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CLINICAL GUIDELINE FOR DIGOXIN IV IN ADULTS - LOADING
DOSE WORKSHEET
1. Aim/Purpose of this Guideline
1.1. This loading dose worksheet is intended to guide medical, nursing and
pharmacy staff in the safe and appropriate prescription and administration of
intravenous digoxin loading doses in adults
2. The Guidance
2.1. See the next page(s)
IV Digoxin Loading Dose Worksheet
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IV Digoxin Loading Dose Worksheet
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3. Monitoring compliance and effectiveness
Element to be
monitored
Lead
Tool
Frequency
Reporting
arrangements
Acting on
recommendations
and Lead(s)
Change in
practice and
lessons to be
shared
Compliance with prescribing and administration in accordance
with this guideline (or other safe practice)
Pharmacy
No specific tool
As required according to clinical incident reports
Via Medicines Practice Committee
Matrons/ward managers
Matrons/ward managers
4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Diversity & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
IV Digoxin Loading Dose Worksheet
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Appendix 1. Governance Information
Document Title
Loading Dose Worksheet – Digoxin IV in
Adults
Date Issued/Approved:
26 September 2014
Date Valid From:
1 August 2014
Date Valid To:
1 August 2017
Directorate / Department responsible
(author/owner):
Ian Nicholls, Governance and EPMA Lead
Pharmacist
Contact details:
01872 252217
Brief summary of contents
Guidance on the prescribing and
administration of intravenous Digoxin in
adults
‘Loading dose’, ‘Loading’ ‘digoxin IV’
‘worksheet’
RCHT
PCH
CFT
KCCG
Suggested Keywords:
Target Audience
Executive Director responsible for
Policy:
Medical Director
Date revised:
August 2014
This document replaces (exact title of
previous version):
Loading Dose Worksheet – Digoxin IV in
Adults v2
Loading dose NPSA working group &
Pharmacy Medicines Information
CSSC Governance DMB (16.9.14)
Approval route (names of
committees)/consultation:
Divisional Manager confirming
approval processes
Not required
Name and Post Title of additional
signatories
Janet Gardner, Governance Lead CSSC
Signature of Executive Director giving
approval
Publication Location (refer to Policy
on Policies – Approvals and
Ratification):
Document Library Folder/Sub Folder
{Original Copy Signed}
Internet & Intranet
Clinical/Pharmacy
Links to key external standards
IV Digoxin Loading Dose Worksheet
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Intranet Only
Related Documents:
Medicines Policy
Training Need Identified?
No
Version Control Table
Date
Versio
n No
October
2011
V1.0
Summary of Changes
Initial Issue
October
2012
V2.0
Clinical update.
August
2014
V3
Update to include EPMA changes and review
practice
Changes Made by
(Name and Job Title)
Ian Nicholls,
Medication Safety
Pharmacist
Ian Nicholls,
Medication Safety
Pharmacist
Ian Nicholls, EPMA
and governance
Pharmacist
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy on Document Production. It should not be altered in any way without the
express permission of the author or their Line Manager.
IV Digoxin Loading Dose Worksheet
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Appendix 2. Initial Equality Impact Assessment Form
Name of Name of the strategy / policy /proposal / service function to be assessed (hereafter
referred to as policy) (Provide brief description): Loading Dose Worksheet – digoxin IV
Directorate and service area:
Is this a new or existing Policy?
All Clinical Areas
Existing
Name of individual completing
Telephone:
assessment: Ian Nicholls
01872 252217
1. Policy Aim*
This loading dose worksheet is intended to guide medical, nursing
Who is the strategy /
and pharmacy staff in the safe and appropriate prescription and
policy / proposal /
administration of intravenous Digoxin IV loading doses in adults
service function
aimed at?
2. Policy Objectives*
To ensure RCHT complies with the requirements of the NPSA
RRR018 Preventing fatalities from medication loading doses
3. Policy – intended
Outcomes*
Reduction in the risk associated with the prescribing and
administration of intravenous Digoxin IV loading doses in adults
4. *How will you
measure the
outcome?
5. Who is intended to
benefit from the
policy?
6a) Is consultation
required with the
workforce, equality
groups, local interest
groups etc. around
this policy?
Review of Clinical Incident Reports
b) If yes, have these
*groups been
consulted?
Yes
C). Please list any
groups who have
been consulted about
this procedure.
The Medication Practice Committee, Nursing, Medical and Pharmacy
staff.
All adult inpatients within the Trust
Yes
7. The Impact
Please complete the following table.
Are there concerns that the policy could have differential impact on:
Equality Strands:
Age
Sex (male, female, transgender / gender
reassignment)
Yes
No
Rationale for Assessment / Existing Evidence
This policy describes activities within the capability
of relevant staff
This policy describes activities not affected by
gender
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Race / Ethnic
communities /groups
This policy describes activities not affected by race
Disability -
Only staff are required to comply with this policy and
if they had a disability that prohibited them from
complying the Trust would make suitable alternative
arrangements to assist them
Religion /
other beliefs
This policy describes activities not affected by faith
and belief
Marriage and civil
partnership
This policy describes activities not affected by
marriage/civil partnership status.
Pregnancy and maternity
Sexual Orientation,
This policy describes activities not affected by
pregnancy or maternity
This policy describes activities not affected by sexual
orientation.
learning
disability, physical
disability, sensory
impairment and
mental health
problems
Bisexual, Gay, heterosexual,
Lesbian
You will need to continue to a full Equality Impact Assessment if the following have been
highlighted:
• You have ticked “Yes” in any column above and
• No consultation or evidence of there being consultation- this excludes any policies
which have been identified as not requiring consultation. or
• Major service redesign or development
No
8. Please indicate if a full equality analysis is recommended.
Yes
9. If you are not recommending a Full Impact assessment please explain why.
It is not required as the guideline does not have a differential impact on any group
Signature of policy developer / lead manager / director
Names and signatures of
members carrying out the
Screening Assessment
Date of completion and submission
1 August 2014
1.
2.
Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead,
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa,
Truro, Cornwall, TR1 3HD
A summary of the results will be published on the Trust’s web site.
Signed _______________
Date ________________
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