Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [257], C).
2. 2.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
3. 3.Show
   Before administering any prescribed drug, look at the patient's prescription chart and check the following:

   1. the correct patient is being given the drug
   2. drug
   3. dose
   4. date and time of administration
   5. route and method of administration
   6. diluent as appropriate
   7. validity of prescription
   8. signature of prescriber
   9. the prescription is legible.
   To ensure that the correct patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317], C).

   To protect the patient from harm (DH [61], C; NMC [257], C).
   If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
   To prevent any errors occurring. E
4. 4.Show
   Select the appropriate pessary and check it against the prescription chart.
   To ensure that the correct medication is given to the correct patient at the appropriate time (RPS [317], C).

Procedure

1. 5.Show
   Close the room door or curtains, keeping the patient covered as much as possible.
   To ensure patient privacy and dignity. E
2. 6.Show
   Take the medication and the prescription chart to the patient. Check the patient's identity by asking them to state their full name and date of birth. If the patient is unable to confirm these details, then check the patient identity band against the prescription chart. If an electronic identity check system for the patient and/or medicine identification is in place, then use it in accordance with hospital policy and procedures. Check the patient's allergy status by asking them or by checking the name band.
   To ensure that the medication is administered to the correct patient and prevent any errors related to drug allergies (NPSA [262], C).
3. 7.Show
   Apply an apron and assist the patient into the appropriate position, either left lateral with buttocks to the edge of the bed or supine with the knees drawn up and legs parted. A light source (e.g. lamp or torch) may be needed.
   To facilitate easy access to the vaginal canal, visualize the external genitalia and vaginal canal, and facilitate correct insertion of the pessary (Chernecky et al. [39], E; Perry [281], E).
4. 8.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub, and put on gloves.
   To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
5. 9.Show
   Clean the area with warm water if necessary.
   To remove any previously applied creams (Downie et al. [82], E).
6. 10.Show
   Remove the pessary from the wrapper and apply lubricating jelly to a topical swab and from the swab onto the pessary. Lubricate the gloved index finger of the dominant hand.
   To facilitate insertion of the pessary and ensure the patient's comfort. C
7. 11.Show
   With the non‐dominant gloved hand, gently retract the labial folds to expose the vaginal orifice.
   To enable insertion of the pessary into the correct orifice (Perry [281], E).
8. 12.Show
   Insert the rounded end of the pessary along the posterior vaginal wall and into the top of the vagina (entire length of finger).
   To make sure the pessary is inserted in the correct position to ensure equal distribution of the medication (Perry [281], E).

   To ensure that the pessary is retained and that the medication can reach its maximum efficiency (Chernecky et al. [39], E).
9. 13.Show
   Wipe away any excess lubricating jelly from the patient's vulval and/or perineal area with a topical swab.
   To promote patient comfort (Potter and Perry [289], E).
10. 14.Show
    Make the patient comfortable and explain that there may be a small amount of discharge. Apply a clean sanitary pad.
    To absorb any excess discharge (Potter and Perry [289], E).

Post‐procedure

1. 15.Show
   Remove and dispose of gloves and apron safely and in accordance with locally approved procedures.
   To ensure safe disposal (HWR [137], C; MHRA [201], C).
2. 16.Show
   Record the administration on appropriate charts.
   To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (RPS [317], C).