PERFORMANCE EVALUATION CHECKLIST

NAME: ____________________________________________ Date: ___________________

YEAR AND GROUP: ____________________ RATING: ________________
ADMINISTERING A SUBCUTANEOUS INJECTION
PROCEDURE
1. States the purposes:
-To provide a medication the client requires
-To allow slower absorption of a medication compared with either the
intramuscular or intravenous site
2. Assessment:
-Allergies to medication
-Specific drug action, side effects, and adverse reactions
-Client's 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
-Ability of the client to cooperate
-Previous injection site used
3. Equipment’s:
-Client's MAR or computer printout
-Vial or ampule of the correct sterile medication
-Syringe and needle(e.g., 3-mL syringe, #25-gauge needle or smaller,
3/8 or 5/8 inch long)
-Antiseptic swabs
-Dry sterile gauze for opening an ampule(optional)
-Clean gloves
4. Check the doctor’s order.
5. Check the medication administration record(MAR)
6. Introduce yourself and verify client’s identity and explain the
procedure.
7. Perform hand hygiene.
8. Provide client's privacy
9. Prepare the medication from the ampule or vial for drug withdrawal.

9. Assist the client to a position in which the arm, leg, or abdomen can be
relaxed, depending in the site to be used
10. Put on clean gloves
11. Select and clean the site
12. Prepare the syringe for injection
13. Remove the needle cap while waiting for the antiseptic to dry. Pull the
cap straight off to avoid containing the needle by the outside edge of the cap

14. 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 with the palm downward for a 90-degree angle insertion,
prepare to inject
15. Inject the medication
16. Remove the needle
17. Dispose of supplies appropriately
18. Document all relevant information
19. Assess the effectiveness of the medication at the time is expected to
act and document it

________________________________
Name and Signature of Clinical Instructor