For intramuscular injecting technique to be effective a paradigm shift is needed to translate research evidence into practice

Abstract

AIMS AND OBJECTIVES: To determine current practice choices made by nurses when administering an intramuscular injection (IMI) and practice changes that have occurred since 2006. BACKGROUND: The relationship of metabolic syndrome linked to atypical antipsychotic use has raised concerns around the effective delivery of depot medication. Since 2000, there has been increasing debate on defining what is best practice when administering IMIs, particularly in areas such as site selection, needle size and technique. DESIGN: Two cross sectional studies across two time frames: 2006 and 2012 with registered mental health nurses to describe intramuscular injecting practice. METHODS: A questionnaire related to intramuscular injecting practice originally administered in 2006 was repeated in 2012 across seven inpatient and community mental health services in Western Australia. RESULTS Eight significant practice changes were recorded and they related to needle size, site selection and Z tracking. The use of the dorsogluteal as nurses preferred site choice contradicts the current literature and reflects the difficulty in progressing evidenced based practice changes. In addition, new practice issues are emerging such as the increased use of atypical long acting injectable medication and the associated weight gain in some consumers. CONCLUSIONS: Computerised tomography has added insights into the effectiveness of current practice techniques to reach the injection site recommended by the manufacturer. Whilst manufacturer recommendations influence site selection and needle size, mental health nurses also need to monitor for glycemic and cardiovascular risk factors associated with the use of atypical antipsychotics.