Oral Medication and Intradermal Injection Check Off - Nursing Skills

**Met** **Unmet** **Preparing the Medications** **Comments** 1. Verify the healthcare providers' orders using the six rights of administration. 2. Compare the MAR with the medication label and the patient's full name after removal from dispensing system. (**FIRST CHECK**) -- Also,...

**Met** **Unmet** **Preparing the Medications** **Comments** 1. Verify the healthcare providers' orders using the six rights of administration. 2. Compare the MAR with the medication label and the patient's full name after removal from dispensing system. (**FIRST CHECK**) -- Also, confirm drug is not expired. 3. Gather the necessary equipment and supplies. 4. Place the medication into cup **without** removing the wrapper. Medications requiring specific assessments (heart rate, blood pressure) or different routes (sublingual, buccal) should be in a separate cup as a reminder. 5. Before going into the room, compare the MAR with the medication label and the patient's full name. **(SECOND CHECK**) **Preparing the Patient for Oral Medications** 6. Perform hand hygiene. 7. Provide patient privacy/drape as appropriate. 8. Introduce yourself to patient/family. 9. Identify patient using two (2) patient identifiers with both armband and verbalization. -- Compare to MAR 10. Explain the procedure to the patient and ensure they agree. 11. Ask the patient if they have any allergies. 12. Discuss purpose of medication, action, and possible adverse effects. 13. At bedside, again compare the MAR with the patient's full name and medication label (**THIRD CHECK**). **Administering the Medication in Pill Form** 14. Explain to the patient what medication you are administering. 15. Open and administer tablets/capsules with the patient in sitting or side lying position. 16. Offer preferred liquid to swallow the medications (as long as it is compatible with medication). **Preparing the Patient for Intradermal Injection** 17. Perform hand hygiene. 18. Provide patient privacy/drape as appropriate. 19. Introduce yourself to patient/family. 20. Identify patient using two (2) patient identifiers with both armband and verbalization. -- Compare to MAR. 21. Explain the procedure to the patient and ensure they agree. 22. Ask the patient if they have any allergies any preferences for injection site. 23. Discuss purpose of injection, action, and possible adverse effects. 24. Explain that the injection may cause burning/stinging. 25. Ask the patient to report any itching or difficulty breathing following injection. 26. Raise the bed to a comfortable height. 27. At bedside, again compare the MAR with the patient's full name and medication label ***(THIRD CHECK).*** **Preparing the Site** 28. Select an appropriate site. Allergy and TB tests: injection site will be on the palm side of the forearm about 5-10 cm (2-4 inches) below the elbow. 29. Support the patient's elbow and forearm on a flat surface. 30. Apply clean gloves. 31. Clean the site with antiseptic swab, starting from the center of the site, rotate the swab outward in circular direction for about 5 cm (2 inches). Let it dry. **Giving the Injection** 32. Remove needle cap by pulling straight off. 33. Hold the syringe between the thumb and forefinger of your dominant hand, with the **bevel pointing UP**. 34. Using non-dominant hand, stretch skin over site with forefinger and thumb. 35. With needle almost against the patient's skin and bevel of the needle facing upward, insert the needle slowly at 5^0^--15^0^ angle until you feel resistance. 36. Advance the needle through the epidermis about 3mm (1/8 inch) beneath the skin. 37. You will see the bulge of the needle tip through the skin. 38. Inject medication slowly. A small bleb (approximately 6mm or 1/4 inch) will form on the skin surface. 39. Withdraw the needle and activate needle safety. 40. Discard the needle and syringe in the sharp's container. 41. Do not massage, apply pressure, or disrupt the bleb. **After the Injection** 42. Remove gloves and perform hand hygiene. 43. Help the patient to a comfortable position. 44. Place personal items and call light within reach. 45. Raise the appropriate number of side rails and lower the bed to the lowest position. 46. Document and report the patient's response and expected/unexpected outcomes. 47. Stay with the patient for several minutes to observe for allergic reaction. 48. Return to the patient's room in 15-30 minutes to assess for acute pain, tingling, burning, or numbness at site. Evaluator Name: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Date: \_\_\_\_\_\_\_\_\_\_\_\_