What is the purpose of using a filtered needle to draw the medication out of the ampule?

1. Carraretto AR, Curi EF, de Almeida CED, Abatti REM. Glass ampoules: risks and benefits. Revista Brasileira de Anestesiologia. 2011;61(4):513–521. [PubMed] [Google Scholar]

2. Preston ST, Hegadoren K. Glass contamination in parenterally administered medication. Journal of Advanced Nursing. 2004;48(3):266–270. [PubMed] [Google Scholar]

3. Heiss-Harris GM, Verklan MT. Maximizing patient safety: filter needle use with glass ampules. The Journal of Perinatal & Neonatal Nursing. 2005;19(1):74–81. [PubMed] [Google Scholar]

4. Zabir AF, Choy CY, Rushdan R. Glass particle contamination of parenteral preparations of intravenous drugs in anaesthetic practice. Southern African Journal of Anaesthesia and Analgesia. 2008;14(3):17–19. [Google Scholar]

5. Meister FL. Ask the experts. Are special filter needles required when drawing up medication from a glass ampule? Are there hidden risks to patients, ie, sharp glass particles, if a filter needle is not used? The American Association of Critical-Care Nurses. 1998;18(4):p. 97. [Google Scholar]

6. Woody G, Davis BA. Increasing nurse competence in peripheral intravenous therapy. Journal of Infusion Nursing. 2013;36(6):413–419. [PubMed] [Google Scholar]

7. Driscoll DF, Lawrence KR, Lewis K, Bistrian BR. Particle size distribution of propofol injection from ampules and vials: the benefits of filtration. International Journal of Pharmaceutical Compounding. 1997;1(2):118–120. [PubMed] [Google Scholar]

8. Puntis JWL, Wilkins KM, Ball PA, Rushton DI, Booth IW. Hazards of parenteral treatment: do particles count? Archives of Disease in Childhood. 1992;67(12):1475–1477. [PMC free article] [PubMed] [Google Scholar]

9. Lusardi P. Research corner: myth versus reality: do we need to filter medication ampules? American Association of Critical-Care Nurses. 2008;19(4):p. 8. [Google Scholar]

10. American Society of Health-System Pharmacists. Ashp guidelines on quality assurance for pharmacy-prepared sterile products. American Journal of Health-System Pharmacy. 2000;57(12):1150–1169. [PubMed] [Google Scholar]

11. Bethune K, Allwood M, Grainger C, Wormleighton C. Use of filters during the preparation and administration of parenteral nutrition: position paper and guidelines prepared by a British pharmaceutical nutrition group working party. Nutrition. 2001;17(5):403–408. [PubMed] [Google Scholar]

12. Infusion Nurses Society. Infusion nursing standards of practice. Journal of Infusion Nursing. 2011;34(1, supplement):S1–S92. [Google Scholar]

13. Comelli M, Bussières JF, Blin C, Forest JM, Hildgen P. Use of filter needles in health institutions. Pharmactuel. 2008;41(3):158–164. [Google Scholar]

14. Stein HG. Glass ampules and filter needles: an example of implementing the sixth “R” in medication administration. Medsurg Nursing. 2006;15(5):290–294. [PubMed] [Google Scholar]

15. Harmon DL. Letter to the Editor. Safer injection practices: filter needle use with glass ampoules. The Anesthesia Patient Safety Foundation Newsletter. 2013:p. 42. [Google Scholar]

16. United States Pharmacopeia. <797> Pharmaceutical Compounding—Sterile Preparations. 35th edition. Rockville, Md, USA: United States Pharmacopeia, United States Pharmacopeial Convention; 2012. [Google Scholar]

17. Larocque B, Coulombe M, Rhainds M. Use of Filter Needles for the Preparation of Medicines in Glass Ampules on Care Units. Quebec City, Canada: Unité d'Évaluation des Technologies et des Modes d'Intervention en Santé (UETMIS); 2012. [Google Scholar]

18. Dinç L, Erdil F. The effectiveness of an educational intervention in changing nursing practice and preventing catheter-related infection for patients receiving total parenteral nutrition. International Journal of Nursing Studies. 2000;37(5):371–379. [PubMed] [Google Scholar]

19. George K, Muninarayanappa B. Effectiveness of structured teaching program on knowledge and practices of staff nurses on prevention of intravenous cannulae complications. Archives of Medicine & Sciences. 2013;1(2):115–119. [Google Scholar]

20. Baldwin W, Murphy J, Shakespeare D, Kelly C, Fox L, Kelly M. Campaign best practice in intravenous therapy. Nursing Times. 2013;109(33-34):22–23. [PubMed] [Google Scholar]

21. Dougherty L, Sque M, Crouch R. Decision-making processes used by nurses during intravenous drug preparation and administration. Journal of Advanced Nursing. 2012;68(6):1302–1311. [PubMed] [Google Scholar]

22. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991;50(2):179–211. [Google Scholar]

23. Ajzen I. Attitudes, Personality, and Behavior. Chicago, Ill, USA: Dorsey Press; 1988. [Google Scholar]

24. Côté F, Gagnon J, Houme PK, Abdeljelil AB, Gagnon M. Using the theory of planned behaviour to predict nurses' intention to integrate research evidence into clinical decision-making. Journal of Advanced Nursing. 2012;68(10):2289–2298. [PubMed] [Google Scholar]

25. Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals’ intentions and behaviours: a systematic review of studies based on social cognitive theories. Implementation Science. 2008;3(1) article 36 [PMC free article] [PubMed] [Google Scholar]

26. Perkins MB, Jensen PS, Jaccard J, et al. Applying theory-driven approaches to understanding and modifying clinicians' behavior: what do we know? Psychiatric Services. 2007;58(3):342–348. [PubMed] [Google Scholar]

27. Witte K. Fishing for success: using the persuasive health message framework to generate effective campaign messages. In: Maibach E, Parrott RL, editors. Designing Health Messages: Approaches from Communication Theory and Public Health Practice. Thousand Oaks, Calif, USA: SAGE Publications; 1995. pp. 145–167. [Google Scholar]

28. Bandura A. Self-Efficacy: The Exercice of Control. New York, NY, USA: Freeman; 1997. [Google Scholar]

29. Petty RE, Wegener DT, Fabrigar LR. Attitudes and attitude change. Annual Review of Psychology. 1997;48:609–647. [PubMed] [Google Scholar]

30. Gagnon MP, Cassista J, Payne-Gagnon J, Martel B. Using the theory of planned behavior to understand nurse intention to follow recommendations regarding the use of filter needles. Submitted for publication, 2014.

31. Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME. Planning Health Promotion Programs: An Intervention Mapping Approach. 3rd edition. San Francisco, Calif, USA: Jossey-Bass; 2011. [Google Scholar]

32. Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology. 2008;57(4):660–680. [Google Scholar]

33. Godin G. Les Comportements dans le Domaine de la Santé: Comprendre pour Mieux Intervenir [Behaviors in the Health Sector: Understand to Better Intervene] Montreal, Canada: Presses de l'Université de Montréal; 2012. [Google Scholar]

34. Ajzen I. From intentions to actions: a theory of planned behavior . In: Kuhl J, Beckman J, editors. Action-Control: From Cognition to Behavior. Heidelberg, Germany: Springer; 1985. pp. 11–39. [Google Scholar]

35. SAS. SAS 9.3 Software, 2014. http://support.sas.com/software/93.

36. Cantor SB, Kattan MW. Determining the area under the ROC curve for a binary diagnostic test . Medical Decision Making. 2000;20(4):468–470. [PubMed] [Google Scholar]

37. Kortteisto T, Kaila M, Komulainen J, Mäntyranta T, Rissanen P. Healthcare professionals' intentions to use clinical guidelines: a survey using the theory of planned behaviour . Implementation Science. 2010;5(1, article 51) [PMC free article] [PubMed] [Google Scholar]

38. Foy R, Walker A, Ramsay C, Penney G, Grimshaw J, Francis J. Theory-based identification of barriers to quality improvement: Induced abortion care . International Journal for Quality in Health Care. 2005;17(2):147–155. [PubMed] [Google Scholar]

39. Rashidian A, Russell I. General practitioners' intentions and prescribing for asthma: using the theory of planned behavior to explain guideline implementation . International Journal of Preventive Medicine. 2012;3(1):17–28. [PMC free article] [PubMed] [Google Scholar]

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Details of the simulation strategy.

Step (theoretical construct targeted)	Details	Parameters (examples)
(1) Presentation of scientific evidence (knowledge)	Present scientific evidence on the negative effects of glass ampoules for patients, information on research, and recommendations about the use of filter needles.	For modeling [28]: attention, remembrance, self-efficacy and skills, reinforcement of model, and identification with model.
(2) Preparing medication from a glass ampoule (perceived behavioral control)	Two nurses prepare medication contained in a glass ampoule (e.g., furosemide or narcotic). One uses a filter needle; the other uses a standard needle.
(3) Positive feedback (reinforcement)	Do positive feedback during the simulation (ability of nurses to manipulate the equipment and to prepare medication).	For reinforcement [28]: reinforced by significant other.
(4) Pointing out ease of use (perceived behavioral control)	Point out the ease of use of filter needles.
(5) Mental imagery of glass particles (attitude)	Lead nurses through imagining glass particles (with pictures) injected in the patient and the microorganisms that become lodged in the capillaries, blocking them.
(6) Comparing time between filter and standard needles (perceived behavioral control)	When the medication is prepared, do a comparison between the time taken to prepare the medication with the filter needle and the standard needle.	For persuasion [29]: repeated connections between behavior and positive feelings.
(7) Verbalization of the situation	Allow time for verbalization of the situation for the nurses who prepared the medication.
(8) Inversing the roles (perceived behavioral control)	Do the simulation again by inversing the roles of the two nurses.
(9) Feedback and evaluation (perceived behavioral control)	Following the simulation, evaluate the potential barriers to the use of filter needles on the unit. Find solutions, if possible. Offer follow-up if there is an impasse or obstacle that was not resolved.
(10) Verbalization of the intervention	Allow time for a verbalization of the overall experience with the intervention.