OSCE for Nursing at Stgh (skill: IM Injection) Checklist

Check for danger
I.e. Wet floor, hazards...

Hand washing
According to WHO guidelines 2009

Introduce self, role and why you are at pt's house

Consent gained
You can ask the pt "is it your first time? Where do you usually get your injection? Do you prefer your right or left side ?"

ID Checked. Check for allergies.

Validate prescription
1. Correct pt
2. Drug
3. Dose
4. Date and time of administration
5. Route and method of administration
6. Diluent as appropriate
7. EXPIRY DATE of medication checked
8. Signature of prescriber
9. Prescription is legible

Ensure pt is comfortable
I.e. Offer repositioning, toilet, pain killers...

Disinfect hands and Prepare equipment
I.e. Trolley, ensure everything is dry, sealed, intact and not expired.
Need to be verbalised.

Go back to patient, prepare gloves, remove garment to expose site and assess area of injection
I.e. Free of bruises, signs of inflammation, oedema, infection, skin lesions...
If skin is intact... Preference of site?

Clean the injection site
With a swab saturated with isopropyl alcohol 70% for 30 seconds and allow to dry for 30 seconds
Warn the pt that it might feel a bit cold

Correct technique
-With the non-dominant hand stretch the skin slightly around the injection site
-holding the sry he with the dominant hand like a dart, inform the patient and quickly plunge the needle at an angle of 90 degrees into the skin until about 1 cm of the needle is left showing
-pull back the plunger. If no blood is aspirated, depress the plunger at approximately 1mL every 10 seconds (injecting the drug slowly).
-wait 10 seconds before withdrawing the needle
-withdraw the needle rapidly. Apply gentle pressure to any bleeding point but do not massage the site.
-ask pt if he/she would like a small plaster over the puncture site

Activate safety device (where appropriate) and dispose everything safely
I.e. Ensure that all sharps and non-sharp waste are disposed safely and in accordance with locally approved procedures
VERBALISE that you dispose sharps into sharps bins and syringes into an orange clinical waste bag.

Thank pt, hand washing, Document and escalate if needed.
Documentation has to include site of injection, date of next appointment and it has to be SIGNED