ST. MARY’S COLLEGE OF TAGUM INC.

Tagum City, Davao del Norte

NURSING PROGRAM
Performance Evaluation Checklist
Administration of Parenteral Injections

Name of Student: ____________________________________________

Placement: ______________________
School Year: ______________________
Semester/Term: S.Y._____ First semester Second semester summer
LEGEND
5 Competent Performs consistently in an effective manner
4 Progress Acceptable Performs effectively and efficiently with minimal misses
3 Progress Moderately Performs efficiently with some misses
Acceptable
2 Progress Fairly Performs with more misses
Acceptable
1 Progress Poorly Performs with lots of mistakes
Acceptable

1 2 3 4 5 Remarks
A. Preparation
1. Check the medication ticket.
a. Check the drug name, dosage,
frequency, route of
administration, and the
expiration date of the
medication.
b. If the medication ticket is
unclear or pertinent information
is missing, compare the
medication ticket with the
physician’s most recent written.
2. Know the reason why the client is
receiving the medication, the drug
classification, contraindications, usual
drug range, side effects, and nursing
consideration for administering the
medication.
3. Verify the client’s ability to take the
medication parenterally.
a. Determine the amount of
medicine, site of injection, size
of the patient including the sizes
of syringes and needles to be
used.
4. Organize the supplies.
B. Implementation
5. Perform hand hygiene.
6. Obtain the appropriate medication.
Read the medication ticket and take
the appropriate medication from
the from the patient’s box or
refrigerator.
7. Compare the label of the medication
container or unit-dose package against
 the medication ticket.
8. Check the expiration date of the
medication.
9. Use only medications that have clear
and legible labels.
10. Prepare the medication.
 Preparing medicine from an
ampule:
a. Flick the upper stem of
the ampule several
times with a fingernail.
b. Disinfect the neck of the
ampule using a wet
cotton balls or alcohol
swab.
c. Use an ampule opener
or place a piece of
sterile gauze or alcohol
wipe between your
thumb and the ampule
neck or around the
ampule neck and break
off the top by bending it
toward you.
d. Dispose of the top of
the ampule in the
sharps container.
e. Withdraw the
medication.
e.1 Place the ampule on
a flat surface.
e.2 Prepare the syringe
and the needle. Use
appropriate size
depending on the
type and amount of
medications to be
used.
e.3 Remove the cap of
the needle and
insert the needle
into the center of
the ampule.
e.4 Do not touch the rim
of the ampule with
the needle tip or
shaft.
 Preparing medicine from a
vial:
a. Remove the cap/plastic
covering of the vial.
b. Disinfect the rubber
using a wet cotton balls
or an alcohol swab in a
circular motion.
c. Prepare appropriate
amount of diluent (if
medicine is in powdered
 form.
d. Mix the solution, if
necessary by rotating
the vial between the
palms of the hands, not
by shaking.
e. Calculate the exact dose
then withdraw the
medication.
11. For Skin Testing:
11.1 Withdraw 0.9 ml of
sterile water using
tuberculin syringe with
aspirating needle then add
0.1 ml of the medicine to be
used. Expel any air bubbles
from the syringe.
11.2 Change the
aspirating needle with a #25
to #27gauge safety needle
(1/4 to 5/8 inch long)
11.3 Check again the
medicine if it is the exact
medicine to be used.
11.4 Place the prepared
medicine on the medication
tray. Prepare all the other
needed equipment before
going to the room of the
patient.
11.5 Perform hand
hygiene.
11.6 Introduce yourself.
11.7 Identify the patient
using two identifiers.
11.8 Explain to the
patient the purposes of
performing skin testing.
Inform the patient about
the discomfort he/she
might experience while
performing the procedure.
Instruct the patient that you
will create a small wheal or
bleb on the surface of the
skin.
11.9 Provide privacy for
the patient.
11.10 Select and clean the
site. Avoid using sites that
are tender, inflamed, or
swollen and those who have
lesions.
11.11 Apply gloves as
indicated by
hospital/agency policy.
11.12 Cleanse the skin at
the site using a firm circular
 motion starting at the
center and widening the
circle outward.
11.13 Allow the area to air
dry.
11.14 Remove the needle
cap while waiting for the
site to dry.
11.15 Expel air bubbles
from the syringe.
11.16 Grasp the syringe in
your dominant hand, close
to the hub, holding it
between the thumb and
forefinger. Hold the needle
almost parallel to the skin
surface, with the bevel of
the needle up.
11.17 Inject slowly 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 into the
dermis.
- Stabilize the syringe and
needle.
- Inject the medication
carefully and slowly so
that it produces a small
wheal on the skin.
- Withdraw the needle
quickly at the same
angle at which it was
inserted. Encircle the
wheal/bleb using black
pen.
- Do not massage the
area.
- Instruct the patient not
to scratched the site
and that the reading will
be done after 30
minutes.
- Place the patient on a
comfortable position
before leaving the
room.

12. For subcutaneous Injection: (follow

procedures 1-10).
12.1 Perform hand
hygiene.
12.2 Introduce yourself.
12.3 Identify the patient
 using two identifiers.
12.4 Explain to the
patient the purposes of the
procedure.
12.5 Provide privacy.
12.6 Select and clean the
site.
- Select a site free of
tenderness, hardness,
swelling, scarring,
itching, burning or
localized inflammation.
- Select a site that has not
been used frequently.
12.7 Apply clean gloves.
12.8 Clean the site with
an antiseptic solution or
alcohol swab. Start at the
center of the site and clean
in a widening circle.
12.9 Allow the area to
dry.
12.10 Place and hold a dry
cotton ball between the
third and fourth fingers of
the non-dominant hand, or
position the cotton ball on
the patient’s skin above the
intended site.
12.11 Prepare the syringe
for injection.
- Remove the needle cap
while waiting for the
site to dry.
12.12 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.
- Using the non-dominant
hand, pinch or spread
the skin at the site, and
insert the needle using
the dominant hand and
a firm steady push.
- When the needle is
inserted, move your
non-dominant hand to
the end of the plunger.
- Inject the medication by
holding the syringe
steady and depressing
the plunger with a slow,
even pressure.
 12.13
- Remove the needle
smoothly, pulling along
the line of insertion
while depressing the
skin with your non-
dominant hand.
- If bleeding occurs, apply
pressure to the site with
dry sterile gauze until it
stops.
13. For Intramuscular Injection: (follow
procedures 1-10 & 12.1-12.11)
13.1 Inject the
medication
- Use the ulnar side of the
non-dominant hand to
pull the skin
approximately 2.5 cm (1
in.) to the side.
Rationale: Pulling the
skin and subcutaneous
tissue or pinching the
muscle makes it firmer
and facilitates needle
insertion.
- Hold the syringe
between the thumb and
forefinger (as if holding
a pen), pierce the skin
quickly and smoothly at
a 90° 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
your 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 (approximately
10 seconds per
milliliter) while holding
the syringe steady.
13.2 Withdraw the needle.
13.3 Withdraw the
needle smoothly at the
 same angle of insertion.
13.4 Apply gentle
pressure at the site with a
dry cotton ball.
13.5 It is not necessary to
massage the area at the site
of injection.
13.6 If bleeding occurs,
apply pressure with a dry
sterile gauze until it stops.

14. Activate the needle safety device or

discard the uncapped needle and
attached syringe into the proper
receptacle.
15. . Remove and discard gloves.
16. Perform hand hygiene.
17. Document all relevant information.
- Include the time of
administration, drug
name, dose, route, and
the client’s reactions.
18. Assess the effectiveness of the
medication at the time it is expected to
act.

______________________________ _________________________
Student Clinical Instructor