Preparing and Administering an Injection — Practice Checklist

Step-by-Step Procedure (8 steps)

1. 1.

   Verify the medication order against the "rights" of medication administration: right patient, right drug, right dose, right route, right time, right documentation.

2. 2.

   Check the medication vial or ampule for the correct drug, concentration, and expiration date, and inspect for discoloration or particulates.

3. 3.

   Draw up the correct dose using proper aseptic technique, expelling air bubbles before administration.

4. 4.

   Select the correct needle gauge and length, and the correct site for the ordered route (deltoid or vastus lateralis for IM; outer upper arm or abdomen for subcutaneous; inner forearm for intradermal).

5. 5.

   Cleanse the site with antiseptic and allow it to dry before inserting the needle at the correct angle for the route (90 degrees for IM, 45 degrees for subcutaneous, 5-15 degrees for intradermal).

6. 6.

   For IM and subcutaneous injections, inject at a steady rate; for intradermal (e.g., a TB skin test), confirm a visible wheal forms, which confirms correct intradermal placement.

7. 7.

   Withdraw the needle, apply gentle pressure (not rubbing, which can bruise), and dispose of the needle immediately in a sharps container — never recap a used needle.

8. 8.

   Document the medication, dose, route, site, and time immediately, and observe the patient briefly for any immediate reaction.

Quality Checkpoints (4)

Confirm each of these before considering the task complete.

• All "rights" of medication administration are checked before drawing up or giving the injection, not just before charting it afterward.

• Needle gauge, length, angle, and site all match the ordered route — not substituted out of habit.

• The needle is disposed of immediately in a sharps container with no recapping.

• Documentation (drug, dose, route, site, time) happens immediately, not from memory later in the shift.

Avoid These Mistakes

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  Giving an IM injection at the wrong angle or site, increasing the risk of hitting a nerve or blood vessel.

• ⚠

  Not checking for a wheal on an intradermal injection, which means the dose may have gone subcutaneous instead — a false-negative risk for a TB test.

• ⚠

  Recapping a used needle, a leading cause of accidental needlestick injuries.

• ⚠

  Rubbing the injection site immediately afterward, which can push medication out of the muscle or cause bruising.