Briscese, Matthew A., BSN

Fulmer, Morgan L, BSN, RN

Karasek, Nicole L, BSN, RN

Leech, Christine D, BSN, RN

Mazzante, Rachael, BSN, RN

Wapinsky, Kaylyn V., BSN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingAffecting Change in the Administration ofSubcutaneous Anticoagulation TherapyMorgan L. Fulmer BSN, RNLehigh Valley Health Network, morgan_l.fulmer@lvhn.orgNicole L. Karasek BSN, RNLehigh Valley Health Network, nicole_l.karasek@lvhn.orgRachael Mazzante BSN, RNLehigh Valley Health Network, rachael.mazzante@lvhn.orgMatthew A. Briscese BSNLehigh Valley Health Network, Matthew_A.Briscese@lvhn.orgChristine D. Leech BSN, RNLehigh Valley Health Network, Christine_D.Leech@lvhn.orgSee next page for additional authorsFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtFulmer, M. L., Karasek, N. L., Mazzante, R. Briscese, M. A., Leech, C. D., Wapinsky, K. V. (2016, October 28). Affecting Change in theAdministration of Subcutaneous Anticoagulation Therapy. Presented at: Lehigh Valley Health Network, Allentown, PA.AuthorsMorgan L. Fulmer BSN, RN; Nicole L. Karasek BSN, RN; Rachael Mazzante BSN, RN; Matthew A. BrisceseBSN; Christine D. Leech BSN, RN; and Kaylyn V. Wapinsky BSNThis presentation is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/patient-care-services-nursing/787AFFECTING CHANGE IN THE ADMINISTRATION OF SUBCUTANEOUS ANTICOAGULATION THERAPYMorgan Fulmer, Nicole Karasek, Rachael Mazzante, Matthew Briscese, Christine Leech, Kaylyn WapinskyLearners’ Objective:▪ To describe the process and lessons learned in the implementation of identified EBP projects, from clinical question to practice change. Background▪ Many patients are prescribed heparin injections prophylactically multiple times throughout the day to reduce their risk of venous thromboembolism.  ▪ These injections may cause discomfort and agitation, therefore, decreasing patient satisfaction.▪ To improve the patient experience, two nurse resident evidence based practice projects focused on the administration of anticoagulation therapy.Standardized Subcutaneous Anticoagulant Administration Significance▪ A pre-data survey completed on 5K and 7C found there is a large inconsistency between how RNs administer anticoagulation therapy injections.▪ The survey focused on the following:• Syringe and Needle size• Utilization of airlock technique• Length of injection in secondsPre-education Survey ResultsLENGTH OF INJECTION (in seconds)0-5 20 RNs 62.5 %6-10 8 RNs 25 %>10 4 RNs 12.5 %DO YOU UTILIZE THE AIRLOCK TECHNIQUE?Yes 12 RNs 37.5% No 20 RNs 62.5 %SYRINGE SIZE1 mL 11 RNs 34.4 %3 mL 21 RNs 65.6 %NEEDLE SIZE25 G, 5/8” 15 RNs 46.9 %27 G, 5/8” 17 RNs 53.1 %Purpose▪ The purpose of the evidence based practice project completed on 5K and 7C was to utilize the literature to educate RNs on the correct administration of subcutaneous anticoagulants, therefore, creating a standardized administration technique.Evidence▪ A 3 mL syringe and a needle size of 25 gauge, 5/8 of an inch reduced bruising size compared to the use of a 1 mL syringe▪ Slower injection speed (20-30 seconds) leads to better outcomes in bruising and pain▪ Utilization of airlock technique leads to better outcomes in bruising and pain▪ Use of a 25 gauge, 5/8 inch needle is in the accordance with current LVHN policyPICO Question▪ Does providing medical-surgical nurses a TLC education module on subcutaneous anticoagulation administration based on evidence-based research, compared with no education, create a standardized administration technique?• P: Nurses administering subcutaneous anticoagulation therapy to adult patients on medical-surgical units.• I: Providing education via TLC module to medical-surgical nurses regarding the correct administration technique for subcutaneous anticoagulant therapy based on evidence-based research • C: No educational intervention • O: Create a standardized administration technique Intervention▪ TLC module was created by the group summarizing the evidence for proper administration of subcutaneous anticoagulant therapy.▪ Module was uploaded and assigned to all RNs on 5K and 7C by unit PCS.▪ Communication was sent to staff by unit PCS and nurse residents to remind them to complete the module. Results▪ 42/55 (76%) RNs on 5K and 7C completed the TLC education module on subcutaneous anticoagulation therapy▪ 21/42 (50%) RNs who reviewed the TLC module completed the post-intervention survey▪ The results conclude that the education module was effective in teaching RNs the correct technique to administer subcutaneous anticoagulants.LENGTH OF INJECTION (in seconds)0-10 2 RNs 9.5 %10-20 2 RNs 9.5%30 17 81%SHOULD YOU UTILIZE THE AIRLOCK TECHNIQUE?Yes 21 RNs 100%No 0 RNs 0%SYRINGE SIZE1 mL 0 RNs 0%3 mL 21 RNs 100%NEEDLE SIZE25 G, 5/8” 19 RNs 90.5%27 G, 5/8” 2 RNs 9.5%References▪ Akbari Sari A, Janani L, Mohammady M, Nedjat S. Slow versus fast subcutaneous heparin injections for prevention of bruising and site-pain intensity. Cochrane Database of Systematic Reviews 2014, Issue 7. Art. No.: CD008077. DOI:10.1002/14651858.CD008077.pub3.▪ Akpinar, R.B. (2013). The effect of local dry heat pack application on recovering the bruising associated with the subcutaneous injection of heparin. Journal of Clinical Nursing, 22, 2531-2535. doi: 10.1111/jocn.12216.▪ Avsar, G., & Kasukci, M. (2013). International Journal of Nursing Practice. Assessment of Four Different Methods in Subcutaneous Heparin Applications with Regard to Causing Bruise and Pain, 19, 402-408. doi:10.1111/ijn.12079▪ Chan, H. (2001). Effects of injection duration on site-pain intensity and bruising associated with subcutaneous heparin. Journal of Advanced Nursing, 35(6), 882-892. Retrieved June 4, 2015, from EBSCO Host.▪ Pourghaznein, T., Azimi, A.V., & Jafarabadi, M. A. (2013). The effect of injection duration and injection site on pain and bruising of subcutaneous injection of heparin. Journal of Clinical Nursing, 23, 1105-1113. doi:10.1111/jocn.12291. ▪ Ross, S., & Soltes, D. (1995). Heparin and haematoma: Does ice make a difference? Journal of Advanced Nursing, (21), 434-439. ▪ Vanbree, N., Hollerbach, A., & Brooks, G. (1984). Critical evaluation of three techniques for administering low-dose heparin. Journal of Nursing Research, 33(1), 15-19. Retrieved June 4, 2015, from EBSCO Host.▪ Zaybak, A., & Khorshid, L. (2008). A study on the effect of the duration of subcutaneous heparin injection on bruising and pain.  Journal of Clinical Nursing, 17, 378-385. doi:10.1111/j.1365-2702.2006.01933.xUse of Cryotherapy in Reduction of Pain During Subcutaneous Heparin InjectionsPurpose▪ The purpose of the project, done by nurse residents on 6K and 4T, focused on the utilization of cryotherapy prior to subcutaneous injections.Background• Many studies have shown that utilizing ice therapy before injection reduces pain scores (0-10) for patients receiving heparin subcutaneously.• Currently at LVHN, there are no established best practice protocols to utilize cryotherapy for subcutaneous injections.EvidencePICO QuestionIn adult medical-surgical patients 50 yearsof age and over, does the utilization of coldapplication at the injection site prior to administration reduce pain compared to thecurrent heparin subcutaneous injectionprocedure?PICO QUESTION▪ P: Adult medical surgical patients▪ I: Ice administration for 5 minutes prior to subcutaneous heparin injections▪ C: No ice administration prior to injection▪ O: Decrease in pain (numbered scale)Intervention/Comparison▪Pain scores were collected for both a control group and an experimental group.ResultsResults▪ Applying ice to the injection site prior to subcutaneous heparin injection decreased overall pain scores for explored patient population.  An overall decrease in pain has potential to increase overall patient satisfaction while hospitalized.References▪ Avşar, G., & Kaşikçi, M. (2012.). Assessment of four different methods in  subcutaneous heparin applications with regard to causing bruise and pain.  International Journal of Nursing Practice,402-408.▪ Dursun, M., & Akpınar, R. (2014). The effect of topical applications performed before subcutaneous heparin injection on development of bruise and hematoma. SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital Sisli Etfal, 296-302.▪ Ross, S., & Soltes, D. (1995). Heparin and haematoma: Does ice make a difference? Journal of Advanced Nursing, 434-439.▪ Şendir, M., Büyükyilmaz, F., Çelik, Z., & Taşköprü, I. (2015). Comparison of 3 Methods  to Prevent Pain and Bruising After Subcutaneous Heparin Administration.  Clinical Nurse Specialist,174-180.Outcomes▪ Revised LVHN policy on subcutaneous injections to reflect the evidence and specify the following administration parameters:• Use of 3 mL syringe• Use of 25 gauge, 5/8 inch needle• Administer over 30 seconds• Inject utilizing the airlock technique• Use of cryotherapy prior to injection is recommended to minimize pain and bruising▪ All RNs educated in revised policy via TLCNext Steps▪ More research should be conducted including variation in time of ice application in correlation with pain scores.Learnings▪ Some hospital policies lack specificity and can be a springboard for research.▪ Potential EBP/research topics are embedded in your daily practice.▪ It is difficult to energize RNs with education and to change their current practice.▪ Time management affects compliance to new initiatives.The Ultimate Revelation▪ A focused EBP project, completed by a small group of newly licensed RNs, can impact the entire network and potentially the entire profession of nursing on a global level if disseminated!Questions/Comments?• Nicole Karasek, 7C• Rachael Mazzante, 7C• Morgan Fulmer, 5K

Affecting Change in the Administration of Subcutaneous Anticoagulation Therapy

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Affecting Change in the Administration of Subcutaneous Anticoagulation Therapy

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