Moving the Needle: Shifting Practice to the Ventrogluteal Site for Intramuscular Injection

Purpose: The struggle over shifting nursing practice to choosing the ventrogluteal (VG) site over the dorsogluteal (DG) site for intramuscular (IM) injections is well documented. There is a vast amount of evidence that points nursing practice towards using the VG site as the safer choice (Blanchard & Payette, 2011; Walsh & Brophy, 2016; Zimmerman, 2010). Unlike the DG site, the VG site is free from major nerves and blood vessels, has a thinner layer of subcutaneous tissue, and may be less painful for patients (Isseven & Midilli, 2020). Despite the evidence, many nurses continue to choose the DG site for large volume, deep IM injections. Our community health center services over 55,000 patients and delivers a large number of IM medications. Most nurses in our organization choose the DG site for injection. A quality improvement project was initiated to promote the VG site as the safest choice for deep IM injections.
Description: Prior to the start of the project, nurses across the organization were surveyed regarding their injection practices. The survey had a 70% response rate and showed the DG site being the preferred site for IM injection. 67% of nurses stated they used the DG site every time they performed a deep IM injection. Just as concerning, 86% of nurses claimed they had never used the VG site. The top two responses for not using the VG site were lack of knowledge and lack of training. A long-term goal and timeline were established prior to starting the project and shared with the nursing staff. In 12 months, at least 50% of nurses would be using the VG site at least 75% of the time. Nurses would be surveyed again at 6 months into the project and lastly at 12 months. The project consisted of in-person didactic and skill-based education, infographics, just-in-time training with nurses during patient appointments, a video on proper landmarking and injection, and a patient education handout. The project expanded to include a VG injection site class for all onboarding nurses. Seven months into the project, “injection site drop-ins” were held for review on all injection sites. Nine months into the project, nursing annual competencies will incorporate safe injection practices including injection site choice and proper landmarking.
Evaluation/outcome: Survey data collected at six months showed a drop in the survey response rate to 50%. However, data from the survey revealed a positive trend, with only 6% of nurses responding they are continuing to use the DG site every time, and only 12% claiming they had never used the VG site. The repetitive reason given for not using the VG site was patient refusal. Data indicated approximately 34% of nurses are using the VG site at least 75% of the time. Results of each survey along with educational initiatives are shared with the nursing staff via conversations, email, and on the organization’s intranet. Project interventions will continue as planned. Twelve-month data will be collected and analyzed prior to the conference date.