MaricopaNursing-Scottsdale Community College
NUR0.552-Nursing Theory and Science I
GRADING SHEET
Injectable Medication Administration Skill Performance Evaluation
Student: _________________________________
Date: ____________
Exam # _____
Grade: ___________
Completion time: ____________
Performance Standards:
Medication “Rights”
Right Knowledge
 Verbalize appropriate syringe/needle types and angles according to route
o Intradermal (ID)
o Subcutaneous (Sub-q)
o Intramuscular (IM)
 Verbalize appropriate injection sites/locations according to route
o Intradermal (ID)
o Subcutaneous (Sub-q)
 Demonstrate accurate location of Intramuscular (IM) injection sites using
appropriate anatomical landmarks
o Deltoid
o Vastus Lateralis
o Ventrogluteal
 Verbalize maximum amount of medication that can be injected at various
sites
 Demonstrate proper selection of syringe and needle type according to route
o Intradermal (ID)
o Subcutaneous (Sub-q)
o Intramuscular (IM)
Right Patient
 Check patient ID band (Use 2 patient identifiers)
 Compare ID band to MAR
Right Medication
 Check patient’s allergy band
 Administer correct medications to patient
Right Dose
 Administer correct amount of medication to patient for each injection
o Intradermal (ID)
o Subcutaneous (Sub-q)
o Intramuscular (IM)
Right Route
 Prepare medications appropriately
o Draw up medication properly from a vial
o Prepare a mixed insulin syringe in the correct manner
o Draw up medication properly from an ampule
Possible
Points
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
Points
Earned
MaricopaNursing-Scottsdale Community College
NUR0.552-Nursing Theory and Science I
GRADING SHEET
Injectable Medication Administration Skill Performance Evaluation
Performance Standards (cont.):
Medication “Rights” (cont.)
Right Route (cont.)
 Proper administration and precautions according to route
o Intradermal (ID)
o Subcutaneous (Sub-q)
o Intramuscular (IM)
Right Documentation
 Document meds given/not given; Proper signature/title
Medication “Checks”
 Compare meds to MAR when obtained from source
 Validate meds with MAR prior to preparing them
 Verify meds at patient’s bedside prior to administering
Other
 Completes within total allotted time (30 minutes) Note: For this performance
evaluation, students are graded based on what was completed during allotted
timeframe of 30 minutes.
Total Points
Instructor Comments:
Student Signature________________________
Possible Points
Points Earned
0.5
0.5
0.5
0.5
0.5
0.5
0.5
0.5
15
Instructor Signature____________________________