Name: Date

Year level RLE group

Intramuscular Injection

Excellent Very Satisfactory Needs

(4) Satisfactory (2) Improvement

(3) (1)

1. Assemble the
equipment

2. Verifies the
medication order

3. Washes hands

4. Prepares the
medication using
aseptic technique

5. Identifies the patient

6. Explains the procedure

to the patient

7. Provides privacy and

positions the patient
as required

8. Select an appropriate
injection site using
anatomical landmarks

9. Cleanse the injection

site with an antiseptic
wipe using friction,
allows to dry
10. Removes the needle
cover using aseptic
technique

11. Informs the patient

that you are ready to
give the injection

12. Administer the

injection

ROUTINE METHOD
a. Draws skin taut,
using the thumb
and fingers of the
non-dominant
hand
b. Thrust the needle
quickly into the
tissue to its full
length at a 90
degrees angle,
using dart like
motion
c. Aspirate by pulling
back on the
plunger to ensure
that a blood vessel
has not been
entered.
d. If blood has been
aspirated,
withdraw the
needle and discard
the medication
e. Inject the
medication slowly
by pushing on the
plunger and
holding the
syringe steady.
f. Remove the
needle quickly by
following the line
 of insertion
g. Apply pressure to
the injection site
with an antiseptic
sponge
h. Massage the site
with a circular
motion to
enhance
absorption

13. Asses the injection site

for bleeding. Applies
additional pressure if
necessary

14. Assist the patient to a

comfortable position,
noting safety factors

15. Discards equipment or

return it to the
appropriate area

Remarks:

Rating Scale:
Excellent 96-100%
Very Satisfactory 90-95%
Very Good 85-89%
Good 80-84%
Fair 75-79%
Poor 74% and below
TOTAL GRADE

Evaluated by: Conforme

________________________________
 Signature over printed name of the
student
Signature over printed name of the
Clinical Instructor