{{org_field_logo}}

{{org_field_name}}

Registration Number: {{org_field_registration_no}}

---

Syringe Driver Guidance and Best Practices for Nurses Policy

1. Purpose

The purpose of this policy is to ensure the safe, effective, and appropriate use of syringe drivers at {{org_field_name}} to provide continuous subcutaneous infusions (CSCI) for residents who require palliative care, pain management, or symptom control. The policy ensures that all registered nurses are trained in best practices for syringe driver use, medication management, risk assessment, and incident reporting.

This policy aligns with The Regulation and Inspection of Social Care (Wales) Act 2016, The Nursing and Midwifery Council (NMC) Standards of Proficiency for Nurses, The Medicines Act 1968, and Care Inspectorate Wales (CIW) guidelines on the administration of controlled drugs and medical devices.

2. Scope

This policy applies to:

• Registered nurses at {{org_field_name}} who are responsible for the setup, monitoring, and discontinuation of syringe drivers.
• Senior management and clinical leads, ensuring oversight and governance of syringe driver use.
• Medical professionals and external prescribers, ensuring collaborative care in medication management.
• Residents and families, ensuring informed consent, person-centred care, and family engagement in decision-making.

3. Managing Syringe Drivers Efficiently

3.1 Indications for Syringe Driver Use

Syringe drivers are used when oral or transdermal medication administration is ineffective or impractical. Indications include:

• End-of-life care, ensuring continuous pain relief and symptom management.
• Severe nausea or vomiting, preventing effective oral medication absorption.
• Dysphagia (swallowing difficulties), common in advanced dementia, neurological disorders, or cancer care.
• Uncontrolled pain, requiring continuous opioid infusion for comfort.

Syringe drivers must only be used following a clinical assessment by a prescriber, with a clear rationale documented in the resident’s care plan.

3.2 Prescribing and Authorisation

All medications administered via a syringe driver must be prescribed by a doctor or an independent nurse prescriber. The prescription must include:

• Medication name, dose, and dilution instructions.
• Infusion duration (typically 24 hours).
• Compatibility with other prescribed drugs.
• Special instructions (e.g., breakthrough symptom management, drug titration guidance).

The five rights of medication administration must always be followed:

1. Right resident
2. Right medication
3. Right dose
4. Right time
5. Right route

Before administering any medication, two registered nurses must verify the prescription and ensure correct preparation.

3.3 Equipment and Setup

Only approved syringe drivers (e.g., McKinley T34 or BD BodyGuard) should be used at {{org_field_name}}. Key setup guidelines include:

• Use a luer lock syringe to prevent accidental disconnection.
• Always prime the tubing to ensure there are no air bubbles.
• Secure the syringe driver in a safe, accessible position for easy monitoring.
• Document the start time, infusion rate, and volume on the resident’s medication chart.

A baseline assessment of the resident’s pain level, sedation, and vital signs should be completed before starting the infusion.

3.4 Monitoring and Troubleshooting

Registered nurses must monitor syringe drivers every four hours to check:

• Medication levels and infusion site (redness, swelling, or leakage).
• Device function, ensuring there are no alarms or blockages.
• Resident’s comfort and symptom control, adjusting care as needed.

Common Syringe Driver Alarms and Responses

• Occlusion alarm → Check for kinks, blockages, or tissue infiltration.
• Battery low warning → Replace with a fully charged battery immediately.
• End of infusion alert → Reassess the resident’s medication needs before setting up a new infusion.

3.5 Medication Compatibility and Safety

Mixing multiple drugs in a syringe driver can lead to precipitation, instability, or reduced efficacy. Nurses must:

• Consult an approved compatibility chart before mixing drugs.
• Use sterile water or sodium chloride 0.9% as diluents unless otherwise specified.
• Avoid mixing more than three medications in a single syringe driver, unless approved by a pharmacist.

If incompatibility is suspected, stop the infusion immediately and seek medical advice.

3.6 Prevention and Management of Complications

Potential complications associated with syringe drivers include:

• Tissue irritation or extravasation – Rotate infusion sites every 24–48 hours.
• Breakthrough symptoms – Ensure PRN medication is prescribed for additional symptom control.
• Accidental disconnection – Always secure the syringe driver out of reach and use secure tubing connections.

All incidents must be reported and recorded, ensuring continuous learning and quality improvement.

3.7 Family and Resident Communication

Families may feel anxious about syringe driver use. To ensure clear communication and informed consent, nurses must:

• Explain why the syringe driver is necessary and how it works.
• Reassure families that it provides effective symptom control.
• Discuss end-of-life care planning in a sensitive and compassionate manner.

Where a resident lacks mental capacity, decision-making must follow the Mental Capacity Act 2005 and involve family members, advocates, or legal representatives.

3.8 Documentation and Record-Keeping

Accurate record-keeping is essential for safe syringe driver management. Nurses must document:

• Medication administered and any adjustments made.
• Infusion start and stop times.
• Resident response to medication (pain relief, sedation, side effects).
• Site condition and any issues encountered.

All documentation must be stored securely and reviewed by the clinical team.

3.9 Syringe Driver Training and Competency Assessments

All registered nurses at {{org_field_name}} must complete:

• Mandatory syringe driver training every two years.
• Practical competency assessments before independently managing syringe drivers.
• Regular refresher sessions on device troubleshooting and medication safety.

Training records must be kept up to date and available for CIW inspection.

3.10 Incident Reporting and Continuous Improvement

All errors, malfunctions, or adverse reactions must be reported immediately to the Registered Manager and prescriber. The incident must be:

1. Recorded in the incident log.
2. Reviewed as part of clinical governance meetings.
3. Investigated to identify areas for improvement.

CIW inspectors may request evidence of incident management and staff training records to ensure regulatory compliance.

4. Responsibilities

4.1 Management Responsibilities

• Ensuring all staff are trained and competent in syringe driver use.
• Reviewing and updating syringe driver policies and procedures annually.
• Auditing medication administration records to ensure compliance with best practices.

4.2 Nursing Responsibilities

• Setting up, monitoring, and troubleshooting syringe drivers.
• Administering medication safely, following the five rights of drug administration.
• Ensuring residents and families are fully informed about syringe driver use.
• Reporting any errors or concerns immediately.

5. Related Policies

This policy should be read in conjunction with:

• Medication Management and Administration Policy
• End-of-Life and Palliative Care Policy
• Infection Prevention and Control Policy
• Mental Capacity and Deprivation of Liberty Safeguards Policy

6. Policy Review

This policy will be reviewed annually or sooner if new CIW guidance emerges. The Registered Manager is responsible for ensuring compliance with CIW and NMC standards.

---

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.