Skill Check-Off Competency:
Medication Administration
Step / Action / AcceptableOR
Unacceptable
(A/U)
Oral
Assessment / Reviews patient allergies, medication history, and diet
Assesses physical conditions or lab values that may affect drug administration
Assesses patient’s knowledge of medication use and physical limitations related to medication intake
Safety / Checks accuracy of MAR with original order
Hand Hygiene / Performs appropriate hand washing
Medication Preparation / Prepares medications at cart or preparation area
Does “5 Rights” safety check
Prepares medication for one client at a time
Selects correct drug and compares label of med. with MAR
Correctly calculates drug dose if necessary
Does not touch medication with fingers while transferring med. from container to med cup
Liquids / Gently shakes container containing liquid medication
Measures ordered amount of medication into med cup at eye level
Uses base of meniscus for measurement
Uses calibrated oral syringe to measure small doses of liquid medications
All Medications / Checks expiration date on all meds.
Narcotics / Compares narcotic record and drug supply for correct drug count
Compares MAR with prepared drugs
All Drugs / Does not leave medications unattended
Administering / Takes meds to patient at correct time
Identifies patient (name & birthday) with arm band and verbally
Explains purpose of drug
Assists patient to suitable position for drug intake
Offer preferred fluid to help patient swallow meds.
Documentation / Records administration of med. on MAR
Attention!!!: Above Bold Typed actions included with all forms of medication administration!!!
Topical/Dermal
Creams/ Ointments / Softens drug in gloved hands by rubbing briskly between hands
Spreads evenly over surface following direction of hair growth
Documentation / Records administration of med. on MAR
Nitroglycerin / Applies appropriate amount of ointment on dose paper over measuring guide
Removes previous paper and wipes residual ointment with tissue
Specifies appropriate body areas to administer this drug
Verbalizes importance of rotating sights
Applies ointment to skin surface and does not rub or message
Dates, times, initials paper
Secures paper
Documentation / Records administration of med. on MAR
Patches / Locates and removes old patch
Cleanses area
Chooses appropriate position for specific patch
Removes new patch from package holding patch by edge
Applies patch and presses firmly with palm for 10 seconds
Disposes of old patch by folding in half with sticky sides together
Documentation / Records administration of med. on MAR
Ear
Preparation / Warms medication under running warm water
Positioning / Positions patient in optimal position and secures head with own hands
Over 3 years old: Pulls pinna up and back
< 3 yrs old: Pinna pulled down and back
Gently wipes out ear canal if occluded
Holds dropper 1 cm above ear
Asks patient to remain in side-lying position for 5 to 10 minutes
Gently messages tragus of ear
Documentation / Records drug and concentration, number of drops, time, which ear received drops, and initials
Records condition of ear canal in nurses notes and any change in patient’s hearing acuity
Eye
Preparation / Warms solution to room temperature
Position / Has patient lied supine or sit back in chair with head slightly hyperextended
Cleans outer eye if necessary
With nondominant hand presses against bony orbit with cotton
Has patient look upward
Holds eye dropper approximately 1-2 cm above conjunctival sac
Administers prescribed drops
Asks patient to close eye
Applies gentle pressure to nasolacrimal duct for 30 to 60 seconds when administering drugs causing systemic effects
Documentation / Records med. administration on MAR includes number of drops and eye receiving med. if not already noted
Records condition of eye in nurses’ notes
Nose
Hand Hygiene / Applies gloves
Preparation / Instructs patient to gently blow nose
Positioning / Tilts head conducive to medication of affected sinus
Instructs patient to breath through mouth
Instillation / Holds dropper 1 cm above nares and instills prescribed number of drops towards ethmoid bone
Instructs patient to remain supine for 5 minutes and avoid blowing nose
Reposition / Assists patient to comfortable position after drops are absorbed
Documentation / Records drug administration time on MAR, makes sure # of drops and nostril(s) receiving medication also included
Record patient’s response in nurses’ notes
Vaginal
Privacy / Makes certain room door or curtain is closed
Hand Hygiene / Applies gloves
Positioning / Assists patient to dorsal recumbent position
Privacy / Drapes abdomen and lower extremities
Able to visualize vaginal orifice uses special lighting if necessary
Assessment / Assures wellbeing of external genitalia
Instillation / Lubricates suppository or fills applicator
Gently separates labia with nondominant hand
Inserts rounded end of suppository 3-4 inches OR
Inserts applicator 2-3 inches and pushes plunger to deposit med.
Documentation / Note appearance of genitalia in nurses’ notes
Records med. administration on MAR
Rectal
Privacy / Makes certain room door or curtain is closed
Hand Hygiene / Applies gloves
Positioning / Assists patient to side-lying Sims’ position with upper leg flexed upward
Privacy / Only exposes rectal area
Instillation / Lubricates suppository and own gloved index finger
Separates buttocks
Gently inserts suppository approx. 4 inches
Disposes of gloves
Reminds client to lie flat for 5 minutes
Places call light within patient’s reach
Performs hand hygiene
Documentation / Records med. administration on MAR
Records patient’s response to med. in nurses’ notes
Inhalation
Patient information / Explains and demonstrates (when possible) proper steps in administering inhaler med.
Explains and demonstrates proper steps in administering meds. via spacer device
Verbalizes required 20 – 30 second time space between repeated inhalations
Explains cleansing process and frequency for inhaler
Documentation / Records med. administration in MAR
Record patient’s response to medication in nurses’ notes including pulse, respirations, breath sounds, adverse effects
Record skills taught to patient and his ability to perform them
A. Oral Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
B. Topical Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
C. Ear Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
D. Eye Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
E. Nose Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
F. Vaginal Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
G. Rectal Medication Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
K. Inhalation Administration Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
* 80% of the actions included in each form of drug administration must be rated as acceptable in order to pass the particular method of administration
Skill Check-Off Competency:
Medication Administration--Injectables
Step / Action / AcceptableOR
Unacceptable
(A/U)
Assessment / Reviews patient allergies, medication history, and diet
Assesses physical conditions or lab values that may affect drug administration
Assesses patient’s knowledge of medication use and physical limitations related to medication intake
Safety / Checks accuracy of MAR with original order
Checks expiration date on all meds.
Hand Hygiene / Performs appropriate hand washing
Medication Preparation / Prepares medications at cart or preparation area
Does “5 Rights” safety check
Prepares medication for one client at a time
Selects correct drug and compares label of med. with MAR
Correctly calculates drug dose if necessary
Does not leave medications unattended
Administering / Takes meds to patient at correct time
Identifies patient (name & birthday) with arm band and verbally
Explains purpose of drug
Assists patient to suitable position for drug intake
Ampule / Taps top of ampule to move fluid to base
Places gauze over neck of ampule
Snaps neck of ampule away from hands
Uses filtered needle to draw up medication
Draws up med. without spilling and expresses bubbles from syringe
Replaces filtered needle
Vial / Removes cap of vial and wipes rubber seal with alcohol swab
Injects vial with amount of air equivalent to med. dose
Withdraws correct amount of fluid for prescribed dose and expresses bubbles from syringe
Mixing Medications
Insulin / Swabs top of each vial with alcohol
Injects air equivalent to dose into vial with cloudy insulin first without touching fluid
Injects air equivalent to dose into vial with clear insulin second
Keeps needle in vial, inverts vial, and withdraws appropriate dose
Purges bubbles and has another nurse check dose
Withdraws ordered dose of medication from cloudy insulin vial without contaminating vial with other insulin
Withdraws needle from vial and has dose checked by another nurse
Carpuject and Ampule (mixing 2 meds in 1 syringe) / Activates cartridge and loads into holder
Purges air and fluid from cartridge to result in ordered dose
Places filter needle on syringe system
Taps top of ampule to move fluid to base
Places gauze over neck of ampule
Snaps neck of ampule away from hands
Draws up ordered dose without spilling or purging carpuject med. into ampule
Replaces filtered needle
Intradermal Injections
Privacy / Closes room door or curtain
Hand Hygiene / Performs appropriate hand cleaning
Injection / Selects appropriate site
Cleanses site with alcohol swab
Pulls cap of needle straight off of syringe
Stretches skin with nondominant hand
Inserts needle at 5 to15 degree angle
Forms approximate m¼ inch bleb on skin surface during injection
Does not message site
Properly disposes needle
Hand hygiene / Performs proper hand washing
Documentation / Records administration of med. in MAR
Subcutaneous Injections
Equipment / Chooses appropriate needle size for type of injection and properly obtains medication
Privacy / Closes room door or curtain
Hand Hygiene / Performs appropriate hand cleaning
Injection / Selects appropriate injection site
Verbally assists patient to relax and assists to a comfortable position
Properly swabs chosen site with alcohol swab
Pulls cap of needle straight off of syringe
Holds syringe as if grasping a dart
Pinches skin with nondominant hand
Inserts needle at 45- to 90- degree angle
Injects medication at appropriate speed
Places swab over the site after injection, does not message site, applies pressure to site for 30 -60 seconds if heparin is given
Discards syringe appropriately
Assists patient to comfortable position
Hand hygiene / Performs proper hand washing
Documentation / Records administration of med. in MAR includes site of inj.
Records client response to medication
Intramuscular Injections
Equipment / Chooses appropriate needle size for type of injection and properly obtains medication
Privacy / Closes room door or curtain
Hand Hygiene / Performs appropriate hand cleaning
Injection / Selects appropriate injection site
Verbally assists patient to relax and assists to a comfortable position
Properly swabs chosen site with alcohol swab
Pulls cap of needle straight off of syringe holds syringe in dominant hand perpendicular to patient’s body
Verbalizes how to administer med. in a Z-track
Injects needle at 90 degree angle, quickly
Aspirates for 5 to 10 seconds and the injects medication at appropriate speed
Places swab over the site after injection, does not message site
Discards syringe appropriately
Assists patient to comfortable position
Hand hygiene / Performs proper hand washing
Documentation / Records administration of med. in MAR includes site of inj.
Records client response to medication
H. Intradermal Injection Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
I. Subcutaneous Injection Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
J. Intramuscular Injection Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
L. Mixing 2 Medications Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
M. Mixing Insulin Skill Performance (circle one):
PASS FAIL
Instructor’s initials and date: ______
Student’s initials: ______
* 80% of the actions included in each form of drug preparation and administration must be rated as acceptable in order to pass the entire parental medication group of skills