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Administering Subcutaneous Injection

Discuss about the Infection Control Practices for Intradermal.

I was assigned to administer subcutaneous injection to a patient named Antonio, who have survived an umbilical hernia surgery and is under the post operative care. The Physician has advised a deep vein prophylaxis for the patient management.  I ensured that I would follow the NMC codes of nursing standard.   I was working with the patient for in the post operative care unit and was allotted to give the medication in the form of subcutaneous injection. I was allotted to give an anticoagulant heparin of dosage 5000units as per the dosage written in the patients drug chart. ( Ampules containing 25000 units and volume 0.2 ml). As I entered the room, I introduced myself and then identified the patient using two easy identifiers. Accurate verification of the identity of the patient is an important component of the medication administration as per the six rights of medication administration (Alabdulhafith et al., 2014). I explained the procedure and the information of the medicine to the patient. As per the NMBA nursing standard 6.1, I am entitled to provide a safe care to the patient, hence in order to avoid any infection I had donned the gloves after finishing the five moments of hand and hygiene. I made it sure that before administering the injecting I wiped the patient’s skin as allowed it to dry for 30 seconds. It is necessary to understand whether the time of administration match the order. According to Pourghaznein  et al.,(2014), it is necessary to ensure that specified time intervals has been maintained. I ensured that I abide by the nursing protocols for the subcutaneous administration of the medication, as it complies with the standard 6.5, where a nurse it accountable to the policy guidelines, regulations and the protocols. At first I chose a site that is free of any lesions and bony prominences. I pinched the area where I would administer the injection. Pinching pulls the adipose tissue away from the muscles making the administration of the injection easier. I held the syringe in my dominant hand between my thumb and forefinger and then inserted the needle at an angle of 45 º. After that I made it sure to dispose of the injection into the bins. I made it sure that I had used the two step process of syringe disposal as per the FDA standard.  This was my experience of choosing the administration site of the subcutaneous injection.

Importance of Infection Control for Subcutaneous Injection

I was a bit perturbed regarding the administration as I have heard of the complications that can happen due to the application of subcutaneous injection. I cross checked the medicine dosage as Heparin is a high risk medicine and special care should be taken to ensure correct dosages and the correct timing. As per the feedback from my peers I had administered the injection too quickly. Slow injection is the normally preferred approach as per the study by Hutin  et al., (2013) it has been found that slow injection would have a less pain intensity and bruising size at the administration site.   I was nervous whether this would affect the patient’s recovery. The choice of the injection site needs a good clinical judgment and proper review of the patient (Hutin et al., 2012). Proper administration of the medication ensures that there is a smooth flow of blood through the capillaries. I ensured to follow the 6 rights of medication administration, the right client, right route, right drug and right dose and the right time. (Murphy et al., 2012).As a registered nurse I am aware of the nursing standards of medication administration, in exercising my professional accountability in the best interest of my patient.

However, I was happy that I received a positive feedback from the patient as well as my teachers. I ensured that I would use the feedback in my next scope of practice as self evaluation and monitoring the progress in an important part of my profession and align with the NMBA nursing standard 7.

One of the positive results of the skill assessment is to acquire mastery over subcutaneous administration of medicines. I have understood that we have to be careful about four factors while the medication administration, that is the technique, route of administration, the site of administration and the equipments used. As per the nursing standard 6.6, as a registered nurse I should be able to withhold or administer in context of the condition of the patient.  I have administered the medicine at an angle of 45 degree by pinching the skin, although 90 degree angle is more preferable in case of subcutaneous medicine. I believe that I have maintained asceptic technique throughout the procedure for avoiding infections, as per the nursing standard 6.4. . Infections during application of injections increase the chance of blood borne infections and may increase the patient complicacy.  According to Pourghaznein et al., (2014), the site of administration must correlate with the route of administration and the condition of the patient. This patient had just undergone an umbilical hernia surgery hence the site of injection would certainly not be the belly.

Nursing Standards for Medication Administration

I have tried my best to the safety protocols of medication administration as it is an integral part of my profession and also in compliance with the nursing standard 1.4 (Nursing-and-Midwifery-Board of Australia, 2018). However there has been a mistake from my part as I would have kept the medicine for 10 seconds before removing. As per the nursing standard, 6.5, timing is important in the administration of medicines.

The nursing professional standard 7.1 states that it is necessary to evaluate the practice management, which in this case I have accomplished by obtaining feedback from the tutor and my peers.  As per the nursing standard 1.7, I should continuously strive for the quality improvement of my care by applying an evidence based research (standard 1.7). I plan to be more confident in the future practices. I believe that I have worked as per the medication application guidelines, which is very important for developing the professional standard among the nurses.

While administering the injection I made sure, that I abide by the standard 1.1 of NMBA, by ensuring a safe quality practice while administering the medicine (Nursing-and-Midwifery-Board of Australia, 2018). I understood that nurses are responsible for safe medication administration and prevent complexities. A small mistake in techniques may lead to life threatening conditions.

I have understood that there are certain precautions that have to be taken before the administration of the injection, which is in accordance to the standard 6.1 of the NMBA standards like cross checking of the prescriptions, correct dosages and the route of administration of the medicines. I was mindful in doing the hand washing using water and soap for avoiding infections. I was well aware while pinching the skin of the patient as elevating or pinching of the skin may increase the risks of injury. The needle might pierce the opposite side of the skin folds and may enter the skin of the health care workers. As a nurse I made it sure that I check the past medical histories, as it may influence the application of injections. Medical history includes renal impairment, insulin resistance, sex, age as it helps to mitigate complications in patient and helps the registered nurse to be in compliance with the nursing standard 6.6.  

I have understood that a proper clinical environment actually serves as a potential environment of learning. Evidence based practice is used by the nurses for providing a higher quality of care (Wehba et al., 2013). It about integrating the best available evidence with clinical experiences for an appropriate decision making process. According to (Nursing-and-Midwifery-Board of Australia, 2018), it is the basic right of the patient to receive safe care and it is the duty of the health care professionals to use the strongest existing evidences to provide care to the patient.

Importance of Clinical Environment in Learning

I have realized that for becoming a competent nurse I would have to decide, what type of a learner I am and will be able to reflect upon my clinical skills, since I believe that as a responsible nurse I would be able to reflect on my experience and check how they are going to shape my future practice, which is again the core value of the nursing standard 6.1.  I have understood that analysis and self awareness is one of the crucial aspects of reflection. Self regulation helps us to control our own action, creating less vulnerable situations. According to the NMBA codes of nursing conduct, a nurse always keeps the interest of the patient in the forefront (Nursing-and-Midwifery-Board of Australia, 2018). It is extremely essential for a nurse to understand his own learning style. As a student I should always remain motivated such that the mentor or the nurse educator will also be motivated to encourage my learning. I have understood that I am a kinesthetic learner that requires hand on activities for going in to the depth of any topic, incompliance with standard that states that a registered nurse would be able to monitor and evaluate the progress towards better outcomes (Standard 7.1). My professional standards would describe my competent level of care in each phase of medication administration, which would reflect and desired an achievable level of performance.

Conclusion

Personal understanding and insight has helped to develop my interpersonal skills. This practice has not only boosted up my clinical skills but has also removed the fear from my mind regarding the administration of an injection. This practice has also initiated the use of evidence based research in my practice as I have researched a lot about the subcutaneous injections. It has also helped me to understand that my style of learning I kinesthetic learning as I gain knowledge by hand on practices. Finally, the experience has fostered a confidence level in me that I would not repeat the same mistakes ever again.

As a part of my action plan I ensure that I would observe my educators carefully and should try to incorporate those in to future practice. I would try to maintain a reflective journal where I would be able to evaluate my performance that would help me to incorporate the nursing standard 1.2 within my actions. As stated by Bastable,  (2003), nurses excel in their practice by practicing self reflection and self evaluation . I believe that lifelong learning and would hence constantly strive to remain updated with the recent advancements regarding the legislation, guidelines and the policies relevant to nursing and apply evidence based practice in care.  Finally I would excel in the medication application and clinical reasoning as it would improve my practice and would help me to abide by the six rights of medication administration.  In order to remove my nervousness, I would like to encounter difficult situations where I can apply my learning strategies; hence I always prefer experimental learning. The feedback collected from the patient and my educator would help be to improve the gaps left in the future scope of practice.

References

Alabdulhafith, M., & Sampalli, S. (2014). NFC-based Framework for Checking the Five Rights of Medication Administration. Procedia Computer Science, 37, 434-438.

Bastable, S. B. (2003). Nurse as educator: Principles of teaching and learning for nursing practice. Jones & Bartlett Learning.

Beecher, M. D., & Henry, K. (2017). Ethics and clinical research. In Ethics and Medical Decision-Making (pp. 3-9). Routledge.

Hutin, Y., Hauri, A., Chiarello, L., Catlin, M., Stilwell, B., Ghebrehiwet, T., & Garner, J. (2013). Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections. Bulletin of the World Health Organization, 81(7), 491-500.

Johns, C., & Freshwater, D. (Eds.). (2009). Transforming nursing through reflective practice. John Wiley & Sons.

Murphy, E. L., DeVita, D., Liu, H., Vittinghoff, E., Leung, P., Ciccarone, D. H., & Edlin, B. R. (2012). Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clinical Infectious Diseases, 33(1), 35-40.

Nursing-and-Midwifery-Board of Australia. (2018). Retrieved from https://file:///C:/Users/user/Downloads/Nursing-and-Midwifery-Board---Standard---Registered-nurse-standards-for-practice---1-June-2016%20(1).PDF

Pourghaznein, T., Azimi, A. V., & Jafarabadi, M. A. (2014). The effect of injection duration and injection site on pain and bruising of subcutaneous injection of heparin. Journal of clinical nursing, 23(7-8), 1105-1113.

Wehba, S. R., Rinda, J. E., Trohimovich, B. M., & Pelletier, J. (2013). U.S. Patent No. 8,560,345. Washington, DC: U.S. Patent and Trademark Office.

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