PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF NURSING
(Dalubhasaan ng Nursing)

BACON – SKILLS LABORATORY CHECKLIST

Name: Date:
Year Level and Block: Clinical Instructor:

Rating Scale:
3 Performed correctly, systematically according to standard with correct rationale.
2 Performed correctly, though not systematically but with correct rationale.
1 Performed correctly, not systematically with inadequate/incorrect rationale.
0 Performed incorrectly/not done

Purpose
 Obtains medication from ampule, using aseptic technique, for administration by a
parenteral route

Equipment
 Doctor’s order
 Computerized medication administration record (or manual record if computerized
record is not available)
 Barcode or electronic client and medication identification scanner, if
application/available
 Ampule with prescribed medication
 Appropriate-size syringe and filter needle for type of injection and viscosity of
solution
 Medication label or small piece of tape
 Extra needle
 Medication tray
 Alcohol swabs or antiseptic swabs
 Ampule file (optional)
 Sterile 2 x 2 gauze pad
 Paper towel
 Pen

Assessment
 Appearance of solution (clarity, absence of sediment, color indicated on instruction
label)
 Ampule label for expiration date of drug
 Medication allergies or sensitivity to latex (if latex gloves used)
General Consideration
 Maintain the sterility of syringe, needle, and medication while preparing the drug
using principles of asepsis
 Never use drug if it is cloudy, discolored, or contains a precipitate, unless the
manufacturer’s instructions allow it.

Preparing Medication from an Ampule

Implementation of the Procedure

Procedure/Steps Performance Remarks/Suggestion Demerit

1 Assemble equipment:
 Ampule of sterile medication
 File (if ampule is not scored) and
small gauze square or plastic
ampule opener
 Antiseptic swabs
 Syringe
 Filter needle for drawing
medication from the ampule
Assessment: Assess the
• Appearance of solution (clarity,
absence of sediment, color indicated
on instruction label)
• Ampule label for expiration date of
drug
• Check Medication allergies or
sensitivity to latex (if latex gloves
used)
2 Check/ Medication Card/Doctor’s Order
Check the label on the ampule
carefully against the medicine card
doctor’s order to make sure that the
correct medication is being prepared
Follow the three checks for
administering medication. Read the
label on the medication
 When it is taken from the
medication cart
 Before withdrawing the
medication
 After withdrawing the
medication
 After withdrawing the
medication
Procedure
1 Perform hand hygiene and observe
other appropriate infection control
procedures
2 Check label of medication ampule
with medication record, adhering to
the five rights of drug
administration. Use barcode
scanning if available/applicable
Note: Perform dosage calculation if
dosage in ampule differs from
amount required
3 Prepare the medication ampule
for drug withdrawal:
Holding ampule, gently Flick the
upper stem of the ampule several
times with a fingernail or gently tap
neck with fingers or make a
complete circle with the ampule by
rotating wrist
4 Place an alcohol swab/antiseptic
swab or sterile gauze pad around
neck of ampule with fingers of
dominant hand; firmly place fingers
of nondominant hand around lower
part of ampule with thumb
5 With a quick snapping motion of the
wrist, break top of ampule away
from you and others who may be
near you
6 Place top of ampule on paper towel
or Dispose of the top of the ampule
in the sharp’s container
7 Withdraw the medication:
Place the ampule on a flat surface.
Remove the cap from the filter
needle and Attach the filter needled
to the syringe
8 Press plunger of syringe all the way
down; do not aspirate air into
syringe.
9 Place and insert needle into the
center of the ampule without letting
needle or hub touch cut edges of the
ampule. Do not touch the rim of the
ampule with the needle tip or shaft
10 Withdraw appropriate amount of
solution and remove needle from
ampule
11 Place ampule on paper towel until
ready to discard, or discard
immediately
12 If bubbles are in syringe:
 Hold syringe vertically, with
needle pointing up
 Pull back and flick syringe
with fingers
 Slowly push plunger up to
release air, but not to the
point of expelling the
solution
13 Recheck amount of solution in
syringe, comparing to drug volume
required
14 Compare drug label to medication
record
15 Change needle if drug is known to
cause tissue irritation; replace cap
16 Label syringe with drug name and
dosage amount
17 Place syringe, medication record,
and additional alcohol
swab/antiseptic swab on medication
tray in preparation for
administration immediately after
identifying the client
using/observing the proper
procedure
Note: With a single-dose ampule,
hold the ampule slightly on its side,
if necessary, to obtain all the
medication. Dispose of the filter
needle by placing in a sharp’s
container.
18 If giving an injection, replace the
filter needle with a regular needle,
tighten the cap at the hub of the
needle, and push the solution into
the needle to the prescribed amount.
19 Restore or discard all the equipment
appropriately
20 Perform Hand hygiene
21 Document the following:
Name of medication
Date and time medication was
drawn
Dosage drawn
In addition, if the medication is a
controlled substance, follow agency
policy and procedure for recording
medication in Controlled Substance
Record Book. Include any amount
of the controlled substance that was
wasted, the name of the nurse
preparing the controlled substance,
and the name of the nurse
witnessing use and, if appropriate,
witnessing the discarding of the
wasted amount.

References-Sources:
Kozier, B., Erb, G. L., Berman, A., & Snyder, S. J. (2008). Kozier and Erb's Fundamentals
of Nursing 8th Edition. New Jersey, USA: Pearson Education, Inc.
Jean Smith-Temple and Joyce Young Johnson. Nurses’ Guide to Clinical Procedures 6th
Edition (Wolter Kluwers /Lippincott Williams and Wilkins)

Prepared by: Prof. Maria Andrea L. Endeno

Total Deduction or Demerit: Total Score:

I fully understood how I was graded for this particular skill and it was properly
explained to me.

Student’s FULLNAME & signature

I have explained and discussed how I have graded my student for this
particular skill.

Clinical Instructor FULLNAME &