Injectable medications: self-reported practices of nursing professionals

Survey study that assessed the self-reported frequency of injection medications through a validated electronic questionnaire, applied from September to December 2017.

Results:

The 1,295 computed responses showed non-compliances such as sharing multidose vials for two or more patients (10.8%), reusing single-use supplies, such as use of saline flush syringes for different patients (1.2%) and needle recapping after use (4.9%). Greater adherence to glove use for administration of intravenous injections (80.5%) and lack of training for handling safety devices (13%) were reported. Correlational data showed that, the older the age, the better the self-reported injecting practices.

Conclusion:

Although most practices are within Safe Injecting practices, there are reports of risky practices, such as sharing single-use supplies. Training for the use of safety devices is not yet a reality for all professionals, since many reported it as rare.

DESCRIPTORS
Nursing Care; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Medication Therapy Management; Patient Safety

Injecting practices	Relative Frequency
Injecting practices	Always	Almost Always	Sometimes	Almost Never	Never
Disinfection of trays before preparing an injection	74.6	17.8	4.7	1.5	1.3
Use of supplies with damaged packaging	7.6	1.2	2.3	6.5	82.4
Hand hygiene before and after preparing injections	86.0	11.1	1.9	0.7	0.3
Sharing saline vials for reconstitution of medication	7.3	9.7	14.2	15.4	53.4
Use of multidose vials for two or more patients	10.8	10.0	12.9	12.6	53.8
Disinfection of the rubber septum of multidose vials with 70% alcohol before entering	64.3	16.1	8.2	5.2	6.2
Disinfection of vials and ampoules with 70% alcohol before entering	63.8	15.7	8.2	5.8	6.6
Reuse of needles or syringes for the same patient when preparing medications	2.4	4.3	5.7	7.9	79.8
Reuse of needles or syringes for different patients when preparing medications	0.5	0.3	0.6	1.6	96.9
Hand hygiene with soap and water before administering intravenous medication	71.3	16.7	7.1	1.9	3.1
Hand hygiene with alcohol-based solution before administering intravenous medication	66.0	16.9	10.7	3.3	3.2
Use of gloves for the administration of intramuscular medications	65.4	7.5	9.3	9.0	8.8
Use of gloves for the administration of subcutaneous medications	59.5	7.8	8.7	11.6	12.4
Use of gloves for the administration of intravenous medications	80.5	8.0	4.9	3.6	2.9
Cleaning skin before the administration of intramuscular medications, except for vaccines	96.1	1.5	0.8	0.5	1.2
Cleaning skin before the administration of subcutaneous medications, except for vaccines	90.9	3.2	1.7	0.9	3.2
Contact with skin after cleaning and before administering injections	4.4	2.9	9.7	16.8	66.1
Sterile dressing for catheter fixation/maintenance	49.6	11.4	10.5	11.1	17.4
Changing peripheral access according to the standards of the service before signs of phlebitis	72.4	13.8	5.3	2.7	5.7
Disinfection of connectors before medication administration	57.8	13.8	9.2	5.7	13.5
Reuse of protection caps	8.3	15.5	17.1	10.0	49.1
Inadequate storage of protection caps of peripheral catheters for reuse	2.3	5.5	10.5	9.9	71.8
Reuse of syringes with a new needle for medication administration in a single patient	5.4	2.2	4.4	5.6	82.3
Reuse of syringe for saline flush of peripheral venous catheters of different patients	1.2	0.4	0.6	1.2	96.5
Training for handling needles and catheters with safety device	13.0	12.4	27.3	27.1	20.3
Needle recap after injection	4.9	4.6	9.0	10.3	71.3
Unprotected transportation of syringes and needles to the disposal site	20.1	10.4	14.6	16.4	38.6

	Mean±SD	Median	Maximum	Minimum
Preparation of the environment
Vocational Education and Training (N=538)	7.0±2.3	6.0	18.0	5.0
Graduate degree (N=239)	7.4±2.4	7.0	16.0	5.0
Post-graduate degree (N=511)	7.8±2.8	7.0	21.0	5.0
Preparation of Medications
Vocational Education and Training (N=538)	14.7±4.6	14.0	36.0	9.0
Graduate degree (N=239)	15.2±4.3	14.0	30.0	9.0
Post-Graduate degree (N=511)	15.2±4.6	15.0	34.0	9.0
Medication Administration
Vocational Education and Training (N=538)	43.0±8.8	42.5	72.0	24.0
Graduate degree (N=239)	43.0±8.7	42.0	68.0	28.0
Post-Graduate degree (N=511)	43.9±9.4	43.0	77.0	25.0
Care after Administration
Vocational Education and Training (N=538)	14.0±4.1	14.0	26.0	7.0
Graduate degree (N=239)	14.5±4.1	14.0	27.0	7.0
Post-Graduate degree (N=511)	14.0±3.9	14.0	27.0	7.0
Total Score
Vocational Education and Training (N=538)	78.7±15.1	77.5	139.0	49.0
Graduate degree (N=239)	80.0±14.1	79.0	128.0	55.0
Post-Graduate degree (N=511)	80.9±16.0	80.0	134.0	49.0

Questionnaire Domains	Age (n=1271)	Professional Experience (n=1295)
Preparation of the Environment	r=-0.191 p<0.0001	r=-0.06 p=0.0425
Preparation of Medications	r=-0.062 p=0.0282	r=0.013 p=0.6447
Medication Administration	r=-0.095 p=0.0007	r=-0.017 p=0.5397
Care after Medication Administration	r=-0.111 p<0.0001	r=-0.060 p=0.0312
Total Score	r=- 0.138 p<0.0001	r=-0.036 p=0.1923

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Rosely Moralez de Figueiredo, Rod. Washington Luiz, Km 235, Monjolinho CEP13565905 – São Carlos, SP, Brazil rosely@ufscar.br

Brasil

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Injectable medications: self-reported practices of nursing professionals* Apoio financeiro O presente trabalho foi realizado com apoio da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Código de Financiamento 001.

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Injectable medications: self-reported practices of nursing professionals^* Apoio financeiro O presente trabalho foi realizado com apoio da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Código de Financiamento 001.