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Barriers and Facilitators to Injection Safety in Ambulatory Care Settings

Published online by Cambridge University Press:  04 July 2018

Claire Leback ,
Diep Hoang Johnson ,
Laura Anderson ,
Kelli Rogers ,
Daniel Shirley  and
Nasia Safdar
Claire Leback
Affiliation:
University of Wisconsin, Madison, Wisconsin
Diep Hoang Johnson
Affiliation:
University of Wisconsin Health, Madison, Wisconsin
Laura Anderson
Affiliation:
University of Wisconsin Health, Madison, Wisconsin
Kelli Rogers
Affiliation:
University of Wisconsin Health, Madison, Wisconsin
Daniel Shirley
Affiliation:
Division of Infection Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nasia Safdar*
Affiliation:
Division of Infection Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Address correspondence to Nasia Safdar MD, PhD, Associate Professor, University of Wisconsin-Madison, 1685 Highland Avenue, Madison WI 53705 ([email protected]).
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Abstract

OBJECTIVE

Identify factors referred to as barriers and facilitators that can prevent or assist safe injection practices in ambulatory care settings to guide quality improvement.

DESIGN

In this mixed-methods study, we utilized observations and interviews.

SETTING

This 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 INTERVENTIONS

Direct 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.

RESULTS

In 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.

CONCLUSIONS

Perceived 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

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 7 , July 2018 , pp. 841 - 848
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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