injection safety 843
table 1. Injection Safety Observation Checklista Reported by Number of Injections Adherence to Elements from May to August 2017 (n=106)
Adherence to Injection Safety Elements by Clinic Area with Predominant SEIPS Theme Reported During Interviews, Adherent, No./Totalb (%)
Observation Elements/Predominant SEIPS Themes after Coding
1. Medication is drawn or prepared in a clean, designated area.
Environment
2. Medication is drawn up and administered using needleless access device, if applicable.
Tools/technology
3. Rubber septum of medication vial is cleansed with alcohol prior to access. Organization, tools/technology
Adult Primary Care Pediatrics, Urgent Care, and Family Medicine
10/10 (100) 33/36 (92) Medical Specialty 10/13 (77) 17/19 (89) 14/14 (100) 7/7 (100)
Common themes reported: ∙ Suboptimal condition of the medication room and location ∙ Unavailability of separate medication room away from patient care area ∙ Inadequate size and lighting 0/8 (0)
2/19 (11) 0/9 (0)
Common themes reported: ∙ Unavailability of safety needleless devices for medication preparation ∙ Type of needle used 8/9 (88)
21/26 (81) 8/8 (100)
4. Needles, syringes, IV solution bags, and IV tubing and connectors are used for only one patient.
Organization, tools/technology
Common themes reported: ∙ Need ongoing training and refresher courses ∙ Scheduled time allowed for training is needed ∙ Need easy access to training materials and reminder tools ∙ Need clear and easy access to policies 7/7 (100)
36/36 (100)
5. If using a multidose vial, expiration date is checked prior to administration. Workflow, persons, organization
Common themes reported: ∙ Clear labels and organization of medication storage ∙ Adequate staffing and training ∙ Availability of continued training courses ∙ Clear and easy accessible policies and protocols ∙ Leadership qualities and financial availability ∙ Availability of stocks ∙ On-line or computers resources for easy ordering 5/5 (100)
3/5 (100) Procedural Dialysis Imaging
7/10 (70) 12/12 (100) 1/7 (14)
8/11 (73) 14/14 (100) 6/7 (86)
13/13 (100)
20/20 (100) 14/14 (100) 9/9 (100)
4/5 (80)
6. If using a multidose vial, medication is kept in a centralized location. Environment, organization
Common themes reported: ∙ High patient turnover resulting in reduced time ∙ Increase multitask due to high volume ∙ Daily routine protocol for checking before preparing injections ∙ Staff behavior and ability to pay attention to details ∙ Ongoing education and training for safe injections ∙ Clear labeling protocol is needed 2/2 (100)
5/5 (100) 3/6 (50)
7. If using a single use vial, not used for >1 dose or >1 patient.
Organization, tools/technology
Common themes reported: ∙ Condition of medication and location ∙ Adequate size of clinic ∙ Organized medication room and sufficient medication storage ∙ Leadership qualities and financial availability 6/6 (100)
31/31 (100) 7/7 (100)
8. If patient needs to be physically stabilized for injection, additional help is available and utilized.
Workflow, persons
Common themes reported: ∙ Clear labels and organization of medication storage ∙ Adequate staffing and training ∙ Availability of continued training courses ∙ Clear and easy accessible policies and protocols ∙ Availability of stocks ∙ On-line or computers resources for easy ordering 4/4 (100)
15/18 (83) NA
NA
NA
NA
NA
NA
NA
20/20 (100) 14/14 (100) 9/9 (100)
10/10 (100) NA
Common themes reported: ∙ Be prepared and plan for the day ∙ Pre-visit and injection planning ∙ Team work and available staff ∙ Patient cooperation, physical condition, and responsive to instruction
NA
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