Professional Documents
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Procedure Checklist With Rating Form Administering Intradermal Injections
Procedure Checklist With Rating Form Administering Intradermal Injections
SCHOOL OF NURSING
Year/Section/Group/Number
Rate the student's performance by checking the appropriate box using the following criteria:
5 - Excellent (Carries out procedures efficiently, systematically and independently/Personality trait is observed at all times)
4 - Very Satisfactory (Carries out procedures efficiently and systematically but requires minimal guidance and supervision/Personality trait is
observed at all times)
3 - Satisfactory (Carries out the procedures efficiently and systematically but requires moderate guidance and supervision/Personality trait is
observed at all times)
2 - Fair (Carries out the procedures efficiently and systematically but requires close guidance and supervision/Personality trait is observed at all
times)
1 - Poor (Carries out the procedures inefficiently, unsystematically even under close guidance and supervision/Personality trait is observed at all
times)
0 - Not done
Criteria 5 4 3 2 1 0
ASSESSMENT
1. Check accuracy and completeness of each medication administration record
(MAR) with prescriber’s medication order.
2. Review pertinent information related to medication: action, purpose, normal
dose, route, side effects, adverse reactions, time of onset, peak of action and
nursing implications.
3. Assess patient’s medical and medication history and history of allergies.
Know his or her normal response to an allergy.
4. Check date of expiration for medication.
5. Assess patient symptoms or condition for which medication has been
prescribed.
PLANNING
6. Prepare the materials needed.
7. Obtain the appropriate medication. Read the MAR and prepare medications
for one client at a time. Select the proper medication from the unit stock/
patient’s medication drawer
8. Compare the label of the medication against the order on the patient’s MAR/
CMAR. Check the expiration date and perform calculations. Return expired
medications to the pharmacy
9. Bring medications to patient’s bedside and keep in sight at all times.
IMPLEMENTATION
10. Wash hands.
11. Identify the patient using two identifiers (1.e name and birth date or name
and account number.) Compare identifiers with information on the patient’s
medical record.
12. Explain the procedure and purpose to the patient and family.
13. Provide privacy.
14. Re-check again the medication against the MAR at the patient’s bedside.
15. Explain to the client that the medication will produce a small wheal/ bleb. The
client will feel a slight sting as the medicine enters dermis.
16. Select the injection site:
16.1 Site can be: forearm about a hand’s width above the wrist and three or
four finger widths below the antecubital space.
Total Score:
Comments/Suggestions:
*Total points shall be transmuted using the table for 100 pts. Passing cut-off point is 65.
Interpretation: __________________________
Evaluator: Conforme: