Kingdom of Saudi Arabia

Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

Nursing Competency Program

MEDICATIONS ADMINISTRATION
Employee Name: __________________________ ID No. : ___________________________
Department/Unit: __________________________ Date of Joining: ___________________
Competency Start Date: ____________________________________

Competency Assessment Instructions – This Template must NOT be altered:

1. All ELEMENTS of the Competency (KSA) must be assessed by the patient bedside.
2. Simulation in the Clinical Area or Skills Lab can be used if available and should only be used in
exceptional situations i.e. Clinical Area VERY busy.
3. It is essential that the Reference, Websites and Training Requirements be completed in advance of the
Competency assessment and NOT on the same day.
4. The Assessor is obliged to initial each element assessed and not √ - this happens in the first column.
The Assessor is required to write a comment e.g. Needs more preparation and will be assed again on the
date and time”.
SCORING VALUE
1 Novice – no background experience related to this function/ procedure
2 Limited – performs skill/procedure only monthly or less often
3 Competent/highly skilled- well skilled but no experience within last year
4 Proficient/ expert – well- skilled, current experience within last year
Competency Statement :
Ability to correctly and SAFELY complete a COMPREHENSIVE PATIENT ASSESSMENT,
REASSESSMENT and VITAL SIGNS of patient needs in area of practice. Indicate N/A for any
competency elements not relevant to area of practice.
Knowledge (√each element) Scoring value Comments
1 2 3 4
1 State accurately the process of medication
---------- administration and the 10 Rights of medication
administration.
2 State and explain the responsibilities with
---------- patient medication in the unit.
3 Describe the process of transcribing and
---------- verification of physician order.
4 State and explain different routes of medication
--------- administrations. (I.V, IM, Oral & others).
5 State and explain High Alert Medication
---------- (HAM), Look Alike Sounds Alike Medications
(LASA), and Narcotic Medication.
6 Describe the completion of the independent
---------- double check process, monitoring, storing,
labeling, administration and documentation of
High Alert Medication (HAM), Look Alike
Sounds Alike Medications (LASA).
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 Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

7 Verbalize the medication can be given through

---------- Verbal order and Telephone order.
8 Describe the process of handling medications
---------- brought from home by the patient.
9 Discuss the process of medication not given
---------- during patient on NPO (nothing per Orem)
10 Verbalize storage and expiry of nursing unit
---------- floor stock.
11 State the nurse’s role and responsibility when
---------- anaphylactic reaction is identified.
4 State and explain different routes of medication
--------- administrations. (I.V, IM, Oral & others).
12 State the process of reporting Medication
---------- Error.
14 Discuss the documentation of medication
---------- administration in medication sheet.
15 State nurse's responsibilities towards
---------- administering stat, PRN medication..
Skills (√each element) Scoring Value Comments
1 2 3 4
1 Demonstrate checking physician order and 10
---------- right of medication administration
2 Demonstrate process of storing,labeling,
administering of medication (High Alert
---------- Medication,Look-alike-sounds-alike
Medication,Narcotic and unit floor stock
medications)
3 Complete the completion of the independent
---------- double check process, patient monitoring time,
and documentation
4 Demonstrate the proper administration of
medications through I.V, I.M,SC,Intrathecal,
---------- Intradermal & others)
5 Discuss the role of the nurse during medication
---------- error reportring
6 Carry out the nurse’s role and responsibility
---------- when a reaction is identified including the
immediate action to be taken, completion of
the necessary reporting procedure and
documentation required
7 Demonstrate completeness of equipment
______ preparation prior to medication administration.
Attitude (√Each Element) Scoring Value Comments
1 2 3 4
1 Not to be judgmental and accepts patient

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 Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

response and/or refusal for the administration

---------- of medication.
2 Ability of nurse to respond professionally and
---------- calmly if a reaction to the medication
administration occurs.
3 To be self-aware of limitations in knowledge
---------- and skills and verbalize these with nurse in
charge
4 To be approachable and open to answer patient
---------- and family's questions.
5 Attentive to overall patient experience e.g.
---------- pain, anxiety and have ability to provide
comfort and emotional support as needed
Reference, Websites and Training Requirements:
(These must be completed at least 1 month prior to the Competency Assessment. Policies must be
numbered with the Policy Title; Books referenced must state the specific Chapter for employee to read.)
Reference, Websites and Training Employee
Date
Signature
www.RnCeus.com
www.heart.org
http:circ.ahajournals.org
www.ihi.org/IHI/programs/campaign/campaign.htm
http://www.rcplondon.ac.uk/resources/national-early-warning-score-
news.
http://pediatrics.aapublications.org/content/125/4/e763.full.html

Specific Learning Performance Learning Strategies Comments for Follow-up

Opportunity Expectations with Agreed with Deadline Learning Strategies and
Identified Deadline Deadline Date/s
1.
2.
3.
4.
5.

Competency Completed by: ___________________________________

Designation: _______________________________________________

NAME OF EMPLOYEE ID # SIGNATURE DATE COMPETENCY

ASSESSMENT
COMPLETED

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 Kingdom of Saudi Arabia
Ministry Of Health
Jazan Health Directorate
Prince Mohammed Bin Nasser Hospital

Nursing Education & Staff Development

When completed, the Original must be given to the CRN who will collate the Compliance
Rates for the Unit and before sending it on to the Education Department. The Education
Department will collate the Compliance Rates for the Nursing Services Department. The
Original is to be given to the Employee for their Portfolio and a hard copy kept in the
Employee’s Unit and Nursing Department file.

Original – Employee for Portfolio

Copy held by Head Nurse/CRN in Unit
Copy held in Nursing/Education Department

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