Lake County Health Department and Community Health Center
Instructor Practical Skill Evaluation
(Note to evaluator-Do not give any instruction during testing)
Skill – Intramuscular injection
Standard Area– Patient Care- Intramuscular injection
Employee:
Date:
STANDARD: OSHA / Patient Care
Skill: The Staff member will demonstrate the ability to accurately perform and
Reference:2002 College of Nurses of Alberta Manual document Intramuscular injection
PERFORMANCE OUTCOME: The staff member will complete this task within 5 minutes with a minimum of 20 items answered correctly.
EQUIPMENT REQUIRED:, Personal Protective Equipment, alcohol wipe, syringes,
1st
2nd
3rd
4th
5th
No.
TASK STEPS
Pass
Pass
Pass
Pass Pass
Review physician’s medication order for client’s name , drug name, time and route of
1.
administration
Assess client’s history of allergies and know substances client is allergic to and normal
2.
allergic reactions
3.
Check date of expiration for medication vial
4.
Assess for contraindications
5.
Wash Hands prior to touching vial
6.
Prepares correct medication dose from vial. Checks that all air is expelled
7.
Ask patient for two patient identifiers
8.
Explains steps of procedure to client
9.
Observes client’s verbal and non verbal response towards receiving injections
10.
Wash hands thoroughly. Apply gloves
11.
Privacy of client
12.
Select appropriate injection site. Inspect site for suitability for injection.
13.
Assist client to comfortable position
14.
Cleanse site with an antiseptic swab. Rotate outward
15.
Remove needle cap by pulling it straight off
16.
Hold syringe between thumb and forefinger of dominant hand
17.
Administer IM injections
17.a. Position non dominant hand at proper anatomical landmark and pull skin downward
17.b. Inject needle quickly at 90 degree angle to muscle
17.c. Move dominant hand to plunger.
17.d. Avoid moving syringe while slowly pulling back on plunger to aspirate for blood
17.e. Inject medication slowly
17.f. Wait 10 seconds then smoothly and steady withdraw needle
18.
Assist client to comfortable position
19.
Discard needle into sharps container
20.
Remove gloves and wash hands
21.
Evaluate clients response to medication
Critical Criteria: (Failure to do any of these items is automatic failure of exam)
___ Perform hand hygiene
___ Properly disposed on needle
___ Explain Procedure to patient
Lead Evaluator/ Employee Comments:
Lead Evaluator Print Name
Date
Employee
Date
Print Name