Why injection site managment?

In my different vocational roles, I have had the privilege of working along side clinical educators who have instructed on a variety of health related issues. However, I credit one education experience as being the catalyst for why I have a particular interest in injection site management.

As staff escorted a family who had a newly diagnosed little one with Type I diabetes to our education room, I gathered my materials for what would be presented to them in our session. I heaved the 100 plus page family education binder onto the table and started surveying the scene.. Syringes, alcohol wipes, anatomical charts, blood glucose meter, monitoring strips and insulin pens littered the table where this family would learn in all its complexity what it really takes to now care for their child. Tired, the parents listened to another 2 hours of instruction and diligently practiced pulling up syringes of saline to mimic insulin administration. Holding the syringes up to the lights, the parents would squint, examine them for microscopic differences in dosage, look to the educators for a nod of approval and practice over again and again to make sure it was emblazoned into their memory. Rote learning was used to teach the importance of technique, selecting an injection site, pinching the skin, cleaning and making sure to choose a different site for the next injection. Over and over this sequence was preformed; however, one concept was routinely highlighted as unclear. How to ensure that injection sites were adequately rotated was never fully realized and understood. You see, the teaching tools for this consisted of anatomical charts with grid - like patterns (Figure 1). Frankly, it is a confusing display in my opinion as the image is not to individual scale of the child and does not offer any real world systematic approach. The best suggestion offered to the parents was to use imagination: "Pretend there's a clock or calendar on your child's abdomen, place injection's at 12,1,2," and so on. As I was trying hard to remember if I had fed the dog that morning, I wondered if I would be able to execute this if my child needed this level of care.

 

(Figure 1)
My thoughts drifted back to when Carter received his autism spectrum diagnosis. The expectations that were placed on the level of care he would need included, speech, occupational and physical therapies, accommodations at school, medication to control his neurological ticks, anxiety and ADHD, home behavior interventions, and so on. It was assumed by the medical staff who cared for him that Carter's needs were the only priority issues in our family. Important? Yes! VERY, but not ONLY. It had to be taken into consideration that our family was complex, with many needs and different dynamics.

Focusing my attention back to our session, my ear caught yet another parent asking, "How do we keep track of where this injection was placed?"- I knew then, this was not a lack of understanding on part of our clientele- it was on us, who were utilizing methods and tools to teach that were not effective.