CP 4.20: Vitamin B12 Injection

PURPOSE

The Community Paramedic (CP) works together with primary care providers to support patients in the community wherever possible. In some cases, Nurses, Nurse Practitioners or Physicians may request assistance from the CP through the normal request for service process to help administer Vitamin B12 injections for patients with anemia or other clinical indications.

POLICY STATEMENTS

The CP should demonstrate the attitudes, knowledge, and clinical skills necessary to provide safe and effective immunization administration. In order to provide Influenza vaccinations, PCP CPs must have completed the following course and received the associated EMALB Schedule 2 endorsement. RACCPs may provide the service without this additional training.

• BCEHS – Administration of Vitamins in the Out-of-Hospital Setting

CPs can provide the full scope of functions related to Vitamin B12 injections following completion of the required training and EMALB Schedule 2 endorsement, including administration and management of any adverse events.

GUIDELINE

In response to a request for URGENT PRIMARY CARE SERVICE from a primary health care provider, and following standardized procedures for CP patient visits, the CP will:

• Retrieve the Vitamin B12 injection from local source
• Assess the patient, obtain informed consent, prepare, and educate the patient
• Prepare the injection, administer the injection, monitor, and manage any adverse events
• Document, in Siren, the therapy or therapies and assessment provided on this visit

PROCEDURE

1. Obtain service request, establish dosing frequency and identify where CP may retrieve the Vitamin B12 Injection
2. Explain purpose of the Vitamin B12 Injection and assess patient’s understanding of procedure and discuss any concerns the patient may have prior to injection
3. Review possible complications or reactions with the patient and verify their understanding of when follow-up care from the primary health care provider would be required
4. Confirm identity and obtain verbal consent prior to undergoing any procedure
5. Wash your hands with soap & water, or with alcohol-based hand sanitizer
6. Practice the 8 RIGHTS of safe medication administration:
   1. Right patient
   2. Right drug
   3. Right dose
   4. Right route
   5. Right time
   6. Right reason
   7. Right frequency
   8. Right documentation
7. Administer Injection
   1. Select appropriate site for administration
   2. Use sterile technique for administration of intramuscular injection
8. Practice principles of safe sharps handling
9. Communicate with the primary care provider if any other concerns arise. It is recommended that all clients are observed for 15 minutes post-injection
10. If severe adverse reaction, refer to BCEHS CPG E09: Anaphylaxis and request emergency ambulance response
11. Document injection in Siren and inform primary care provider of administration once patient event complete

DOCUMENTATION

Homebound:

• Document in SIREN ePCR under Procedures:
  • Dose administered
  • Route of administration
  • Any reactions following injection
• If you consulted with the primary care provider or CliniCall, document in SIREN under Procedures

REFERENCES & SUPPORTING RESOURCES

1. BC Guidelines – Cobalamin (Vitamin B12) Deficiency
2. National Institutes of Health – Vitamin B12 Fact Sheet for Health Professionals
3. BCEHS CPG E09: Anaphylaxis