Authors (including presenting author) :
Khan JB (1), Ng YL(1, Fan J(1), Chim WK (1)
Affiliation :
(1)Coronary Care Unit of Tseung Kwan O Hospital
Introduction :
Subcutaneous (SC) enoxaparin often leads to complications such as induration, haematoma, and particularly pain and bruising due to inappropriate injection techniques and lack of reference of last injection site resulting in repeated injection into the same area. These adverse reactions can limit the area for future injection, cause patient anxiety and disturbance in body image, leading to denial and rejection of the treatment by patients, and decrease patients’ trust in nurses’ competency. In August 2017 a questionnaire survey was conducted in CCU of TKOH to identify practice gap among nurses. The survey revealed practice variations with some were contrary to current evidence-based practice such as unaware of choosing the injection site 5cm away from the umbilicus, scar or bruise (n=10, 50%), performed aspiration prior to injection (n=3, 15%) and gave fast injection (n=16, 80%). Besides, nurses were not required to record the injection site used
Objectives :
To update and standardize the injection techniques of SC enoxaparin and to implement an injection site record in CCU so that the potential complications of SC enoxaparin are minimized
Methodology :
1. The in-house administration protocol of SC enoxaparin was revised that reflected recommendations in the evidence-based guidelines. A reference guide was created and put on the injection trolley for staff easy reference. 2. An injection site record with diagram adapted from the “capalliary blood glucose & insulin injection record” of TKOH was devised to locate and record the injection sites. A remarks column was added for reporting abnormalities. This chart was returned after patient’s discharge for review nurses’ compliance on selection and record of injection site. 3. In September 2017, training sessions were provided to all CCU nurses with return demonstrations were required. 4. In October 2017, patients’ response and nurses’ feedback was collected and the injection sites on the diagram of the injection record chart were modified. After the amendment, no pain was reported and the modified injection sites were adopted.
Result & Outcome :
In March 2018, nurses’ compliance with the updated protocol was evaluated by the review of the injection site record from September 2017 to February 2018 and assessment of SC enoxaparin injection techniques for all nurses (n=19) using skill evaluation form. Results showed that nurses were 100% compliance with the administration guidelines of the protocol
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