Competency Performance Checklist

Administering Subcutaneous Insulin Injections /Sliding Scale

Student: _______________________________________ Date: _______________

Element

Competency Demonstrated?

0 1 2

1. Explained procedure to client, performed hand hygiene and observed other appropriate
infection control procedures.
 

2. Applied clean gloves.

 

3. Using sliding scale chose correct dosage.

 

4. Choose correct type of Insulin

5.
 

6. Inspected vial for type, concentration, clarity, expiration date and condition of port
 

 
7. Gently rotate if NPH (cloudy)
 

8. Selected site that had not been used frequently.

 

9. Use a 3/8-inch, #25-, or #26-gauge needle or smaller, and inserted it at a 90-degree angle.
 

10. Cleaned site with antiseptic swab. Started at center of site and cleaned in a widening
circle to about 5 cm. Allowed area to dry thoroughly.
 

11.  Removed needle cap while waiting for antiseptic to dry. Pulled cap straight off to avoid
contaminating needle by outside edge of cap.
 

12. Grasped the syringe in the dominant hand and held between
thumb and fingers.

13. Used the nondominant hand, pinche to make a fold or spread the skin at the site, and
inserted the needle.
 

 
14. After needle inserted, moved nondominant hand to end of
plunger.

15. Injected medication by holding syringe steady and depressing plunger with a slow, even
pressure.
 

16. Removed needle smoothly, pulling along the line of insertion while depressing skin with
nondominant hand.
 

17. Applied pressure to sit with dry sterile gauze if bleeding occurred.
 

18. Disposed of supplies appropriately.

 

19. Removed and discarded gloves. Performed hand hygiene.

 

20.   Did not massage site after injection and Documentation

 

 
 

Evaluator: _______________________________