COMPETENCIES 4 3 2 1

Verify the order with the patient's chart

 Determine whether the patient has allergies. If an allergy or contraindications
exist, don’t administer the medication and instead notify the doctor
Perform hand hygiene.
 Check the medication’s color, clarity, and expiration date. If the medication is
expired, return it to the pharmacy and obtain new medication.
 Visually inspect the medication for particles, discoloration, and other signs of loss
of integrity; don’t administer if its integrity is compromised
Choose equipment appropriate to the prescribed medication and injection site.
f. Patient’s prescribed medication
g. Patient medication administration record
h. 25g to 27g ½“ to 5/8” needle
i. 1 – to 3-Ml syringe
j. Anti-septic pads
k. Optional: gloves, filter needle, antiseptic cleaning agent, insulin syringe
 Prepare a syringe with the prescribed amount using sterile technique. Calculate
dosage and have another nurse verify it, if necessary
Procedure Checklist for SC Medications Administration

 Perform hand hygiene

Confirm the patient’s identify using at least two patient identifiers
Explain the procedure to the patient and provide privacy. If the patient is receiving
the medication for the first time, teach him about potential adverse reactions and
other concerns related to the medication
Verify that the medication is being administered at the proper time, in the
prescribed dose, and by the correct route to reduce risk of medication errors
Select an appropriate injection site
Provide privacy. Position and drape the patient appropriately. Expose the injection
site
Put on gloves, if contact with the blood or body fluids is likely or if your skin or the
patient’s skin isn’t intact. Gloves aren’t required for routine SC injections because
they don’t protect against needle stick injury
Clean the injection site with an alcohol pad using a circular motion outward, allow
the skin to dry to avoid stinging sensation from introducing antiseptic into
subcutaneous tissue
Loosen the protective needle sheath
With your non-dominant hand, grasp the skin around the injection site firmly to
elevate the subcutaneous tissue forming a 1’ (2.5cm) fat fold
Holding the syringe in your dominant hand, insert the loosened needle sheath
between the fourth and fifth fingers of your other hand while still pinching the
skin around the injection site. Pull back the syringe with your dominant hand to
uncover the needle by grasping the syringe like a pencil. Don’t touch the needle
Position the needle with its bevel up. Tell the patient he’ll feel a needle prick
Insert the needle quickly and smoothly deep into the muscle at a 45 – or 90 –
degree angle. Release the patient’s skin to avoid injecting the drug into
compressed tissue and irritating nerve fibers
After injection, remove the needle gently but quickly at the same angle used for
insertion and if, present, activate the safety mechanism to prevent accidental
needle stick injury
Cover the site with an antiseptic pad, and apply gentle pressure. Do not massage
the site
Remove and discard the antiseptic pad
Check the injection site for bleeding and bruising
Discard all equipment according to standard precautions and facility policy.
Remove and discard your gloves, if worn, and perform hand hygiene
Document the procedure

Procedure Checklist for ID MEDICATIONS ADMINISTRATION

 COMPETENCIES 4 3 2 1
Verify the order with the patient’s chart
Review the patient’s medical record for drug allergies or contraindications to
the procedure
Perform hand hygiene
Check the medication’s color, clarity, and expiration date. If the medication has
expired, return it to the pharmacy and obtain a new vial.
Choose equipment appropriate to the prescribed medication and injection site.
a. Patient’s medication administration record and medical record
b. Tuberculin or 1 ml syringe with a 26G or 27G ½” to 3/8” needle
c. Prescribed medication or antigen
d. Alcohol pads
e. Gauze pads
f. Optional: resuscitation equipment, gloves pen
Prepare a syringe with the prescribed amount using sterile technique
Perform hand hygiene
Confirm the patient’s identity using at least two patient identifiers
Explain the procedure to the patient and provide privacy
Put on gloves, if needed. Put on gloves if contact with blood or other body
fluids is likely or if your skin or the patient’s skin isn’t intact; gloves aren’t
recommended for routine intradermal injection because they don’t protect
against needle stick injury
Instruct the patient to sit up and to extend her arm and support it on a flat
surface, with the ventral forearm exposed
With an alcohol pad, clean the surface of the ventral forearm about two or
three finger breadths distal to the antecubital space. Wipe the area from the
center of the injection site working outward. Be sure the test site you have
chosen is free of hair or blemishes. Allow the skin to dry before administering
the injection
While holding the patient’s forearm in your hand, stretch the skin taut with
your thumb
With your free hand, hold the needle at a 10 to 15 degree angle to the
patient’s arm, with its bevel up
Insert the needle about ½ “ (1.27 cm) below the epidermis. Stop- when the
needle’s bevel tip is under the skin, and inject the antigen slowly. You should
feel some resistance as you do this, and a wheel should form as you inject the
antigen. If no wheal forms, you have injected the antigen too deeply; withdraw
the needle, and administer another test dose at least 2” (5cm) from the first
site
Withdraw the needle at the same angle at which it was inserted. Don’t rub the
site. Rubbing could irritate the underlying tissue, which may affect test results
If you’re administering multiple antigens, inject them at sites at least 2” apart
Circle each test site with a marking pen, and label each site according to the
recall antigen given. Instruct the patient to refrain from washing off the circles
until the test is completed
Don’t recap the needle. Dispose of needles and syringes according to your
facility’s policy
Remove and discard your gloves in the appropriate container, if worn, and
perform hand hygiene
Assess the patient’s response to the skin testing in 24 to 48 hours
Document the procedure