Barriers and Facilitators to Injection Safety in Ambulatory Care Settings

Abstract

OBJECTIVEIdentify factors referred to as barriers and facilitators that can prevent or assist safe injection practices in ambulatory care settings to guide quality improvement.DESIGNIn this mixed-methods study, we utilized observations and interviews.SETTINGThis study was conducted at ambulatory clinics at a midwestern academic medical center from May through August 2017. Sites included a variety of clinical settings that performed intramuscular, intradermal, intravenous, or intra-articular injections.PARTICIPANTS AND INTERVENTIONSDirect observations of injections and interviews of ambulatory care staff were conducted. An observation checklist was created, including standards of injection safety from nationally recognized guidelines. Interview questions were developed using the System Engineering Initiative for Patient Safety (SEIPS) model. Interviews were recorded, transcribed, and then coded by 2 investigators.RESULTSIn total, 106 observations and 36 interviews were completed at 21 clinics. Injection safety standards with the lowest adherence included using needleless access devices to prepare injections (33%) and the proper use of multidose vials (<80%). Of 819 coded interview segments, 461 (56.3%) were considered facilitators of safe injection practices. The most commonly identified barriers were patient movement during administration, feeling rushed, and inadequate staffing. The most commonly identified facilitators were availability of supplies, experience in the practice area, and availability of safety needles and prefilled syringes.CONCLUSIONSPerceived barriers and facilitators to infection control elements of injection safety are interconnected with SEIPS elements of persons, organizations, technologies, tasks, and environment. Direct observations demonstrated that knowledge of safety injection standards does not necessarily translate to best practices and may not match self-reported data.Infect Control Hosp Epidemiol 2018;39:841-848.

Latent factors affecting safer injection practices that reduce infection and how education can improve them

“…A survey conducted to evaluate any di culties during injection practice showed decreased compliance regarding needleless access devices (33%) and multi-dose vials (< 80%). The respondents concordant with our observation, also stated that they were too busy and understaffed to perform proper infection-prevention strategies [20]. In a previous cross-sectional study conducted in Korea, the factors affecting the performance of proper intravenous injection practice of nurses in small and medium-sized hospitals were awareness of the importance of the in-hospital system for infection control and knowledge of preventive strategies for safe injection [21].…”

Why the Utilization of Ready-to-Administer Syringes During High-Stress Situations Is More Important Than Ever

“…Because it is estimated that 44% of nurses who administer IV push medications do so >5 times per shift, this could lead to multiple opportunities for use errors to occur. 7 Leback et al 34 used the framework of the Systems Engineering Initiative for Patient Safety (SEIPS) model to evaluate barriers and facilitators for safe injection practices. The researchers categorized the results using 5 SEIPS elements: persons, organization, technologies and tools, tasks, and environment.…”

“…Additional barriers to safe injection practice included environmental concerns, such as small patient care areas and limited storage areas; organizational barriers, which included inadequate staff or training and financial constraints; patients' unsafe movements, potentially leading to a needlestick injury; and tools, such as glass vials and lack of safety needles. 34 These barriers can be further amplified in high-stress situations, such as during the COVID-19 pandemic.…”

Injection Safety in the United States: Miles to Go?

“…Inadequate staffing, suboptimal training, and lack of safety needles and single-dose medications were among the barriers to injection safety reported in ambulatory care. 7,8 Clearly, there is still much work to be done. The authors recommend numerous strategies to prevent these "never events" and emphasize that every health care professional has an obligation to both practice injection safety and report unsafe practices.…”