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Intramuscular Injection Welcome to Kaiser Permanente Southern California Student Unpaid Field Experience and Training Inpatient/Hospital and Outpatient/Ambulatory 1 Table of Contents 1 Policy: Student Unpaid Field Experience and Training- SC.QRM.PCS.026 Pg. 3 Appendix A. Onboarding Process 2 Policy: Drug-Free Workplace- NATL.HR.030 Pg. 13 3 Principles of Responsibility (Compliance) Respect Confidentiality, Privacy, and Security Pg. 20 Focus Resources on Member and Patient Care Protect Our Assets and Information 4 2020 Ambulatory Health Care and Hospital National Patient Safety Goals Pg. 31 5 Situation, Background, Assessment and Recommendation (SBAR) Pg. 33 6 Emergency Codes Pg. 34 Student Nurses Continue with Items 7-11 7 KP Nursing Professional Practice Model Pg. 36 8 KP Nursing Professional Practice: Nursing Vision and Values Pg. 37 9 Medication Administration Pg. 38 Policy/Practice Excerpts: Student Un-Paid Field Experience/ Regional High-Alert Medication Safety Practices Safe Medication Practices, General; Oral Drug Administration; Enteral Drug Administration; Intramuscular Injection; Subcutaneous Injection; Metered Dose Inhaler Use; IV Secondary Line Drug Infusion; Rectal suppository Administration 10 Bar Code Scanning Medication Administration- Instructions for Students Pg. 55 11 Nurse Knowledge Exchange + Pg. 56 2 3 4 5 6 7 8 Appendix A 1.0 Onboarding Process 1.1 All participating Schools agree to adhere to a standardized process for Program Participant prerequisites. 1.1.1 Student/Faculty prerequisites website address: http://kpnursing.org/_SCAL/professionaldevelopment/orientation/index.html 1.1.2 Refer to Nursing Pathways website for Medical Center specific requirements. 1.2 Prior to the start of unpaid field experience and training, the School will verify and attest to KP in writing that the following information is on file for assigned Program Participants: 1.2.1 Criminal Record Search (Background Check): A criminal record search (felony and misdemeanor) encompassing the seven (7) years preceding the start of their unpaid field experience and training will be conducted for all Program Participants unless a greater or lesser search period is permitted or required by state law as per KP policy. If a Program Participant is convicted of a crime during their unpaid field experience and training, it is the School’s responsibility to notify KP within five (5) business days. The Program Participant’s return to the unpaid field experience and training will be determined by KP. Background screening performed by the vendor is valid for 90 days from the start of the program. 1.2.2 Drug Testing: Program Participants will be tested for the following substances: amphetamines, barbiturates, benzodiazepines, benzoylecgonine (cocaine), cannabinoids (marijuana), meperidine (Demerol), methadone, opiates, oxycodone, phencyclidine (angel dust), and propoxyphene. Drug testing is valid for 90 days from the start of the program. 1.2.2.1 Program Participants whose first test results are reported “negative- dilute minor”, will be given the opportunity to retake the test within 48 hours of notification. If the second test is “negative-dilute minor”, the results will be considered satisfactory. 1.2.2.2 A minimum duration of 12 months must elapse before a Program Participant whose results were unsatisfactory will be reconsidered for participation in unpaid field experience and training at a KP facility. 1.2.3 If a Program Participant shows signs of being under the influence of drugs and/or alcohol during their unpaid field experience and training in a KP Facility, the incident must be reported immediately to the Faculty/School and the KP Chief Nurse Executive, or Department Manager. The Faculty will remove the Program Participant from the patient care area and follow necessary school protocol to dismiss the Program Participant from the premises. 1.2.4 Factors which may establish a reasonable suspicion include, but are not limited to: 1.2.4.1 Sudden unexplained changes in behavior which adversely impact work performance. 1.2.4.2 Discovery of presence of alcohol or drugs in a Program Participant’s possession or near the Program Participant’s assigned KP Facility. 1.2.4.3 Odor of alcohol and/or residual odor suspicious for alcohol or drugs. 1.2.4.4 Personality changes or disorientation. 9 1.2.4.5 Violation of safety policies, involvement in an onsite accident or near accident, in combination with any of the above factor(s). 1.2.5 All significant or unusual incidences during the unpaid field experience and training must be reported to the KP Chief Nurse Executive or Department Administrator/Manager, Director of PD&E/Education Lead, the Academic Liaison and/or designee, and documented on the KP Unusual Occurrence Report (UOR) system. 1.2.6 The initial background check and drug screening will satisfy the screening requirement during continuous matriculation of the Program Participant for the duration of their participation in the unpaid field experience and training. If the Program Participant discontinues participation in the program for more than one consecutive semester, a new background check and drug screening will be required. 1.2.7 A current AHA and BLS certification is required and/or other certifications as requested. 1.2.8 Immunizations are current and include: 1.2.8.1 Tuberculosis Screening (TB) – Program Participants are required to demonstrate evidence of screening for TB. 1.2.8.1.1 If Tuberculin Skin Test (TST) or Interferon-Gamma Release Assays (IGRA) are negative: 1.2.8.1.1.1 Provide one TST within 1 year and another TST within 2 years or 1.2.8.1.1.2 One negative IGRA within 1 year 1.2.8.1.2 If Tuberculin Skin Test (TST) or Interferon-Gamma Release Assays (IGRA) are positive: 1.2.8.1.2.1 Provide documentation of positive screening test or history of isonicotinic acid hydrazide (INH) or other TB therapy and a negative chest x-ray within one (1) year from the start of their current academic program. In addition, a negative history since the date of the chest x- ray by completing health screening questionnaire is required. More recent screening may be required if clinically appropriate. 1.2.8.2 Measles, Mumps, and Rubella (MMR)- Program Participants are required to demonstrate evidence of immunity to measles, mumps, rubella by either: 1.2.8.2.1 Documentation of 2 MMR vaccines or 1.2.8.2.2 Positive immune titers to measles, mumps, rubella or 1.2.8.2.3 Laboratory confirmation of disease 1.2.8.3 Varicella Zoster - Program Participants are required to demonstrate evidence of immunity to varicella by either: 1.2.8.3.1 Documentation of 2 varicella vaccines or 1.2.8.3.2 Positive immune titer to varicella or 1.2.8.3.3 Laboratory confirmation of varicella disease, or diagnosis of a history of varicella or herpes zoster (shingles) by a healthcare provider. 10 1.2.8.4 If non-immune or equivocal to measles, mumps and varicella in the absence of appropriate vaccination documentation, Program Participants will be required to receive one dose of the appropriate vaccine before being cleared to start their unpaid field experience and training. Documentation of the second required dose, 4 weeks later, must be provided. If non-immune or equivocal to rubella, Program Participants will require only one dose of MMR. 1.2.8.5 Hepatitis A - Hepatitis A is required for Program Participants whose main duties involve food preparation or serving food within any KP Facilities. Program Participants are required to demonstrate evidence of screening for immunity to Hepatitis A by either: 1.2.8.5.1 Documentation of 2 Hepatitis A vaccines or 1.2.8.5.2 Positive immune titer to Hepatitis A or 1.2.8.6 Hepatitis B - Program Participants are required to be screened for immunity to Hepatitis B by either: 1.2.8.6.1 Demonstrate immunity by a positive Hepatitis B antibody after a complete Hepatitis B Vaccine series or 1.2.8.6.2 Present proof of past infection (i.e. positive HBcAb or HBsAg) or 1.2.8.6.3 Begin/complete Hepatitis B vaccination series followed by Hepatitis B antibody testing 1.2.8.7 Influenza (Flu) Vaccine - Program Participants are required to demonstrate evidence of Flu Vaccination during the current flu season. If current seasonal flu vaccine is not available at the start of the rotation (i.e. July or August), documentation must be provided within 30 days of the current season’s flu vaccine’s availability. 1.2.8.8 Tetanus, Diphtheria and Acellular Pertussis (Tdap) Vaccine- Program Participants are required to demonstrate a Tdap vaccine by immunization record signed by a qualified health provider. 1.2.8.9 Other - Other immunizations and health screenings, as required by law or reasonably requested by Kaiser Entities in accordance with Kaiser Entities’ applicable policies and procedures, may be unilaterally amended by Kaiser Entities by a written notice to the School. 1.2.8.10 Declinations - Immunization declinations will not be accepted at any Facility. 1.3 Faculty whose classifications require current California professional licensure and/or certification must provide proof to KP in writing. 1.4 KP HealthConnect Access – Program Participants, who are expected to access patient records, must submit the Common Provider Master (CPM) form to KP at least four (4) weeks prior to the start of the unpaid field experience and training to obtain access to the HealthConnect documentation system. 1.5 KP HealthConnect Training – The School will facilitate access to approved KP HealthConnect training. 11 1.6 Program Participants will read, complete, and submit all prerequisites prior to the start of the unpaid field experience and training. 1.7 Faculty must verify the completion of the prerequisites as stated in this policy. KP may validate compliance by auditing Student files.
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    Depo Lupron and Testosterone are both given by intramuscular injection. The following is a guideline on their administration. Eileen Durham, RN, NP Version 12 Jan 2010 Description Intramuscular (IM) injections are given directly into the central area of selected muscles. There are a number of sites that are suitable for IM injections; there are three sites that are most commonly used in this procedure described below. The volume of viscosity of the medication to be injected determines the site that should be used. IM injections cause stretching of the muscle fiber so the larger the muscle used the less discomfort. Intramuscular Injection Sites Depo Lupron Depo Lupron 3 month preparation should only be injected into the Gluteus medius due to the viscosity and volume of the medication approx. 1.5 – 2 cc. Depo Lupron 1 month preparation can be injection into the vastus lateralis or the gluteus medius. Testosterone Testosterone administered to adolescents and adults can be injected into any of the sites listed below, as long as the volume is 1 cc or less. For a volume of 1.5 use the vastus lateralis or Gluteus medius, if the volume is 2 cc you must you the largest muscle the Gluteus medius. If the volume is greater then 2 cc you must divide the dose and give 2 injections as the maximum volume in the Gluteal muscle is 2 cc. Testosterone administered to infants and toddlers use only the anteriolateral aspect of the thigh. Deltoid muscle The deltoid muscle located laterally on the upper arm can be used for intramuscular injections.
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