CHECKLIST FOR ADMINISTERING ORAL MEDICATION

STEPS RATIONALE
1. Silently recite a prayer for the success To ask for guidance
of the procedure.
2. Assess for any contraindications to the Alteration in GI function interfere with
client receiving oral medication. medication distribution, absorption, and
excretion.
3. Assess client’s medical history, history Information reflects patient’s need for potential
of allergies, medication history, and responses to medication.
diet history.
4. Review assessment and laboratory Data reveals the need to hold medication or that
data that may influence drug medication is contraindicated.
administration.
5. Assess client’s knowledge regarding Determines patient’s need for medication
health and medication usage. education and guidance needed in drug achieve
drug adherence.
6. Assess client’s preference for fluids. Fluids ease swallowing and facilitate absorption
from the GI tract.
7. Check accuracy and completeness of The order is the most reliable source only legal
each record with prescriber’s written record of medication that the patient is to
medication order. receive.
8. Prepare medication: Enhances time management and efficiency.
8.1 Wash hands. Prevent transfer of microorganisms.
8.2 Arrange medication tray and cups in Organization of equipment saves time and
medication preparation area or move reduces error.
medication cart to position outside client’s
room.
8.3 Unlock medicine drawer or cart. Medication are safeguarded when in locked in
cabinet, cart, or computerized medication
dispensing system.
8.4 Prepare medication for one client at a Preventing distractions limits preparation errors.
time. Keep all pages of records for one client
together.
8.5 Select correct drug from stock supply or Reading labels and comparing the with
unit-dose drawer. transcribed order reduces error.
8.6 Calculate drug dose as necessary. Double- Double checking reduces error.
check calculation.
8.7 To prepare tablets or capsules from a floor Avoid contamination and waste of medication.
stock bottle, pour required number into
bottlecap and transfer medication-to-
medication cup. Do not touch medication with
fingers. Extra tablets or capsules may be
returned to bottle. Break prestored
medications using a gloved hand or pill-
cutting device.
8.8 To prepare unit-dose tables or capsule,
place packaged table or capsule directly into
medicine cup. (Do not remove wrapper.)
8.9 Place tablets or capsules to be given to
client at the same time in one medicine cup
unless client requires pre-administration
assessments.
8.10 If client has difficulty swallowing and
the pill may be crushed, use a pill-crushing
device. If a pill-crushing device is not
available, place tablet between two
medication cups and grind with a blunt
instrument. Mix ground tablet in small
amount of soft food (e.g., custard or
applesauce).
9. Prepare Liquids:
9.1 Remove bottle cap from container and
place cap upside down.
9.2 Hold bottle with label against palm of
hand while pouring.
9.3 Hold medication cup at eye level and fill
to desired level on scale.
9.4 Discard any excess liquid into sink. Wipe
lip and neck of bottle with paper towel.
9.7 Check expiration date on all medications.
9.8 Compare record with prepared drug and
container.
9.9 Return stock containers or unused unit-
dose medications to shelf or drawer and read
label again.
9.10 Do not leave drugs unattended.
10. Administering medications:
10.1 Take medications to client at correct
time.
10.2 Identify client by comparing name on
record with name on client’s identification
bracelet. Ask client to state name.
10.3 Explain to client the purpose of each
medication and its action. Allow client to ask
any questions about drugs or she is receiving.
10.4 Assist client to sitting position or to side-
lying position if sitting is contraindicated.
11. Administer drugs properly:
11.1 Allow client to hold solid medications in
hand or cup before placing in mouth.
Wrapper maintains cleanliness of medication
and allows you to identify medication name and
dose at patient’s bedside.
Keeping medication that require pre
administration assessments separate from other
makes it easier to withhold medication, as
necessary.
Large tablets are often difficult to swallow.
Ground tablet mixed with palatable soft food is
usually easier to swallow.
This avoids contaminating the inside of the cap.
This prevents the label from becoming soiled
and illegible because of spilled liquids.
This method ensures accuracy of measurement.
This prevents the cap from sticking.
Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
Reading labels and comparing them with
transcribed order reduces error.
Reading label of medications in multi-dose
containers reduces administration errors.
Nurse is responsible for safekeeping of drugs.
Ensures intended therapeutic effect and
complies with professional standards.
Ensure correct patient.
Patient has the right to be informed.
Sitting position prevents aspiration during
swallowing.
Patients become familiar with medications by
seeing each drug.
11.2 Offer water or juice to help client
swallow medications. Give client cold
carbonated water if available and not
contraindicated.
11.3 For drugs administered sublingually,
instruct client to place medication under
longue and allow it to dissolve completely.
Caution client against swallowing tablet.
11.4 For drugs administered buccally, instruct
client to place medication in mouth against
mucous membranes of the cheek until it
dissolves. Avoid administering liquids until
medication has dissolved.
11.5 Mix powdered medication with liquids at
bedside and give to client to drink.
11.6 Caution client against chewing or
swallowing lozenges.
11.7 Give effervescent powders and tables to
client immediately after they have dissolved.
11.8 If the client is unable to hold
medications, place medication cup to client’s
lips and gently introduce each drug into the
mouth, one at a time.
11.9 If table or capsule falls to the floor,
discard it and repeat preparation.
11.10 Stay in room until client has completely
swallowed each medication. Ask client to
open mouth if you are uncertain whether
mediation has been swallowed.
11.11 When administering highly acidic
highly acidic medications, offer client a
nonfat snack if not contraindicated.
11.12 Assist client in returning to a
comfortable position.
11.13 Dispose of soiled supplies.
12. Wash hands.
13. Return to client’s room within 30
minutes to evaluate client’s response
to medication.
14. Ask client or family member to
identify drug name and explain
purpose, action, dosage, schedule, and
potential side effects of drug.
15. Notify prescribe if the client exhibits a
toxic effect or allergic reaction or if
there is an onset of side effects. If
Choice of fluid can improve fluid intake.
Medication is absorbed through blood vessels of
undersurface of the tongue.
Buccal medication act locally on mucosa or
systematically as they are swallowed in saliva.
Powdered medication often thicken and harden
making swallowing different.
Medication acts through slow absorption
through oral mucosa, not gastric mucosa.
Effervescent improves unpleasant taste often
relieves GI problems.
Administer single tablet or capsule eases
swallowing and decreases risk of absorption.
The medication is already considered
contaminated.
Ensures the patient received the ordered dosage.
If left unattended, some patients do not take the
medication causing risk to the health in the
patient.
Reduces gastric irritation.
Maintains patient’s comfort.
Reduce transmission of microorganisms.
Reduce transmission of microorganisms.
Evaluates the therapeutic effect of the
medication, allergic reaction and side effects.
Determines level of knowledge gained by the
patient and the family.
To make necessary implementation of care to
reduce risks of the toxic effect, allergic reaction
or if there is an onset of side effects. If either of
 either of these occurs, withhold further these occurs, withhold further doses of
doses of medication medication
16. Record administration (or For documentation.
withholding) of oral medications.
 CHECKLIST FOR RECONSTITUTING MEDICATION FROM POWDER

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success To ask for guidance
of the procedure.
ASSESSMENT
2. Review physician’s order; including Determines patient’s need for medication
client’s name, drug name, form, route, education and guidance needed in drug achieve
dosage, and time administration. drug adherence.
3. Review pertinent information related To prevent medication error.
to medication, including action,
purpose, side effects and nursing
implications.
PLANNING
4. Gather appropriate equipment. To save time and efficiency.

5. Perform hand washing. To reduce transfer of microorganisms.

IMPLEMENTATION
6. Remove cap covering vial containing To determine the correct solution to be inserted
powdered medication and vial in the powder for reconstitution.
containing diluent. Label may specify
use of sterile water, normal saline, or
special diluent provided with the
medication.
7. Firmly swab both caps with alcohol Not all drug manufacturers guarantee that caps
swab and allow to dry. of unused vials are sterile.
8. Draw up diluent into syringe with In preparation prior mixing the medication.
needle.
9. Insert tip of needle through the center Diluent begins to dissolve and reconstitute
of the rubber seal of vial of powdered medication.
medication and inject diluent into vial.
10. Remove needle.
11. Mix medication by gently rolling vial Ensures proper dispersal of medication through
between hands until completely solution. Shaking produces air bubbles.
dissolved.
12. Reconstituted medication in vial is
ready to be drawn into syringe.
13. Draw up medication into syringe. In preparation prior administration.
EVALUATION
14. Check if you have drawn the correct To ensure the correct amount of medication to
volume medication. be given to the patient.
CHECKLIST FOR PREPARING INJECTIONS (AMPULE, VIAL, VIAL CONTAINING
POWDER)
INDICATORS/STATEMENTS
1. Silently recite a prayer for the success
of the procedure.
ASSESSMENT
2. Review specific drug action and
expected response, client’s knowledge
of drug action and nursing
responsibilities.
3. Assess client’s history allergy.
4. Check expiration of medication.
5. Check medication administration
record (MAR), medication card or
patient’s chart.
6. Follow the three checks for
administering medications. Read the
label on the medication:
a. When it is taken from the medication
chart.
b. Before withdrawing the medication.
c. After withdrawing the medication.
PLANNING
7. Organize the equipment.
8. Take note of the 6 R’s in medication
administration.
9. Perform hand washing.
IMPLEMENTATION
10. Prepare medication
10.1Ampule preparation
10.1.1 Tap top of ampule lightly and
quickly with finger until fluid moves
from neck of ampule.
10.1.2 Place small gauze pad around neck
ampule.
10.1.3 Snap neck of ampule quickly and
firmly while pointing it away from your body.
10.1.4 Draw up medication quickly.
10.1.5 Hold ampule upside down or set it on a
flat surface. Insert syringe or filter needle into
RATIONALE
To ask for guidance
Determines patient’s need for medication
education and guidance needed in drug achieve
drug adherence.
Information reflects patient’s need for potential
responses to medication.
Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
The order sheet is the most reliable source and
only legal record of medications that patient is
to receive. Ensures patient receives the correct
medications. Illegible MARs are a source of
medication errors.
To avoid medication error.
Enhances time management and efficiency.
To avoid medication error.
Reduce transmission of microorganisms.
Dislodges any fluid that collects above the neck
of ampule. All solution moves into lower
chamber.
Placing a pad around the neck of the ampule
protects your fingers from trauma as glass tip is
broken off.
Protects yuir fingers and ace from shattering
glass.
Broken rim of ampules is considered
contaminated. When ampule is inverted,
center of ampule opening. Do not allow
needle tip or shaft to touch rim of ampule.
10.1.6 Aspirate medication into syringe by
gently pulling back on plunger.
10.1.7 Keep needle tip under surface of liquid.
Tip ampule to bring all fluid within reach of
needle.
10.1.8 If air bubbles are aspirated, do not
expel air into ampule.
10.1.9 To expel excess air bubbles, remove
needle from ampule. Hold syringe with needle
pointing up. Tap side of syringe to cause
bubbles to rise toward needle. Draw back
slightly on plunger, the push plunger upward
to eject air. Do not eject fluid.
10.1.10 If syringe contains excess fluid, use
sink for disposal. Hold syringe vertically with
needle tip up and slanted slightly toward sink.
Slowly eject excess fluid into sink. Recheck
Fluid level in syringe by holding it vertically.
10.1.11 Cover needle with its safety sheath or
cap. Change needle on syringe or use filter
needle if you suspect medication is on needle
shaft.
10.2Vial containing a solution:
10.2.1 Remove cap covering top of unused
vial to expose sterile rubber seal, keeping
rubber seal sterile. If using a multi-dose vial
that has been used before, firmly and briskly
wipe surface of rubber seal with alcohol swab
and allow it to dry.
10.2.2 Pickup syringe and remove needle cap.
Pull back on plunger to draw amount of air
into syringe equivalent to volume of
medication to be aspirated from vial.
10.2.4 With vial on flat surface, Insert tip of
needle with beveled tip entering first through
center of rubber seal. Apply pressure to tip of
needle during insertion.
10.2.5 Inject air into vial’s airspace, holding
on to plunger. Hold plunger with firm
pressure; plunger may be forced backward by
air pressure within the vial.
10.2.6 Invert vial while keeping firm hold on
syringe and plunger. Hold vial between thumb
and middle fingers of nondominant hand.
solution comes out if needle tip or shaft touches
rim of ampule.
Withdrawal of plunger creates negative pressure
within syringe , which puffs fluid into syringe.
Precents aspiration of air bubbles.
Air pressure forces liquid out of ampule and
medication is lost.
Withdrawing plunger too far removes it from
barrel. Holding the syringe vertically allows
fluid to settle in bottom of barrel so it is not
expelled. Air at top of barrel and within needle
is then expelled.
/medication dose prepared accurately. Position
if needle allows medication to be expelled
without flowing down needle shaft.
Prevents contamination of needle. Filter needles
cannot be used for injection. Scooping
technique prevents needlestick injury.
Vial comes packaged with seal that cannot be
replaced after the cap removal.
Inject air first into vial to prevent buildup of
negative pressure in vial when aspirating
medication.
Center the seal is thinner and easier to penetrate.
Injecting beveled tip first and using firm
pressure prevent coring of rubber seal, which
could enter vial or needle.
Injecting air before aspirating fluid creates
vacuum needed to get medication to flow into
syringe. Injecting into airspace of vial prevents
formation of bubbles and inaccuracy in dose.
Inverting vial allows fluid to settle in lower half
of container. Position of hands prevents forceful
movement of plunger and permits easy
Grasp end of syringe barrel and plunger with
thumb and forefinger of dominant hand to
counteract pressure in vial.
10.2.7 Keep tip of needle below fluid level.
10.2.8 Allow air pressure from vial to fill
syringe gradually with medication. Pull back
slightly on plunger to obtain correct amount
of solution.
10.2.9 When desired volume has been
obtained, position needle into vial’s airspace.
Tap side of syringe barrel carefully to
dislodge any air bubbles. Eject any air
remaining at top of syringe into vial.
10.2.10 Remove needle from vial by pulling
back on barrel of syringe.
10.2.11 Hold syringe at a 90-degree angle at
eye level to ensure correct volume and
absence of air bubbles. Remove any
remaining air by tapping barrel to dislodge
any air bubbles. Draw back slightly on
plunger, the push plunger upward to eject air.
Do not eject fluid.
10.2.12 If medication is to be injected into
client’s tissue, change needle to appropriate
gauge and length according to route or
medication.
10.2.13 For multidose vial, make label that
includes date of mixing, concentration of drug
per milliliter, and your initials.
10.3Vial containing a powder
(reconstituting medications):
10.3.1 Remove cap covering vial of powdered
medication and cap covering vial of proper
diluent.
10.3.2 Pick up syringe and remove needle cap.
Pull back on plunger to draw amount of air
into syringe equivalent to volume of
medication to be aspirated from vial.
10.3.3 3. With vial on flat surface, insert tip of
needle with beveled tip entering first through
center of rubber seal. Apply pressure to tip of
needle during insertion.
10.3.4 Inject air into vial’s airspace, holding
on to plunger. Hold plunger with firm
pressure; plunger may be forced backward by
manipulation of syringe.
Prevents aspiration of air.
Positive pressure within vial forces fluid into
syringe.
Forcefully striking barrel while needle is
inserted in vial bends needle. Accumulation of
air displaces medications and causes plunger to
separate from barrel, resulting in loss of
medications.
Accidentally pulling plunger rather than barrel
causes plunger to separate from barrel, resulting
in loss of medications.
Holding syringe vertically allows fluid to settle
in bottom of barrel so it is not expelled.
Inserting needle through rubber stopper dulls
beveled tip. New needle is sharper.
Ensures that future doses will be prepared
correctly.
Not all drug manufacturers guarantee that caps
of unused vials are sterile.
Inject air first into vial to prevent buildup of
negative pressure in vial when aspirating
medication.
Center the seal is thinner and easier to penetrate.
Injecting beveled tip first and using firm
pressure prevent coring of rubber seal, which
could enter vial or needle.
Injecting air before aspirating fluid creates
vacuum needed to get medication to flow into
syringe. Injecting into airspace of vial prevents
air pressure within the vial.
10.3.5 Invert vial while keeping firm hold on
syringe and plunger. Hold vial between thumb
and middle fingers of nondominant hand.
Grasp end of syringe barrel and plunger with
thumb and forefinger of dominant hand to
counteract pressure in vial.
10.3.6 keep tip needle below fluid level.
10.3.7 Allow air pressure from vial to fill
syringe gradually with medication. Pull back
slightly on plunger to obtain correct amount
of solution.
10.3.8 When desired volume has been
obtained, position needle into vial’s air-space.
Tap side of syringe barrel carefully to
dislodge any air bubbles. Eject any air
remaining at top of syringe into vial.
10.3.9 Remove needle from vial by pulling
back on barrel of syringe.
10.3.10 Hold syringe at a 90-degree angle at
eye level to ensure correct volume and
absence of air bubbles. Remove any
remaining air by tapping barrel to dislodge
any air bubbles. Draw back slightly on
plunger, then push plunger upward to eject
air. Do not eject fluid.
10.3.11 Insert tip of needle through center of
rubber seal of powdered medication. Inject
diluent into vial. Remove needle.
10.3.12 Mix medication thoroughly. Roll vial
palms, Do not shake.
10.3.13 Read label carefully to determine dose
after reconstitution.
EVALUATION
10.3.14 Dispose of soiled supplies. Place
broken ampule and/or used vials and used
needle in puncture-proof and leak-proof
container.
10.3.15 Clean work area.
10.3.16 Wash hands.
CHECKLIST FOR ADMINISTERING INJECTIONS (SQ, ID & IM)
formation of bubbles and inaccuracy in dose.
Inverting vial allows fluid to settle in lower half
of container. Position of hands prevents forceful
movement of plunger and permits easy
manipulation of syringe.
Prevents aspiration of air.
Positive pressure within vial forces fluid into
syringe.
Forcefully striking barrel while needle is
inserted in vial bends needle. Accumulation of
air displaces medications and causes plunger to
separate from barrel, resulting in loss of
medications.
Accidentally pulling plunger rather than barrel
causes plunger to separate from barrel, resulting
in loss of medications.
Holding syringe vertically allows fluid to settle
in bottom of barrel so it is not expelled.
Diluent begins to dissolve and reconstitute
medication.
Ensures proper dispersal of medication through
solution. Shaking produces air bubbles.
Avoid medication errors.
Prevents accidental injury to staff. Controls
transmission of infection.
Reduce transmission of microorganisms
Reduce transmission of microorganisms
 INDICATIORS/STATEMENTS
1. Silently recite a prayer for the success
of the procedure.
ASSESSMENT
2. Review specific drug action and
expected response, client’s knowledge
of drug action and nursing
responsibilities.
3. Assess client’s history allergy.
4. Check expiration date of the
medication.
5. Check medication administration
record (MAR), medication card or
patient’s chart.
6. Follow the three checks for
administering medications. Read the
label on the medication:
a. When it is taken from the medication
cart.
b. Before withdrawing the medication.
c. After withdrawing the medication.
PLANNING
7. Organize the equipment.
8. Prepare correct medication dose from
ampule or vial. Check carefully. Be
sure all air is expelled.
9. Take note of 6R’s in medication
administration.
10. Explain procedure and rationale to the
client and significant others. Tell client
the injection will cause a slight
burning or sting.
11. Provide privacy.
12. Perform hand washing.
13. Keep sheet or grown draped over
client’s body parts not requiring
exposure.
IMPLEMENTATION
14. Select appropriate injection site.
Inspect skin surface of site for bruises,
inflammation, or edema:
a. For subcutaneous (SQ) injections:
RATIONALE
To ask for guidance
Determines patient’s need for medication
education and guidance needed in drug achieve
drug adherence.
Information reflects patient’s need for potential
responses to medication.
Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
The order sheet is the most reliable source and
only legal record of medications that patient is
to receive. Ensures patient receives the correct
medications. Illegible MARs are a source of
medication errors.
To avoid medication error.
Enhances time management and efficiency.
Ensures intended therapeutic effect and
complies of the medication to be given to the
patient.
Prevent medication errors.
Help minimize patient’s anxiety.
Respects dignity of patients while area is
injected is exposed.
Reduce transfer of microorganisms.
Provides privacy to the patients.
Injection sites need to be free of abnormalities
that interfere with medication absorption.
Subcutaneous injections are sometime
 Palpate sites for masses or tenderness.
Avoid these areas. For daily insulin
injections, rotate site daily. Check that
needle is correct size by grasping
skinfold at site with thumb and
forefinger. Measure fold from top to
bottom.
b. For intramuscular (IM) injections:
Note integrity and size of muscle and
palpate for tender or hard areas. Avoid
these areas. If injections are given
frequently, rotate sites.
c. For intradermal (ID) injections: Note
lesions or discoloration for forearm.
Select site three to four finger widths
below antecubital space and a hand
width above wrist.
15. Assist client to a comfortable position:
a. For SQ injections: Have client relax
arm,
b. leg, or abdomen, depending on site
chosen.
c. For IM injections: Have client lie flat,
on side, or prone, depending on site
chosen.
d. For ID injections: Have client extend
e. elbow and support it and forearm on
flat surface.
f. Talk with client about subject of
interest.
16. Relocate site using anatomical
landmarks.
17. Cleanse site with an antiseptic swab.
Apply swab at center of site and rotate
outward in a circular direction for
about 5 cm.
18. Hold swab or gauze between third and
fourth fingers of non-dominant hand.
19. Remove needle cap or sheath from
needle by pulling it straight off.
20. Hold syringe between thumb and
forefinger of dominant hand:
a. For SQ and IM injections: Hold as
dart, with palm down.
mistakenly given in muscle especially in
abdomen and thigh sites,. Appropriate size and
needle and angle of injection ensure medication
is injected in subcutaneous tissue.
Ventrogluteal site is preferred sites for adults.
This site is also preferred for children who are
receiving viscous and irritating solutions.
An ID sites needs to be clear so you can see
results of skin test and interpret them correctly.
Relaxation of site minimizes discomfort.
Reduces strain on muscle and minimizes
discomfort of injections.
Reduces strain on muscle and minimizes
discomfort of injections.
Stabilize injection sites for easiest accessibility
Stabilize injection sites for easiest accessibility
Distraction recues anxiety.
Injection into correct anatomical sites prevents
injury to nerves, bones, and blood vessels.
Mechanical action of swab removes secretions
containing microorganisms.
Gauze or swab remains readily accessible when
needle is withdrawn.
Preventing needle from touching sides of cap
prevents contamination
Quick, smooth injections requires proper
manipulation of syringe parts.
 b. For ID injections: Hold with bevel With bevel up, medication is less likely to be
of needle pointing up. deposited into tissues below dermis.
21. Administer injection: Pinching skin elevates subcutaneous tissue and
21.1SQ injection: desensitizes area.
21.1.1 For average-size client,
spread skin tightly across
injection site or pinch skin
with non-dominant hand.
21.1.2 Inject needle quickly and Quick, firm insertion minimizes discomfort.
firmly at a 45- degree
angle, then release skin, if
pinched.
21.1.3 Inject medication slowly. Quick insertion minimizes discomfort.
21.2IM injection: Z- track creates zigzag path through tissues that
21.2.1 Position non-dominant seals needle tract to avoid tracking of
hand at proper anatomical medication.
and marks and pull skin
down to administer in a Z-
track. Inject needle quickly
into muscle at a 90-degree
angle.
21.2.2 If client’s muscle mass is Ensures medication reaches muscle mass.
small, grasp body of
muscle between thumb and
fingers.
21.2.3 Avoid moving syringe Disrupt the flow of medication to the correct
while slowly pulling back site/.
on plunger to aspirate drug.
21.2.4 Inject medication slowly. Minimizes discomfort.
21.2.5 Wait 10 seconds, then Allows for the medication to absorbed into
smoothly and steadily muscle before removing the syringe rather than
withdraw needle while leaking back our through tract that needle
placing antiseptic swab or created.
dry gauze gently above or
over injection site.
21.3ID injection: Needle pierces tight skin more easily,
21.3.1 With non-dominant hand,
stretch skin across injection
site with forefinger or
thumb.
Ensures the needle tip is in dermis.
21.3.2 Place needle against
client’s skin and insert it
slowly at a 5 to 15-degree
angle until resistance is
felt. Advance needle
 through epidermis
approximately 3 mm below
skin surface so that needle
tip
21.3.3 Inject medication slowly.
Remove needle and begin
again if no resistance is
felt.
22. Withdraw needle while applying
alcohol swab or gauze gently over site.
23. Do no massage site after SQ injection
of heparin or insulin or after ID
injection. Apply bandage over ID site.
24. Assist client to comfortable position.
25. Discard uncapped needle enclosed in
safety shield and attached syringe into
puncture and leak proof receptacle. If
unable to leave client’s bedside, use a
one-handed technique to recap needle.
26. Wash hands.
EVALUATION
27. Stay with client and observe for any
immediate reactions.
28. Ask client to explain purpose and
effects of medication.
29. For ID injections, use skin pencil and
draw circle around perimeter of
injection site. Check site within 48 to
72 hours of injection.
30. Record medication administration.
31. Record and report client’s response to
injection and any undesirable effects
caused by the medication.
Slow injection minimizes discomfort at site.
Support of tissue around injection site
minimizes discomfort during needle
withdrawal.
Massage causes underlying tissue damage.
Gives patient sense of well-being.
Prevents injury to patient and health care
personnel. Recapping needles increases risk if
needlestick injury.
Reduces the transfer of medications.
Dyspnea, wheezing, and circulatory collapse are
signs of severe anaphylactic reaction, which is
life threatening.
To evaluate clients perception regarding
medication administered.
Pencil marks makes sites easy to find. Result of
skin testing are read at various times on the
basis of type of medication used or type of skin
testing completed.
For documentation
For documentation

CHECKLIST FOR ADMINISTERING TOPICAL MEDICATIONS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of To ask for guidance.
the procedure.
ASSESSMENT
2. Review physician's order for client's name, To avoid medication error.
name of drug, strength, time of
administration, site of application.
3. Review pertinent information related to the Check that MAR and doctor’s orders are
administration of the medication such as consistent.
action, purpose, side effects and nursing
implications.
4. Assess condition of client’s skin. Cleanse To reduce number of microorganisms.
skin if necessary, to visualize adequately.
5. Determine whether client has known The patient will gain independence in
allergy to latex or topical agent. Determine administering their own medication.
whether client is physically able to apply
medication
PLANNING
7. Identify client and introduce yourself to the To ensure the medication will be given to the
client. right patient. To establish rapport.
8. Explain procedure and rationale to the To reduce anxiety and gain cooperation.
client and significant others.
9.Gather appropriate equipment To save time.
10. Perform hand washing. This step prevents the transfer of
microorganisms.
IMPLEMENTATION
11. Apply topical creams, ointments, and oil-
based lotions.
11.1 Wear gloves. Exposed affected area If skin is broken, sterile gloves will prevent
while keeping unaffected areas covered. the spread of microorganisms.
11.2 Wash affected area, removing all debris, This removes previous topical medications.
and previous medications.
11.3 Soak area with plan warm water to This removes previous topical medications.
removed crusted tissues.
11.4 Pat skin or allow to air dry. This removes previous topical medications.
11.5 If skin is excessively dry and flaking, This prevents irritation of hair follicles.
apply topical agent while skin is still damp.
11.6 Remove gloves and apply new dean This step prevents the transfer of
gloves. microorganisms.
11.7 Place medication in the palm of gloved Softening makes topical medication easier to
hand and soften by rubbing briskly between spread.
hands
11.8 Once medication is thin and smooth To distribute the medication evenly.
smear it evenly over skin surface, using long
and even strokes that follow direction of the
hair growth.
11.9 Explain to client that skin may feel Some topical medications contain oils.
greasy.
12. Ensure client’s comfort and safety.
13. Perform hand washing.
14. Report and record nursing intervention.
EVALUATION
15. Evaluate condition of skin
16. Observe client's ability to apply
medication.
17. Evaluate learning needs of client and
family.
18. Identify unexpected outcomes and
intervene as necessary
CHECKLIST FOR INSTILLING EYE AND EAR MEDICATIONS
INDICATORS/STATEMENTS
1. Silently recite a prayer for the success of
the procedure.
This step prevents the transfer of
microorganisms.
Accurate and timely documentation improves
patient safety.
To assess the patient’s skin in response to the
medication.
To assess if the client can apply medication
correctly.
For further instructions or the need to educate
the patient/family regarding the procedure.
To implement immediate care to lessen the
risks and harm to the patient.
RATIONALE
To ask for guidance.
ASSESSMENT
2. Review physician's order for client's name,
name of drug. concentration, number of drops
(if liquid) time and eye or ear.
3. Review pertinent information related to the
administration of the medication such as
action, purpose, side effects and nursing
implications.
4. Assess condition of external eye or ear
structures.
5. Determine whether client has symptoms of
discomfort or hearing or visual impairment.
6. Determine whether client has any known
allergies to medications.
7. Assess client's ability to manipulate or hold
dropper.
PLANNING
8. Identify client and introduce yourself to the
client.
9. Explain procedure and rationale to the
client and significant others.
10. Gather appropriate equipment.
11. Perform hand washing
IMPLEMENTATION
12. Compare the medication card with the
label of medication.
13. Review the six rights of medication.
14. Verify client's identification.
15. Apply gloves.
16. Ask client to lie supine or sit back in chair
with neck slightly hyperextended for eye
drops. For eardrops, position client on the side
or sitting in chair with affected ear facing up.
Gently wash away drainage from inner and
outer canthus.
17. Instill eyedrops.
17.1 Apply gloves. Hold cotton balls or
cleanse tissue in nondominant hand on
client's cheekbone just below lower eyelid
17.2 With tissue or cotton resting below lower
lid, gently press downward with thumb or
To avoid medication error.
Ensures correct administration of medication
Provides baseline data with which to compare
response to medications.
Impairments of the essential senses of vision
and hearing contribute to early demise and
are important causes of morbidity for
individuals who are blind or deaf.
Protects client from risk of allergic
medication response.
Reflects client ability to learn to self –
administer medication.
For proper identification for the client and for
the health care provider.
Alleviate anxiety of the patient.
Save time and efficiency.
Reduce transfer of microorganisms.
To ensure the patient receives the correct
medication.
Prevent medication error.
To ensure the medication will be
administered to the correct patient.
Gloves protects the nurse from potential
contact with patient body fluids and
medications.
Proper positioning helps to stop medication
from running off.
Cotton or tissue absorbs medication that
escapes eye.
Technique exposes lower conjunctival sac.
Retraction against bony orbit prevents
forefinger against bony orbit, exposing
conjunctival sac.
17.3 Ask client to look at celling.
17.4 Rest dominant hand gently on clients
forehead, and
17.5 Drop prescribed number of medications
drops into conjunctival sac.
17.6 If client blinks or close eyes or if drops
land on outer lid margins, repeat procedure.
17.7 After instilling drops, ask client to close
eye gently.
18. To instill eye ointment.
18.1 Apply gloves. Ask client to look up.
18.2 Apply thin stream of ointment along
upper fid margin on inner conjunctiva.
18.3 Have client close eyes and rub lid lightly
in circular motion with cotton ball, if rubbing
is not contraindicated.
18.4 If excess medication is on eyelid, gently
wipe it from inner to outer canthus.
19. If client needs an eye patch, apply clean
one by placing it Over affected eye so entire
eye is covered. Tape securely
20. Instill eardrops.
20.1 Apply gloves if drainage is present
20.2 Hold bottle in hand. Position client with
affected ear facing up.
20.3 Straighten ear canal by pulling auricle
upward and outward (adult) or down and back
(child).
20.4 If cerumen or drainage occludes
outermost portion of ear canal, wipe out
gently with cotton-tipped applicator, taking
not to force wax inward.
20.5 Instill prescribed drops holding dropper
1/2 inch above ear canal.
20.6 Ask client to remain in side-lying
position 5- 10 minutes and apply gently
massage or pressure to ear with finger.
pressure and trauma to eyeball and prevent
fingers from touching the eye.
For the medication to be absorbed properly.
Prevent medication from sensitive cornea
Helps prevent accidental contact of eye
dropper with eye structures, thus reducing the
risk of injury to eye and transfer of infection
to dropper.
Conjunctival sac normally holds 1 or 2 drops.
Provides even distribution of medication
across eye.
Therapeutic effect of drug is obtained only
when drops enter conjunctival sac.
Closing and moving the eye allow medicines
to be distributed over the eye.
Gloves protects the nurse from potential
contact with patient body fluids and
medications. Prevent medication from
sensitive cornea
Distributes medication evenly across eye and
lid margin.
Further distributes medication without
traumatizing the eye.
Promotes comfort and prevents trauma to the
eye.
Clean eye patch reduces chance of infection.
To prevent cross infection.
To prepare the ear for insertion of the drop
and ensure the drop reaches the required area.
Straightening the ear canal facilitates vision
of the ear canal and the tympanic membrane.
To ensure comfort.
To prevent infection or trauma.
To ensure that the medication reaches the ear
drum and is absorbed.
EVALUATION
21. Evaluate effects of the medication
22. Note client's response to instillation and
observe for side effects.
23. Evaluate client's ability to self-evaluate.
24. Identify unexpected outcomes and
intervene, as necessary.
CHECKLIST FOR INSERTING RECTAL AND VAGINAL MEDICATIONS
INDICATORS/STATEMENTS
1. Silently recite a prayer for the success of
the procedure.
To avoid any possible allergic reaction for the
client.
Ask the client if any discomfort was felt.
Assess the strengths and weaknesses of the
client that needs improvement.
Allows for analysis and identification of
potential errors, which can lead to
improvements and sharing of information for
safer patient care.
RATIONALE
For guidance.
ASSESSMENT
2. Review physician's order, including client's
name, drug name, form (cream or
suppository), route, dosage, and time of
administration.
3. Review pertinent information related to
medication, including action, purpose, side
effects and nursing implications.
4. Inspect condition of external genitalia and
vaginal canal or rectum (May be done just
before insertion).
5. Encourage client to ask clarification during
communication
PLANNING
6. Verify nursing interventions using
physician's order or nursing care plan
7. Identify client and introduce yourself to the
client.
8. Explain procedure and rationale to the
client and significant others.
9. Gather appropriate equipment
10. Perform hand washing.
IMPLEMENTATION
11. Create a climate of warmth and
acceptance.
12. Address the client by name.
13. Use questions appropriately
a. Ask one at a time
b. Allow time to answer.
c. Use open-ended questions
14. Use clear and concise statements.
15. Focus on understanding the client,
providing feedback, assisting problem solving. understand and determining a course of
16. Adjust time allowed based on client's
needs.
To avoid medication error.
Determines patient’s need for medication
education and guidance needed in drug
achieve drug adherence.
This decreases the chance of moving
microorganisms.
To provide proper procedure.
To better understand the client what is being
said and to answer the other clarification of
the client.
To provide a right prescription for
medication.
Providing nursing care for the correct client
with appropriate way.
This ensures that the right client receives the
right medication.
Providing information fosters cooperation,
understanding and participation in care.
Organization facilitates accurate skill
performance.
To prevent transfer of microorganisms.
To make the client comfortable.
To make the client feel important and
validated.
To improve the whole range of
communication.
Asking questions one at a time allows the
client to understand the prospect's challenges.
To better explained what the client wants to
say.
To give the client the freedom and space to
answer in as much detail.
To understand the client what you have being
discussed and what to do next.
To figuring out what the client did not
action to fix it.
To ensure the client’s satisfaction.
17. Summarize what was discussed.
18. Ensure client's comfort and safety.
19. Perform hand washing.
20. Report and record nursing intervention.
EVALUATION
21. Observe responses towards
communication.
22. Request for feedback from the client.
23. Verify if information obtained is accurate.
24. Identify unexpected outcomes and
intervene as necessary.
CHECKLIST FOR STARTING AN INTRAVENOUS INFUSION
INDICATORS/STATEMENTS
1. Silently recite a prayer for the success of
the procedure.
To know properly about what care given
next.
To provide continuity of care.
Reduce transmission of microorganisms.
For documentation
To assess the effectiveness of the medication.
To identify the visual cues about the clients
understanding and feelings that they are
unable or unwilling to verbalize.
Listening to the client feedback makes the
client feel involved and important.
To make sure that the client make an
important health decision.
RATIONALE
To ask for guidance.
ASSESSMENT
2. Assess client's status.
3. Verify prescriber's order for IV therapy.
4. Check solution label.
5. Encourage client to ask clarification during
procedure.
PLANNING
6. Identify client and introduce yourself to the
client
7. Explain procedure and rationale to the
client and significant others.
8.Gather appropriate equipments
9. Perform hand washing and put on a
disposable glove.
IMPLEMENTATION
10. Create a climate of warmth and
acceptance.
11. Address the client by name.
12. Choose site. Use distal veins of hands and
arms first
13. Choose IV cannula or catheter.
14. Connect infusion bag and IV tubing and
run solution through tubing to displace air,
cover end of tubing.
15. Raise bed to comfortable working height
and position for patent adjust lighting.
Position patient's am below heart level to
encourage capillary filling. Place protective
pad on bed under patient's arm.
16. Apply tourniquet 6-8 inches above the
injection site. Palpate for a pulse distal to the
tourniquet. Ask patient to open and dose first
several times or position patient's am in a
dependent position to distend a vein.
17. Ensure Apply alcohol swab for 2-3
minutes in a circular motion , moving outward
from injection site. Allow to dry.
18. With hand not holding the venous access
device, steady patient's arm and use finger or
thumb to pull skin taut over vessel.
19. Holding needle bevel up at 5-25 degrees
angle, depending on the depth of the vein,
pierce skin to reach but not penetrate vein.
Provides baseline data prior the infusion.
To avoid error.
To ensure the correct solution.
To alleviate anxiety.
To ensure the correct patient as well as the
correct medication that the patient will be
receiving.
To reduce patient’s anxiety and facilitate
cooperation.
Enhance time and efficiency.
Reduces transmission of microorganisms.
To minimize discomfort.
To facilitate cooperation and alleviate client’s
anxiety.
To determine where to insert needle and
serve as the IV site.
To select a site that is least restrictive for the
patient
Prevent air bubbles entering patient’s
vascular system.
To avoid back pain.
To make vein more prominent. To impede
venous return.
To remove presence of microorganisms. In
order not to introduce any
This stabilizes the vein and makes the skin
taut for needle entry. It can also make initial
tissue penetration less painful.
Allows the sharp tip of the needle to fierce
the skin first.
20. Decrease angle of needle further until To lessen pain.
nearly parallel with skin. then enter vein either
directly above or from the side in one quick
motion.
21. H backflow of blood is visible, straighten To ensure that the needle entered the vein.
angle and advance needle. Advance needle % Reinserting the needle into the vein penetrate
venipuncture. Hold needle hub and slide the wall of vein resulting to embolization.
catheter over the needle into the vein. Never
reinsert needle into the plastic catheter or pull
the catheter back into the needle.
22. Remove needle while pressing lightly on To secure the catheter into the vein.
the skin over the catheter tip, hold catheter
hub in place.
23. Release tourniquet and attach infusion To initiate blood flow.
tubing, open clamp enough to allow drip.
24. Slip a sterile 2 inches x 2 inches gauze pad Gauze pad elevates hub off skin to prevent
under the catheter hub. pressure area.
25. Anchor needle firmly in place with tape. To secure the IV catheter in place.
26. Cover the insertion site with a transparent Minimizes catheter movement and
dressing or sterile gauze, tape in place with dislodgement. Protects site from
non-allergenic tape but do not encircle contamination.
extremity.
27. A padded approximate length arm board To prevent too much movement or bending
may be applied to an area of flexion. that will cause injury to the site.
28. Calculate infusion rate and regulate flow Ensure appropriate infusion flow.
of infusion.
EVALUATION
29. Evaluate site, cannula, size and type, For documentation
number of attempts at insertion, time, solution,
IV rate.
30. Ask patient what he/she feels after the To ensure if the procedure is done correctly.
procedure.
31. Check for the flow of the infusion. To determine any adjustments with the flow.
32. Discard materials used. To reduce transmission of microorganisms.

CHECKLIST FOR ADMINISTERING PERIPHERAL INTRAVENOUS INFUSION

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of To ask for guidance.
the procedure
ASSESSMENT
2. Review client's medical record for order.
Follow "6 R's " for administration of
medications.
3. Observe client for signs and symptoms
indicating fluid or electrolyte imbalances.
4. Assess client's prior experience with
Intravenous (IV) therapy.
5. Assess laboratory data and client’s allergies
and other risk factors.
PLANNING
6. Explain procedure to client.
7. Assist client to a comfortable sitting or
lying position.
8. Perform hand washing.
9. Organize equipment on bedside stand or
overbed table.
10. Change client's gown to a more easily
removable gown with snaps at shoulder, if
available.
IMPLEMENTATION
11. Open sterile packages and maintain a
sterile technique throughout.
12. Check IV solution. Make sure prescribed
additives (e.g., potassium, vitamins) have
been added. Check solution for color, clarity,
and expiration date. Check bag for leaks.
13. Open Infusion set.
14. Place roller clamp about 2 to 4 cm below
drip chamber and move roller clamp to "off
position.
15. Remove protective sheath over IV tubing
port.
16. Insert infusion set into fluid bag or bottle.
Remove protector cap from tubing insertion
spike and insert spike into opening of IV bag.
Cleanse rubber stopper on bottled solutions
with anti-septic and insert spike into black
To ensure proper medication administration.
To manage the care of the client with fluid
and electrolyte imbalance.
To save time in explaining to the patient prior
to the procedure.
To determine the right medication that you
will give to the patient.
Providing information fosters cooperation.
To avoid discomfort.
To prevent the spread of infection
To save time.
To care out proper procedure.
Check packages for sterility by assessing
intactness, dryness, and expiry date prior to
use. Any torn, previously opened, or wet
packaging, or packaging that has been
dropped on the floor, is considered non-
sterile and may not be used in the sterile
field.
To ensure safety of the patient prior to
administration.
Prevent touch contamination, which allows
microorganism to enter infusion equipment
and bloodstream.
Close proximity of roller clamp to drip
chamber allows more accurate regulation of
flow rate. Moving clamp to off prevents
accidental spillage of IV fluid during
priming.
Provide access for insertion of infusion
tubing into solution using sterile technique.
Flat surface on the top of bottle solution may
contain contaminants, whereas opening to
plastic bag is recessed. Prevents
contamination of bottled solution during
insertion of spike.
rubber stopper of IV bottle.
17. Prime infusion tubing by filling with IV
solution. Compress drip chamber and release,
allowing it to fill one third to one half fl.
18. Remove tubing protector cap and slowly
release roller damp to allow fluid to travel
from drip chamber through tubing lo needle
adapter, return roller damp to "off position
after tubing is primed.
19. Clear tubing of air bubbles Firmly tap IV
tubing where air bubbles are located. Check
entire length of tubing to ensure that all air
bubbles are removed.
20. Replace tubing cap protector on end of
tubing.
21. Optional: Prepare heparin or normal saline
lock for infusion. Use a sterile technique to
connect the IV plug to the loop or short
extension tubing. Inject 1 to 3 ml normal
saline through the plug and through the loop
or short extension tubing
23. Place tourniquet 10 to 15 cm above
insertion site. Check presence of distal pulse.
24. Select well-dilated vein. Foster vein
dilation with the following techniques:
24.1 Stroke the extremity from distal to
proximal sites below the proposed
venipuncture site.
24.2 Tell client to open and close the first of
the arm where the site has been selected.
24.3 Lower the extremity on which the site
has been selected.
25. Release tourniquet temporarily. Clip
excess hair at site,
26. Cleanse insertion site using firm, circular
motion, and povidone iodine solution. Refrain
from touching cleansed site. Allow the site to
dry for at least 2 minutes. If client is allergic
to iodine, use 70% alcohol and allow site to
Priming ensures that tubing is clear of air
before connection with VAD. Slow fill of
tubing decreased turbulence and chance of
bubble formation. Closing clamp prevents
accidental loss fluid.
Removes air from tubing preventing it from
being introduced into vein.
Large air bubbles act as emboli.
Priming removes air from tubing so it does
not enter patient’s vascular system.
Short extension tubing prevents traction on
VAD. Many agencies use short extension
tubing for continuous infusions and stand-
alone saline locks.
Tourniquet should be tight enough to impede
venous return but not occlude arterial flow. If
the patient has fragile veins, tourniquet
should be applied loosely or not at all to
prevent damage to veins and bruising.
Increased volume of blood in vein at
venipuncture site makes vein more visible.
Promotes venous filling
To make the vein more prominent.
To control blood flow.
Restore blood flow and prevents vasospasm
when preparing for venipuncture. Hair
impedes venipuncture or adherence of
dressing.
Decrease risk of infection.
dry for 60 seconds.
27. Perform venipuncture. Anchor vein by
placing thumb over vein and stretching skin
against the direction of insertion 7 to 10 cm
distal to the site.
27.1Over-the needle catheter. Insert over-the-
needle catheter with bevel up at 20- to 30-
degree angle slightly distal to actual site and
in the direction of the vein.
27.2 Needleless V catheter safety device:
Insert using same technique as for over-the-
needle catheter.
28. Look for blood return through tubing of
butterfly needle or flashback chamber of over-
the-needle catheter. Lower needle until almost
flush with skin. Advance butterfly needle until
hub rests at venipuncture site. Advance over-
the-needle catheter 1/4 inch into vein and then
loosen stylet. Advance catheter into vein until
hub rests at venipuncture site. Do not reinsert
the stylet once it is loosened.
29. Stabilize the catheter with one hand by
placing pressure on the hub or on the vein
above insertion site. Release tourniquet and
remove stylet from over-the-needle catheter,
do not recap the stylet. Slide the catheter off
the stylet while gliding the protective guard
over the stylet.
30. Connect needle adapter of administration
set or heparin lock o hub of over-the-needle
catheter or butterfly tubing. Do not touch
point of entry of needle adapter.
32. Release roller clamp slowly to begin
infusion at a rate to maintain patency of IV
line.
33. Secure IV catheter or needle: Place narrow
piece of tape under catheter hub with sticky
side up and cross tape over catheter.
Stabilizing the vein with the non-dominant
hand prevents vein from rolling during
venipuncture.
Places needle at a 20 to 30 degrees angle to
the vein when vein is punctured, risk for
puncturing posterior vein wall reduced.
Superficial veins required a smaller angle.
Deeper veins require a greater angle.
Increased venous pressure from tourniquet
increase backflow of blood into catheter or
tubing. Allow for full penetration of vein
wall, placement of the catheter in the inner
lumen of the vein, and advancement of the
catheter off the stylet. Reduce risk for
introduction of microorganism along catheter.
Advancing the entire stylet into the vein may
penetrate the wall of the vein, resulting in
hematoma. Reinsertion od stylet causes
catheter shearing in the vein and potential
catheter embolization.
Premits venous flow, reduces backflow of
blood, and allows connection with
administration set with minimal blood loss.
Prompt connection of infusion site maintains
patency of vein and prevents risk of exposure
to blood. Maintains sterility.
Regulate flow of IV infusion upon entering
the bloodstream of the patient.
To protects from dislodgement.
 CHECKLIST FOR ADMINISTERING MEDICATIONS BY IV BOLUS

INDICATORS/STATEMENTS RATIONALE
1. Silently recite a prayer for the success of To ask for guidance
the procedure.
ASSESSMENT
2. Review specific drug action and expected Determines patient’s need for medication
response, client's knowledge of drug action
and nursing responsibilities.
3. Assess client's history of allergy.
4. Check expiration date of the medication.
5. Check the medication administration record
(MAR). medication card or patient's chart.
PLANNING
6. Organize the equipment
7. Prepare medication from vial or ampule.
Check dilution instructions. Apply a small-
gauge needle to syringe
8. Take note of the 6 R's in medication
administration.
9. Explain procedure and rationale to the
client and significant others with a smile. Tell
client the injection will cause a slight
10. Provide privacy
11. Perform hand washing.
12. Apply disposable gloves.
IMPLEMENTATION
13. Determine that IV fluids are infusing at
proper rate.
14. Procedure for existing line:
14.1 Select injection port of tubing closest to
needle insertion site.
14.2 Cleanse injection port with antiseptic
swab
14.3 Connect syringe to IV line.
14.4 Occlude IV line by pinching tubing
above port.
14.5 Continue to occlude tubing while
injecting medication slowly.
14.6 Release tubing. Withdraw syringe and
recheck IV rate.
15. Dispose of all equipment property.
education and guidance needed in drug
achieve drug adherence.
Knowledge of allergies influences body’s
response to medication. Prevent adverse
reaction from the medications.
Medications used past its expiration date may
lose strength, be inactive, or harm the patient.
The order sheet is the most reliable source
and only legal record of medications that
patient is to receive. Ensures patient receives
the correct medications. Illegible MARs are a
source of medication errors.
Enhances time management and efficiency.
In preparation in administering medication.
Reduce medication error.
Keeps patient informed and ensures patient-
centered care. Helps identify possible
infiltration early.
Reduce patient anxiety.
Reduce transmission of microorganisms.
Reduce transmission of microorganisms.
Administering medication through IV bolus
there is a possible risk of blood exposure.
To determine the correct medication and
amount of medication that the patient will
receive.
Follows provisions of needle safety and
prevention act of 2001.
Prevents introduction of microorganisms
during needle insertion.
Prevents damage to diaphragm of port and
subsequent leakage.
Final check that medication is being delivered
into blood stream.
Ensure the medication entered the blood
stream. Ensures safe medication infusion.
Injection of bolus alters rate of fluid infusion.
Rapid fluid infusion causes circulatory
overload.
Reduce transmission of microorganisms
16. Remove and dispose of gloves.
17. Wash hands
EVALUATION
18. Stay with client and observe for any
immediate reactions.
19. Observe client closely for adverse
reactions during and for several minutes after
administration.
20. Record medication administration
ADDING MEDICATIONS TO INTRAVENOUS FLUID CONTAINERS
INDICATORS/STATEMENTS
1. Silently recite a prayer for the success of
the procedure
ASSESSMENT
2. Check prescriber's order to determine type
Reduce transmission of microorganisms
Reduce transmission of microorganisms
To observe the success of the medication
administration.
To provide immediate care for any signs of
adverse reaction to lessen risks to the patient.
For documentation.
RATIONALE
To ask for guidance.
To determine what kind of drug is going to be
of intravenous (IV) solution to use and type of
medication and dosage.
3. Collect necessary information for safe
administration of the drug
4. Assess for the compatibility of multiple
medications in a single IV solution.
5. Assess client's systemic fluid balance.
6. Assess client's history of allergies
7. Assess IV insertion site for signs of
infiltration or phlebitis.
8. Assess client's understanding of the purpose To reassure patients, gain confidence and
of the drug therapy
PLANNING
9. Assemble supplies in medication room.
10. Prepare prescribed medication from vial or
ampule.
11. Explain procedure with a smile to the
client to gain participation
IMPLEMENTATION
11. Add medication to new container.
11.1 Locate injection port
11.1.1 Solutions in bags: Locate medication
injection port on plastic IV solution bag.
11.1.2 Solutions in bottles: Locate injection
site on IV solution bottle, which is often
covered by a metal or plastic cap.
11.2 Wipe off port or injection site with
alcohol or antiseptic swab.
11.3 Remove needle cap or sheath from
syringe and insert needle through center of
injection port or site.
11.4 Inject medication.
11.5 Withdraw syringe from bag or bottle.
11.6 Mix medication and IV solution by
holding bag or bottle and turning it gently end
to end.
11.7 Complete medication label with name,
dose of medication, date, time, and initials.
administered.
To ensure safety in administering the drug.
To check the compatibility of the medication
and the IV fluids.
To identify any deficits of the I and O of the
patients.
To determine if patients has allergies to the
medications.
To determine site for signs of infection,
infiltration, or a dislocated catheter.
cooperation.
For preparation to the procedure.
To ensure that the patient understands the
procedure, gives her consent and participates
throughout the procedure.
To reduce the risk of introducing
microorganisms into the container when
needle is inserted.
To locate where to properly insert injection.
To locate where to properly insert injection.
To reduce the risk of introducing
microorganisms into the container when
needle is inserted.
This ensures that the needle enters the
container, and the medication can be
dispersed into the solution.
This should disperse the medication
throughout the solution.
This document that medication has been
added to the solution.
Stick label on bottle
12. Bring assembled items to client's bedside.
13. Identity client.
14. Explain procedure to client and alert client
to expected sensations.
15. Regulate infusion at ordered rate.
16. Add medication to existing container.
17. Prepare vented IV bottle or plastic bag:
17.1 Check volume of solution remaining in
bottle or bag.
17.2 Close off IV infusion clamp.
17.3 Wipe off medication port with an alcohol
or antiseptic swab.
17.4 Insert syringe needle through injection
port and inject medication.
17.5 Lower bag or bottle from IV pole and
gently mix. Rehang bag
17.6 Complete medication label and stick it to
bag or bottle.
17.7 Regulate infusion to desired rate.
18. Properly dispose of equipment and
supplies. Do not cap needle of syringe.
Discard sheathed needles as a unit with needle
covered.
19. Wash hands.
EVALUATION
20. Observe client for signs and symptoms of
drug reactions.
21. Observe client for signs and symptoms of
fluid volume excess.
22. Periodically return to client's room to
assess IV insertion site and rate of infusion.
23. Observe client for signs or symptoms of
IV infiltration.
24. Record solution and medication added to
parenteral fluid on appropriate form and report
and side effects observed.
Identifying the patient ensures the right
patient receives the right intervention /
procedure and helps prevent errors.
Explanation allays the patient’s anxiety.
For accurate rate infusion.
To determine accurate fluid volume.
This prevents the medication from infusing
directly into the client as it is injected to the
bag or bottle.
To reduce the risk of introducing
microorganisms into the container when
needle is inserted.
The bag is supported during the injection of
the medication to avoid punctures.
This established accurate flow rate.
This document that medication has been
added to the solution.
For accurate rate infusion.
This prevents inadvertent injury to others and
the spread of microorganisms.
To reduce the risk of introducing
microorganisms into the container when
needle is inserted.
To determine any rapid effects of the drug.
To determine fluid rate.
Accurate documentation is necessary to
prevent medication errors.
To determine any sign of infiltration to the
patients.
Document the medications on the appropriate
form in the client’s record.