Mitigating subcutaneous hemorrhage and pain following the subcutaneous administration of low-molecular-weight heparin: a best practice implementation project

ABSTRACT Introduction: Subcutaneous anticoagulant therapy is commonly used in the cardiology department. However, these injections often cause localized bleeding and discomfort, reducing patient medication compliance and nursing satisfaction. Evidence indicates that standardized injection procedures can significantly reduce complications. Objectives: This project aimed to implement best practices to minimize post-injection issues—including subcutaneous hemorrhage, pain, and hematomas—following the subcutaneous administration of low-molecular-weight heparin. Methods: This project was conducted in a cardiovascular department of a tertiary care hospital in Changsha, China. Using the JBI Evidence Implementation Framework, a baseline audit was conducted to compare current practices against 14 evidence-based recommendations. The sample included 15 nurses and 74 patients. Barriers to compliance with best practices were identified and a follow-up audit was conducted to measure the impact of the improvement strategies. Results: The follow-up audit revealed significant improvements compared to baseline, with 12 of the 14 criteria reaching 80% compliance or higher. The incidence of pain was significantly lower in patients (68.6% vs 33.3%, X 2 = 9.162, p < 0.05), as was the average degree of pain and subcutaneous bleeding (Z1 = −3.223, Z2 = −2.389, p < 0.05). Nurses’ theoretical knowledge of standardized subcutaneous injection procedures also significantly improved (53.07 ± 6.86 vs 91.40 ± 4.70, t = −19.129, p < 0.001). Conclusions: This project successfully demonstrated that standardization of care minimizes post-injection complications. The nurse manager's leadership was instrumental in the success of the initiative. Subsequent initiatives should provide targeted training to address low-adherence areas, continuous monitoring of nursing practices, and further research to optimize compliance with evidence-based guidelines. Spanish abstract: http://links.lww.com/IJEBH/A439