Ateneo de Zamboanga University

COLLEGE OF NURSING
PERFORMANCE EVALUATION CHECKLIST
NAME: _____________________________________ DATE PERFORMED: _________________
YEAR & SECTION: ___________________________

ADMINISTERING VAGINAL INSTILLATIONS

Definition: Vaginal suppositories are solid medications that are inserted into
the vagina with a special applicator. The body absorbs drugs from vaginal
suppositories quickly. They work faster than medications you take by
mouth. This is because suppositories melt inside the body and absorb
directly into the bloodstream.
Purpose: To treat bacterial or fungal infections, vaginal dryness and or use for birth
control
PREPARATION 1 2 3 4 5
1. Assess:
 The vaginal orifice for inflammation; amount,
character, and odor of vaginal discharge.
 For complaints of vaginal discomfort.
2. Determine:
If assessment data influence the administration of the
medication.
3. Assemble equipment and supplies:
 Drape
 Correct vaginal suppository
 Clean gloves
 Lubricant for a suppository
 Disposable towel
 Clean perineal pad
4. Check the Medicine Administration Record.
Check the MAR for the drug name, strength, and
prescribed frequency.
If the MAR is unclear, or pertinent information is
missing, compare it with the most recent primary care
provider’s written order.
Report any discrepancies as agency policy dictates.
5. Know why the client is receiving the medication, the
drug classification, contraindications, usual dose range,
side effects, and nursing considerations for
administering and evaluating the intended outcomes of
the medication.
PROCEDURE
1. Compare the label on the medication with the
medication record and check the expiration date.
2. If necessary, calculate the medication dosage.
3. Explain to the client what you are going to do, why it
is necessary, and how she can cooperate
4. Perform hand hygiene and observe other appropriate
infection control procedures.
5. Provide for client privacy.
6. Prepare the client.
7. Introduce yourself and verify the client’s identity.
8. Ask the client to void.
9. Assist the client to a back-lying position with her
knees flexed and the hips rotated laterally.
10. Drape the client appropriately so that only the perineal
area is exposed.
11. Prepare the equipment.
12. Unwrap the suppository, and put it on the opened
wrapper Or:
13. Assess and clean the perineal area.
14. Put on gloves.
15. Inspect the vaginal orifice, note any odor of discharge
from the vagina, and ask about any vaginal
discomfort.
16. Provide perineal care to remove microorganisms.
17. In administering the vaginal suppository, lubricate the
rounded (smooth) end of the suppository, which is
inserted first.
18. Lubricate your gloved index finger.
19. Expose the vaginal orifice by separating the labia with
your non-dominant hand.
20. Insert the suppository about 8–10 cm (3–4 inches)
along the posterior wall of the vagina, or as far as it
will go.
21. Ask the client to remain lying in the supine position for
5–10 minutes following insertion. The hips may also
be elevated on a pillow.
22. Dry the perineum with tissues, as required.
23. Discard gloves by turning them inside out and
disposing of them and any used supplies as per
agency policy. Perform hand hygiene.
24. Document all nursing assessments and interventions
relative to the procedure. Include the name of the
drug or irrigating solution, the strength, the time, and
the response of the client
TOTAL

________________________
Clinical Instructor
(Signature over printed name)