Adoption of the ventrogluteal site for intramuscular injections has been limited in mental health settings despite its decreased risk of sciatic nerve injury and its promotion as best practice among student nurses. At a center for addiction and mental health in Toronto, Canada, registered practical nurses followed a competency checklist in a simulation setting and then observed and administered supervised ventrogluteal injections in clinical settings. This article describes the comprehensive educational program and its outcomes in practice.
Multi-professional education has evolved & adapted over time to reflect key national guidelines & staff training needs.. Review of all hospital deaths during April 2018 showed less than 30% received a continuous subcutaneous infusion of medication prior to death. Clinical indication was clearly documented & mean starting doses were small (Diamorphine 6 mg, midazolam 7.5 mg). There was no evidence of anticipatory prescribing of syringe drivers, or the prescribing of dose ranges in hospital.Conclusion A review of end-of-life prescribing prompted by the Gosport Report gives assurance that prescribing practices described, are not seen locally. A culture promoting safe endof-life prescribing has been fostered through readily available, evidence-based guidelines, safe procedures for syringe driver use, wide-reaching multi-professional education co-ordinated by the hospice education centre and an active end-of-life audit group. Strong clinical leadership gives a co-ordinated approach to promoting excellent end-of-life care.
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