Nurses' Technique and Site Selection in Subcutaneous Insulin Injection

Abstract of This Evidence Based Project had two aims. The first aim was to investigate the current nursing practices that are based in evidence with regard to subcutaneous insulin administration for adults that are in an inpatient setting with a diagnosis of diabetes. The second aim was to provide an evidence-based educational intervention on injection technique and site selection for subcutaneous insulin administration to nurses that care for patients with diabetes at one hospital in southern California. The research literature has shown that insulin injection technique and site selection affect glycemic control. Insulin, "a high-alert medication" is vital to the care of patient with diabetes, thus proper insulin administration is crucial, and safe strategies must be adopted. Nurses play a significant role in the improvement of the glycemic control in diabetic patients. A 30-item survey questionnaire was developed as part of a needs assessment to evaluate nurses’ knowledge of subcutaneous insulin site selection and technique; this instrument was developed using research evidence in the literature, and consensus and subject matter expert opinion. This survey was sent to 254 nurses working in adult inpatient areas with a diagnosis of diabetes in a 424-bed hospital. The results of the survey demonstrated nurses’ lack of knowledge and of and variability of practice in subcutaneous insulin administration. Evaluation of an educational intervention designed to increase nurses’ of site selection and technique for subcutaneous insulin administration was performed using a 10-item questionnaire, a shortened version of the system-wide 30-item instrument. Small sample (n=10) t-test analysis of the pretest-posttest responses revealed a statistically significant (p<.05) increase in nurses’ knowledge after participating in the educational intervention. Evaluation of the validity and reliability of the 10-item instrument revealed a Cronbach’s alpha of .83 and a test-retest reliability of .80. Insulin injection technique and site selection affect glycemic control in diabetic patients and nurses play a significant role in the improvement of that glycemic control. The results of this pilot project provided evidence in support of the use of an evidence- based practice educational intervention for nurses intended to increase knowledge of site selection and insulin injection technique. The questionnaire developed to measure increase in knowledge was found to have face and content validity and internal consistency and stability. As with all EBP, projects there were implantation challenge, not the least of which was the move to a new hospital location. The final sample for this pilot project was small and ideally, this project will be repeated with larger samples. Plans are currently underway to present the findings of this project to the hospital administration and to repeat the intervention on additional units and even perhaps system-wide.