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Mitigating subcutaneous hemorrhage and pain following the subcutaneous administration of low-molecular-weight
Xing Li1, Weizhen Zou1,2, Li Liu1
1Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, China.
Insights
Standardizing subcutaneous injection procedures for low-molecular-weight heparin significantly reduced patient pain and bleeding. This initiative improved nursing knowledge and compliance with best practices in cardiology care.
Area of Science:
- Cardiology
- Evidence-Based Practice
- Nursing Quality Improvement
Background:
- Subcutaneous anticoagulant injections, commonly used in cardiology, often lead to bleeding and pain, impacting patient compliance.
- Standardized injection protocols are evidence-based strategies to mitigate these adverse effects.
Purpose of the Study:
- To implement and evaluate best practices for subcutaneous low-molecular-weight heparin administration.
- The goal was to minimize post-injection complications such as pain, hemorrhage, and hematomas.
Main Methods:
- A baseline audit assessed current practices against 14 evidence-based recommendations in a tertiary care hospital.
- Barriers were identified, and improvement strategies were implemented.
- A follow-up audit evaluated the impact of these strategies on nursing practices and patient outcomes.
Main Results:
- Post-implementation, 12 of 14 criteria achieved ≥80% compliance.
- Significant reductions in patient-reported pain and subcutaneous bleeding were observed (p < 0.05).
- Nurses' theoretical knowledge of standardized procedures markedly improved (p < 0.001).
Conclusions:
- Standardization of subcutaneous injection care effectively minimizes post-injection complications.
- Nurse manager leadership was crucial for the initiative's success.
- Future efforts should focus on targeted training, continuous monitoring, and optimizing adherence to guidelines.
Introduction:
Subcutaneous anticoagulant therapy is commonly used in the cardiology department. However, these injections often cause localized bleeding and discomfort, reducing patient medication compliance and nursing satisfaction. Evidence indicates that standardized injection procedures can significantly reduce complications.
Objectives:
This project aimed to implement best practices to minimize post-injection issues-including subcutaneous hemorrhage, pain, and hematomas-following the subcutaneous administration of low-molecular-weight heparin.
Methods:
This project was conducted in a cardiovascular department of a tertiary care hospital in Changsha, China. Using the JBI Evidence Implementation Framework, a baseline audit was conducted to compare current practices against 14 evidence-based recommendations. The sample included 15 nurses and 74 patients. Barriers to compliance with best practices were identified and a follow-up audit was conducted to measure the impact of the improvement strategies.
Results:
The follow-up audit revealed significant improvements compared to baseline, with 12 of the 14 criteria reaching 80% compliance or higher. The incidence of pain was significantly lower in patients (68.6% vs 33.3%, X 2 = 9.162, p < 0.05), as was the average degree of pain and subcutaneous bleeding (Z1 = -3.223, Z2 = -2.389, p < 0.05). Nurses' theoretical knowledge of standardized subcutaneous injection procedures also significantly improved (53.07 ± 6.86 vs 91.40 ± 4.70, t = -19.129, p < 0.001).
Conclusions:
This project successfully demonstrated that standardization of care minimizes post-injection complications. The nurse manager's leadership was instrumental in the success of the initiative. Subsequent initiatives should provide targeted training to address low-adherence areas, continuous monitoring of nursing practices, and further research to optimize compliance with evidence-based guidelines.
Spanish Abstract:
http://links.lww.com/IJEBH/A439.
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