A Program to Mitigate the Potential Risks Associated with the Subcutaneous and Intramuscular Injection of Special Oncology Drugs
LING Wai Man, RN, MSc, FHKAN (Medicine-Oncology), Member of Communications Committee of ISNCC;
CHU Yuek Kei Florence, RN, BN
Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital
The use of subcutaneous (SC) and intramuscular (IM) injection of special drugs in oncology setting is escalating in Hong Kong recently due to the advances in medical science. Some of them are used to treat the treatment side effects, such as the growth factors, whereas some are used to treat the cancer disease itself or its complications, like the hormones or anticoagulant. Nowadays, they have accounted for almost one-fourth of the parenteral injections in our Oncology Department. However, the sophisticated drug preparation and injection techniques of some of these drugs pose significant quality and safety issues in the nursing practice. In 2016, a prostate cancer patient ended up with a local abscess at the injection site and required incision and drainage after an improper subcutaneous injection of a long-acting hormonal drug. Post-incident review identified a number of actual and potential risks associated with the related nursing procedure. Therefore, a workgroup was formed in our Department to formulate and implement the improvement actions for mitigating the risks.
The quality improvement program aims to (i) enhance the accuracy and safety of SC and IM injection of the special oncology drugs identified, and (ii) evaluate the nursing staff compliance to the recommended new injection practice.
We revisited our current practice, performed literature review, developed evidence-based guidelines on SC and IM injection of the drugs identified, and designed a quick reference poster as well as a record sheet for clear documentation. Training was provided to our Department’s nurses before the promulgation of the new practice. It covered the drug preparation process, different injection techniques among drugs, choice of injection sites, importance and sequence of site rotation, proper documentation, and patient education on post-injection care. Clinical compliance audit and staff satisfaction survey were then performed in the 4th quarter of 2017 to evaluate the program.
Results and Outcomes:
There was no incidence of injection-related adverse reaction reported after implementing the new guidelines. The overall staff compliance rate of the clinical audit was 99.5%. The nurses were able to fulfil the requirements in all the major aspects of clinical practice concerned. They gave positive feedback on the new practice designed and the staff support provided. Moreover, the value of this program was recognized by the nursing colleagues at the ten General Out-patient Clinics of Hong Kong East Cluster. We had been invited to conduct a lunch talk to them in 2017. We shared our guidelines and the quick reference poster with them to improve their practice as well. In May 2018, our program was accepted for poster presentation in the Hong Kong Hospital Authority Convention, which had attracted over 5,600 delegates from Hong Kong and overseas.
Oncology nurses play a significant role in safeguarding the patient care and service standard in clinical practice. Our program has successfully benefitted the patients by mitigating the potential risks associated with these SC and IM injections. We have also helped our service partners of the same Cluster to improve their service by sharing of good practice.