ADMINISTRATION OF OIL-BASED DEPOT AND OTHER LONGACTING INTRAMUSCULAR ANTI-PSYCHOTIC INJECTIONS TO
ADULTS PROCEDURE
The key messages the reader should note about this document are:
1. This procedure aims to guide practitioners involved in the administration of oilbased depots and other long-acting anti-psychotic medication to ensure that safe
and effective care is delivered.
2. Deep Intramuscular Injections form part of a wider care plan.
3. Importance of clear and transparent documentation.
4. Consent to treatment should be obtained before each administration.
5. It is considered good practice, where additional practitioners are available, for a
second check to be made in order to minimise the risk of error. Furthermore,
individual teams should ensure a robust system is in place to identify when
service user’s injections are due in the event of staff sickness or annual leave.
NB: The second checker – This does not need to be performed by a
qualified member of staff. However the second check needs to performed by
someone who is competent to do so and is able to understand the following:



Name of the depot injection (drug name) againt the depot prescribed
on the prescription _ both need to be the same
Appropriatly strength vial to ensure the least volume of depot is
administered to the service users
Feel confident to escalate or request advice regarding any issue
related to the checking process
This policy/procedure may refer to staff as qualified/registered/professional or other such term to
describe their role. These terms have traditionally referred to individuals in a clinical role at band 5 or
above. Please note that the use of these terms may or may not include nursing associates or
associate practitioners (band 4). For clarification on whether a nursing associate or associate
practitioner is an appropriate person to take on the identified roles or tasks in this policy/procedure
please refer to the job description and job plan for the individual, or local risk assessment.
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DOCUMENT SUMMARY SHEET
ALL sections of this form must be completed.
Document title
Administration of oil-based depot and
other long-acting intramuscular antipsychotic injections to adults procedure
Document Reference Number
MM-0003
Key searchable words
Depot, injection, administration,
competence, training, safety,
documentation.
Executive Team member responsible
(title)
Medical Director
Document author (name and title)
Rob Edwards
Clinical Lead Nurse and Non-Medical
Prescribing Lead (Nursing)
Approved by (Committee/Group)
MOG – Medicines Optimisation Group
Date approved
14 December 2017
Ratified by
Policy & Procedure Group
Date ratified
21 December 2017
Review date
11th December 2020
Frequency of review
At least every three years
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Amendment detail
Version
Amendment
Reason
2.0
Placed into new
procedural format
Updated documentation
2.0
Record keeping section
Added detail required to reflect current
practice.
2.0
Safe disposal of sharps
section
Added detail required to reflect up-to-date
information.
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CONTENTS
Section Description
1
2
Page
The content of the procedural document
1.1
Flow chart of procedure
4
1.2
Description of procedure/process
5
Appendices included as relevant
Appendix A – Standard Operating Procedures
11
Appendix B – Maximum volume for oil-based depot
administration into a single site
17
Appendix C – Training
18
Appendix D – Glossary of Definitions
19
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1.
THE PROCEDURE
1.1 Flow chart of procedure
Assessment of Service User and
information exchange, assessment
of cpacity to consent to treatment
Dose calculation - test dose
required on treatment initiatiation
Choice of syringe and needle;
prepare and draw up medication
Choice of injection site based on
drug license; adminstration of
medication
Evaluation of injection site and
safe dispose of sharps
Record-keeping; arrange next
appointment.
Review care plan at least every 6
months
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1.2 Description of procedure
General Preparation for the Deep IM Injection
Depot preparations should be a treatment option where a service user expresses a
preference for such treatment because of its convenience, or as part of a treatment
plan in which the avoidance of covert non-adherence with antipsychotic drugs is a
clinical priority (NICE, 2009).
The administration of any medication is an opportunity for assessment and
information exchange with the service user and carer(s), where appropriate.
Preparation should include assessment to ascertain if the physical and/or mental
health of the service user has changed since the previous contact. Any beneficial
effects or side-effects experienced since the last injection should be considered and
questions asked of the service user and their carer (where appropriate) to elicit any
concerns or information needs.
Prior to administration, the service user’s prescription should be checked to ensure
that it is legal and valid. Allergy status should be checked.
The LYPFT Medicines Code (MM-0004) outlines the required standards and the
responsibilities of registered practitioners in prescribing, dispensing and
administering medication.
If administering Olanzapine depot injection the elearning must be completed prior to
prescribing or administering the medication for the first time. Registration is required
for access to the elearning which can be found at https://www.ZypAdhera.co.uk .
Dose calculations
Some drug administrations require complex calculations to ensure the correct
volume of medication is administered. Appendix B illustrates the maximum volume
for oil-based depot administration into a single site. If a greater volume is required,
the practitioner should consider whether an alternative strength of the product is
available.
strength available (mg/ml) x required dose (mg) = volume required (ml)
e.g. To give a dose of Zuclopenthixol Decanoate 350mg using the 200mg in
1ml ampoule
(1 ÷ 200) x 350 = 1.75
Volume required = 1.75ml
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When preparing for the administration of medication, it is considered good practice,
where additional practitioners are available, for a second check to be made in order
to minimise the risk of error. This second check may be undertaken by another
registered practitioner or ‘medicines competent’ member of staff (see LYPFT
Medicines Code (MM-0004).
Choice of syringe and needle
Where the product is provided in a pack with a syringe and needle for administration
(i.e. Risperdal Consta, Xepilon or ZypAdhera) the syringe and needle provided
should always be used and the manufacturer’s instructions followed.
Practitioners should ensure that all needles used for the administration of depot
medication incorporate a ‘sharp safe’ mechanism.
Where the practitioner has to select an appropriate syringe and/or needle, it is
necessary to consider the following:

Needle length is indicated on the needle pack in inches and/or millimetres.
An assessment of the length of needle required to reach the appropriate
muscle should be made, taking into account any subcutaneous fat. If the
chosen needle is not long enough to reach the muscle, consideration needs to
be given as to which needle to use. Advice should be sight from the
prescribing practitioner and also pharmacy.

The gauge of the needle refers to the outer diameter of the needle. A smaller
number indicates a larger outer diameter. 21 gauge needles (green hub) are
most commonly used for intramuscular injections. The narrowest needle
which complies with the product licence should be used. Where needles are
supplied with an injection, only those needles should be employed.

The smallest possible size of syringe should be used to accommodate the
volume of the product given.
Hand hygiene
The Trust’s Hand Hygiene Procedure (IC-0002) describes the hand cleansing
technique which should be adhered to. WHO (2010) recommends that non-sterile,
well-fitting, single-use gloves must be worn if the practitioner’s or service user’s skin
is not intact (e.g. through eczema, burns or skin infections) or when there is a
likelihood of coming into direct contact with a service user’s blood or other potentially
infectious materials. See the Standard Infection Control Precautions Protocol (ICDate effective from: 21/12/17
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0004). It should be noted that gloves do not provide protection against needle-stick
injuries and all sharps should be handled with caution.
Preparing and drawing up medication
Medication should be prepared immediately prior to its administration and
practitioners should ensure all necessary equipment is available before proceeding.
Practitioners must ensure that the expiry dates of all equipment are checked prior to
use.
Where medication requires reconstitution this should be carried out in line with
manufacturer’s guidance.
Blunt drawing-up needles with an internal filter are available to prevent the accidental
drawing up of contaminants from glass ampoules. However, the viscosity (thickness)
of the oil and size of the molecules in some oil-based depot injections may make
drawing up through a filter needle difficult and could result in some of the product
being discarded with the draw up needle when it is changed to the needle for
administration. They are therefore NOT recommended for such injections (Hunter,
2008; Feetham & White, 2010)
It is common practice to change the needle used for drawing up to a different needle
for administration, however, this is only necessary where there has been a risk of
blunting the needle (e.g. by perforating a rubber bung or by scratching it on the
inside of an ampoule, Feetham & White, 2010).
Choice of injection site
Most oil-based depot antipsychotic injections must be administered only into the
gluteal muscle by deep intramuscular (IM) injection. The exceptions to this are
flupentixol and zuclopenthixol depots which are also licensed to be administered via
the lateral thigh.
Other long acting injections permit administration into either the deltoid or gluteal
muscle. It is good practice for the prescriber to stipulate the muscle where the depot
is to be given on the prescription, not just ‘I.M’.
Appendix A illustrates the most common injection techniques. Further information
regarding each technique can be found within the Royal Marsden Handbook of
Clinical Nursing Procedures and video tutorials produced by the University of Hull
can be found here: www.reach4resource.co.uk.
The Summary of Product Characteristics for each anti-psychotic injection contains
full details of the sites for which each injection is licensed and can be accessed
online from the Electronic Medicines Compendium: www.medicines.org.uk/emc.
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Where, according to the product licence, a choice of injection site exists, this should
be discussed with the service user. A joint decision on the preferred site should be
made and recorded in the service user’s clinical record.
Whichever site is selected, the registered practitioner must rotate the site and
alternate between the left and right side of the body on each occasion the injection
is administered. The site used on each occasion must be documented accordingly.
The service user should be assisted into the chosen position for administration of the
injection, according to the appropriate chosen site. Privacy and dignity should be
maintained at all times.
It is important to evaluate the injection site both pre and post injection observing for
any signs of swelling, pain, inflammation, infection or tissue damage. If any of these
signs are present or there are any other concerns, advice should be sought from an
appropriate member of the care team before continuing with the procedure.
Practitioners should ensure that an accurate reflection of any discussions that may
take place is recorded in the service user’s clinical record.
The site may be cleaned prior to injection using an alcohol swab. A period of 60
seconds must elapse before the injection to ensure the alcohol has dried on the skin.
Z-Track Administration Technique (See Appendix A: SOP 2)
Z-tracking is the recommended technique for all deep IM injections as it creates a
broken injection pathway (the Z track), containing the medicine in the intended target
muscle and preventing it from moving back up the track to leak out at the skin
surface. This has the advantage of achieving the correct plasma concentration whilst
minimising the risk of pain or lesions at the injection site.
The injection site should not be massaged as this may interfere with the absorption
rate of the depot and cause irritation by forcing the medication into subcutaneous
tissue.
Safe disposal of sharps
Sharps should be disposed of at the point of use in a secure sharps bin. Needles
should never be re-sheathed and the ‘safe sharp’ mechanism should be engaged as
directed and discarded appropriately. In the event of a needlestick injury, the
directions included within the Trust’s Blood Borne Viruses; including Sharps,
Inoculation and Needle stick injury Protection and management procedure (IC-0003)
must be followed. Sharp-safe needles are now commonplace in practice.
Record keeping
Good record keeping is essential for safe service user outcome, transparent practice
and clinical audit.
The clinical record should reflect the registered practitioner’s full, chronological
account of assessment, planning and care and provide information relevant to the
procedure at the time of the administration of the injection.
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No action or omission by the registered practitioner must compromise patient safety;
records must demonstrate this duty of care. The Nursing and Midwifery Council
(NMC) Record Keeping Standards clearly outline expectations in detail and should
be referred to.
As a minimum, the date and time of the injection, the name of the medicine and dose
administered, the site of administration together with the registered practitioner’s
signature and, where applicable, a signature from a second registered practitioner
should be recorded on the service user’s prescription and administration chart. If a
student administers the injection under supervision then their signature must be
countersigned by the supervising registered practitioner.
These will normally be recorded on the prescription and administration record.
Ensure that the assessment of the patient’s capacity to consent is assessed and the
legal requirements of the Mental Health Act are met and both must be recorded.
Record the clinical intervention and specific references to any patient or carer
concerns chronologically. A template for the assessment of mental capacity is
available on paris. A link to assessment of mental capacity is also available on the
LYPFT Staffnet at: http://staffnet/supportservices/Governance/mha/Mental Capacity
Act/MCA - Forms/MCA1 - Capacity Assessment.doc.
The practitioner should calculate when the next injection is due and arrange a
convenient appointment with the service user. The next due date should be recorded
in the service user’s clinical record and diarised where appropriate. Individual teams
should ensure a robust system is in place to identify when service user’s injections
are due in the event of staff sickness or annual leave.
This can include a second practitioner who has already met the service user and
where possible already administered the depot injection.
Practitioners should ensure they adhere to the NMC (2010) Recordkeeping
Standards, recording an accurate reflection of any discussions and decisions made.
Any deviation from normal practice must be clearly recorded in the service
user’s
clinical record with the rationale for the clinical decision to do so.
Any incidents, errors or near misses must be reported as described in the Trust’s
Management of Incidents, Including Serious Incidents Procedure (RM-0002).
Monitoring and review
Immediately following administration the service user should be observed for
adverse effects. Any special instructions for post-injection monitoring in the product
licence must be planned for and followed. For example, after the administration of
olanzapine long-acting injection the service user must be monitored for at least 3
hours for signs and symptoms consistent with olanzapine overdose.
All service users must have their long-acting antipsychotic treatment reviewed by the
clinical team on a regular basis. Such reviews should consider efficacy, including any
changes in symptoms and behaviour, side effects, adherence and physical health
(NICE, 2009).
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Regular monitoring of side effects should be carried out using a validated tool, such
as the Glasgow Antipsychotic Sidee Effect Scale (GASS). The GASS assessment
tool is available on PARIS.
Clinical reviews must be undertaken at least every six months in discussion with the
service user, carer (where appropriate) and the care team, and will usually take
place as part of the Care Programme Approach review. This should be a minimum of
annualy but best practice is for the care plan to be reviewed based on needs and
clinical presentation.
Shared care guidelines
Practitioners should ensure they are aware of the Leeds Health Pathways shared
care guidelines which relate to the prescribing of depot medications and transfer of
care to primary care.
These can be found at: http://nww.lhp.leedsth.nhs.uk.
Test dose
For oil based depot IM anti-psychotic injections it is necessary to give a test dose
before treatment is initiated to assess for tolerability to both the active ingredients as
well as the oily vehicle. Occasionally a service user with a nut allergy may react to
the oil and if a full dose is given from the outset then the service user may
experience more severe, protracted discomfort. For this reason it is important to
check the summary of product characteristics and the service user’s allergy status
prior to administration. Full details of test doses for the oil-based depot injections are
given in each individual Summary of Product Characteristics (SmPC) as well as in
the British National Formulary (BNF).
Missed appointments
Missed appointments or changes to the planned injection due date should be
communicated with the prescriber and documented appropriately in the service
user’s clinical record. Some depot injections have information in their product
literature which can be found at www.medicines.org.uk about what action to take if
the dose is missed e.g. if missed paliperidone monthly depot by more that 6 weeks
since the last dose extra doses need to be given.
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2.
APPENDICES
Appendix A
SOP 1
Standard Operating Procedure 1
General Preparation for Deep Intramuscular (IM) Injection
Applicable to:
Registered nurses required to administer oil-based depots and other
long-acting intramuscular antipsychotic injections in the course of their
practice.
Process 1
Read the prescription and check that the prescription is for that service
user. Establish the identity of the service user using two sources of
information e.g. visual/ wristband and date of birth.
Process 2
Check to see if the service user’s physical or mental health has changed
since the previous contact, including the health of any previous injection
sites.
Process 3
Ask about perceived benefits and any side effects experienced since the
last injection (if this is not the first).
Process 4
Check the prescription to ensure:



Process 5
It is legal and valid
The dose is due and has not already been administered
There are no contra indications or allergies
Locate the medication and check:


The expiry date of the medication to be administered has not
passed
It is the correct formulation
Process 6
Confirm that the service user has the capacity to consent and gives their
consent to the procedure. Record the assessment of capacity clearly in
thr clinical casenotes.
Process 7
Wash your hands according to procedure and put on disposable gloves.
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Process 8
Prepare the injection, making any necessary dose calculations and using
the correct equipment.
Process 9
Carry out a final check of all items in processes 4, 5, 6 & 8. Where
possible get a second practitioner to double check.
Process 10
Chose the site of administration according to the licensed indication for
the injection and in collaboration with the service user.
SOP 2
Standard Operating Procedure 2
Z-Track Administration Technique
Applicable to:
Registered nurses required to administer oil-based depots and other
long-acting intramuscular antipsychotic injections in the course of their
practice. This technique should be used for all IM injections
Process 1
Pull the skin in the target area taut and to one side with either the thumb
or side of the non-dominant hand and maintain firm traction of the skin
throughout the procedure
Process 2
Insert the needle with a darting motion at a 90 degree angle to the skin
surface to an adequate depth to allow the needle to penetrate the
muscle. Keep the graduation markings on the syringe barrel visible at all
times
Process 3
For dorsogluteal injections only
Steady the barrel of the syringe with the remaining fingers of the nondominant hand and pull back on the plunger with the dominant hand to
aspirate. Should blood appear in the syringe all the equipment must be
discarded and the whole procedure started again. If no blood appears it
is safe to continue.
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(Where injections are to be administered into sites where there are no
major blood vessels below the injection site this step is unnecessary)
Process 4
Depress the plunger slowly (1ml per 10 seconds) to allow the muscle
fibres to expand to accommodate the drug
Process 5
Wait a further 10 seconds before removing the needle and once it has
been removed , only then release the traction on the skin
Process 6
If necessary the injection site may be wiped with a dry gauze swab
Process 7
A plaster may be applied if this is the patient’s choice and if they have no
known allergy to latex, iodine or elastoplast®
SOP 3
Standard Operating Procedure 3
Administration Technique for the Deltoid Site
Applicable
to:
Registered nurses required to administer oil-based depots and other longacting intramuscular antipsychotic injections in the course of their practice.
Process 1
Ask the service user to sit down and loosen their clothes so their arm and
shoulder are exposed. Ask them to place their hand on their stomach and
relax the arm
Process 2
Follow processes 1-10 in SOP 1
Process 3
Palpate the upper arm and find the landmarks of the acromion process and
the axilla. The target injection site can be found by visualising an inverted
triangle which extends from the acromion process and down to a point level
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with the axilla. Form a rectangle within the original triangle by placing two
fingers below the acromion process to form the top edge of the rectangle
and with the bottom edge level with the axilla. The side edges of the
rectangle should be parallel to the arm. The injection site is in the middle of
this visualised rectangle.
Process 4
Clean the skin, if necessary with an alcohol swab
Process 5
Administer the injection using a Z-track technique (SOP 2)
Process 6
Dispose of all equipment immediately with safe disposal of sharps into an
appropriate, puncture proof, correctly labelled sharps bin. Do not re-sheath
needle
Process 7
Remove gloves and wash your hands according to Trust procedure
Process 8
Document on the prescription/administration chart and in the clinical record
the date, time and dose of medication administered, injection site and side
of the body plus any deviation from standard practice with a rationale for
the clinical decision to do so.
Process 9
Exchange information about monitoring arrangements, how to manage
common side effects and what to and what to do if the service user
experiences any change to their mental or physical health status before the
next clinical contact
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SOP 4
Standard Operating Procedure 4
Administration Technique for the Dorsogluteal Site
Applicable
to:
Registered nurses required to administer oil-based depots and other longacting intramuscular antipsychotic injections in the course of their practice.
Process 1
Follow processes 1-10 in SOP 1
Process 2
Ask the patient to lie down and loosen their clothes so one buttock is
exposed. Ask them to either lie on their front or side with the femur
internally rotated to minimise pain on administration. The service user may
prefer to stand or bend over a chair rather than to lie down. In such cases
the service user should be asked to take the weight off their foot on the
side where the injection is to be administered.
Process 3
If a syringe and/or needle is provided in the product pack by the
manufacturer this must be used. If not select an appropriate needle length
to reach the gluteus muscle. Consider the Body Mass Index (BMI) and
gender of the service user. In obese service users with a BMI of 30 or
more, a 50mm needle may be required.
Process 4
Draw an imaginary cross onto one buttock and identify the upper outer
quadrant. Divide this first quadrant into quarters. The injection site is
located within the upper outer quadrant of the upper outer quadrant,
approximately 5 to 7.5cm below the iliac crest.
Process 5
Clean the skin if necessary using an alcohol swab
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Process 6
Administer the injection using a Z-track technique (SOP 2)
Process 7
Dispose of all equipment immediately with safe disposal of sharps into an
appropriate, puncture proof, correctly labelled sharps bin. Do not re-sheath
needle
Process 8
Remove gloves and wash your hands according to Trust procedure
Process 9
Document on the prescription/administration chart and in the clinical record
the date, time and dose of medication administered, injection site and side
of the body plus any deviation from standard practice with a rationale for
the clinical decision to do so.
Process 10
Exchange information about monitoring arrangements, how to manage
common side effects and what to and what to do if the service user
experiences any change to their mental or physical health status before the
next clinical contact
SOP 5
Standard Operating Procedure 5
Administration Technique for the Ventrogluteal Site
Applicable
to:
Registered nurses required to administer oil-based depots and other longacting intramuscular antipsychotic injections in the course of their practice.
Process 1
Follow processes 1-10 in SOP 1
Process 2
Ask the patient to lie down and expose their hip. Where the service user
prefers to stand they should be asked to take the weight off their foot on the
side where the injection is to be administered.
Process 3
Palpate the greater trochanter. Place the heel of the opposite hand to the
service user’s leg on the greater trochanter (i.e. your left hand on their right
leg or vice versa). Locate and place index finger of on the anterior superior
ileac spine and travel along it until your index finger is in line with the
vertical axis of the body. Your thumb should be pointing towards the front of
the leg. Spread the middle finger to form a ‘V’. The injection site is in the
middle of this ‘V’ level with the first knuckles of your fingers.
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Process 4
Visualise the site and remove your hand to prevent needlestick injury
Process 5
Clean the skin if necessary using an alcohol swab
Process 6
Administer the injection using a Z-track technique (SOP 2)
Process 7
Dispose of all equipment immediately with safe disposal of sharps into an
appropriate, puncture proof, correctly labelled sharps bin. Do not re-sheath
needle
Process 8
Remove gloves and wash your hands according to Trust procedure
Process 9
Document on the prescription/administration chart and in the clinical record
the date, time and dose of medication administered, injection site and side
of the body plus any deviation from standard practice with a rationale for
the clinical decision to do so.
Process 10
Exchange information about monitoring arrangements, how to manage
common side effects and what to and what to do if the service user
experiences any change to their mental or physical health status before the
next clinical contact
Video tutorials of these procedures can be found at: www.reach4resource.co.uk
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Appendix B
Maximum volume for oil-based depot administration into a single site
Generic Name
Brand/Trade name
Max.
Volume
Flupentixol decanoate 20mg in 1ml
Depixol Injection
2ml
Flupentixol decanoate 100mg in 1ml
Depixol Concentrate
2ml
Flupentixol decanoate 200mg in 1ml
Depixol Low Volume Injection
2ml
Fluphenazine decanoate 25mg in 1ml
Modecate Injection
Not specified
in SPC
Fluphenazine decanoate 100mg in 1ml
Modecate Concentrate injection
Not specified
in SPC
Haloperidol decanoate 50mg in 1ml
Haldol Decanoate 50mg in 1ml
3ml
Haloperidol decanoate 100mg in 1ml
Haldol Decanoate 100mg in 1ml
3ml
Zuclopenthixol decanoate 200mg in 1ml
Clopixol Injection
2ml
Zuclopenthixol decanoate 500mg in 1ml
Clopixol Concentrate Injection
2ml
As cited in:
Guidance on the administration to adults of oil-based depot and other long-acting
intramuscular antipsychotic injections: Fourth Edition (2014)
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Appendix C
TRAINING
There is a requirement that all registered practitioners involved in prescribing,
preparing, administering and monitoring oil-based depot and other long-acting
intramuscular anti-psychotic injections receive training in order to be able to meet the
expected level of competency and standards outlined to prevent harm to patients
through safe practice (NPSA, 2007).
All registered nurses must complete the Trust’s Medicines Calculations and
Medicines Administration for Nurses (available on iLearn) in order to evidence their
competency in this area. Medicines calculations are also available on iLearn and
needs to be completed annually. Nurses wishing to refresh their skills and
knowledge may do so by accessing classroom based training or e-learning (also
available on iLearn), details of which can be found on the Staffnet iLearn page.
Practitioners should recognise and work within the limits of their competence,
seeking advice and support from an appropriate source where required.
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Appendix D
GLOSSARY OF DEFINITIONS
Definition
Meaning
Deltoid site
The location for administration of injection into the deltoid muscle.
Depot
In mental health, this is the term used for oil-based long acting
intramuscular (IM) antipsychotic injections designed to be given by deep
IM injection. They consist of the antipsychotic esterified to a decanoate
or palmitate dissolved in an oily vehicle. The volume to be injected is
deposited deep into the gluteal muscle and forms a depot from where it
leaches over time according to its oil:water partition co-efficient into the
blood stream. This, together with the time taken for circulating enzymes
to hydrolyse the ester back to its base, is responsible for the prolonged
length of action of these formulations.
Dorsogluteal
site
The location for administration of injection into the gluteus maximus.
Often referred to as the “Upper Outer Quadrant of the buttock”. This the
most common site for administration of an oil-based antipsychotic depot
injection. There is currently discussion as part of the rapid tranquilisation
procedure update regarding the use of ventro-gluteal site as an
alternative administration site, depending on the license of the drug.
Long Acting
In mental health, this is the term preferred for non oil-based long-acting
Injection (LAI) intramuscular antipsychotic formulations such as risperidone (Risperdal
Consta), paliperidone (Xeplion) and olanzapine (ZypAdhera) long-acting
injections. The same careful injection technique is required to administer
these products but their release characteristics are very different to each
other as well as to oil-based formulations.
Safer sharp
The term ‘safer sharp’ means medical sharps that incorporate features
or mechanisms to prevent or minimise the risk of accidental injury.
Test dose
An initial low dose of an oil-based depot antipsychotic injection which
must be given to assess for tolerability to both the active ingredient and
its vehicle or any other excipient.
Vastus
lateralis
The lateral quadriceps muscle.
Ventrogluteal
The location for administration of injection into the gluteus medius and
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site
gluteus minimus. Colloquially referred to as the “Hip site”.
Z-tracking
This is the recommended technique for all deep IM injections. it
displaces superficial layers of skin and tissue creating a broken injection
pathway (the z-track) containing the medicine in the intended target
muscle and preventing it from moving back up the track to leak out at
the skin surface. This has the advantage of achieving the correct plasma
concentration whilst minimising the risk of pain or lesions at the injection
site.
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PART B
3.
IDENTIFICATION OF STAKEHOLDERS
The table below should be used as a summary. List those involved in development,
consultation, approval and ratification processes.
Stakeholder
Level of involvement
Medicines Optimisation Group
Development & Consultation
Operational Managers
Consultation
Policies and Procedures Group
Consultation
Infection Prevention and Control Team
Consultation
Lead Nurses
Consultation
4.
REFERENCES & EVIDENCE BASE
CQC (2008) Nurses, the Administration of Medicine for Mental Disorder and the
Mental Health Act 1983 The Care Quality Commission: London
Crowley J, Griffiths M, Hardy S et al (2008) Mental Health Practice Essential Guide:
Administration of Depot and Long Acting Antipsychotic Injections Mental Health
Practice 12 (2): 1-18
Dougherty L & Lister S. Eds (2011) The Royal Marsden Manual of Clinical Nursing
Procedures, 8th Edition. Wiley-Blackwell: Chichester
Greenway K (2004) Using the Ventrogluteal Site for Intramuscular Injection Nursing
Standard 18 (25): 39-42
HSE (2012) EU Directive on preventing sharp injuries in the hospital and healthcare
sector Health and Safety Executive: Bootle
Hunter, J (2008) Intramuscular Injection Techniques Nursing Standard 22 (24): 3540
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Mental Capacity Act 2005
Mental Health Act 1983 (as amended by the Mental Health Act 2007)
NICE (2009) Core Interventions in the Treatment and Management of Schizophrenia
in Primary and Secondary Care (CG82) National Institute for Health and Clinical
Excellence: London
NPSA (2007) Promoting Safer Use of Injectable Medicines: Patient Safety Alert,
National Patient Safety Agency: London
Feetam & White J (Eds.) (2011) Guidance on the administration to adults of oilbased depot and other long-acting intramuscular antipsychotic injections: Third
Edition available at www.hull.ac.uk/injectionguide.
Guidance on the Administration to Adults of Oil-based Depot and other Long-Acting
Intramuscular Antipsychotic Injections 4th Edition, (2014) [online]. Available at:
https://my.rcn.org.uk/__data/assets/pdf_file/0003/565626/SOP_Final_2014_PDF.pdf
[accessed 16th November 2017].
NICE clinical guidelines for psychosis and schizophrenia (CG 178). NICE. Feb 2014.
NMC (2010b) Recordkeeping Standards Nursing and Midwifery Council: London
NMC (2010a) Standards for Medicines Management. Nursing and Midwifery Council:
London
Prescqipp Community interest Company. Antipsychotic drugs. (2014) [online].
Available at: www.prescqipp.info/antipsychotic-drugs/send/113-antipsychoticdrugs/2876-bulletin-135-antipsychotics-update [accessed 16th November 2017].
Rodger M & King L (2000) Drawing up and administering intramuscular injections: a
review of the literature Journal of Advanced Nursing 31(3): 574-582
Schizophrenia: aripiprazole prolonged-release suspension for injection, (2014)
[online]. Available at: www.nice.org.uk/advice/esnm39/chapter/key-points-from-theevidence [accessed 16th November 2017].
Taylor D, Paton C & Kapur S (2012) The Maudsley Prescribing Guidelines in
Psychiatry: 11th Edition Wiley-Blackwell: London
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WHO (2010) Best practices for injections and related procedures toolkit World Health
Organisation: Geneva
Workman B (1999) Safe Injection Techniques Nursing Standard 13 (39):47-53
Zabak A, Gunes UY, Tamsel S et al (2007) Does obesity prevent the needle from
reaching muscle in intramuscular injections? Journal of Advanced Nursing 58
(6):552-556.
5.
ASSOCIATED DOCUMENTATION
LYPFT Medicines Code (MM-0004)
LYPFT Non-Medical prescribing Procedure (MM-0001)
LYPFT Hand Hygiene Procedure (IC-0002)
LYPFT Standard Infection Control Precautions Protocol (IC-0004)
LYPFT Blood Borne Viruses; including Sharps, Inoculation and Needle stick injury
Protection and management procedure (IC-0003)
LYPFT The Management of Incidents, Including Serious Incidents Procedure (RM0002)
6.
Standards/key performance indicators
The key performance indicators below are monitored by the assurance
framework outlined in the table below:

safe administration of depot medication;

compliance with professional and good practice standards for
medicines management;

compliance with the Trust’s Medicines Code.
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7.
EQUALITY IMPACT
The Trust has a duty under the Equality Act 2010 to have due regard to the need to
eliminate unlawful discrimination, advance equality of opportunity and foster good
relations between people from different groups. Consideration must be given to any
potential impacts that the application of this policy/procedure might have on these
requirements and on the nine protected groups identified by the Act (age, disability,
gender reassignment, marriage and civil partnership, pregnancy and maternity, race,
religion and belief, gender and sexual orientation).
Declaration: The potential impacts on the application of this policy/procedure have
been fully considered for all nine protected groups. Through this process I have not
identified any potential negative impacts for any of the nine protected groups.
Print name: Rob Edwards
Job title: Clinical Lead Nurse and Non-Medical Prescribing Lead (Nursing)
Date: 7th December 2017
If any potential negative impacts are identified the Diversity Team must be contacted
for advice and guidance: email; diversity.lypft@nhs.net.
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CHECKLIST
To be completed and attached to any draft version of a procedural document when
submitted to the appropriate group/committee to support its consideration and
approval/ratification of the procedural document.
This checklist and is part of the working papers.
Title of document being newly created / reviewed:
1.
2.
Title
Is the title clear and unambiguous?
Yes
Is the procedural document in the correct format and style?
Yes
Development Process
Is there evidence of reasonable attempts to ensure relevant
expertise has been used?
3.
8.
Yes
Equality Impact Assessment
Has the declaration been completed?
7.
Yes
Approval
Does the document identify which committee/group will approve it?
6.
Yes
Content
Is the Purpose of the document clear?
5.
Yes / No/
Yes
Review Date
Is the review date identified?
Yes
Is the frequency of review identified and acceptable?
Yes
Overall Responsibility for the Document
Is it clear who will be responsible for co-ordinating the dissemination,
implementation and review of the document?
Yes
Name of the Chair of the Committee/Group approving
If you are assured this document meets requirements and that it will provide an essential
element in ensuring a safe and effective workforce, please sign and date below and
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forward to the chair of the committee/group where it will be ratified.
Name
E Weston
Date
14/12/17
Name of the chair of the Group/Committee ratifying
If you are assured that the group or committee approving this procedural document have
fulfilled its obligation please sign and date it and return to the procedural document author
who will ensure the document is disseminated and uploaded onto Staffnet.
Name
C Hill
Date effective from: 11th December 2014
Document Reference Number: MM-0003
Version No: 1.0
Date
21/12/17
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