Hi Kenzo
We had a similar issue in a large ambulatory practice with staff reporting they were uncomfortable with the Ventrogluteal IM injection site. As others have reported, we did a big push to provide educational resources to the nurses to improve their skill level. However, that work alone was not enough to address the change in practice.
We found that the nurse would ask the provider for an order to give the injection into the Dorsogluteal site. We had to work with the providers to stop ordering the workaround, not changing nursing practice. We taught the providers with an update of not using the dorsogluteal site and to not instruct their patients that they would be getting injections in their buttock. This was part of a game changer to set up the expectations for the patient by the providers. Another issue was the patients who came in regularly and demanding to only have the injection in dorsogluteal. We had a service recovering system to address this situation.
The final work was a clarity report that we run on a monthly basis to determine all of the injections, sites, and staff who are giving them. The file goes automatically to the managers to take action. Our rate went from 20% incorrection selection to now less than 1% or zero per our monthly reports. The staff who are not selecting are addressed and the repeat rate is very seldom.
Using a multiple approach with leadership support, provider support, timely data feedback, and clinical experts available to address the skills made the difference. I am confident we have changed the practice and can detect when someone is not using the evidence based practice.
I hope this helps.
Dawn Vonderheide Herr, DNP, MSN, RN, AMB-BC,N E-BC
Director of Ambulatory Clinical Practice
Kaiser Permanente
Southern California Permanente Medical Group Orange County
Consultant for Scope of Practice, Policy and Procedures, Standing Orders, Standardized Procedures, Ambulatory Regulation, Patient Safety
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