Name: _____________________________________________________Date: ________________
Course: _______________________________________ ____ Grade:_______________
COMPETENCY CHECKLIST
ADMINISTERING SUBCUTANEOUS MEDICATION
Expected Outcome: The nurse will properly execute and administer subcutaneous medication
to the right patient observing the 14 Rights of Medication.
Rate the student as follows:
1 - Needs Practice 3 - Very Satisfactory
2 - Satisfactory 4 - Excellent
4 3 2 1
1. Verify doctor’s order
2. Calculate correct dosages
3. Practice hand hygiene
4. Prepare supplies and equipment
5. Practice 14 Rs of Medication (enumerate and explain)
6. Double check data on the medication card with the medicine to be prepared
7. Disinfect rubber cap of vial before inserting needle
8. Replace aspirating needle with sterile needle to be used for injection
9. Place all needed materials on medication tray
10. Introduce self
11. Identity patient using two patient identifiers
12. Verify for allergy
13. Explain procedure and answer questions appropriately
14. Provide patient privacy
15. Assist patient in comfortable position and identify injection sites
16. Disinfect injection site (use cotton balls with alcohol on a circular motion
from inner to outer movement)
17. Remove needle cap and expel air bubbles
18. Grasp and press together firmly between thumb and forefinger the
subcutaneous tissue; insert needle at 45-degree angle
19. Release the tissue and check for the presence of blood
20. If no blood is aspirated, inject the solution slowly
21. If you see blood into the syringe, remove it; prepare another medication
and repeat items 1-20
22. Attach dry cotton ball with micropore tape to the injection site
23. Aftercare
24. Documentation
TOTAL
Formula: Final Grade (in percentage) = total score divided by 96, multiply by 100.
_________________________________________
SIGNATURE ABOVE PRINTED NAME OF RATER
