POLICY & PROCEDURE TITLE: IM Injection in Adult Patient Scope/Purpose: To document the standard of care in administering adult intramuscular injections in HealthPoint clinics. Division/Department: All HealthPoint Providers and clinical staff Policy/Procedure #: Original Date: December 23, 2013 _X Replacement Date Reviewed: Date Revised: Implementation: CPIC Approved: 8.4.18 9.13.18 Responsible Party: CMO, CNO Board Approved: DEFINITIONS: N/A POLICY: PROCEDURE: Intramuscular injections are administered according to established procedure in the adult patient. I. Guidelines A. Perform the 5 Rights of Medication Administration 1. Right patient 2. Right medication 3. Right dose 4. Right route 5. Right time 6. Right documentation B. Perform hand hygiene when preparing and before administering a vaccine or medication C. Identify the patient when you walk into the exam room using 2 methods of identification. 1. Patient name 2. Date of birth D. Obtain written consent for all vaccines. E. Provide a Vaccine Information Sheet (VIS) to the patient prior to administration of vaccine. F. Verify any known food and drug allergies prior to administration. G. Confirm the medication/vaccine order in ecw prior to administration. Verbal orders are not acceptable. : 1 / 8
H. Verify the expiration date, stock selection, and lot number on vial then compare to ecw inventory when you are pulling the vaccine or medication. I. Document on Vaccine/Medication Tracking Log form. J. Label the prepared syringe with the medication name BEFORE leaving the medication area K. Change status in ecw from pending to administered after vaccine or medication is given. L. NEVER give an injection that you did not prepare. II. Preparation A. Select the site of administration for an intramuscular injection. i. Skin surface over the area should be free of bruises, abrasions, and infection. ii. The average adult deltoid muscle can absorb up to 1 ml. iii. The dorsogluteal muscle can absorb up to 3 ml. iv. The ventrogluteal muscle can absorb up to 3 ml v. The vastus lateralis muscle can absorb up to 3 ml B. Select needle size based on site of administration and must be long enough to reach the muscle tissue. i. If given in Deltoid Gender/Weight Needle Length Female or male < 130 lbs 5/8 to 1 A 5/8 needle may be used for patients weighting <130 lbs for IM injection in the deltoid ONLY if subcutaneous tissue is not bunched and the injection is made at a 90-degree angle. Female or male 130-152 lbs 1 Female 153-200 lbs or male 153-260 lbs 1 to 1 ½ Female >200 lbs or male >260 lbs 1 ½ : 2 / 8
C. Select syringe size appropriate to the amount of solution and site of administration. A 3ml hypodermic syringe is most commonly used for IM injections. D. Perform hand hygiene prior to preparing vaccine or medication. E. Prepare the correct dose, expelling any excess air from the syringe. F. If using a multidose vial (Lidocaine, Bacteriostatic water), the rubber septum on vial must be disinfected with alcohol prep pad prior to piercing. G. Label the prepared syringe with the medication name BEFORE leaving the medication area. III. Administration A. Perform hand hygiene prior to gloving. B. Greet the patient and ask them to confirm their name and date of birth. C. Verify any known food and drug allergies D. Educate patient on medication/vaccine (VIS). E. Select an appropriate IM injection site. (See Table 1) F. Put on gloves and position the patient for the injection. G. Clean the site with alcohol swab using a circular motion starting at the center of the site and moving outward in a circular motion. Allow the area to dry completely. H. Hold the barrel of the syringe like a dart and insert the needle quickly and smoothly at a 90-degree angle to the patient s skin with a firm motion. Insert the needle to the hub. i. When administering into the dorsogluteal site or if administering an antibiotic such as Penicillin or Rocephin, aspiration is required. Gently pull back on the plunger to determine whether the needle is in a blood vessel. If blood appears, withdraw the needle, prepare a new injection, and begin again. If no blood is present, inject the medication slowly and steadily by depressing the plunger. ii. When administering into the deltoid, ventrogluteal or vastus lateralis site, aspiration is not required. : 3 / 8
I. Withdraw the needle quickly (DO NOT recap), activate the safety needle and place in sharps container. J. Apply a Band-Aid to the site. K. Remove the gloves and sanitize your hands. L. Change Pending to Administered and record location in ecw : 4 / 8
Table 1 : 5 / 8
Injection site Deltoid: Use the non-dominant hand to feel for the acromion process. Place 2 fingers underneath the acromion process and inject medication at a 90-degree angle into the central and thickest part of the deltoid muscle. Dorsogluteal: Feel for the top of the hip bone, near the waist. Divide buttock into 4 imaginary quadrants and the site will be in the upper outer imaginary quadrant. Insert the needle into the skin at a 90-degree angle to the upper, outside quadrant of the buttock. Maintain the proper boundary lines to avoid injection into the sciatic nerve or the superior gluteal artery. : 6 / 8
Ventrogluteal: Place hand on hip bone (greater trochanter) and place index finger on the anterior superior iliac spine. The middle finger is spread posteriorly as far as possible to touch the iliac crest. A triangle is formed by the fingers and is the area into which the injection is given. Patient may be lying flat, chest down (prone) or on one side. Vastus Lateralis: Area is bounded by the mid-anterior thigh on the front of the leg and the mid-lateral thigh on the side. The proximal boundary is a hand-breadth below the greater trochanter, and the distal boundary is a hand-breadth above the knee. REFERENCES: http://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration Advisory Committee on Immunization Practices (ACIP) United States, 2013 Bonewit-West, Hunt and Applegate. Today s Medical Assistant Clinical & Administrative Procedures, Elsevier, 2016 Print http://www.nursingcrib.com http://www.immunize.org/catg.d/p3084.pdf POLICY/PROCEDURE TRACKING FORM (to be added as last page of each P&P for documentation of changes) : 7 / 8
TITLE: Scope/Purpose: Division/Department: Policy/Procedure #: Original Date: Date Reviewed: Date Revised: Implementation: CPIC New Replacement for: Approved: 8.4.16 8.12.16 8.16.16 8.16.16 8.28.18 8.28.18 Board Approved: Date of Revision Description of Changes 08/04/2016 5 rights of medication administration changed to 8 rights. Added Right Documentation, Right Reason and Right Response Clarification of patient identification prior to administration as defined in 8 rights of medication administration. Added that staff must identify patient when walking into exam room. Further instructions on Adult IM injection sites. Instructional pictures added. 9.13.18 Updated and re-organized guidelines, preparation and administration; additional pictures added : 8 / 8