Patient Safety and Quality Policies

Immunopenotyping Users Guide

UHB 004 - Infection Control Procedure for Meticillin Resistant Staphylococcus Aureus (MRSA) in Acute Hospitals

UHB 009 - Interventions Not Normally Undertaken (INNU) Policy - List of Interventions Not Usually Undertaken by CAVUHB - EHIA

UHB 011 - Acute Pain Management Guidelines (Adult) and EQIA 

UHB 016 - Domestic Abuse Guidelines for The Emergency Unit and EQIA

UHB 017 - Labelling Of Specimens Policy

UHB 018 - A Clinical Policy for Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) for Adults (18+) in Wales

UHB 019 - Infection Control Procedure for Needlestick and Similar Sharps Injuries

UHB 030 - Provision of Intraoperative Cell Salvage Policy - EQIA

UHB 032 - Advanced and Emergency Care Pathway for Children / Young People with Life Threatening / life limiting illness

UHB 033 - Patient Access Policy - EQIA

UHB 045 - Prevention and Management of Adult Inpatient Falls Procedure

UHB 055 - Clostridioides difficile Procedure

UHB 062 - Point of Care Testing (POCT) Policy - EQIA 

UHB 065 - Wales Interim Policy & Procedure for the Protection of Vulnerable Adults from Abuse

UHB 067 - Insertion, Management and Removal of Nasal Bridle Fixation Devices for Naso-Enteral Tubes in Adults Procedure and EQIA

UHB 068 - Blood Component Transfusion Policy

UHB 075 - Viral Gastroenteritis (Norovirus) Infection Control in University Health Board Hospitals Procedure

UHB 076 - Varicella Zoster Procedure & EHIA

UHB 081 - Parenteral Infusion Pump Policy & Procedure

UHB 082 - Medical Equipment Policy & Procedure

UHB 083 - Equality, Inclusion and HR Policy & EQIA

UHB 090 - Patient Sling Inspection Procedure

UHB 092 - Chaperone Policy

UHB 096 - Diabetic Ketoacidosis Management Guidelines in Adults within the University Hospital of Wales (UHW) and University Hospital of Llandough (UHL)

UHB 098 - VVIP / VIP / Celebrities Guideline for Hospital Treatment

UHB 100 - Consent to Examination or Treatment Policy

UHB 101 - Patient Identification Procedure & EQIA

UHB 106 - Policy for the Prevention of Venous Thromboembolism (VTE) in Inpatients aged 16 years and over

UHB 110 - Donations of Organs and Tissues Following Death Policy and EHIA

UHB 114 - Procedure for the Insertion of Nasogastric Feeding Tube, Confirmation of Correct Position and Ongoing Care (for adults)

UHB 116 - Service Evaluation Guidance

UHB 117 - Patient Property Policy and EQIA

UHB 120 - Quality Policy of the Directorate of Laboratory Medicine (CAVUHB)

UHB 132 - Framework For Working with Volunteers & Volunteering Operational Procedure - EHIA

UHB 138 - Incident, Hazard and Near Miss Reporting Policy and the NHS Wales National Policy on Patient Safety Incident Reporting & Management

UHB 140 - Standard Operating Procedure for the Destruction of Controlled Drugs by Authorised Witnesses - Primary Care

UHB 149 - Infection Control Procedure for Infectious Incidents and Outbreaks in University Health Board Hospitals

UHB 153 - Peri-operative Pain Management in Children

UHB 155 - Pressure Ulcer Risk Assessment, Prevention and Treatment Procedure

UHB 162 - Administration of Nebulised Ribavirin in Adults (Haematology) Procedure

UHB 164 - Missing Patients from Premises in which the UHB is Providing Healthcare

UHB 171 - Alcohol, Drug & Substance Misuse Policy

UHB 184 - Apomorphine Administering Procedure via Sub-Cutaneous Infusion Device to inpatients with Parkinsons Disease - EHIA

UHB 189 - Replacement of Balloon Retained Gastrostomy (BRG) Procedure

UHB 190 - Use of Antimicrobial Agents Policy

UHB 191 - Swab Instrument and Sharps Count - Policy and Procedure - EQIA

UHB 194 - Extravasation Procedure & EQIA - Undergoing update

UHB 196 - Conscious Sedation in Adults Procedure

UHB 199 - Care After Death Guidance

UHB 200 - Hand Hygiene Infection Control Procedure

UHB 202 - Symptom -Triggered Alcohol Detoxification in CAV UHB Hospitals - Guideline

UHB 205 - Guidelines on the Diagnosis and Management of Vitamin D Deficiency in Children and Adults

UHB 209 - Safe Handling and Administration of Intrathecal Chemotherapy Procedure

UHB 210 - Healthcare Professionals Overseeing Patient INR Self-Testing Services Practice Guidelines & EQIA

UHB 218 - Management of Fetal Remains, Stillbirth and Neonatal Death Policy

UHB 221 - Nutrition and Catering Policy for Inpatients

UHB 223 - In-house Adaptation, Modification, Manufacture and Repair of Medical Equipment Procedure

UHB 224 - Optimising Outcomes Policy and EQIA / Optimising Outcomes Policy Supporting Procedure

UHB 228 - Written Information for Patients Guidance

UHB 229 - Breastfeeding Policy

UHB 237 - Infection Prevention and Control Procedure for the Management of Patients Known or Suspected to have Mycobacterium Tuberculosis (TB) in Hospital

UHB 239 - Bedrails Procedure

UHB 243 - Discharge Against Clinical Advice (DACA) Procedure

UHB 244 - Sepsis Pathway

UHB 245 - Organ Donation from the Emergency Unit - Standard Operating Procedure

UHB 259 - Decontamination Ultrasound Transducers SOP

UHB 260 - Insertion of a Flocare Bengmark Naso-Intestinal Tube, Confirmation of Correct Position and Ongoing Care in Adults' Procedure

UHB 264 - Guidance For Transferring a Deceased Baby or Child and EQIA

UHB 265 - Infection Control Procedure for Viral Hepatitis and EQIA

UHB 273 - Cleaning Strategy and EQIA

UHB 275 - Ectoparasitic Infestations / Infections: Fleas, Lice and Mites (Scabies) Procedure & EQIA

UHB 278 - Management of a Throat Pack - Policy and Procedure & EQIA

UHB 282 - CAVUHB Reusable Medical Device Decontamination Policy and Procedure

UHB 283 - Policy on the Management of Oral Anticancer Therapy

UHB 285 - Blood and Platelet Shortage Planning Procedure

UHB 316 - Operational Procedure for Rapid Access Chest Pain Clinic

UHB 322 - Ultrasound Clinical Governance Policy & Procedure

UHB 325 - Guidelines for the Administration of Subcutaneous Chemotherapy in the Community

UHB 329 - Management of Parenteral Cytotoxic Chemotherapy Procedure

UHB 330 - Referrals By Non-Medical Professionals for Diagnostic Imaging Investigations (Excluding Clinical Trials and Research) Policy

UHB 331 - Referrals By Non-Medical Professionals For Diagnostic Imaging Investigations (Excluding Clinical Trials and Research) Procedure

UHB 334 - All Wales Paediatric Advance Care Plan (PAC-Plan) Policy for Patients Under 18 Years of Age With Life Threatening or Life Limiting Illness - EQIA

UHB 338 - Standard Operating Procedure for Insertion and Management of Power PICC (Peripherally Inserted Central Catheter) Solo using Ultrasound and Sherlock 3CG Guidance

UHB 347 - Procedure for the Prevention, Control & Management of Multi Drug Resistant Organisms (MDRO) including Carbapenemase Resistant Organisms (CRO), Meticillin Resistant Staphylococcus Aureus (MRSA) and Glycopeptide Resistant Enteroccoci (GRE)

UHB 348 - Blood Component Transfusion Procedure

UHB 349 - Creutzfeldt-Jakob Disease (CJD) and Variant CJD (vCJD) Minimising the Risk of Transmission Infection Prevention & Control Procedure

UHB 351 - Deceased Organ and Tissue Donation Procedure

UHB 364 - Venepuncture for Non-NMC Registered Research Staff Policy

UHB 365 - Procedure for Non-NMC Registered Research Delivery Staff to Perform Venepuncture

UHB 366 - Point of Care Testing (POCT) Procedure

UHB 367 - Nutrition and Catering Procedure for Inpatients

UHB 368 - Management of Simple Ovarian and other Adnexal Cysts Imaged on Ultrasound

UHB 370 - Fetal Remains, Stillbirth and Neonatal Death Procedure

UHB 372 - Discharge from Hospital Policy

UHB 379 - All Wales Policy for Medicines Administration, Recording, Review, Storage and Disposal

UHB 390 - Guidelines for the Management of Acute Inpatient Adult Patients with a Tracheostomy

UHB 402 - Covert Medical Administration Guidance & Covert Medical Administration Flowchart

UHB 403 - Intraoperative Cell Salvage Procedure - EHIA

UHB 405 - All Wales POCT Governance Policy

UHB 417 - Guideline on the Management of Post Sexual Exposure to HIV and Other Bloodborne Viruses

UHB 447 - Carers Procedure

UHB 450 - Parenteral Nutrition Procedures for Adult Patients

UHB 451 - Confirmation of an Expected / Unexpected Death Policy

UHB 452 - Labelling of Specimens Submitted to Medical Laboratories Procedure

UHB 468 - Framework for the Management of Performance Concerns in General Medical Practitioners (GP's) on the Medical Performers List Wales

UHB 483 - Activation of Emergency Unit Massive Haemorrhage Protocol (Paediatric)

UHB 484 - Independent and Supplementary Prescribing Governance Framework (Cymraeg)

UHB 492 - Approval of Gene Therapy Medicinal Products (GTMP) and Gene Therapy Investigational Medicinal Products (GTIMP) Procedure & EHIA

UHB 499 - UHW X-Ray Massive Haemorrhage Protocol

UHB 500 - Interim Clinical Commissioning Urgent Policy - Perinatal Post-Mortem Investigation of Fetal and Neonatal Deaths

UHB 502 - Deteriorating Patient Policy

UHB 509 - Clinical Audit Policy

UHB 510 - Procedure for Review and Implementation of NICE, Health Technology Wales Guidance and All Wales Medicine Strategy Group

UHB 513 - Welsh Language Inpatient Policy (Cymraeg)

UHB 518 - Paediatric Major Haemorrhage Protocol

UHB 519 - Development and Approval of UHB Specific Consent Forms Principles and Framework

UHB 528 - Development and Approval of UHB Local Procedure Specific Patient Information Leaflets Principles and Framework

UHB 529 - Policy for the Management of Suspected and Proven Neutropenic Sepsis in Adults

UHB 531 - Resuscitation Procedures

UHB 555 - Standard Operating Procedure on Requirements for Group and Screen Sampling for Adult Patients Undergoing Surgery for Suspected Appendicitis at CAVUHB

UHB 556 - Management of Visitors within the Operating Theatre Department Policy

UHB 567 - Cardiff and Vale UHB Biological Medicines Value Optimisation Policy

UHB 587 - Outcoming of Outpatient (PMS) Clinics Standard Operating Procedure

UHB 588 - Medical Gases Policy - EHIA

UHB 597 - Accessible Information and Communication Policy 

UHB 599 - Procedure for the Insertion of a Nasogastric Feeding Tube, Confirmation of Correct Position and Ongoing Care (for Children, Infants and Neonates)