INTRODUCTION · Web viewNo open part of the enteral feeding delivery system, feed or enteral tube should be in contact with the hands, clothes, skin or other non – disinfected surface

Enteral Tube Administration Policy (Adults)

Version

3

Name of responsible (ratifying) committee

Nursing and Midwifery Advisory Committee

Date ratified

30 October 2015

Document Manager (job title)

Clinical Nutrition Nurse Specialist

Date issued

16 November 2015

Review date

31 August 2018

Electronic location

Clinical Policies

Related Procedural Documents

Policy for the insertion and maintenance of fine bore feeding tubes in adults

Key Words (to aid with searching)

Enteral Administration, Adult, Policy

Version Tracking

Version

Date Ratified

Brief Summary of Changes

Author

3

30/10/15

Minor changes to ancillary items used

J Pratt

2

27/10/11

S Rogers

CONTENTS

1.INTRODUCTION4

2.PURPOSE4

3.SCOPE4

4.DEFINITIONS4

6.PROCESS5

7.TRAINING REQUIREMENTS6

8.REFERENCES AND ASSOCIATED DOCUMENTATION7

9. EQUALITY IMPACT STATEMENT7

10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS8

ENTERAL FEEDING15

QUICK REFERENCE GUIDE

This policy must be followed in full when developing or reviewing and amending Trust procedural documents.

For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy. The quick reference can take the form of a list or a flow chart, if the latter would more easily explain the key issues within the body of the document

1. Enteral feed must be administered using a non-touch technique.

2. Feed hydrobags and administration sets must be labeled with date of commencement and changed every 24 hours.

3. Feed must not be decanted unless elemental feed is required, in which case the Hydrobag must be changed every 12 hours.

4. Enteral syringes must be used and discarded after each use.

5. PHT staff administering enteral pump feeding must have received training on how to use the pump.

6. All patients receiving or admitted with enteral feeding are referred to the Dietitians.

7. Patients being discharged on enteral feeding are referred to the Clinical Nutrition Nurse specialists, for assessment and discharge planning.

8. Enteral syringes and medicines filter straws must be used when adding 30% sodium chloride to feed.

1. INTRODUCTION

The use of the Gastro-intestinal tract to deliver fluid, medications and feed via a tube has become common practice in the hospital setting. The nutrients contained within enteral feeds make them an excellent environment for the growth of bacteria and other micro-organisms. Infectious complications such as bacteraemia, septicaemia, pneumonia, diarrhoea and infectious enterocolitis have all been attributed to the administration of enteral feeding solutions which have been contaminated with bacteria (1,2,7).

Research has shown that the main sources of bacterial contamination of enteral feeding systems are poor hand hygiene, increased manipulation and hanging times in excess of 24 hours. Good

handwashing techniques, use of non-sterile gloves, minimal handling and employing a non -touch technique all reduce the risk of contamination (1,3,6,7,8,9).

NPSA Alert 19 (2007), recommends the use of enteral syringes/enteral feeding systems that must not be compatible with intravenous lines/intravenous syringes.( Appendix 6) I.V compatible syringes and adaptors must not be used in the enteral administration of feed, fluid or medicines due to the risk of wrong route administration (5)

It is important that staff are competent in the correct use of enteral equipment so that they can safely deliver fluids, medications and feed via this route. This policy therefore aims to give evidence-based, best practice guidance to staff on minimising the risks associated with enteral administration

2. PURPOSE

This policy is designed to guide all Healthcare professionals in safe enteral administration in adults.

3. SCOPE

This policy applies to all competent healthcare professionals caring for adult patients who require enteral administration in the hospital setting.

In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’

4. DEFINITIONS

ENTERAL FEEDING

Using the Gastro-intestinal tract for the delivery of nutrients. For the purpose of this policy it describes artificial nutrition delivered via a tube into the gut.

NON -TOUCH TECHNIQUE

No open part of the enteral feeding delivery system, feed or enteral tube should be in contact with the hands, clothes, skin or other non – disinfected surface.

ENTERAL TUBES

Tubes placed into the GI Tract for the purpose of administering fluid, medication and/or feed. This could be nasogastric (NG), nasojejunal (NJ) gastrostomy (e.g. PEG) gastrojejunostomy, jejunostomy (e.g.surgical, PEJ) (Appendix 6)

ENTERAL SYRINGE

A purple syringe that is not compatible with intravenous catheters or ports. Solely for the administration of enteral feed ,fluid and medications.(Appendix 6)

CONSUMABLES

Plastic items used in enteral administration i.e. administration sets, syringes, extension sets, enteral connectors/adaptors, water containers, integral reservoirs .(Appendix 6.)

DECANTING

Opening sterile feed bottles/containers and pouring feed into another container/reservoir.(Appendix 2)

SINGLE-USE

For use on an individual patient during a single procedure and then discarded. It is not intended to be reprocessed and used again.

SINGLE-PATIENT USE

May be used for more than one episode of use on one patient only. The devise may undergo some form of processing between each use.

HEALTH CARE PROFESSIONALS.

A registered or trained competent member of staff including doctors, nurses and midwives.

5. DUTIES AND RESPONSIBILITIES

Clinical managers are responsible for ensuring the implementation of this Policy and associated Guideline and monitoring compliance.

Clinical Educators/ Practice Development Nurses to disseminate best practice as per Policy.

CNNS team to have a high ward profile to help embed the policy into practice.

6. PROCESS

Clinical Practice Guidelines

ACTION

RATIONALE

Prior to setting up feed wash hands with soap and water and apply non-sterile gloves.

Ensure drip-stands and pumps are clean and in working order.

If Naso-gastric tube is in situ check position of tube as per PHT Policy for Insertion and Maintenance of fine bore feeding tubes in Adults.

Administration sets, water bags and feed bags must be changed every 24hours using a non-touch technique (Appendix 1A) Ready to hang sterile feed should have a maximum hang time of 24hours.

Administration sets, water bags and feed bags must be labelled with the date and time that they were set up.

If the feed administration set is disconnected from the patient the distal end must be capped off and the feeding tube flushed with drinking tap water using a non-touch technique.

Only adaptors designed specifically for enteral use should be used. (Appendix 10)

Feed administration sets are compatible with water bags. Therefore 1 giving set should be used per 24hours and transferred between feed bag and water bag using a non-touch technique.

Feed must not be decanted unless advised by a Dietician or Nutrition CNS. In such circumstances feed and reservoirs must only hang for 12 hours.

Single-use purple enteral syringes must be used with all enteral feeding systems and discarded after each use. (Appendix 10)

Enteral tubes should be flushed with drinking tap water pre and post feed and medication administration.

All patients requiring discharge with enteral feed must be referred to the CNNSs.

Research shows that poor hand hygiene contributes to microbial contamination. 1,3,6,7.

To reduce the risk of contamination and maintain patient safety. 8

To ensure safe administration and maintain patient safety.4

To maintain a closed system to reduce the risk of contamination. 1,3,6,8,9,11

To enable staff to change the sets at the appropriate time. 3,6,7,9

To maintain a closed system and safely deliver feed/water. 1,

To maintain tube patency

Enteral adaptors will only be compatible with enteral devices therefore reducing the risk of wrong route administration. 4.

To maintain a closed system and safely deliver feed/water to the patient. 1,3,6,8,9,11

Ready to hang feed should be used wherever possible. Research shows that increased manipulation and decanting of sterile feed increases contamination. Hanging time is reduced to 12 hours with decanted feeds to minimise the risk of contamination. 1,2,3,9,10,11

To comply with NPSA alerts I.V. syringes should not be used due to the risk of wrong route administration.

5.

To maintain tube patency. 1,3,6,7.

To ensure safe discharge.

7. TRAINING REQUIREMENTS

Staff must be able to demonstrate competence prior to setting up enteral equipment. Clinical managers/Ward managers are responsible for ensuring competence.

CNNS teach on a range of formal and informal staff training sessions/courses.

CNNS team to co-ordinate the Nutrition Champions role.

Nutrition Champions to act as Nutrition resource at ward level and audit practice.

Medical Devices Training- to provide training to ward staff on enteral pumps. This can be arranged directly by contacting medical devices at QAH Ext 5735, 6976, or 3786, alternatively Ward Managers can book staff onto the Setting Direction Study Day.

8. REFERENCES AND ASSOCIATED DOCUMENTATION

1. Anderton, A. (1990) Microbial contamination of enteral feeds. How can we reduce the risk? Nutricia Clinical Care.

2.Donskey, C.J. The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clinical Infectious Diseases, (2004). 39 219-226.

3.Fogg, L. (2007). Home enteral feeding: Part 2 current issues in community practice. British journal of Community Nursing, 12(7) 296-300.

4.Great Britain. National Patient Safety Agency.(2005). Advise to the NHS on reducing harm caused by the misplacement of naso-gastric tubes.

5.Great Britain. National Patient Safety Agency. (2007.) Promoting safer measurement and administration of liquid medicines via oral and other enteral routes.

6.Great Britain. National Institute for Health and Clinical Excellence (2006). Nutrition Support in Adults (Clinical Guideline 32) London: NICE.

7.Great Britain. National Institute for Health and Clinical Excellence (2003). Prevention of healthcare- associated infections in primary and community care. Section 4. London: NICE

8.Great Britain. Medicines and Healthcare Products Regulatory Agency. (2006). Single-use Medical Devices: Implications and Consequences of Reuse. DB2006 (04). London: Department of Health.

9.Mathus-Vliegen,E., Bredius M., & Binnekade J. (2006). Analysis of Sites of Bacterial Contamination in an Enteral Feeding System. Journal of Parenteral and Enteral Nutrition, 30 (6) 519-525.

10.Matlow,A., Jacobson,M., Wray R., et al. (2006). Enteral tube hub as a reservoir for transmissible enteric bacteria. American Journal of Infection Control, 34 (3) 131-133.

11. Stroud, M., Duncan, H. & Nightingale, J. (2003). Guidelines for enteral feeding in adult hospital patients.Gut 52(Suppl VII) vii1 – 12.

9. EQUALITY IMPACT STATEMENT

Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds.

This policy has been assessed accordingly

Our values are the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace.

Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do.

We are committed to promoting a culture founded on these values which form the ‘heart’ of our Trust:

Respect and dignity

Quality of care

Working together

No waste

This policy should be read and implemented with the Trust Values in mind at all times.

10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS

Minimum requirement to be monitored

Lead

Tool

Frequency of Report of Compliance

Reporting arrangements

Lead(s) for acting on Recommendations

Administration sets are labelled and changed every 24 hours

Jo Pratt

spot checks

observation audit

2 years

Policy audit report to:

· Nutrition Support Team

· NMAC

Staff using enteral feeding pumps have received training

Jo Pratt

Spot checks

Observation audit

Data collection

2 years



· NMAC

Enteral syringes are used once and discarded

Ready to hang feed is not used for more than 24 hours

Enteral feeds are set up using a non-touch technique

Jo Pratt

Jo Pratt

Jo Pratt

Spot check

Observation audit

Spot check

Observation audit

Spot check

Observation audit

2 years

2 years

2 years



· NMAC

As above

As above

This document will be monitored to ensure it is effective and to assurance compliance.

APPENDIX 1A

FEED/WATER ADMINISTRATION VIA THE APPLIX PUMP – GRAVITY PRIMING METHOD

EQUIPMENT:-Bag of feed or Hyrdrobag

Administration set

Applix Smart Pump and Dripstand

50ml Enteral syringe and glass of drinking tap water

Non-sterile gloves

1. Wash hands and apply non-sterile gloves. Carry out the procedure using a non-touch technique.

2. Check the expiry date on the feed bag, shake well and twist off cap. If using hydrobag close clamp on bottom of bag open blue cap and fill with amount of water required, close blue cap.

3. Close clamp on Administration Set and attach Administration Set to feed bag or Hydrobag. If using hydrobag undo clamp on bag.

4. Hang bag on drip stand. Place the end of the set in an empty container to catch the drips. Ensure drip container is lower than feed/hydro bag.

5. Squeeze drip chamber so that chamber half fills with feed /water – do not overfill.

6. Open clamp allow feed/water to fill the set. Turn off clamp when feed /water reaches end of Administration Set.

7. Open the door on pump.

8. Locate the clamp on the set and hook into position in pump.

9. Gently pull down on administration set and press into groove at the bottom. Double click the pump door shut. Do not use the lever to close the door.

10. Label feed/water bag and Administration Set with time and date of setting up.

11. Flush the patients enteral tube with 30 – 50 ml of tap drinking tap water

12. Remove cap from end of Administration Set and connect administration set to feeding tube. Undo any clamps on patients tube

13. Turn on pump - set hourly rate - start pump.

14. At end of feed/water administration switch off pump and disconnect administration set from patients tube. Cap end of Administration Set.

15. Flush patient’s tube immediately with 30 –50 ml drinking tap water and cap off tube.

16. Check date and time on administration set – if > 24hrs use (or if next administration will exceed 24 hr use) discard administration set.

APPENDIX 1B

FEED/WATER ADMINISTRATION VIA THE APPLIX SMART PUMP – PUMP PRIMING METHOD.

EQUIPMENT:-Bag of feed or Hyrdrobag

Administration set

Applix Smart Pump and Dripstand

50ml Enteral syringe and glass of drinking tap water

Non-sterile gloves

1. Wash hands and apply non-sterile gloves. Carry out the procedure using a non-touch technique.

2. Check the expiry date on the feed bag, shake well and twist off cap. If using hydrobag close clamp on bottom of bag open blue cap and fill with amount of water required, close blue cap.

3. Close clamp on Administration Set and attach Administration Set to feed bag or Hydrobag. If using hydrobag undo clamp on bag.

4. Hang bag on drip stand. Ensure drip chamber is lower than the feed/water bag. Place the end of the set in an empty container to catch the drips.



7. Locate the clamp on the Administration Set and hook into position in pump.

8. Gently pull down on Administration Set and press into the groove at the bottom Double click door shut – Do not use the lever to close the door.

9. Turn on pump

10. Press and hold the bag symbol on the pump until feed/water is at the end of the administration set.

11. Label feed/water bag and Administration Set with time and date of setting up.

12. Flush the patients enteral tube with 30 – 50 ml of tap drinking tap water

13. Remove cap from end of Administration Set and connect set to feeding tube. Press rate ↑or ↓ to set hourly rate. Start pump.

14. At end of feed/water administration, switch off pump and disconnect administration set from patient’s tube. Cap end of Administration Set.

15. Flush patient’s tube immediately with 30 –50 ml drinking tap water and cap off tube.

16. Check date and time on administration set – if > 24hrs use (or if next administration will exceed 24 hr use) discard administration set.

APPENDIX 2

HOW TO DECANT ELEMENTAL SIP FEED.

EQUIPMENT:

Non-Sterile Gloves

Elemental Sip Feed Cartons

Applix pump Bag Reservoir set

Pump and Drip-Stand

Enteral syringe and glass of drinking tap water.

1. Wash hands

2. Apply non-sterile gloves. Carry out the procedure using a non-touch technique.

3. Check the expiry date on the cartons and shake well. N.B. Remember that decanted feed can only hang for 12hours-so decant the appropriate amount of feed.

4. Close the clamp on the feeding line of the reservoir.

5. Hang bag reservoir on drip stand.

6. Open lid of bag reservoir and decant elemental feed into the reservoir. Securely close lid on reservoir.


8. Open clamp allow feed/water to fill the set. Turn off clamp when feed /water reaches end of Administration Set.


10. Locate the clamp on the set and hook into position in pump.

11. Gently pull down on set and press into groove at the bottom. Double click the pump door shut. Do not use the lever to close the door

12. Label the bag reservoir with the date, time, type and quantity of feed.

13. Flush patients enteral tube with 30-50mls of drinking tap water to ensure tube patency

14. Connect feed administration set to patient and start pump.

15. At the end of administration or after 12 hours, turn off feed and disconnect. Discard any remaining feed.

16. Flush patient’s enteral tube with 30-50mls of drinking tap water to ensure tube patency.


Version: 3

Issue Date: 16 November 2015

Review Date: 31 August 2018 (unless requirements change)Page 1 of 21


Version: 3



APPENDIX 3

HOW TO BOLUS FEED VIA A PEG.

EQUIPMENT:

Non-Sterile gloves

Pack of feed/carton

Empty cup/glass

Enteral catheter tip syringe

Glass of drinking tap water

Bolus adaptor (for feed bag only)

White funnel adaptor (to attach enteral syringe to PEG)

1. Wash hands

2. Apply non-sterile gloves. Carry out the procedure using a non-touch technique.

3. Check the expiry date on the cartons/pack of feed and shake well.

4. If using feed pack-attach bolus adaptor into port on feed pack by piercing valve and screwing on

securely. This allows attachment of 60ml enteral catheter tip syringe.

5. If using cartons decant into a clean cup.

6. Prior to bolusing feed flush the patients tube with 30-50mls of drinking tap water using an enteral syringe.

7. Using an enteral catheter tip syringe either attach to bolus adaptor on feed pack or place in feed filled cup.

8. Draw up the feed by withdrawing the plunger on the syringe until full.

9. Clamp PEG tube and unscrew hub.

10. Attach funnel adaptor and 60ml enteral syringe.

11. Undo clamp on PEG

12. Depress plunger on syringe to expel feed into PEG.

13. Repeat steps 6-11 until desired amount of feed has been given.

14. At end of feed flush 30-50mls of drinking tap water through PEG to maintain patency and cap off hub on PEG tube. Open clamp.

APPENDIX 4

HOW TO UNBLOCK AN ENTERAL FEEDING TUBE.

EQUIPMENT

Non-sterile gloves

10ml enteral syringe

Glass of drinking tap water

1. Ensure all the clamps are open and the tube is not kinked.

2. Ensure distal port/hub is free of feed/medication/debris.

3. If tube looks clear and it is a suspected blocked hub/port change hub.

4. If blockage is visible in tube massage this area.

5. Fill a 20 ml syringe with 10ml of water.

6. Attach the 20ml enteral syringe to distal port.

7. Using a push/withdraw action with the plunger of the syringe try to flush the tube.

8. If blockage does not clear leave for half and hour and try again-as blockage may have dispersed.

9. Contact Nutrition CNS’s on 5918 or Bleep 1813/1484. if above methods do not clear tube.

To prevent tube blockages you must:

1. Flush the enteral tube with 30 –50ml tap water as soon as the feed finishes.

2. Flush the tube before and after feed administration with 30-50 ml tap water.

3. Ensure medications are completely dispersed/dissolved prior to administration – see Procedure for the Administration of Medicines

4. Flush the tube in between each medication with 10ml tap water if administering more than one medication.

APPENDIX 5

ENTERAL FEEDING

HOW TO ADD SALT SOLUTION TO 500ML BAG OF

FRESUBIN ENERGY FEED

EQUIPMENT:

Sterile dressing pack

Dressing Trolley/Tray

1 x 500ml bag of Fresubin Energy feed

1 x 10ml Enteral Syringe

2 x medicines filter straw

1 x 10ml Ampoule of 30% NaCI (salt)

Ampoule Opener

· Wash Hands and clean trolley/tray

· Wash Hands again

· Open Salt (NaCI) ampoules and place on Trolley.

· Twist off cap on bag of feed and place bag on edge of trolley

· Open dressing pack.

· Open Filter straws and 10ml syringe onto sterile field

· Put on gloves

· Attach the Filter Straw to syringe and draw up 6 mls ONLY of Salt (NaCI),

· Remove Filter straw, then attach a new Filter straw to the syringe.

.

· Firmly push the Filter Straw through the one way valve system on the Fresubin Energy feeding bag - you will need to hold the straw close to the end that goes into the bag of feed. Push the Filter straw all the way in to the bag.

· Inject Salt solution into bag of feed.

· Remove Filter straw.

· Shake the bag of feed thoroughly to disperse the salt solution.

· Discard used equipment. Place salt ampoules in sharps box. Remove and discard gloves.

· Proceed to set up the feed as per usual. Attach additive label to bag to state that 7mls of 30% NaCL has been added to feed

APPENDIX 6

ENTERAL FEEDING


FRESUBIN ENERGY FEED

EQUIPMENT:



1 x 1000ml bag of Fresubin Energy feed




Ampoule Opener


· Wash Hands again





· Put on gloves



.

· Firmly push the Filter Straw through the one way valve system on the Fresubin Energy feeding bag - you will need to hold the straw close to the end that goes into the bag of feed. Push the Filter straw all the way in to the bag.





· Proceed to set up the feed as per usual. Attach additive label to bag to state that 12mls of 30% NaCL has been added to feed.

APPENDIX 7

ENTERAL FEEDING


FRESUBIN ORIGINAL FEED

EQUIPMENT:



1 x 500ml bag of Fresubin Original feed




Ampoule Opener


· Wash Hands again





· Put on gloves



.

· Firmly push the Filter Straw through the one way valve system on the Fresubin Original feeding bag - you will need to hold the straw close to the end that goes into the bag of feed. Push the Filter straw all the way in to the bag.






APPENDIX 8

ENTERAL FEEDING


FRESUBIN ORIGINAL FEED

EQUIPMENT:



1 x 500ml bag of Fresubin Original feed




Ampoule Opener


· Wash Hands again





· Put on gloves



.

· Firmly push the Filter Straw through the one way valve system on the Fresubin Original feeding bag - you will need to hold the straw close to the end that goes into the bag of feed. Push the Filter straw all the way in to the bag.






APPENDIX 9

ENTERAL FEEDING


SURVIMED OPD FEED

EQUIPMENT:



1 x 500ml bag of Fresubin survimed OPD feed




Ampoule Opener


· Wash Hands again





· Put on gloves



.

· Firmly push the Filter Straw through the one way valve system on the Fresubin Servimend OPD feeding bag - you will need to hold the straw close to the end that goes into the bag of feed. Push the Filter straw all the way in to the bag.






APPENDIX 10 ENTERAL EQUIPMENT

Name

Description

Order No

NHS Stock No

Quantity

Cost

Administration Sets – YPump Set (Easy Bag)

To allow administration of feed or water via a giving set for either gravity or pump feeding via an enteral tube.

7752102

7752102

Pack 30

£0.01

Water Bags (Hydrobags)

For the administration of water via an administration set into an enteral tube

7751101

7751101

Pack 30

£0.01

Y Pump Set (EasyBag)

To allow 2 bags of feed or 1 bag of feed and a water bag to hang simultaneously-when 1 bag finishes next one starts.

7752106

7752106

Pack 30

£0.01

Enteral Syringes

purple single use oral/enteral syringes which attach directly onto male luer connections-e.g. PEG hubs/ NGT connections. Available in the following sizes:

1ml

FTR1155

Box 100

£5.67 per box

3ml

FTR1156

Box 100

£5.38 per box

5ml

FTR1157

Box 100

£5.38 per box

10ml

FTR1158

Box 100

£8.08 per box

20ml

FTR1159

Box 100

£10.54 per box

60ml female luer lock

FTR1160

Box 50

£11.17 per box

Medicina Medicine Filter Straw

To be used with enteral syringe to add 30% NaCl solution to Ready to Hang Feed Bag.

FVK137

Box 200

£86.88 per box

Equality Impact Screening Tool

To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval for service and policy changes/amendments.

Stage 1 - Screening

Title of Procedural Document: Enteral Tube Administration Policy (Adults)

Date of assessment

14.7.15

Responsible

Department

Nutrition Nurses

Name of person completing assessment

Jo Pratt

Job Title

CNNS

Does the policy/function affect one group less or more favourably than another on the basis of :

Yes/No

Comments

· Age

NO

· Disability

Learning disability; physical disability; sensory impairment and/or mental health problems e.g. dementia

NO

· Ethnic Origin (including gypsies and travellers)

NO

· Gender reassignment

NO

· Pregnancy or Maternity

NO

· Race

NO

· Sex

NO

· Religion and Belief

NO

· Sexual Orientation

NO

If the answer to all of the above questions is NO, the EIA is complete. If YES, a full impact assessment is required: go on to stage 2, page 2

More Information can be found be following the link below

www.legislation.gov.uk/ukpga/2010/15/contents

Stage 2 – Full Impact Assessment

What is the impact

Level of Impact

Mitigating Actions

(what needs to be done to minimise / remove the impact)

Responsible Officer

Monitoring of Actions

The monitoring of actions to mitigate any impact will be undertaken at the appropriate level

Specialty Procedural Document: Specialty Governance Committee

Clinical Service Centre Procedural Document:Clinical Service Centre Governance Committee

Corporate Procedural Document:Relevant Corporate Committee

All actions will be further monitored as part of reporting schedule to the Equality and Diversity Committee


Version: 3

