Kilroy Grainne, Lorbiecki Meghan, Ndakuya-Fitzgerald Florine, Hagle Mary
Grainne Kilroy, BSN, RN, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
Meghan Lorbiecki, MSN, RN, CNL, PMH-BC, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
J Am Psychiatr Nurses Assoc. 2024 Jul-Aug;30(4):819-827. doi: 10.1177/10783903231178556. Epub 2023 Jun 27.
Administering intramuscular (IM) injections is common in the adult mental health patient care setting, using the deltoid, vastus lateralis, ventrogluteal, or dorsogluteal site. Mental health nurses frequently use the dorsogluteal site to administer short and long-acting IM injections as specified in the drug package insert or because of patient agitation. However, the site is often not recommended due to the potential risk of nerve injury.
Aims of this evidence-based quality improvement project were to (1) determine the best evidence for supporting the safe use of the dorsogluteal site for short and long-acting IM injections and (2) implement this evidence through nurse education.
This project had two phases: Determining best evidence through an integrative literature review and implementing the recommendations to use the dorsogluteal site when directed by the drug package insert, clinical need, nursing judgment, or patient preference. Implementation followed the Plan-Do-Study-Act quality improvement process and involved written resources and simulation.
Evidence supported the use of the dorsogluteal site in four instances and the importance of education. Nurses were highly satisfied with the education and opportunity to practice their skills with feedback during return demonstration. After studying nurses' follow-up survey results, a refresher simulation and medical center guideline were completed. There were no reports of IM injection patient injuries after 2 years and approximately 768 dorsogluteal and ventrogluteal IM injections in the academic medical center.
Pursuing recent and possibly overlooked evidence provided guidance in supporting the safe use of the dorsogluteal site for IM injections.
在成人心理健康患者护理环境中，肌内注射很常见，注射部位包括三角肌、股外侧肌、臀中肌或臀大肌。心理健康护士经常根据药品包装说明书或因患者躁动，使用臀大肌部位进行短效和长效肌内注射。然而，由于存在神经损伤的潜在风险，该部位通常不被推荐。
本循证质量改进项目的目的是：（1）确定支持安全使用臀大肌部位进行短效和长效肌内注射的最佳证据；（2）通过护士教育实施该证据。
本项目有两个阶段：通过综合文献回顾确定最佳证据，并在药品包装说明书、临床需求、护理判断或患者偏好的指导下，实施使用臀大肌部位的建议。实施过程遵循计划-执行-研究-行动质量改进流程，包括书面资料和模拟。
证据支持在四种情况下使用臀大肌部位，并支持教育的重要性。护士对教育以及在回示过程中获得反馈以练习技能的机会高度满意。在研究护士的随访调查结果后，完成了复习模拟和医疗中心指南。在学术医疗中心，两年内未报告肌内注射患者受伤情况，且进行了约768次臀大肌和臀中肌肌内注射。
寻求最新且可能被忽视的证据为支持安全使用臀大肌部位进行肌内注射提供了指导。
