Name: __________________________________ Yr.& Sec. __________Date: _________ C.I.

_____________

INTRADERMAL (ID) RUBRICS

CRITERIA
4 3 2 1
Proficient Approachin Developing Beginning Rating
g
proficiency
PROCEDURE Independently Performs Performs Performs
performs all skills with skills with skills with
skills fluently assistance of assistance of assistance
and without faculty 1 - 2 faculty 3 - 4 of faculty
difficulty. times during times during greater than
simulation. simulation 4 times
during
simulation
STEPS
1.Check accuracy and
completeness of each medication
administration record (MAR) with
prescriber’s medication order.
Check patient’s name and
medication name, dosage, and route
and time for administration.
2. Check date of expiration for
medication.
3. Perform hand hygiene.
Aseptically prepare correct
medication dose from ampule or
vial. Check label of medication with
MAR two times while preparing
medication.
4. Close room curtain or door.
5. Introduce self and Identify patient
using two identifiers (e.g., name and
birth date or name and account
number) according to facility policy.
Compare identifiers with information
on patient’s MAR or medical record.
6. Compare name of medication on
label with MAR one more time at
patient’s bedside
7. Explain steps of procedure and
tell patient that injection will cause a
slight burning or sting.
8. Apply clean gloves. NOTE: If
patient has latex allergy, use latex-
free gloves.
9. Select appropriate injection site.
Inspect skin surface over sites for
bruises, inflammation, or edema.
*Note lesions or discolorations of
skin. If possible, select site three to
four finger widths below antecubital
space and a hand width above wrist.
10. Help patient to comfortable
position:
*Have patient extend elbow and
support it and forearm on flat
surface.
11. Clean site with an antiseptic
swab. *Apply swab at center of site
and rotate outward in circular
direction for approximately 5 cm (2
inches).

12. Hold swab or gauze between

third and fourth fingers of non-
dominant hand.
13. Remove needle cap or sheath
from needle by pulling it straight off.
14. Hold syringe between thumb
and forefinger of dominant hand
*Hold bevel of needle pointing up.
15. With non-dominant hand stretch
skin over site with forefinger or
thumb.
16. With needle almost against
patient’s skin, insert it slowly with
bevel up at a 5- to 15-degree angle
until resistance is felt. Advance it
through epidermis to approximately
3 mm (1 8 inch) below skin surface.
You will see needle tip through skin.
17. Inject medication slowly.
Normally you feel resistance. If not,
needle is too deep; remove and
begin again. Non-dominant hand
can stabilize needle during the
injection.
18. While injecting medication,
notice that small bleb approximately
6 mm (1 4 inch) in diameter
(resembling mosquito bite) appears
on surface of skin. Instruct patient
that this is a normal finding.
19. Withdraw the needle quickly at
the same angle at which it was
inserted.
• Do not massage the area.
20. Help patient to comfortable
position
21. Discard uncapped needle or
needle enclosed in safety shield and
attached syringe into puncture-proof
and leak-proof receptacle.
22. Remove gloves and perform
hand hygiene
23.Observe patient’s response to
medication at times that correlate
with onset, peak, and duration of
medication.
24.Use skin pencil and draw circle
around perimeter of injection site.
Read site within appropriate amount
of time, designated by type of
medication or skin test administered.
25. Chart medication dose, route,
site, time, and date given on MAR
immediately after giving medication .
TOTAL POINTS: 100

____________________________________________ ____________________________________________
Signature over Printed name of the Student Signature over Printed name of the Clinical Instructor

Prepared:
Marie Christine N. Mercado, RN, MAN, Ed.D
Level II – RLE Coordinator

Noted:
Jill Marie C. Hermogenes, RN, MAN, Ed.D Approved:
Assistant Dean Michelle B. Yu, RN, MAN, DM
Dean