THE <NAME> PRACTICE
PROTOCOL
Title:
Protocol for the Administration of Hydroxocobalamin to adults
by Health Care Assistants (HCA)
Review Date:
August 2014
Version:
1.0
Introduction:
To enable suitably trained Health Care Assistants who have undertaken relevant training (as outlined
below), to administer hydroxocobalamin as a duty delegated by the General Practitioner or registered
nurse.
Characteristics of staff
Staff group (s)
Additional Requirements
Continuing Training Requirement
Clinical Condition
Clinical Condition to be treated
Criteria for inclusion
Criteria for exclusion or further action
Health Care Assistants
Successful completion of relevant training (as
outlined below)
 Completion of period of supervised practice and
assessment of competence.
 Training and competence in the correct
procedure of administering medication via intramuscular injection.
 Knowledge of The Adam Practice policy on
management of Anaphylaxis in the community.
 Adherence to Practice policies on infection
control, patient consent and management of
vaccinations.
18 monthly updates in Basic Life Support and the
treatment of Anaphylaxis.
Demonstration of competence in relation to this
medication within the PDP and appraisal process.
Continuing competency as part of the annual
appraisal/review process
Pernicious or other macrocytic anaemia’s
Any patient aged 16yrs and over, non pregnant and
who has the capacity to consent.
All patients should have a recorded diagnosis, have
received initial treatment and now require
maintenance doses.
A PSD should be written in the notes to include
drug, dose, frequency and site of administration,
with any follow-up arrangements.
Patients with an unconfirmed diagnosis of
pernicious or other macrocytic anaemia.
Recently diagnosed patients who are receiving the
initial two weeks of treatment.
Any person less than 16 years of age.
Patients for whom consent is not given or do not have
the capacity to consent.
Excluded patients: Refer to nurse/GP
Pregnancy/breastfeeding: Refer to GP
Suspected hypersensitivity reactions: Refer to GP.
Page 1 of 3
Administration of B12 by HCAs v1.0
Author: C Mechen
Date: 14 February 2013
THE <NAME> PRACTICE
PROTOCOL
Recommended
treatment, route and legal status
Dosage
Frequency of
administration &
maximum dosage
Follow-up & advice
Side effects & their management
Special considerations
Administrated by intramuscular injection into an
appropriate site ie.deltoid muscle.
1mg/1ml dose
Normal regime is initially 1mg injection 3 times a
week for 2 weeks, then maintenance therapy of 1
mg injection every 2-3 months. Different conditions
may require alternative regimes.
Advise patient when next injection is due.
Remind them to report any stomach symptoms
immediately to GP.
Nausea, headache, dizziness; fever,
hypersensitivity reactions (including rash and
pruritus); injection-site reactions; hypokalaemia and
thrombocytosis during initial treatment;
chromaturia.
Advise patients to seek medical attention if they
feel unwell after an injection. Refer to GP.
Any signs of anaphylaxis – seek immediate
assistance & follow practice protocol.
Should not be given without formal diagnosis
Adverse reactions
Health Care Assistants must ensure the availability of an Anaphylactic shock of Adrenaline 1:1000.
If a general adverse reaction does occur:
 Record in patient’s notes
 Inform patient’s General Practitioner as soon as possible
 Local reactions should be seen by either the general practitioner or practice nurse.
If anaphylactic reaction occurs
 Give treatment in accordance with The Adam practice policy on Anaphylaxis Record in
patient’s notes
 Inform patient General Practitioner as soon as possible
Relevant training
1.
The Health Care Assistants will attend a training session covering the following aspects of the
administration of hydroxocobalamin
 Appropriate anatomy and physiology
 Correct procedure for the administration of hydroxocobalamin by intramuscular injection
 Drug store requirements
 Cautions and side effects related to the administration of hydroxocobalamin
 Documentation
 Legal aspects of drug administration
2.
The HCA will undergo a period of supervised practice and to be directly observed
administering 10 x intramuscular injections of hydroxocobalamin either by the general
practitioner or the practice nurse.
3.
Health Care Assistants should have a minimum of (2) years experience within a relevant
Health Care setting and either working towards or have successfully completed a relevant
course/qualification i.e. NVQ 3 / Foundation accredited course. They should have completed
a Basic Life Support course.
Page 2 of 3
Administration of B12 by HCAs v1.0
Author: C Mechen
Date: 14 February 2013
THE <NAME> PRACTICE
PROTOCOL
Assessment of competence
Assessment of competence will be undertaken following the period of supervised practice as outlined
above.
Competence will be assessed by direct observation of the HCA’s ability to:
 Prepare the patient for the procedure
 Safe administration of the medication (including choice of site and needle technique)
 Correct disposal of clinical waste
 Correct documentation
The Health Care Assistant will also be assessed (via oral questioning) on issues relating to the
therapeutics of hydroxocobalamin.
Clinical Aspects
The following will be required:
1.
2.
3.
4.
Patient specific directions – agreed by the General Practitioner
Patient identification - required prior to the administration of medication (confirmed by the
patient declaring his or her name, date of birth and home address).
Consent – informed consent must be obtained from the patient.
Record keeping – The following should be recorded in the patients notes, either according
to the GP practice system, or within the district nursing documentation drug administration
records
 Name of drug, dose route and site of administration
 Date administered
 Batch No and expiry date
 Signature of person administering
Significant Events
Any significant event which occurs during or as the result of administration of medication must be
reported to the Practice Manager/General Practitioner or Registered Nurse, and the incident reported
via the significant event reporting framework.
Audit
The HCA will be expected to participate in audit in relation to patient outcomes and the development
of this role.
Page 3 of 3
Administration of B12 by HCAs v1.0
Author: C Mechen
Date: 14 February 2013