Hospital-wide Evidence-based Practice Change to Ventrogluteal Intramuscular Injection by Nurses

Introduction

Dorsogluteal (DG) region, the upper outer quadrant, of buttock is a common site for intramuscular injection by nurses. In December 2016, the Medical Council of Hong Kong recommended changing to the ventrogluteal (VG) site. Therefore, an evidence-based project group was established under our Nursing Services Division to follow up this issue.

Objectives

The group aimed at (i) examining the evidence for the VG site; (ii) formulating the evidence-based strategies for promoting the practice change among our nurses; and (iii) implementing the action plan of change and evaluating its effectiveness.

Methodology

The Johns Hopkins Nursing Evidence-based Practice Model was adopted. Apart from reviewing the evidence for VG site, the project also covered the: (a) optimal locating method of VG site; (b) occupational and health issues concerned; and (c) optimal method for facilitating the change. Hospital-wide nurses training was conducted, especially for senior nurses who had never learned the VG injection skill before. As informed by the evidence, simulated practice was incorporated, a new poster was designed for work places, and a video clip was produced for on-going education. Participants were required to pass the skill assessment in simulation setting. Their knowledge gain, attitude change and performance would be evaluated. Incidence of patient injury and staff needle stick injury would also be captured.

Results & Outcome

Thirty identical training sessions were conducted from December 2017 to October 2018 for nearly 860 nurses. No incidence of patient injury and staff needle stick injury was reported so far. After training, the nurses’ mean knowledge score increased from 2.98 to 5.58/6 (p< 0.001, paired t-test). Proportion of nurses willing to use VG rose from 19.3% to 95.6% (p< 0.001, McNemar's test). Among the 691 nurses who used to choose DG site, 654 of them (94.6%) were willing to change to VG. The strongest motivator was the knowledge of the benefits of VG over DG. Conversely, difficulty of the VG skill perceived was the most common barrier for change. Analysis by the logistic model also revealed that more experienced the nurses, less likely they would choose VG. But they tended to be more willing to change after training in our cohort. These results are promising. Clinical audit will be conducted later to verify the actual clinical behaviour.