Clinic staff ask pt how to find injection site?

OrganizedChaos, LVN · Sep 18, 2015

I am very thankful for her honesty, but I'm also concerned with her relying on the patient to provide information on where and how to find the appropriate injection site. It is not the patient's responsibility to have the correct answer, and I could have given her incorrect information that could have had consequences for my health (and others if she continues to perform this action incorrectly.)
In a previous experience the LPN told me she didn't know how to do it and wasn't comfortable doing it. I think that response is much more appropriate than asking the patient to give directions and guidance on how to perform a skill they may have no knowledge of. I have family members who hate needles and have to look away every time they get an injection.
Even though she did the better thing in comparison to those who don't ask at all and just go for it, I don't find that very bold. The bold thing to do would have been to tell me she didn't know how to perform the injection and she would find someone who was capable. And if she doesn't know the difference, she needs to take the initiative to find out, otherwise she shouldn't be providing patient care.

I would understand that an MA doesn't know how to give an IM injection but an LVN, that's scary.

CrunchRN, ADN, RN · Sep 18, 2015

Speak with the clinic manager. They need to teach the staff how to find the proper site. Sheesh.

klone, MSN, RN · Sep 18, 2015

Yikes, that's pretty scary.

Where I work, the MAs can give simple IMs like Depo. They cannot give IMs that have to be reconstituted (such as ceftriaxone).

What I find frustrating is that so many nurses and MAs continue to give IMs in the dorso-gluteal site, rather than the preferred ventrogluteal. So when I go to give a shot, and the patient sees me landmark my VG site, they freak out "You can't give it there! That's not the right spot!" and I always try to explain that it's the preferred spot, less pain, less risk of hitting a nerve, etc.

I do always ask their preference between "hip or arm" though.

klone, MSN, RN · Sep 18, 2015

And yes, I agree that the appropriate thing to do would be to contact the clinic manager and just explain that you're concerned that the MAs don't seem to be familiar with finding the landmarks to give an appropriate IM injection, and instead rely on asking the patient if it's in the correct spot, and perhaps some clinical inservicing is in order.

111th, ADN, LPN · Sep 18, 2015

Yikes, that's pretty scary.
Where I work, the MAs can give simple IMs like Depo. They cannot give IMs that have to be reconstituted (such as ceftriaxone).
What I find frustrating is that so many nurses and MAs continue to give IMs in the dorso-gluteal site, rather than the preferred ventrogluteal. So when I go to give a shot, and the patient sees me landmark my VG site, they freak out "You can't give it there! That's not the right spot!" and I always try to explain that it's the preferred spot, less pain, less risk of hitting a nerve, etc.
I do always ask their preference between "hip or arm" though.

It is policy at my clinic to give all IMs in the dorsal gluteal area (or deltoid when appropriate). We have a good mix of LPNs and MAs and we are considered equal in terms of what we can give and how. Interesting how facilities differ!

Farawyn · Sep 18, 2015

Yikes, that's pretty scary.
Where I work, the MAs can give simple IMs like Depo. They cannot give IMs that have to be reconstituted (such as ceftriaxone).
What I find frustrating is that so many nurses and MAs continue to give IMs in the dorso-gluteal site, rather than the preferred ventrogluteal. So when I go to give a shot, and the patient sees me landmark my VG site, they freak out "You can't give it there! That's not the right spot!" and I always try to explain that it's the preferred spot, less pain, less risk of hitting a nerve, etc.
I do always ask their preference between "hip or arm" though.

I never gave depo in the arm.

ArtClassRN, ADN, RN · Sep 18, 2015

Clinics have eliminated the positions of knowledgeable clinicians. You know how you have ring up your own groceries now?

Same thing. Good luck everyone.

BuckyBadgerRN, ASN, RN · Sep 18, 2015

I would have stopped her immediately and asked for her supervisor. No way does she get 3 strikes with me!!

My apologies ahead of time if this is posted in the wrong section.
I need some advice as to if I should report a situation I experienced and who to report it to.
I'm going to try to make this quick and simple, but if more details are wanted I can elaborate.
Today I went to my clinic to get my depo-provera injection and the CMA asked me,
"So how do they give this in your hip? How do they find the right spot?"
I explained how to find the site, and she then asked me after finding the spot, "Does this look right? Is this where they usually do it?"
After having to tell her not to pinch the skin during an IM injection, she told me "you don't look like you have enough meat though."
This is the third time at this clinic I have encountered a situation where the person giving the injection was unaware how to locate the appropriate site and/or the correct technique to administer the injection.
I feel this is not necessarily the staffs fault for not being aware of the location and techniques of giving these injections if this information came into practice after they have graduated and their facility has not trained them on it.
But I am very uncomfortable with the fact that this last time I was asked by the person responsible for administering my injection how to do it and where to give it. I'm a nursing student and I have learned about the appropriate injection sites and techniques, but she was not aware of that..

BuckyBadgerRN, ASN, RN · Sep 18, 2015

Makes one wonder who does phone triage. Or are you in a state that allows an LPN or MA to do this task? It is not allowed where I live.

Unfortunately, they do not have any RNs on staff. Only CMAs and LPNs. Because of previous similar experiences with other staff not being comfortable giving ventrogluteal injections, I always request to see a certain MA who performs the injection correctly. Unfortunately she is out on maternity leave right now.
I do appreciate being asked where I want my injection, I have chronic back pain from a car accident and I found that ventrogluteal injections are painless where as dorsogluteal injections leave my back hurting the rest of the day. I just don't think it is appropriate to ask the patient to show you the appropriate site.

ixchel · Sep 18, 2015

I wonder if maybe they're asking you specifically because you are so skinny. I know I'll ask hard sticks where nurses normally land IVs successfully on them. Really skinny people are a little daunting to find good IM or SQ sites on.

ktwlpn, LPN · Sep 18, 2015

I would understand that an MA doesn't know how to give an IM injection but an LVN, that's scary.

We have recent graduate RN,BEN's x two whom have never given an IM injection as well as the occasional LPN who has only given one during clinical.Nothing wrong with admitting you are uncomfortable with an unfamiliar procedure.

MinneNurse, BSN, RN · Sep 18, 2015

Makes one wonder who does phone triage. Or are you in a state that allows an LPN or MA to do this task? It is not allowed where I live.

That is a good question, I'm not sure who does their phone triage. I was specifically told there are no RNs on staff except for one APRN. I'm not sure if this is within the LPN or MA scope of practice. I'm in Minnesota if anyone knows.