Name: Date
Year level RLE group
Subcutaneous Injection
Excellent Very Satisfactory Needs
(4) Satisfactory (2) Improvement
(3) (1)
1. Assemble the
equipment
2. Verifies the
medication order
3. Washes hands
4. Prepares the
medication using
aseptic technique
5. Identifies the patient
6. Explains the procedure
to the patient
7. Provides privacy and
positions the patient
as required
8. Select an appropriate
injection site using
anatomical landmarks
9. Cleanse the injection
site with an antiseptic
wipe using friction,
allows to dry
10. Removes the needle
cover using aseptic
technique
11. Informs the patient
that you are ready to
give the injection
12. Administer the
injection
ROUTINE METHOD
a. Draws skin taut,
using the thumb
and fingers of the
non-dominant
hand
b. Thrust the needle
quickly into the
tissue to its full
length at a 45
degrees angle.
c. Inject the
medication slowly
by pushing on the
plunger and
holding the
syringe steady.
d. Remove the
needle quickly by
following the line
of insertion
e. Apply pressure to
the injection site
with an antiseptic
sponge
13. Asses the injection site
for bleeding. Applies
additional pressure if
necessary
14. Assist the patient to a
comfortable position,
noting safety factors
15. Discards equipment or
return it to the
appropriate area
Remarks:
Rating Scale:
Excellent 96-100%
Very Satisfactory 90-95%
Very Good 85-89%
Good 80-84%
Fair 75-79%
Poor 74% and below
TOTAL GRADE
Evaluated by: Conforme
________________________________
Signature over printed name of the
Signature over printed name of the student
Clinical Instructor