To Assess the Adequacy of Steps followed during the administration of Intramuscular Injection in selected areas of Tertiary Hospital, Thrissur
Aneeta V. A1, Angel K. F1, Anila Mol K1, Anila Jose M1, Hasni K. A 1, Jibina Scaria1,
Katherine Davis1, Nandhana V Gosh1, Rincy P. R2, Philo Resmi3, Angela Gnanadurai4
1Fourth Year B.Sc Nursing Students, Jubliee Mission College of Nursing, Kachery, Thrissur.
2Asst. Professor, Jubilee Mission College of Nursing, Kachery, Thrissur.
3Vice Principal, Jubilee Mission College of Nursing, Kachery, Thrissur.
4Prinicipal, Jubilee Mission College of Nursing, Kachery, Thrissur.
*Corresponding Author E-mail: hasnisalamkaniyath@gmail.com, rincy.p.r828@gmail.com
ABSTRACT:
Title: A study to assess the adequacy of steps followed during administration of intra muscular injection in selected areas of tertiary hospital Thrissur. Objectives: Assess the adequacy of steps followed during administration of intramuscular injection, Associate the level of adequacy of steps followed during the administration of intramuscular injection with selected demographic and clinical data variables. Methodology: The research design adopted for the study was descriptive design. Random sampling technique was adopted to choose the samples. The study was conducted among 160 IM injection procedures in female medical ward, male medical ward, female surgical ward, male surgical ward, female ortho ward, male ortho ward, injection room, Emergency department of tertiary hospital Thrissur. Observational checklist was used to assess the practice of nurses, in following adequate steps during the administration of intramuscular injection. Results & Discussion: While assessing the socio demographic and clinical data variable of nursing personnel it shows that 67(41.9%) belongs to the age group of 26-35years, in gender 153(95.6%) are females, education qualification 109(68.1%) are general nursing, 46(28.8%) have an experience between 3-5 years, 69(43.1%) injection were from injection room,125(78.1%)were not participated in any continuing programme,150(93.8%) have not witnessed any injection abscess,142(88.8%) have adequate availability of equipments during the administration of intramuscular injection ,159(99.4%) were following non Kardex system in selected areas of tertiary hospital. While assessing the socio demographic and clinical data variable of the patient it shows that, 50(31.3%) belongs to the age group of 26-35 years, 102(63.8%) were females, 62(38.85) have school level education, 132(52.5%) of injection was done on ventro gluteal site, 121(75.6%) were able to perform activities of daily living independently, 109(68.1%) of injection were done with care, no signs of infection were observed. Title: A study to assess the adequacy of steps followed during administration of intra muscular injection in selected areas of tertiary hospital Thrissur. Objectives: Assess the adequacy of steps followed during administration of intramuscular injection, Associate the level of adequacy of steps followed during the administration of intramuscular injection with selected demographic and clinical data variables. Methodology: The research design adopted for the study was descriptive design. Random sampling technique was adopted to choose the samples. The study was conducted among 160 IM injection procedures in female medical ward, male medical ward, female surgical ward, male surgical ward, female ortho ward, male ortho ward, injection room, Emergency department of tertiary hospital Thrissur. Observational checklist was used to assess the practice of nurses, in following adequate steps during the administration of intramuscular injection. Results & Discussion: While assessing the socio demographic and clinical data variable of nursing personnel it shows that 67(41.9%) belongs to the age group of 26-35years, in gender 153(95.6%) are females, education qualification 109(68.1%) are general nursing, 46(28.8%) have an experience between 3-5 years, 69(43.1%) injection were from injection room,125(78.1%)were not participated in any continuing programme,150(93.8%) have not witnessed any injection abscess,142(88.8%) have adequate availability of equipments during the administration of intramuscular injection, 159(99.4%) were following non Kardex system in selected areas of tertiary hospital. While assessing the socio demographic and clinical data variable of the patient it shows that, 50(31.3%) belongs to the age group of 26-35 years, 102(63.8%) were females, 62(38.85) have school level education, 132(52.5%) of injection was done on ventro gluteal site, 121(75.6%) were able to perform activities of daily living independently, 109(68.1%) of injection were done with care, no signs of infection were observed. Thus, it was found that all the nurses follow adequate steps in intramuscular injection. From this study it is found that there is association between the adequacy of steps followed during the administration of intramuscular injection with comfort level of patient(p=0.021), availability of equipments for injection(p=0.001) and experience of the nursing personnel(p=0.012). Conclusion: The adequacy of steps followed by the nursing personnel during the administration of intramuscular injection showed that 71.25% had adequate, 28.75% had moderately adequate and 0% inadequate. A statistically significant association was found between level of adequacy of steps followed by nursing personnel with experience (p=0.012), availability of equipments (p=0.001) and comfort level of patients (p=0.021). The investigator concluded that level of adequacy of steps followed by the nursing personnel during the administration of intramuscular injection 71.25% adequate. The availability of these knowledge will definitely improve the patient safety and outcome during intramuscular injection.
KEYWORDS: Assess, Intramuscular Injection, Adequacy of Steps.
INTRODUCTION:
Intramuscular therapy is widely used in health care of patients admitted in hospital. The intramuscular therapy includes administration and maintenance of medication. While is generally administered safely, frequent delivery of medication have led to adverse incidence. Safe intramuscular injection requires knowledge and skill in the application of the equipment, drug calculation, the risk involved and how to prevent adverse consequences. There must be a specific supervised practice which must include direct observation, quality monitoring and enhancement strategies. Intramuscular medication errors are frequent events. They are associated with considerable but little is known about their causes. Training needs should be addressed to reduce the rate of intramuscular drug preparation and administration errors. Internationally, unsafe injection practices result in millions of infections that lead to serious morbidity and mortality, therefore, the challenge for the nurse is to follow adequate steps while giving intramuscular injection.
The present study was undertaken to assess the adequacy of steps followed during the administration of intramuscular injection. Proper following of the steps may reduce the complication and infection at the site.
MATERIALS AND METHOD:
Research Approach:
Quantitative approach is used in this study to assess the adequacy of steps followed during the administration of intramuscular injection.
Research Design:
Descriptive research design is used in this study to assess the adequacy of steps followed during the administration of intramuscular injection.
Setting of the Study:
The settings of the study are Male medical ward, Female medical ward, Male surgical ward, Female surgical ward, Male ortho ward, Female ortho ward, Emergency department, Injection room of tertiary hospital.
Population:
The target population of the study includes all the patients who are prescribed for intramuscular injection in tertiary hospital, Thrissur Accessible population of the study include all the patients who are prescribed with intramuscular injection in Male medical ward, Female medical ward, Male Surgical ward, Female surgical ward, Male ortho ward, Female Ortho ward, Emergency department and Injection room of tertiary hospital, Thrissur.
Sample:
In the present study, samples includes patients who are prescribed with intramuscular injection in the selected areas (Male medical ward, Female medical ward Male surgical ward, Female surgical ward, Male ortho ward, Female ortho ward, Emergency department, Injection room) of tertiary hospital Thrissur.
Sampling Technique:
In this study simple random sampling by lottery method is used. First researcher will prepare the list of patients, receiving intramuscular injection after referring the patient’s chart. Then lott is taken from the list prepared.
Sample Size:
Our supporting studies have large number of samples and hence we decided to take 160 intramuscular injection administration procedures in selected wards of tertiary hospital, Thrissur as our sample size.
Description and Scoring of Data Collection Tools:
Description of the Tool:
The tool consists of section A and section B.
Section A includes two parts.
Socio demographic and clinical data questionnaire of nursing personnel (part 1) Patients who receive intramuscular injection (Part 2)
Section B:
It is the structured observation checklist to assess the adequacy of steps followed during the administration of intramuscular injection among nursing personnel. It comprises of 40 points covering the various steps that should be followed during the administration of intramuscular injection. Each step is evaluated as ‘yes’ or ‘no’.
The steps are categorized in to headings. Assessment contain 9 items, preparation of equipments and supply contains 3 items, procedure contain 18 items, and post procedural care include 10 items.
Scoring:
Maximum score of following adequate steps in administration of intramuscular injection is 40. Minimum score of following adequate steps in administration of intramuscular injection is 0.
Inference:
|
Level of Adequacy |
Range of Score |
Percentage (%) |
|
Adequate |
32-40 |
>80% |
|
Moderately Adequate |
24-31 |
60-79% |
|
Inadequate |
<24 |
<60% |
SECTION1: Socio -Demographic and Clinical Data Variable of Nursing Personnel:
The data include Age, Gender, education, Years of experience, participated in any continuing programme, Present working area, Presence of any abscess, Articles in tray, System followed in ward.
Table 1 (a) Distribution of nursing personnel based on socio-demographic variable such as Age, Gender, education, Years of experience. (n=160)
|
S No |
Socio-demographic data |
Frequency |
Percentage (%) |
|
1. |
Age |
|
|
|
|
1.18-25 |
33 |
20.6 |
|
|
2.26-35 |
67 |
41.9 |
|
|
3.36-40 |
59 |
36.9 |
|
|
4.>40 |
1 |
0.6 |
|
2. |
Gender |
|
|
|
|
1.Male |
7 |
4.4 |
|
|
2.Female |
153 |
95.6 |
|
3. |
Education |
|
|
|
|
1.M.sc Nursing |
0 |
0 |
|
|
2.B.sc Nursing |
27 |
16.9 |
|
|
3.Post B. Sc Nursing |
6 |
3.8 |
|
|
4.General Nursing |
109 |
68.1 |
|
|
5.Student Nursing |
18 |
11.3 |
|
4. |
Experience |
|
|
|
|
1.More than 10 years |
22 |
13.8 |
|
|
2.Between 5-10 years |
53 |
33.3 |
|
|
3.Between 3-5 years |
46 |
28.8 |
|
|
4.Between 2-3 years |
9 |
5.6 |
|
|
5.Less than 2 years |
9 |
5.6 |
|
|
6.Nursing student 1st year |
8 |
5.0 |
|
|
7.Nursing student 2nd year |
11 |
6.9 |
|
|
8.Nursing student 3rd year |
2 |
1.3 |
Data from Table 1 (a) reveals that, 67(41.9%) belongs to the age group of 26-35, in gender 153(95.6%) are females, education qualification 109(68.1%) are general nursing,46(28.8%) have an experience between 3-5 years.
Table 1(b) Distribution of nursing personnel based on socio-demographic variable such as participated in any continuing programme, Present working area, Presence of any abscess, Articles in tray, System followed in ward. (n=160)
|
SL No. |
Socio-demographic data |
Frequency (f) |
Percentage (%) |
|
1 |
Present working area |
|
|
|
|
1.female medical ward |
8 |
5 |
|
|
2.Male medical ward |
10 |
6.3 |
|
|
3.Female surgical ward |
7 |
4.4 |
|
|
4.Male surgical ward |
15 |
9.4 |
|
|
5.Female ortho ward |
15 |
9.4 |
|
|
6.Male ortho ward |
19 |
11.9 |
|
|
7.Injection room |
69 |
43.1 |
|
2 |
Participated in any programme |
|
|
|
|
1.Yes |
35 |
21.8 |
|
|
2.No |
125 |
78.1 |
|
3 |
Witnessed any injection abscess |
|
|
|
|
1.Yes |
10 |
6.3 |
|
|
2.No |
125 |
78.1 |
|
4 |
Availability of equipments |
|
|
|
|
1.Yes |
142 |
88.8 |
|
|
2.No |
18 |
11.3 |
|
5 |
System followed |
|
|
|
|
1.Kardex |
1 |
0.6 |
|
|
2.Non kardex |
159 |
99.4 |
Table 1(b) reveals that 69 (43.1%) injection were from injection room, 125 (78.1) were not participated in any continuing programme, 150 (93.8%) Not witnessed any injection abscess, 142 (88.8%) have adequate availability of equipments, 159 (99.4%) follow nonkardex system.
SECTION 2: Socio-demographic and clinical data variable for patients who are prescribed for intramuscular injection in tertiary hospital
This section describe socio-demographic variable of patient. The data include Age, Gender, Educational qualification, Sites of intramuscular injection, Activity of daily living, Perceived comfort level, Signs of infection noticed after 24 hour.
Table 2 (a): Distribution of patients based on Age, Gender, Educational qualifications, sites for intramuscular injection. (n=160)
|
SL. No |
Socio-demographic data |
Frequency (f) |
Percentage (%) |
|
1 |
Age |
||
|
|
1.16 -25 |
28 |
17.5 |
|
|
2. 26-35 |
50 |
31.3 |
|
|
3. 36-45 |
31 |
19.4 |
|
|
4. 46-55 |
23 |
14.4 |
|
|
5. >55 |
28 |
17.5 |
|
2 |
Gender |
||
|
|
1.Female |
102 |
63.8 |
|
|
2.Male |
58 |
36.3 |
|
3 |
Educational qualification |
||
|
|
1.schoolar |
62 |
38.8 |
|
|
2.diplomar |
45 |
28.1 |
|
|
3.Graduate |
36 |
22.5 |
|
|
4.Postgraduate |
7 |
4.4 |
|
|
5.Professional |
10 |
6.3 |
Table 2(a) shows that 50(31.3%) belongs to the age group of 26-35, 102(63.8%) were females, 62(38.85%) have school level education.
Table 2 (b): Distribution of patients based on, Site for intra muscular injection, Activity of daily living, Perceived comfort level, Sign of infection noticed after 24 hour. (n=160)
|
Sl No |
Socio-demographic data |
Frequency |
Percentage (%) |
|
(f) |
|||
|
1 |
Site used |
|
|
|
|
1.Deltoid |
25 |
15.6 |
|
|
2. Dorso- gluteal |
3 |
1.9 |
|
|
3. Ventro-gluteal |
132 |
52.5 |
|
|
4. Rectus femoris |
0 |
0 |
|
2 |
Activity of daily living |
|
|
|
|
1. Independent |
121 |
75.6 |
|
|
2. Need assistance |
33 |
20.6 |
|
|
3. Fully dependant |
6 |
3.8 |
|
3 |
Perceived comfort level |
|
|
|
|
1. Done with care |
109 |
68.1 |
|
|
2. Done in hurry |
17 |
10.6 |
|
|
3. More pain |
12 |
7.5 |
|
|
4. Less pain |
22 |
11.8 |
|
|
5. Preference of staff by patient |
0 |
0 |
|
4 |
Sign of infection noticed after 24 hours |
|
|
|
|
1. Yes |
0 |
0 |
|
|
2. No |
160 |
100 |
Table 2 (b) shows that 132 (52.5%) of injection was done on ventro gluteal site, 121 (75.6%) were able to perform activities of daily living independently and 109 (68.1%) of injection were done with care, no any sign of infection were observed.
SECTION 3: Distribution of nursing personnel based on level of adequacy of steps followed during intra muscular injection steps.
Table 3- Distribution of nursing personnel based on level of adequacy of steps followed during intra muscular injections steps.
(n=160)
|
S. No |
Components |
Adequate |
Moderately adequate |
Inadequate |
|||
|
f |
% |
f |
% |
f |
% |
||
|
1 |
Assessment |
141 |
88.12 |
18 |
11.25 |
1 |
0.62 |
|
2 |
Preparation of equipments and supplies |
89 |
55.62 |
69 |
43.12 |
2 |
1.25 |
|
3 |
Procedure |
107 |
66.87 |
53 |
33.12 |
0 |
0 |
|
4 |
Post Procedural care |
117 |
73.12 |
37 |
23.12 |
6 |
3.75 |
|
5 |
Overall |
114 |
71.25 |
46 |
28.75 |
0 |
0 |
Table 3 depicts that in the assessment part of injection 141(88.12%) is adequate, 18(11.25%) is moderately adequate and 1(0.62%) were adequate. In the preparation of equipments and supplies 89(55.62%) were adequate, 69(43.12%) were moderately adequate and 2 (1.25%) were inadequate. In the procedural part 107 (66.87%) were adequate and 53(33.12%) were moderately adequate. In the post procedural section 117 (73.12%) were adequate, 37(22.12%) were moderately adequate and 6(3.75%) were inadequate. The overall result shows that 114(71.25%) of nursing personnel done the intra muscular injection adequately and 46 (28.75%) were moderately adequate
SECTION 4: Association between the levels of adequacy of steps followed during the administration of intramuscular injection with selected socio demographic and clinical data variables of nursing personnel.
Table 4(a)-Distribution of Chi-square value, degree of freedom and ‘p' value with selected socio demographic and clinical data variables of nursing personnel.
|
Sl. No |
Socio-demographic data |
Chi-square |
df |
P Value |
|
|
Age |
1.45 |
2 |
0.091 |
|
|
Gender |
0.95 |
1 |
0.196 |
|
|
Education |
0.6 |
3 |
0.076 |
|
|
Experience |
4.01 |
3 |
0.012* |
|
|
Participated in any programme |
2.31 |
2 |
0.084 |
|
|
Witnessed any injection abscess |
0.25 |
1 |
0.271 |
|
|
Availability of equipments |
12.09 |
1 |
0.001*** |
|
|
System followed |
0.37 |
1 |
0.731 |
*Significant (P<0.05) l *** Highly Significant (P<0.001)
Table 4(a) shows that there is significant association observed in experience (p=0.012) of the nursing personnel and availability of equipments (p=0.001). The articles required are medication vial, syringe, injection tray, kideney tray, paper bag, bowl, dry and sprited cotton, pair of clean gloves and edication card.
Table 4(b) -Chi square (χ2), and p value of association on level of adequacy of steps followed during the administration of intramuscular injection with experience & availability of equipments. (n=160)
|
Experience |
Checklist |
Chi-square |
p value |
|||
|
Adequate and moderately adequate |
Inadequate |
|||||
|
f |
% |
f |
% |
|
||
|
1. |
18 |
81.8 |
4 |
18.2 |
4.01 |
0.012* |
|
2. |
41 |
77.4 |
12 |
22.6 |
||
|
3. |
34 |
73.9 |
12 |
26.1 |
||
|
4. |
24 |
61.5 |
15 |
38.5 |
||
|
Availability of equi-pments |
|
|
|
|
|
|
|
1. |
110 |
77.5 |
32 |
22.5 |
12.09 |
0.001*** |
|
2. |
7 |
38.9 |
11 |
61.1 |
|
|
*Significant (P<0.05) *** Highly Significant (P<0.001)
Table 4(b) shows that 81.8% of nursing personnel has the experience (more than 10 years), hence they followed the steps during intramuscular injection adequately. 77.5% of nursing personnel has followed the steps during the administration of intramuscular injection adequately with availability of equipments.
SECTION 5: Association between the levels of adequacy of steps followed during the administration of intramuscular injection with selected socio demographic and clinical data variables of patient.
Table 5(a) -Distribution of Chi-square, degree of freedom and ‘P' value with selected socio demographic and clinical data variables of patient. (n=160)
|
Sl. No |
Socio-demographic data |
Chi-square |
df |
P Value |
|
1 |
Age |
5.293 |
4 |
0.007 |
|
2 |
Gender |
0.047 |
1 |
0.144 |
|
3 |
Educational qualification |
4.112 |
2 |
0.083 |
|
4 |
Sites used |
2.737 |
1 |
0.049 |
|
5 |
Activity of daily living |
0.040 |
1 |
0.163 |
|
6 |
Perceived comfort level |
7.559 |
3 |
0.021* |
|
7 |
Sign of infection noticed after 24 hours |
0 |
0 |
0 |
*Significant (P<0.05)
Table 5(a) shows that there is significant association in the comfort level (p=0.021) while administration of intra muscular injection.
Table 5(b): Chi-square (χ2), and p value of association on level of adequacy of steps followed during the administration of intramuscular injection with comfort.
(n=160)
|
Percieved Comfort level |
Checklist |
Chi-square |
p value |
|||
|
Adequate and moderately adequate |
Inadequate |
|||||
|
f |
% |
f |
% |
|||
|
1 |
83 |
76.1 |
26 |
23.9 |
12.096
|
0.001***
|
|
2 |
14 |
82.4 |
3 |
17.6 |
||
|
3 |
5 |
41.7 |
7 |
58.3 |
||
|
4 |
15 |
68.2 |
7 |
31.8 |
||
***Highly Significant (P<0.001)
Table 5(b) shows that there is significant association in the comfort level (p=0.021) while administration of intra muscular injection. It is evident that 76.1% of nursing personnel has followed the steps of intramuscular injection adequately when done with care, hence the patient received comfort level.
RESULTS:
1. In the present study, 71.25% of the nursing personnel followed the steps of intramuscular injection adequately.
2. 28.75% of nursing personnel followed the steps of intramuscular injection moderately adequate.
3. 0.62% of nursing personnel followed the steps of intramuscular injection inadequately.
4. In this study, we found that there is significant association between availability of equipment, comfort level with level of adequacy of steps followed during intramuscular injection by the nursing personnel. There is significant association observed in availability of equipments (p=0.001) and experience of the nursing personnel (p=0.012). There is significant association observed in comfort level (p=0.021) of patient while administering of intra muscular injection.
CONCLUSION:
The findings of the study include adequacy of steps followed by the nursing personnel during the administration of intramuscular injection showed that 71.25% had adequate, 28.75% had moderately adequate and 0% inadequate. A statistically significant association was found between level of adequacy of steps followed by nursing personnel with experience (p=0.012), availability of equipments (p=0.001) and comfort level of patients (p=0.012). The other socio-demographic and clinical data variables has no association with level of adequacy of steps followed by the nursing personnel during the administration of intramuscular injection. The availability of these knowledge will definitely improve the patient safety and outcome during intramuscular injection.
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Received on 08.07.2025 Revised on 23.07.2025 Accepted on 05.08.2025 Published on 14.08.2025 Available online from August 23, 2025 Int. J. of Advances in Nursing Management. 2025;13(3):179-184. DOI: 10.52711/2454-2652.2025.00035 ©A and V Publications All right reserved
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