Far Eastern University Institute of Nursing NCM 101 First Semester SY: 2011-2012 Performance Evaluation Tool for

Intradermal Injection Name________________________________________ Score: _______ Section/Group:____________________ Date:________ Grade description: 2 procedure was completely and correctly done 1 procedure was incompletely and/or incorrectly done 0 procedure was not done Preparation 1 Assess: . Appearance of the injection site Specific drug action and the expected response Clients knowledge of the drug action and response Check agency protocol about the sites to use for skin tests 2 Assemble equipment and supplies: . Vial or ampule of the correct medication/vaccine Sterile 1 ml syringe calibrated into hundredths of milliliter (tuberculin syringe), and a to 5/8 inch long 25 to 27 gauge needle Alcohol swabs/sterile water swabs for vaccine 2 x 2 sterile gauze square (optional) Clean gloves (according to agency protocol) Epinephrine 3 Check the MAR. . Check the label on the medication/vaccine carefully against the MAR to make sure that the correct medication/vaccine is being prepared. Follow the three checks for administering medications. Read the label on the medication. When it is taken from the medication cart Before withdrawing the medication After withdrawing the medication. 4 Organize the equipment. . Procedure 2 1 0 Remarks

1 . 2 . 3 . 4 . 5 . 6 .

Perform hand hygiene, and observe other appropriate infection control procedures. Prepare the medication from the vial or ampule for drug withdrawal Prepare the client Explain to the client that the medication will produce a small wheal, sometimes called a bleb Provide for client privacy. Select and clean the site. Select a site Avoid using sites that are tender, inflamed, or swollen and those that have lesions. Put on gloves as indicated by agency policy. Cleanse the skin at the site using a firm, circular motion, starting at the center and widening the circle outward. Allow the area to dry thoroughly. Prepare the syringe for the injection. Remove the needle cap while waiting for the antiseptic to dry. Expel any air bubbles from the syringe (for medications only). Grasp the syringe in your dominant hand, holding it between thumb and forefinger. Hold the needle almost parallel to the skin surface with the bevel of the needle up. Inject the fluid. With the non-dominant hand, pull the skin at the site until it is taut. Insert the tip of the needle far enough to place the bevel through the epidermis. The outline of the bevel should be visible under the skin surface. Stabilize the syringe and the needle, and inject the medication carefully and slowly so that it produces a small wheal on the skin. Withdraw the needle quickly at the same angle it was inserted. Activate the needle safety device. Do not massage the area. Dispose of the syringe and needle in the sharps container. Remove gloves if used. Circle the injection site with ink to observe for redness or induration per agency policy. Document all relevant information. Record the testing material given, the time, the dosage, route, site and nursing assessments.

7 .

8 .

9 .

Total Score

________________________________ Signature of Faculty Signature of Student

________________________________

Far Eastern University Institute of Nursing NCM101 First Semester SY: 2011 2012 Performance Evaluation Tool for Intramuscular Injection Name________________________________________ Score: _______ Section/Group:____________________ Date:________ Grade Description: 2 procedure was completely and correctly done 1 procedure was incompletely and/or incorrectly done 0 procedure was not done Preparation 1. Assess Client allergies to medication Specific drug action, side effects, and adverse reactions Clients knowledge of and learning needs about the medication Tissue integrity of the selected site Clients age and weight, to determine site and needle size Clients ability or willingness to cooperate 2. Determine: Whether the size of the muscle is appropriate to the amount of medication to be injected. 3. Assemble equipment and supplies Clients MAR Sterile medication (ampule or vial ) Syringe and needle of size appropriate for the amount of solution to be administered. 2 1 0 Remarks


4.

5. 1. 2.

3. 4.

5.

6.

Antiseptic swab/sterile water swabs for vaccines Clean gloves Check the MAR. Check the label on the medication carefully against the MAR to make sure that the correct medication is being prepared. Follow the three checks for administering medications. Read the label on the medication: When it is taken from the medication cart Before withdrawing the medication After withdrawing the medication Confirm that the dose is correct. Organize the equipment. Procedure Perform hand hygiene, and observe other appropriate infection control procedures. Prepare the medication from the ampule or vial for drug withdrawal. Whenever feasible change the needle on the syringe before the injection. Invert the syringe needle uppermost, and expel all excess air. Provide for client privacy. Prepare the client. Check the clients identification band. Assist the client to a supine, lateral, prone or sitting position depending on the chosen site Obtain assistance in holding an uncooperative client. Explain the purpose of the medication and how it will help, using the language that the client can understand. Include relevant information about effects of the medication. Select, locate and clean the site. Select a site free of skin lesions, tenderness, swelling, hardness or localized inflammation and one that has not been used frequently If injections are to be frequent,, alternate sites. Avoid using the same site twice in a row. Locate the exact site for the injection. Put on clean gloves. Clean the site with an antiseptic swab. Using a circular motion, start at the center and move outward about 5cm. Transfer and hold the swab between the third and fourth fingers of your non dominant hand in readiness for needle withdrawal, or position the

7. 8.

9.

10 . 11 . 12 .

swab on the clients skin above the intended site. Allow the skin to dry prior to injecting medication. Prepare the syringe for injection. Remove the needle cover and discard without contaminating the needle. Inject the medication. Use the ulnar side of the non dominant hand to pull the skin approximately to the side or pinch the muscle if the client is emaciated or an infant. Holding the syringe between the thumb and forefinger, pierce the skin quickly and smoothly at a 90-degree angle, and insert the needle into the muscle. Hold the barrel of the syringe steady with your non dominant hand, and aspirate by pulling back on the plunger with the dominant hand. Aspirate for 5 to 10 seconds. If blood appears in the syringe, withdraw the needle, discard the syringe, and prepare a new injection. If blood does not appear, inject the medication steadily and slowly while holding the syringe steady. After injection, wait for 10 seconds. Withdraw the needle. Withdraw the needle smoothly at the same angle of insertion. Release the skin. Apply gentle pressure at the site with a dry sponge, do not massage the site If bleeding occurs, apply pressure with a dry sterile gauze until it stops Activate the needle device, or discard the uncapped needle and attached syringe into the proper receptacle. Remove gloves. Perform hand hygiene. Document all relevant information. Include the time of administration, drug name, dose, route, and the clients reaction. Assess effectiveness of the medication at the time it is expected to act. Total Score

_________________________________

_________________________________

Signature of Faculty Signature of Student

Far Eastern University Institute of Nursing NCM101 First Semester SY: 2011 2012 Performance Evaluation Tool for Subcutaneous Injection Name________________________________________ Score: _______ Section/Group:____________________ Date:________ Grade description: 2 procedure was completely and correctly done 1 procedure was incompletely and/or incorrectly done 0 procedure was not done Preparation 2 1. Assess: Allergies to medication Specific drug action, side effects, and adverse reactions Clients knowledge and learning needs about the medication Status and appearance of subcutaneous site for lesions, erythema, swelling, ecchymosis, inflammation and tissue damage from previous injections. 1 0 Comments

Ability of the client to cooperate during the injection Previous injection sites used 2. Assemble equipment and supplies: MAR or computer print out Vial or ampule of the correct medication Sterile syringe and needle Antiseptic swabs ( sterile water swabs for vaccine) 2x2 dry sterile gauze square for opening an ampule (optional) Clean gloves (according to agency protocol) 3. Check the MAR. Check the label on the medication carefully against the MAR to make sure that the correct medication is being prepared. Follow the three checks for administering medications. Read the label on the medication. When it is taken from the medication cart Before withdrawing the medication After withdrawing the medication. 4. Organize the equipment. Procedure 1 Perform hand hygiene, and observe other . appropriate infection control procedures. 2 Prepare the medication from the vial or ampule . for drug withdrawal 3 Provide for client privacy . 4 Prepare the client . Introduce yourself, and verify clients identity. Assist client to a position in which the arm, leg, and abdomen can be relaxed, depending on the site to be used. Obtain assistance in holding an uncooperative client. 5 Explain the purpose of the medication/vaccine . and how it will help, using language that the client can understand. Include relevant information about effects of the medication. 6 Select and clean the site. . Select a site free of tenderness, hardness, swelling, scarring, itching, burning, and localized inflammation. Select a site that has not been used frequently. Put on clean gloves (optional) As agency protocol indicates, clean the site with an antiseptic swab (sterile water swab for vaccine). Start

7 .

at the center of the site and clean in a widening circle to approximately 5 cm (2inches). Allow the area to dry thoroughly. Place and hold the swab between the third and fourth fingers of the non-dominant hand, or position the swab on the clients skin above the intended site. Prepare the syringe for injection Remove the needle cap while waiting for the site to dry. Pull the cap straight off to avoid contaminating the needle by the outside edge of the cap. Dispose off the needle cap. Inject the medication. Grasp the syringe in your dominant hand by holding it between your thumb and fingers. With palm facing to the side or upward for a 45-degree angle insertion or the palm downward for a 90-degree angle insertion, prepare to inject. Using the non-dominant hand, pinch or spread the skin at the site, insert the needle using the dominant hand and a firm steady push. When the needle is inserted, move your nondominant hand to the end of the plunger. Inject the medication by holding the syringe steady and depressing the plunger with slow, even pressure. With many subcutaneous injections, the needle should be imbedded within the skin for five seconds after complete depression by plunger to ensure complete delivery of the dose. Remove the needle. Remove the needle slowly and smoothly, pulling along the line of insertion while depressing the skin with the non-dominant hand. If bleeding occurs, apply pressure to the site with dry, sterile gauze until it stops. Dispose supplies appropriately. Activate the needle safety device, or discard the uncapped needle and attach syringe into designated receptacles. Remove gloves. Perform hand hygiene. Document all relevant information. Document the medication given, dosage, time, route, and any assessments. Many agencies prefer that medication administration be recorded on the medication record. Assess the effectiveness of the medication at the time

8 .

9 .

1 0

1 1

it is expected to act. Total Score

__________________________________ Signature of Faculty Signature of Student

__________________________________