Version 21