SAINT MICHAEL’S COLLEGE OF LAGUNA
SCHOOL OF NURSING
                                           PERFORMANCE CHECKLIST
                                          INTRAMUSCULAR INJECTION
    Name: _______________________________________                       Date:________________________
    Clinical Instructor:_______________________________                 Performance Grade:____________
    Equipment:
    Medicine tray:
            Medication card
            An appropriately sized syringe with a correct needle length
            Filter needle
            Alcohol-based antiseptic solution
            The correct drug in an appropriate dose
            Dry cotton swab
            The safe needle and waste disposal unit
            Micropore
    Rating Scale: 2 – Good (Done) 1 – Needs Improvement (Not done)
                                                                                          Done   Not     Remarks
                                                                                                 done
                 Procedure
1       Wash hands and wear gloves.
2 707Draw-up the appropriate medication into the syringe using a drawing-up ne
  needle.
3       Remove the drawing-up needle and immediately dispose of it into a sharps
        bin, then attach the needle to be used for performing the injection
4       Remain with the patient until each medication is swallowed. Never leave
        medication at the patient’s bedside
5       Choose an appropriate site for the injection.
6       Position the patient to provide optimal access to your chosen site
7       Gently place traction on the skin with your non-dominant hand away from
        the injection site, continuing the traction until the needle has been removed
        from the skin.
8       Warn the patient of a sharp scratch
9       Holding the syringe like a dart in your dominant hand, pierce the skin at a
        75 - 90° angle. Insert the needle quickly and firmly, with the bevel facing
        upwards, leaving approximately one-third of the shaft exposed (however
        this varies between sites and patients).
10      Aspirate to check the location of the needle (if appropriate)
11      If aspiration does not reveal evidence of intravascular needle placement,
        inject the contents of the syringe whilst holding the barrel firmly. Inject the
        medication slowly at a rate of approximately 1ml every 10 seconds.
12      Remove the needle and immediately dispose of it into a sharps container
13      Apply gentle pressure over the injection site with a cotton swab or gauze.
      Do not rub the site.
14.   Replace the cotton ball with a plaster
15    Dispose of your clinical equipment into an appropriate clinical waste bin
16    Wash your hands
17    Document the details of the procedure and the medication administered
 Comments: ____________________________________________________________________
              ____________________________________________________________________
 Name and Signature of Clinical Instructor                          Signature of the Student
 ______________________________                                     ___________________