DAVAO ORIENTAL STATE UNIVERSITY

FACULTY OF NURSING AND ALLIED HEALTH SCIENCES

Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

INTRADERMAL OF INTRACUTANEOUS INJECTION

Name:___________________________________________________ Grade:
Year and Section:__________________________________________ Date:_______________

Performance Rubrics
Score Qualitative Description Criteria
Demonstrates accuracy and integrates knowledge
and skills appropriately. Clearly stated the steps of
4 Excellent
every procedure and profoundly demonstrate with
rationale
Demonstrate moderately with assistance in
integrating knowledge and skills. Clearly stated
3 Good the steps of every procedure and properly
P
demonstrated; however, failed to state the
E
complete rationale.
R
Demonstrates average performance integrating
F
the knowledge and skills. Clearly stated the steps
O
2 Acceptable of every procedure and properly demonstrated but
R
fail to state the rationale. Consequently, failed to
M
answer pertinent queries appropriately.
E
Demonstrate the gaps in the necessary knowledge
D
and requires frequent and utmost assistance that
lacks the skills. Partially stated the steps of every
1 Needs Improvement
procedure, incorrectly demonstrated without
rationale, or stated the rationale but failed to
perform the procedure or vice versa.
Frequently lacks knowledge and skills that are
0 Not Performed unable to perform and state every procedure and
rationale.

Definition: It is the introduction of a solution by means of syringe and needle into the superficial layer of the skin
just below the epidermis of the skin. The ID injection route has the longest absorption time of all
parenteral routes.

Purposes:
1. To identify allergens to which the client may be hypersensitive (skin test).
2. To diagnose individuals who have developed antibodies against specific pathogens, such as tubercle
bacillus.
3. To vaccinate, e.g., BCG.

Sites of Injection:
1. Inner surface of the forearm
2. Upper chest if not hairy
3. Upper back beneath

Safety Considerations:
1. Do not aspirate. It is not necessary to aspirate because the dermis is relatively without vessels.
2. Always take steps to eliminate interruptions and distractions during medication preparation.
3. If the patient expresses concern about the medication or procedure, stop and explore the concerns. Re-verify
the order with a physician if appropriate.
1 | INTRADERMAL OR INTRACUTANEOUS INJECTION
 DAVAO ORIENTAL STATE UNIVERSITY
FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

Equipment:
A. Medication Tray containing the following;
1. Medicine ticket
2. Prescribed medication
3. Sterile water
4. Disposable sterile tuberculin syringe
5. Disposable sterile 1 cc syringe/ tuberculin syringe
6. Disposable sterile needle G25-26.5/8”
7. Disposable sterile aspirating needle
8. Alcohol swab
9. Dry cotton balls
10. Waste receptacle
11. Disposable gloves or non-sterile gloves
B. Sharps Containers

Procedures Performed Not Performed Remarks

PREPRATION 4 3 2 1 0

1. Checks the medical order in the chart.

Rationale: Reading the order ensures that the nurse follows the
doctor's directions.

2. Prepare the medication ticket.

Rationale: Properly identifying medication decreases risk of
inadvertently administering the wrong medication. Preparing
medications correctly decreases risks to the patient.

3. Assesses the client’s history of allergies and note the

substances the client is allergic to and normal allergic
reactions.
Rationale: Certain substances have similar compositions. The
nurse should not administer substances if the client is known to
be allergic to prevent its occurrence.

4. Washes hands.
Rationale: Handwashing deters the spread of microorganisms.

5. Assembles all equipment in a clean and flat area.

Rationale: Prevents having to stop procedure to fetch needed
items.

6. Recites the 10 basic rights of Drug Administration.

Rationale: Promotes client’s safety by preventing medication
error.

7. Pick up the syringe and attach the aspirating needle.

Rationale: This prevents contamination of the needle and
syringe.

2 | INTRADERMAL OR INTRACUTANEOUS INJECTION

 DAVAO ORIENTAL STATE UNIVERSITY
FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

8. Prepares the medication: Follows the preparation of
medication from a vial or ampule.
Rationale: Pharmaceutical products for parenteral
administration are supplied in various containers.

Note: To prepare for skin testing, withdraw 0.9 cc of the diluent and 0.1 cc of the prescribed medicine.
9. Change aspirating needle with G-25 or 26 needle. Maintain
sterility by retaining the cap of the needle. Place on top of
hypo towel.
Rationale: Prevents tissue damage and reduces pain, maintains
sterility to avoid infection. It also ensures safe and accurate
medication delivery and keeps the needle clean by placing it on
a sterile surface.

10. Present preparation to C.I or head nurse for checking

together with the empty ampule or vial of the drug prepared
and medication booklets for signing.
Rationale: This guards against error in medication.

11. Carry tray to client’s room.

Rationale: This prevents errors in medication.

12. Identify the client and explain the procedure.

Rationale: Explaining the procedure to the patient promotes
understanding, reduces anxiety, and ensures cooperation for a
smooth and safe intradermal injection.

13. Put on non-sterile gloves.

Rationale: Gloves help prevent exposure to blood and bloody
fluids (BBF), reducing the risk of infections and contamination,
especially in healthcare and emergency response settings.

14. Select an area on the inner aspect of the forearm (or other
appropriate sites. Assist the patient to the appropriate
position as required.
Rationale: The forearm is a convenient and easy location for
introducing an agent intradermally. Moreover, site should be
free from lesions, rashes, and moles. Selecting the correct site
allows for accurate reading of the test site at the appropriate
time.

15. Disinfect the site with alcohol swab and allow to dry.
Rationale: Disinfecting the puncture site with an alcohol swab
helps reduce the risk of infection by removing dirt, oils, and
potential contaminants from the skin. Allowing the alcohol to
dry ensures that it does not cause stinging or discomfort during
the puncture, as well as preventing any potential interference
with the procedure.

3 | INTRADERMAL OR INTRACUTANEOUS INJECTION

 DAVAO ORIENTAL STATE UNIVERSITY
FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

16. Picks up syringe and removes the cap. Use your non-
dominant hand to grasp the dorsal forearm and gently pull
the skin taut.
Rationale: Taut skin provides easy entrance for the needle.

17. Places the needle 5–15-degree angle against the client’s

skin. With bevel side up, insert the needle beneath can be
seen through the skin. Insert the needle only about 1/8 inch
or almost flat against the client skin.
Rationale: Intradermal tissue will be entered when the needle is
held as near parallel to the skin as possible and is inserted
about 1/8 inch.

18. Injects solution slowly about 0.1 cc forming a bleb/wheal.

Rationale: If a small wheal or bleb appears, the agent is in
intradermal tissue.

19. Withdraws the needle quickly at the same angle that it was
inserted.
Rationale: Withdrawing the needle quickly and at the angle at
which it entered the skin minimizes tissue damage and
discomfort for the client.

20. Do not massage the area after removing the needle. Pat dry.
Rationale: Massaging the area where an intradermal injection
is given may interfere with test results by spreading medication
to underlying subcutaneous tissue.

21. Encircle the wheal with a blue or black pen.

Rationale: Encircling the wheal (the raised area of the skin
formed after an intradermal injection) with a blue or black pen
ensures clear and visible documentation of the site and
response to the test. The ink helps in accurately marking the
location of the wheal, making it easier to assess and interpret
later. It also provides a reference for measuring the size of the
wheal, which is essential for determining the reaction. A red
pen may influence the reading.
Avoiding the use of gel or sign pens because their ink can blot,
fade, or smear easily in the skin which could compromise the
result of the skin test.

22. Use the fish-hook technique to recap the used needle and
place it on top of the medication tray. (Do not throw right
away!)
Rationale: Most accidental puncture wounds occur when
recapping the needles. Leaving the needle uncapped protects
the nurse from accidental injury with the needle.

4 | INTRADERMAL OR INTRACUTANEOUS INJECTION

 DAVAO ORIENTAL STATE UNIVERSITY
FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

23. Write the time injected, due time and site at the back of the
medicine ticket.
Rationale: The nurse considers the well-being of the client

24. Instruct the client and /or watcher not to disturb the wheal
nor erase the mark. Inform the client/ watcher that you will
be back with the physician after 30 minutes
Rationale: The physician will interpret the result of the
procedure.

25. Inform the CI or NOD of the procedure done client’s name,

due time and site. Endorse the medicine ticket to the NOD.
Rationale: Awareness of the procedure done and to give time to
contact the physician for interpretation.

26. Leave the medicine ticket and the used hypodermic syringe
on the sterile towel for possible re-skin testing.
Rationale: If the result is doubtful, there may be a need to re-
skin testing as ordered.

27. Remove gloves

Rationale: Proper glove removal prevents contamination and
the spread of harmful pathogens.

28. Washes hands.

Rationale: Handwashing deters the spread of microorganisms
.
29. Observe the area for signs of a reaction within 30 min.
accompany the attending physician or ROD to interpret the
result.
Rationale: A circle easily identifies the site of intradermal
injection and allows for careful observation of the exact area.

30. Write the positive (+) or negative (-) sign on the appropriate
space of the medicine ticket, medication sheet.
Rationale:
Writing the skin test result ensures proper documentation for
future reference and continuity of care.
A positive result indicates:
a. Potential exposure to a specific infection (e.g., tuberculosis
in Mantoux Test).
b. Allergic reaction to certain medications such as local
anesthetics, antibiotics (e.g., penicillin), or other
substances.

Referral to a doctor is crucial for further evaluation, diagnosis,

and management. A healthcare provider can order additional
tests, interpret the result in context, and determine the

5 | INTRADERMAL OR INTRACUTANEOUS INJECTION

 DAVAO ORIENTAL STATE UNIVERSITY
FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

appropriate treatment or follow-up plan to ensure the patient's
health and well-being.
31. Document in the chart the administration of the medication.
a. Time
b. Name
c. Amount and dosage
d. Site of injection
e. Result
f. Name of physician who interpreted the result.
Rationale:
The time of administration is important for tracking the timing
of the medication or test.
Documenting the medication or substance name ensures that the
correct medication has been administered. It provides a clear
record for future reference and prevents errors, ensuring that
the right treatment is tracked for the patient.
Recording the amount and dosage ensures that the patient
received the proper quantity of the medication or substance.
This is crucial for avoiding over- or under-dosing and for
compliance with the prescribed treatment plan.
Documenting the site of injection (e.g., forearm, upper back) is
important for tracking where the injection was given, especially
if multiple sites are used for testing or treatment. It also helps
identify any possible site reactions or complications and ensures
the procedure is reproducible, if necessary, in future
administrations.
The result, particularly for diagnostic procedures (e.g., TB skin
test), is essential for tracking the patient's response to the test. It
provides critical information for determining further actions or
treatments, including referrals or follow-up testing. Accurate
documentation of the result is necessary for proper clinical
decision-making.
Recording the name of the physician who interpreted the result
ensures accountability and provides a reference for follow-up if
there are any questions or concerns regarding the result. It is
part of maintaining a clear, traceable medical record and
ensures that the interpretation is properly documented for legal,
clinical, and regulatory purposes.

32. Maintains body mechanics throughout the performance of

the procedure.

33. Manifests neatness in the performed procedure.

34. Receptive to criticisms.

35. Observes courtesy.

36. Shows calmness while performing the procedure.

6 | INTRADERMAL OR INTRACUTANEOUS INJECTION

 DAVAO ORIENTAL STATE UNIVERSITY
FACULTY OF NURSING AND ALLIED HEALTH SCIENCES
Bachelor of Science in Nursing
Guang-guang, Dahican, City of Mati, Davao Oriental

Modified Observe Structure Clinical Examination (OSCE) Checklist

37. Uses correct English.

38. Shows mastery of the procedure.

Total Number of Items Performed

CLINICAL INSTRUCTORS’ COMMENTS:

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Students’ Signature over Printed Name Clinical Instructors’ Signature Over Printed Name

7 | INTRADERMAL OR INTRACUTANEOUS INJECTION