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IntroductionIn this essay I will be reflecting upon a skill I have undertook whilst in clinical practice. The skill that I have chosen to reflect upon is the administration of injections. I will describe the procedure of how the skill was carried out, discuss how the theory supports the practical skill and then reflect on how the experience influence how I carry out the skill in the future. Within this body of work, all names have been changed in order to maintain confidentiality which is compliant with the Nursing and  Midwifery Council’s code of conduct and local trust policy (NMC, 2015).What? During clinical practice I had the opportunity to administer injections as majority of the patients on my ward were largely limited in mobility as the vast majority were post operative admissions. This led to many of them requiring a drug called Dalteparin, which is an anticoagulant (blood thinner).When administering injections, it is imperative that you wash your hands, to prevent cross infection not only between patients but also to prevent the transfer of microorganisms from the environment to the patient (Loveday et al., 2017). In line with the medicine administration procedures, I followed through with the 5 R’s: right dose, patient, route, time and also medication (Barber, 2013).  To confirm their identity, I had asked them for their name, date of birth and whether they had any allergies and ensured their details matched the medchart database. I then gained consent from the patient and ensured they were comfortable during the procedure and prepared the injection. After this, it is imperative to follow aseptic technique and wear gloves as there will be patient contact. I draw the curtains before I expose the injection site, as this is a subcutaneous injection, the injection site is primarily on the stomach. I proceed to pinch the skin with my non-dominant hand and insert the needle, ensuring it is at a 90 degree angle. I push the plunger on the syringe, and held the needle in place for at least 5 seconds, before removing the needle and unpinching the skin. I then activated the built in safety device on the needle, before disposing it in the sharps container. After the procedure, I removed my gloves and washed my hands once more and documented the successful administration.  So what? As aforementioned, it is imperative that you wash your hands. There are five points of handwashing: prior to patient contact or which includes aseptic technique procedures, post patient contact, after contact with bodily fluids, mucus membranes and also non intact skin, after contact with patient surrounds and belonging that may be contaminated and also immediately after the removal of gloves. These steps have been identified as points where you can prevent cross contamination. Washing hands using the advised method ensures that the areas that are commonly missed (the thumbs, the fingertips and the space in between each finger), are decontaminated (Patel, 2015).When administering any medications, it is important to follow procedure. The procedure for medicine administration is the 5 R’s. This helps to minimise any drug incidents and errors (Calkin and Calkin, 2010). By following this specific procedure, it prevents a medication error from occurring.Gaining consent is a major and an imperative part of every patient orientated procedure (McHale, 2009). The particular patient I had administered the injection to had a hearing impairment. Therefore in order to gain consent and ensure that the patient was well informed, I had written down what the procedure inclined. The patient had signaled to me and the nurse that was observing that he had understood by giving us a thumbs up gesture, which is the universal signal that an individual has understood. Although he had expressed that he could lip read, I felt that it was necessary to outline the procedure on paper, to help minimise any miscommunication. This type of consent is called implied consent as it was an action that indicated the patient’s wishes. Before I administer the injection, I must ensure that the sharps bin is in very close proximity to where the procedure will occur so I can swiftly dispose of the needle, which will help minimise the chances of a needle stick injury (Health & Safety Executive, 2013). Before the procedure, I must encourage my patient to sit or lie in a comfortable position and ensure the curtains are drawn before the injection site is exposed. This is to ensure that the patient’s privacy and dignity is maintained (CSP, 2001) (NMC, 2015). With a subcutaneous injection, it targets the fatty layer under the skin. This is the reason why injection sites are on the stomach, the thighs, the back of the upper arm and the upper back area between the hip and the buttock. It is important to rotate the site of the injection as it can minimise any irritation in the surrounding area of the injection site.  The procedure outlined by (Merriman & Greenway, 2016) states all of these injection sites besides the lower back and the buttock, however the procedure outlined by Elkin in The Royal Marsden Manual of Clinical Procedures, it includes them all (Elkin et al., 2007). This discrepancy is most likely due to the source being outdated, and therefore new research may have suggested that the upper back and the buttock are not suitable for subcutaneous injection administration. The skin around the preferred injection site should be pinched in order to help separate the subcutaneous tissue from the muscle (FIT, 2011). This precaution is taken to avoid a drug error, for example, if you were not to pinch the skin, it is possible to unintentionally administer the drug via the intramuscular route. Another measure to help avoid an intramuscular injection administration is that the needle must be inserted at a 90 degree angle in the injection site. Before disposing the needle in the sharps bin, I activated the built in safety device. This is a guard that minimises the chances of getting a needle stick injury (RCN, 2010).Now what?Upon, reflecting on my experience in practice I have highlighted a few amendments that can be made in future practice. I have discovered that rotating the injection site, especially with patients that are long term inpatients, as frequently administering injections in the same area can cause irritation, which I have witnessed firsthand. During my time in clinical practice, I did not find it common practice to rotate the injection site, which has led me to follow in the footsteps of my seniors. I now know that this is very important as is likely to avoid patient discomfort. Another fault that I have become aware of is respecting a patient’s privacy and dignity. Injections were often administered without drawing the curtains of the patient in question. This does not adhere to the NMC code of conduct as is directly disregards the privacy clause, especially as you expose an area that is normally covered to administer the injection.  I will be sure to amend this practice the next time I am in clinical practice and for the rest of my time in practice. Lastly, my reflection in practice has led me to understand the importance of regular training as old methods can quickly become outdated, and therefore may not be regarded as safe practice any longer. Conclusion To summarise, I have described the procedure of how injections are carried out, discussed how the theory supports every step of the practical skill and have explained why those specific steps are taken, providing evidential support. I have then reflected on how the experience has influenced the way in which I will carry out the skill in the future.I have gained an understanding of why it is imperative to routinely read up on new research, as well as attending regular training because in the healthcare industry research is quickly outdated, therefore previous practices can become invalid, as safer and refine techniques come into practice. In future, I will

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