Medical injection use in Guyana: Guidelines, practices and documentation

Description: The 2011-2012 USAID-funded Guyana Safe Injection Project (GSIP) conducted a small study on injection prescribing practices in Guyana. GSIP's interest stemmed from its mandate to assist Guyana's Ministry of Health (MOH) to reduce the risk of accidental needle-stick injuries. The study aimed in part to document which injections were administered, how frequently, and whether key injections were being prescribed according to national Standard Treatment Guidelines (STGs) and in line with the Essential Drug List (EDL).

Methods: The study was conducted at seven health facilities following approval from the MOH's Internal Review Board. Data collected from injection ledgers, individual patient records, and in qualitative interviews with prescribers and pharmacists were entered into Access databases and then exported to Excel for analysis. Initial analyses were prepared by GSIP and Initiatives staff and then reviewed collectively. A report on the study was written and submitted to MOH and USAID.

Results: In February, 2012, 2,841 injections were administered during 2,249 patient encounters at the five sites where injections were delivered and systematically documented. Data collection and retrieval were hampered by: incomplete record-keeping (on patient information, presenting symptoms, diagnoses, treatments prescribed and delivered), poor or inconsistent filing, and lack of records kept on out-patient visits. Novalgin, Voltaren (diclofenac) and Buscopan made up just over half of the injections prescribed. The list of injections whose use was documented was cross-referenced with the EDL. The “Analgesics, Antipyretics, Non-Steroidal Anti-Inflammatory Drug (NSAID)” category comprised over 40 percent of the injections. Another 25 percent of the injections were from the EDL's “Gastrointestinal Drugs” category. About 100 instances were documented of use of injections not included in the EDL, including Phenergan (promethazine HCl). There were injections in use at health facilities at levels not sanctioned in the EDL. The prevalence of injections in use at facilities varied.

Recommendations: 1) Guyana's EDL and STGs should be updated to include substances that are being prescribed so that supplies can be properly procured and usage appropriately controlled; 2) Health workers should be periodically retrained in the use of the EDL and STGs, especially following revisions, in order to ensure that they remain up-to-date in their practices; 3) Refreshers and implementation of documentation system are also warranted. Finally, GSIP recommended conducting similar reviews on the most commonly used medications to determine whether providers are using them according to guidelines and best practices.