Safe Injection and Drug Calculation Introduction · Safe Injection and Drug Calculation Introduction Practical Skills Teaching Phase 1b Medical Students. ... Appendix D – Downloadable

Safe Injection and Drug Calculation Introduction

Practical Skills Teaching

Phase 1b Medical Students

Clinical Skills and Simulation Team – November 2014 Page 2

Contents

Introduction to workshop .............................................................................................. 3

Overall Session Aim ........................................................................................................ 4

Intended Learning Outcomes ........................................................................................ 4

Workshop Structure – Guidance for Tutors ................................................................... 5

Introduction ................................................................................................................... 7

Safe Injection .................................................................................................................. 7

Pre and Post Injection Checks ........................................................................................ 7

Sub-cutaneous Injection ................................................................................................ 8

Intramuscular Injection .................................................................................................. 8

Assessment .................................................................................................................... 9

Appendix A – Intra Muscular Injection Procedure Checklist ....................................... 10

Appendix B – Sub Cutaneous Injection Procedure Checklist ....................................... 11

Appendix C – Equipment Required – Safe Injection: ................................................... 12

Appendix D – Downloadable Resource Documents: ................................................... 13

Appendix E - Useful resources: .................................................................................... 14


Introduction to workshop Welcome! Thank you for agreeing to participate in Phase 1b Practical Skills Teaching.

The workshop outcomes for the students are to learn the skills required to administer injections to an adult patient and to learn the basic principles of drug calculation. During the practical session, we also hope to use the opportunity to ask the students to develop their communication skills as it is very common for a patient to be nervous or even phobic of this sort of procedure.

Just as a reminder, more information about these skills can be found at the Clinical Skills Resource site for tutors. The link to the module is:

http://medic.cardiff.ac.uk/clinicalskills/

Please find the Safe Injection Administration and Drug Calculation modules within the list of e-modules. In addition, all resources required for this session are downloadable from the above link. Please find under the tab ‘C21 Session Plan and Resources’. We are aiming for the students to be: Accurate Efficient Compassionate

Thank you again for your participation.

http://medic.cardiff.ac.uk/clinicalskills/


Overall Session Aim To provide students with the theoretical knowledge and support required for them to carry out the reconstitution, and administration of a medicine, in a safe and competent manner.

Intended Learning Outcomes

By the end of this workshop the students should be able to:

Define the reasons for carrying out an injection with reference to legal and

professional implications.

Identify the anatomical sites suitable for carrying out injections.

Detail and prepare the trolley with appropriate equipment used to carry out safe

injection.

Demonstrate, to a level expected of the students stage of training, a degree of

competence in the procedural steps required to carry out safe intramuscular and

sub-cutaneous injection on a simulation model.

Display a professional manner and good communication skills towards the patient

(actor student), and throughout the skills simulation session.

Demonstrate competence in the ability to read the prescription chart and BNF.

Apply prior learning through participation in group ‘discovery’ session of basic

drug calculation.

Evaluate own learning and recognise how improvements can be made.


Workshop Structure – Guidance for Tutors

Taught Session Time: 180 minutes

Session Progression Additional Resources

Part 1 - Safe Injection Administration

10 minutes Registration and Housekeeping Students to sign in and collect their name badges

Student name badge, registers and housekeeping brief

5 minutes Introduction Welcome to Students and Tutors

Students given clip boards with quiz sheets

10 minutes Formative Quiz Question and Answer Session based on Self Directed Learning of e-modules: Safe Injections and Drug Calculations. Students to work collaboratively to provide answers to quiz questions

Quiz PowerPoint and/or paper based question sheet

10 minutes Formative Quiz Answers Interactive answer session

Tutor answer sheet and/or PowerPoint with answers

15 minutes Practical Tutor Demonstration Tutor to provide a full demonstration of the practical skill of reconstitution and administration of a powdered medicine. Demonstrate both intramuscular and sub-cutaneous injections on model.

Model – Injection Trainer Procedure Checklist Safe Injection Scenario

5 minutes Questions and Answers Students given the opportunity to ask any questions that may have arisen during demonstration

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30 minutes Practice Students work in pairs and practice performing practical skill Tutor to support and lend guidance where necessary Tutors to encourage patient / student communication – Student pair can act out student-patient relationship then swap

Model – Injection Trainer Procedure Checklist Safe Injection Scenario

20 minutes Coffee Break

Part 2 - Drug Calculation

15 minutes Introduction Tutor to discuss principles of Drug Calculation based on Drug Calculation e-module

Tutor Drug Calculation Resource

30 minutes Discovery Exercise Students rotate around 6 drug calculation stations working in pairs Five minutes per question

Student discovery exercise sheets Calculators BNF per station

20 minutes Discovery Exercise Interactive answer session

Tutor answer sheet and/or PowerPoint with answers

5 minutes Round up Any other questions

5 minutes Evaluation


Introduction

Safe Injection

Injections are sterile solutions, suspensions or occasionally, emulsions. They are prepared by

dissolving, emulsifying or suspending the active ingredient in water for injection or a suitable

diluent liquid.

The term injection describes the giving of this medicine by means of a needle and syringe.

Injections are invasive, and strict aseptic technique is required during preparation and

administration to minimise the risk of infection.

Giving injections is a regular and commonplace activity which doctors may be expected to

carry out. Good injection technique can make the experience for the patient relatively

painless however, mastery of the technique is essential. The procedure may involve some

discomfort, and, as the risk of tissue or nerve damage exists, selecting a suitable site is an

important concern.

Pre and Post Injection Checks

Check prescription including allergies

Prepare medication as per prescription

Ensure you have the right patient,

right time and right dose

Obtain consent Ensure Patient is

comfortable Select site

Following injection observe site for at least 15 minutes


Sub-cutaneous Injection

The Sub-cutaneous (SC) route is used for a slow sustained absorption of medication, up to 1-2 ml being injected into the subcutaneous tissue.

The recommended sites for SC injection are:

Lateral aspects of upper arms and thighs

Umbilical region of abdomen

Upper arms are favourable choice, and least likely to cause discomfort to patient.

Avoid areas of bruising, tenderness, hardness, infection or inflammation.

Intramuscular Injection Intramuscular injections deliver medication into well perfused muscle, providing rapid systemic action and absorbing fairly large doses, these being from 1ml in a deltoid, to 5ml in the ventrogluteal site.

The four popular sites for administering IM injections are:

Deltoid

Dorsogluteal

Ventrogluteal

Vastus Lateralis


Assessment For the purposes of this workshop, students will be assessed on a formative basis. This will take place in three parts: 1. A quiz at the start of the session based on the students’ prior self-directed

learning of both Safe Injection and Drug Calculation e-learning modules. 2. A ‘Discovery Exercise’ based on the rotation through a number of ‘stations’

where work sheets are provided, and students work in pairs to provide the answers for a number of drug calculation questions.

3. The practical component is assessed through observation and feedback on the

student performance with the aim of encouraging further practice and improvement. Throughout the session it is proposed that frequent questions should be posed to the students, encouraging each student as the session progresses.


Appendix A – Intra Muscular Injection Procedure Checklist

Wash hands

Apply gloves

Consult drug chart – correct drug, dose, expiry date

Select appropriate syringe and needles (5ml syringe, green drawing up needle and green or blue giving needle)

Prepare medication to correct dose

Explain procedure to patient and obtain consent

Assist patient to comfortable position

Select appropriate site – give rationale

Clean site with 70% isopropyl alcohol swab if appropriate

Allow to dry

Stretch skin for IM injection

Angle needle at 90o. Leave 1/3rd shaft exposed

Gently draw on plunger to aspirate. If blood appears, withdraw needle, replace, and start again

Depress plunger slowly (Approximately 1ml per 10 seconds)

Withdraw needle and use gauze to apply gentle pressure to site

Dispose of sharps in appropriate container (yellow)

Wash hands

Document procedure


Appendix B – Sub Cutaneous Injection Procedure Checklist

Wash hands

Apply gloves

Consult drug chart – correct drug, dose, expiry date

Select appropriate syringe and needles (5ml syringe, green drawing up needle and orange giving needle)

Prepare medication to correct dose

Explain procedure to patient and obtain consent

Assist patient to comfortable position

Select appropriate site – give rationale

‘Bunch up’ skin for SC Injection

Angle needle at 90o. Leave 1/3rd shaft exposed

Depress plunger

Withdraw needle and use gauze to apply gentle pressure

Dispose of sharps in appropriate container

Wash hands

Document procedure


Appendix C – Equipment Required – Safe Injection:

EQUIPMENT – Required per workstation

Table Gauze

Chair Mock Powder Drug – Amoxicillin 1g - See Template

Box of Gloves – Large Mock Liquid Drug – Insulin Lantus – See Template

Box of Gloves – Medium Injection Trainer Model

Box of Gloves – Small Kidney Dish

Inco Sheet Yellow Sharps Container

Alcohol Hand Gel Timer i.e. stop watch

Syringes – 5ml Resource - Prescription Chart

Syringes - Insulin Resource – The 5 R’s

Water Ampoules Resource – Injection Site – Deltoid

Sterets Resource – Injection Site – Vastus Lateralis

Needles – Blue Resource - Scenario

Needles – Green Resource – Drug Leaflet - Amoxicillin

Needles – Orange


Appendix D – Downloadable Resource Documents:

The below indicate available downloadable resources for optional use within the session (http://blogs.cardiff.ac.uk/clinicalskillscentre/safe-injection-drug-calculation/):

Mock Drug – Avery Label Template (L7159) – Amoxicillin

Mock Drug – Avery Label Template (L7159) – Insulin Lantus

Safe Injection and Drug Calculation Formative Quiz – Answer Sheet

Safe Injection and Drug Calculation Formative Quiz – PowerPoint

The 5 R’s

Safe Injection Scenario

Injection Site – Deltoid

Injection Site – Vastus Lateralis

Drug Information Leaflet – Amoxicillin

Discovery Task 1

Discovery Task 1 – Tutor Answers

Discovery Task 2


Discovery Task 3


Discovery Task 4


Discovery Task 5


Discovery Task 6


http://blogs.cardiff.ac.uk/clinicalskillscentre/safe-injection-drug-calculation/


Appendix E - Useful resources: Patel, N. and Knight, D. 2009. Clinical Practical Procedures for Junior Doctors. Churchill Livingstone: Elsevier Dornan, T. and O’Neill, P. 2006. Core Clinical Skills for OSCEs in Medicine. Churchill Livingstone: Elsevier Stoneham, M. and Westbrook, J. 2007. Invasive Medical Skills: A Multimedia Approach. Blackwell Publishing Athreya, B.H. 2010 Handbook of Clinical Skills: A Practical Manual. World Scientific Thomas, J. Monaghan, T. 2007. Oxford Handbook of Clinical Examination and Practical Skills. Oxford Medicine Online