Injection Site Selection – Changing Practice

Aim: STOP the use of the dorsogluteal site for intramuscular injections by the ambulatory nurses. The nurses reported they were using the unapproved dorsogluteal intramuscular site (Lippincott, 2019). The nurses' rationale for the site selection was due to patient requests and the nurses’ discomfort using the ventrogluteal and vastus lateralis injection sites. The literature reported similar findings. Of reporting nurses, 35.9% were uncomfortable using the ventrogluteal site (Sari, Sahin, Yasar, Taskiran, & Telli, 2017). The targeted group for the change of practice were nurses who administered testosterone and ceftriaxone injections. Testosterone was given by over 190 nurses in 15 nurse-run clinics. Ceftriaxone was given by over 220 nurses in the 22 back offices for primary care, urgent care, and specialty care.

Methods: The quality improvement project used the knowledge-to-action framework (Graham et al., 2006), which focused on leadership support of the goal, use of audits, feedback, and content expertise. The audits were released monthly to the managers with the names of those staff who did not select the correct injection site. The managers used the audits to provide feedback to the individual nurse to guide change of practice. Those nurses who reported they were uncomfortable with their current skills were supported with training and practice sessions for ventrogluteal and vastus lateralis injections.

Results: The results were a successful change of practice and sustainability. The testosterone group interventions began in March 2019. This group demonstrated a reduction of incorrect site selection from the baseline of 10.6% to less than 1% from December 2019 through December 2020. The ceftriaxone group interventions began in May 2019. This group demonstrated a reduction of incorrect site selection from the baseline of 20% to less than 1% from December 2019 through December 2020.

Conclusions: The results demonstrated sustainability of the desired practice change for the correct site selection for intramuscular injections by the ambulatory nurses. Patient safety was improved with the reduction of the selection of the dorsogluteal site. The knowledge-to-action framework can be used with other identified clinical practice gaps where implementation and adherence are critical to success.

References

• Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26(1), 13-24. doi:10.1002/chp.47
• Lippincott Procedures. (2019, June 14). Intramuscular injection, ambulatory care. Retrieved from https://procedures.lww.com/lnp...,injection,site,injections,sites,injecting&a=false&ad=false
• Sari, D., Şahin, M., Yaşar, E., Taşkiran, N., & Telli, S. (2017). Investigation of Turkish nurses’ frequency and knowledge of administration of intramuscular injections to the ventrogluteal site: Results from questionnaires. Nurse Education Today, 56, 47-51. doi:10.1016/j.nedt.2017.06.005