Preparing and Administering an Injection — Practice Checklist

Step-by-Step Procedure (7 steps)

1. 1.

   Verify the order against the patient's chart: right patient, right drug, right dose, right route, right time — the "five rights" of medication administration.

2. 2.

   Check the medication vial or ampule for expiration date, correct concentration, and visible particulates or discoloration before drawing it up.

3. 3.

   Draw up the exact ordered dose using an appropriately sized syringe and needle for the route (IM, subcutaneous, or intradermal) and the patient's body habitus.

4. 4.

   Select and clean the injection site appropriate to the route — deltoid or vastus lateralis for IM, abdomen or upper arm for subcutaneous, forearm for intradermal.

5. 5.

   Administer at the correct angle for the route (90° for most IM injections, 45° for subcutaneous, nearly flat/15° for intradermal) and aspirate or inject per current technique guidance for that medication.

6. 6.

   Dispose of the needle immediately in a sharps container — never recap, bend, or set down an uncapped needle.

7. 7.

   Document the medication, dose, site, route, and time given, and observe the patient for any immediate reaction before they leave.

Quality Checkpoints (4)

Confirm each of these before considering the task complete.

• The five rights (patient, drug, dose, route, time) are checked against the order before drawing up the medication.

• The vial/ampule is checked for expiration, correct concentration, and clarity before use.

• Needle gauge and length match both the route and the patient's body size.

• The patient is observed for a reaction for the period your office protocol requires before discharge.

Avoid These Mistakes

• ⚠

  Drawing up the wrong concentration of a medication that comes in multiple strengths (a well-known source of serious dosing errors).

• ⚠

  Using IM technique and needle length for a medication that should be given subcutaneously, or vice versa.

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  Not rotating sites for patients receiving frequent injections, leading to tissue damage at a single overused site.

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  Recapping a used needle by hand instead of using a sharps container, risking a needlestick injury.