Administering intramuscular injections: How does research translate into practice over time in the mental health setting?

Wynaden, Dianne; Tohotoa, Jenny; Omari, Omar Al; Happell, Brenda; Heslop, Karen; Barr, Lesley; Sourinathan, Vijay

doi:10.1016/j.nedt.2014.12.008

Cited by 43 publications

(69 citation statements)

References 40 publications

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“…Even though the literature has supported the z-track for years (not vaccines), current evidence may not be fully used in practice. [6,8] Evidence supports the use of the ventrogluteal site for deep IM injections. [14,15] Fifty-five (41%) of the 206 respondents did not know of, ever use, or know how to locate this site.…”

Section: Practice Variationmentioning

confidence: 98%

“…To reduce medication leakage out of the muscular tissue onto the skin post injection, z-track method (displacing the skin) has been recommended by many nursing texts and the literature for decades. [6][7][8][9] This procedure causes less discomfort and fewer IM adverse effects than the "traditional" injection method yet the variation of use in educational resources and in practice is notable. [10] As obesity rates are rising, healthcare personnel must increasingly consider gender when giving IM injections.…”

Section: Practice Variationmentioning

confidence: 99%

“…[6,36] Three academic faculty with questionnaire experience reviewed the added questions to ensure content validity; the IIQ specifically addressed intramuscular injection practices, frequency of injection, injection education and training, needle and site choices, and situational questions.…”

Section: Designmentioning

confidence: 99%

“…Additionally, we recommend adopting BMI as a standard to determine appropriate needle length throughout the United States comparable to other countries conducting similar research. [6,11,12,24,25] We recommend the CDC and WHO update IM injection recommendations to include BMI and needle length based on various sized populations. [33,52] Lastly, additional research on thickness of subcutaneous tissue (fat pad) is needed similar to Poland's study in 1997.…”

Section: Future Studymentioning

confidence: 99%

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Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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Background and Objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education. Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis. Results: Most respondents were registered nurses with 4 -15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities. Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

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Section: Practice Variationmentioning

confidence: 98%

Section: Practice Variationmentioning

confidence: 99%

Section: Designmentioning

confidence: 99%

Section: Future Studymentioning

confidence: 99%

See 2 more Smart Citations

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

View full text Add to dashboard Cite

show abstract

“…Local stakeholders (patient, family, physician, and consultant) and global stakeholders (industry, regulators, academics, and the public) interact in complex ways (social media, literature, lay press, guidelines, advertising, formularies, package inserts, and direct interaction) to generate choices based on a variety of inputs (indication, feasibility, preference, and cost) (11)(12)(13)(14)(15)(16). Because of this complexity, actual practice can be characterized only empirically, answering questions such as what treatment choices are being made in clinical practice, how many patients experience which combination of therapies, and how patterns may change over time or across different locations and practice types.…”

mentioning

confidence: 99%

Characterizing treatment pathways at scale using the OHDSI network

Hripcsak

Ryan

Duke

et al. 2016

Proc. Natl. Acad. Sci. U.S.A.

285

222

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Observational research promises to complement experimental research by providing large, diverse populations that would be infeasible for an experiment. Observational research can test its own clinical hypotheses, and observational studies also can contribute to the design of experiments and inform the generalizability of experimental research. Understanding the diversity of populations and the variance in care is one component. In this study, the Observational Health Data Sciences and Informatics (OHDSI) collaboration created an international data network with 11 data sources from four countries, including electronic health records and administrative claims data on 250 million patients. All data were mapped to common data standards, patient privacy was maintained by using a distributed model, and results were aggregated centrally. Treatment pathways were elucidated for type 2 diabetes mellitus, hypertension, and depression. The pathways revealed that the world is moving toward more consistent therapy over time across diseases and across locations, but significant heterogeneity remains among sources, pointing to challenges in generalizing clinical trial results. Diabetes favored a single first-line medication, metformin, to a much greater extent than hypertension or depression. About 10% of diabetes and depression patients and almost 25% of hypertension patients followed a treatment pathway that was unique within the cohort. Aside from factors such as sample size and underlying population (academic medical center versus general population), electronic health records data and administrative claims data revealed similar results. Large-scale international observational research is feasible.observational research | data network | treatment pathways A learning health system (1) must systematically evaluate the effects of medical interventions to enable evidence-based medical decision-making. Randomized clinical trials serve as the cornerstone for causal evidence about medical products (2, 3), but evidence from these trials may be limited by an insufficient number of persons exposed, insufficient length of exposure, and inadequate coverage of the target population, factors that limit external generalizability. Observational studies can contribute to the larger goal of causal inference at three stages: (i) the design of experiments, such as determining what are the current therapies that should be compared with a new therapy; (ii) the direct testing of clinical hypotheses on observational data (4-8) using methods to correct for nonrandom treatment assignment as part of the effect estimation process; and (iii) better understanding of population characteristics to improve the extrapolation of both observational and experimental results to new groups.Without sufficiently broad databases available in the first stage, randomized trials are designed without explicit knowledge of actual disease status and treatment practice. Literature reviews are restricted to the population choices of previous investigations, and pilot studi...

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