Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
General Luna Street corner Muralla Street
Intramuros, Manila

COLLEGE OF NURSING
(Dalubhasaan ng Narsing)

Bacon – SKILLS LABORATORY CHECKLIST

ADMINISTRATION of MEDICATION–
ADMINISTERING INTRAMUSCULAR MEDICATIONS INJECTION with STEP RATIONALE

PURPOSE
• Delivers ordered medication into muscle tissue
• Used when patient can’t take drug orally, IV administration is inappropriate, or the drug
can be altered by digestive juices

Equipment
• Doctor’s order
• Computerized medication administration record or manual record if computerized
record is not available
• Barcode or electronic client medication identification scanner, if available/applicable
• Medication to be administered
• Alcohol swabs/antiseptic swabs
• Non-sterile gloves
• Medication tray
• 3-ml/5ml syringe with 1-,1.5-, 0r 2-in. needle (21, 22 or 23 gauge)
• Pen

Assessment

• Medication order
• Site of last injection
• Client’s response to previous injections, as noted in chart
• Intended injection site and condition (presence of bruises, tenderness, skin breaks,
nodules, or edema)
• Factors affecting size and gauge of needle (client’s size and age, site of injection,
viscosity, and residual effects of medication)
• Medication allergies or sensitivity to latex (if latex gloves used)
• Specific drug action, side effects and adverse reactions
• Client’s knowledge and learning needs about the medication
• Tissue integrity of the selected site
• Client’s age and weight, to determine site and needle size
• Client’s ability or willingness to cooperate
Special Consideration

• To slow their absorption, some drugs for IM administration are dissolved in oil or other
special solutions. Mix these preparations well before drawing them into syringe
• Never inject into sensitive muscles, especially those that twitch or tremble when you
assess site landmark and tissue depths
• For repeated injections, keep a rotation record that lists all available injection sites,
divided into various body areas. Rotate from a site in the first area to a site in each of
the other areas. Then return to a site in the first area that is at least 1” (2.5 cm) away
from the previous injection site in that area

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
• If the patient has experienced pain or emotional trauma from repeated injections,
consider numbing the area before cleaning it by holding ice on it for several seconds
• If you must inject more than 5 ml of solution, divide the solution and inject it at two
separate sites
• IM injections can damage local muscle cells, causing elevations in enzyme level (creatine
kinase) that can be confused with elevations resulting from damage to cardiac muscle,
as in MI
• Dosage adjustments are usually needed when changing from IM route to the oral route
• Age Awareness: For infants and children, the vastus lateralis muscle of the thigh is used
most often because it’s usually the best developed and contains no large nerves or
blood vessels, minimizing the risk of serious injury. The rectus femoris muscle may also
be used in infants but is usually contraindicated in adults; the gluteal muscles can be
used as the injection site only after a toddler has been walking for about a year; Elderly
patients have decreased muscle mass, so IM drugs can be absorbed more quickly than
expected and will probably bleed or ooze from the site after injection so applying a
small pressure bandage maybe helpful

Implementation of the Procedure/Steps with Rationale

PROCEDURE RATIONALE

Preparation
1. Assess the following:
• Medication order
• Site of last injection • Promotes safe drug administration
• Client’s response to previous injections, as noted
in chart
• Intended injection site and condition (presence of
bruises, tenderness, skin breaks, nodules, or • Injection site should be free of lesions
edema) • Select appropriate needle size to ensure
• Factors affecting size and gauge of needle (client’s that needle will be injected into the
size and age, site of injection, viscosity, and muscle
residual effects of medication)
• Medication allergies or sensitivity to latex (if latex
gloves used)
• Specific drug action, side effects and adverse
reactions
• Client’s knowledge and learning needs about the
medication
• Tissue integrity of the selected site
• Client’s age and weight, to determine site and
needle size
• Client’s ability or willingness to cooperate
2. Assemble equipment: • All the equipment is readily available
• Doctor’s order • To save time and effort
• Computerized medication administration • Promotes efficiency
record or manual record if computerized • Promotes safe drug administration
record is not available
• Barcode or electronic client and medication
identification scanner, if available/applicable
or computer printout
• Medication to be administered-Sterile
medication (usually provided in a vial or
ampule)
PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
• Syringe and needle of a size appropriate for
the amount of solution to be administered, 3-
ml/5ml syringe with 1-,1.5-, 0r 2-in. needle
(21, 22 or 23 gauge)
• Alcohol swabs/antiseptic swabs
• Non-sterile gloves
• Medication tray
• Pen
3. Check the MAR • Checking the label avoids medication errors
• Check the label on the medication carefully • Promotes safe drug administration
against the MAR to make sure that the correct
medication is being prepared
• Follow the three checks for administering
medications. Read the label on the medication
✓ When it is taken from the medication cart
✓ Before withdrawing the medication; and
✓ After withdrawing the medication

• Confirm that the dose is correct • Ensure the medication is given in right dose

4. Organize the equipment • All the equipment readily available,

promotes efficiency
Procedure
1. Perform hand hygiene, and observe other • Reduce transmission of microorganisms
appropriate infection control procedures
2. Prepare the medication from the ampule or vial • Because the outside of a new needle is free
for drug withdrawal of medication, it does not irritate
• Whenever feasible, change the needle on the subcutaneous tissues as it passes into the
syringe before the injection muscle
• Invert the syringe needle uppermost, and expel all • Creates positive pressure in vial/aspirates
excess air solution into syringe
3. Provide for client privacy • Close door or curtains around bed and keep
gown or sheet draped over body to prevent
embarrassment
4. Prepare the client
• Introduce yourself • Gain cooperation and reduce anxiety
• Verify/check the client’s identification band • To ensure that the right client receives the
medication
• Position client for site selected or Assist the client • Allows access injection area; promotes
to a supine, lateral, prone, or sitting position, comfort
depending on the chosen site • Appropriate positioning promotes relaxation
of the target muscle
• For vastus lateralis, lying flat or supine with
knee slightly flexed
• For ventrogluteal, lying on side or back with
knee and hip slightly flexed
• For deltoid, standing with arm relaxed at
side, sitting with lower arm relaxed on lap,
or lying flat with lower arm relaxed across
abdomen
• Note: Obtain assistance in holding an • This prevents injury due to sudden
uncooperative client movement after needle insertion
5. Explain the purpose of the medication and how it • Information can facilitate acceptance and
will help, using language that the client can compliance with the therapy

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
understand. Include relevant information about
effects of the medication

6. Select, locate, and clean the site

• Select a site free of skin lesion, tenderness, • The vastus lateralis is recommended as the
hardness, swelling, scarring, or localized site of choice for toddlers and children.
inflammation, and one that has not been used • Ventrogluteal or deltoid recommended
frequently sites for older child. Adolescent, and adult.
• Locate the exact site for the injection. Avoid using • This is to reduce the discomfort of
the same site twice in a row intramuscular injections
• Put on clean gloves • Wearing gloves decreases the risk of
transmission of microorganisms. To reduce
the risk of contamination of health-care
workers hands with blood and other body
fluids
• Clean the site with an antiseptic swab. Using a • The mechanical action of swabbing removes
circular motion start at the center and move skin secretions, which contain
outward about 5 cm (2 inches). Allow alcohol to microorganism
dry • Reduces m/o transfer; prevents irritation at
injection site from alcohol
• Get a dry cotton swab, transfer, and hold the dry • This will help reduce the discomfort of the
cotton swab between the third and fourth fingers injection
of your nondominant hand in readiness for needle
withdrawal; or position the swab on the client’s
skin above the intended site. Allow the skin to dry
prior to injecting medication.
7. Prepare the syringe for injection
• Remove the needle cover and discard without • Facilitate smooth insertion
contaminating the needle
• If using a prefilled unit-dose medication, take • Medication left on the needle can cause
caution to avoid dripping medication on the pain when it is tracked through the
needle prior to injection. If this does occur, wipe subcutaneous tissue (Nicoll & Hesby, 2002)
the medication off the needle with sterilize gauze
8. Inject the medication using a Z-track technique
• Use the ulnar side of the nondominant hand to • Pulling the skin and subcutaneous tissue or
pull the skin approximately 2.5cm (1inch) to the pinching the muscle makes it firmer and
side facilitates needle insertion
• Holding the syringe between the thumb and • Using a quick motion lessens the client’s
forefinger, pierce the skin quickly and smoothly at discomfort
90-degree angle, and insert the needle into the
muscle
• Hold the barrel of the syringe steady with your • If the needle is in a small blood vessel, it
nondominant hand, and aspirate by pulling back takes time to the blood to appear
on the plunger with your dominant hand. Aspirate • Aspiration of blood indicates intravenous
for 5-10 seconds. If blood appears in the syringe, placement of needle
withdraw the needle, discard the syringe, and
prepare a new injection
• If blood does not appear, inject the medication • Injecting medication slowly promotes
steadily and slowly (approximately 10 seconds per comfort and allows time for tissue to expand
milliliter) while holding the syringe steady and begin absorption of the medication

• After injection, wait for 10 seconds • Waiting permits the medication to disperse
into the muscle tissue, thus decreasing the
client’s discomfort
PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
9. Withdraw the needle
• Withdraw the needle smoothly at the same angle • This minimizes tissue injury
of insertion. Release the skin
• Apply gentle pressure at the site with a dry • Use of alcohol swab may cause pain or a
sponge burning sensation
• It is not necessary to massage the area at the site • Massaging the site may cause the leakage of
of injection. If bleeding occurs, apply pressure medication from the site and result in
with a dry, sterile gauze until it stops irritation (Hunter, 2008)
10. Activate the needle device, and or discard the • Proper disposal protects the nurse and
uncapped needle and attached syringe into the others from injury and contamination. The
proper receptacle. Remove gloves. Perform hand CDC recommends not capping the needle
hygiene before disposal to reduce the risk of
needlestick injuries
11. Document all relevant information. • For recording and reporting purposes
• Name of drug, amount, time, route, and date and • Promotes patient safety and quality of care
time administered
• Assessment data relevant to purpose of
medication
• Assessment of site before and after injection
• Assess the effectiveness of the medication at the
time it is expected to act

References-Sources:

Kozier & Erbs, Fundamentals of Nursing checklist, 8th Edition

Kozier & Erb’s Fundamentals of Nursing Concepts, process, and Practice, 9th Edition
Sue C. DeLaune, Patrick K. Ladner, Fundamentals of Nursing Standards & Practice, 4th Edition
Jean Smith-Temple and Joyce Young Johnson. Nurses’ Guide to Clinical Procedures 6th Edition (Wolter
Kluwers /Lippincott Williams and Wilkins)
Nurses’s Quick Check – Skills. Lippincott Williams & Wilkins

Initially Prepared by: Prof. Maria Andrea L. Endeno

Modified and reupdated by: Dr. Jennifer P. Reyes and Prof. Leizel Pandi, 2nd Semester 2020-2021

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
Republic of the Philippines
PAMANTASAN NG LUNGSOD NG MAYNILA
(University of the City of Manila)
General Luna Street corner Muralla Street
Intramuros, Manila

COLLEGE OF NURSING
(Delubhasaan ng Narsing)

Bacon – SKILLS LABORATORY CHECKLIST

ADMINISTRATION of MEDICATION – INTRAMUSCULAR INJECTION

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
• Delivers ordered medication into muscle tissue
• Used when patient can’t take drug orally, IV administration is inappropriate, or the drug
can be altered by digestive juices

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
available/applicable
• Medication to be administered
• Alcohol swabs/antiseptic swabs
• Non-sterile gloves
• Medication tray
• 3-ml/5ml syringe with 1-,1.5-, 0r 2-in. needle (21, 22 or 23 gauge)
• Pen

Assessment
• Medication order
• Site of last injection
• Client’s response to previous injections, as noted in chart
• Intended injection site and condition (presence of bruises, tenderness, skin breaks,
nodules, or edema)
• Factors affecting size and gauge of needle (client’s size and age, site of injection,
viscosity, and residual effects of medication)

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
• Medication allergies or sensitivity to latex (if latex gloves used)
• Specific drug action, side effects and adverse reactions
• Client’s knowledge and learning needs about the medication
• Tissue integrity of the selected site
• Client’s age and weight, to determine site and needle size
• Client’s ability or willingness to cooperate

Special Consideration
• To slow their absorption, some drugs for IM administration are dissolved in oil or other
special solutions. Mix these preparations well before drawing them into syringe
• Never inject into sensitive muscles, especially those that twitch or tremble when you
assess site landmark and tissue depths
• For repeated injections, keep a rotation record that lists all available injection sites,
divided into various body areas. Rotate from a site in the first area to a site in each of
the other areas. Then return to a site in the first area that is at least 1” (2.5 cm) away
from the previous injection site in that area
• If the patient has experienced pain or emotional trauma from repeated injections,
consider numbing the area before cleaning it by holding ice on it for several seconds
• If you must inject more than 5 ml of solution, divide the solution and inject it at two
separate sites
• IM injections can damage local muscle cells, causing elevations in enzyme level (creatine
kinase) that can be confused with elevations resulting from damage to cardiac muscle,
as in MI
• Dosage adjustments are usually needed when changing from IM route to the oral route
• Age Awareness: For infants and children, the vastus lateralis muscle of the thigh is used
most often because it’s usually the best developed and contains no large nerves or
blood vessels, minimizing the risk of serious injury. The rectus femoris muscle may also
be used in infants but is usually contraindicated in adults; the gluteal muscles can be
used as the injection site only after a toddler has been walking for about a year; Elderly
patients have decreased muscle mass, so IM drugs can be absorbed more quickly than
expected and will probably bleed or ooze from the site after injection so applying a
small pressure bandage maybe helpful

Implementation of the Procedure/Steps

Procedure Performance Remarks/Suggestion

3 2 1 0 DEMERIT

Preparation
1. Assess:
• Assess the following:
• Medication order
• Site of last injection
• Client’s response to previous
injections, as noted in chart
• Intended injection site and
condition (presence of bruises,
tenderness, skin breaks, nodules,
or edema)
• Factors affecting size and gauge of
needle (client’s size and age, site of
injection, viscosity, and residual
effects of medication)
• Medication allergies or sensitivity
to latex (if latex gloves used)
• Specific drug action, side effects
and adverse reactions
• Client’s knowledge and learning
needs about the medication

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
• Tissue integrity of the selected site
• Client’s age and weight, to
determine site and needle size
• Client’s ability or willingness to
cooperate

2. Assemble equipment:
• Assemble 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 available/applicable
• or computer printout
• Medication to be administered-
Sterile medication (usually
provided in a vial or ampule)
• Syringe and needle of a size
appropriate for the amount of
solution to be administered, 3-
ml/5ml syringe with 1-,1.5-, 0r 2-in.
needle (21, 22 or 23 gauge)
• Alcohol swabs/antiseptic swabs
• Non-sterile gloves
• Medication tray
• Pen

3. Check the MAR

• Check the MAR
• Check the label on the medication
carefully against the MAR to make sure
that the correct medication is being
prepared
• Follow the three checks for
administering medications. Read the
label on the medication
✓ When it is taken from the
medication cart
✓ Before withdrawing the
medication; and
✓ After withdrawing the
medication
• Confirm that the dose is correct ✓

4. Organize the equipment

Procedure
1. Perform hand hygiene, and observe
other appropriate infection control
procedures
2. Prepare the medication from the
ampule or vial for drug withdrawal
• Whenever feasible, change the needle
on the syringe before the injection

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
• Invert the syringe needle uppermost,
and expel all excess air
3. Provide for client privacy
4. Prepare the client
• Introduce yourself, and verify/check
the client’s identification band
• Assist the client to a supine, lateral,
prone, or sitting position, depending
on the chosen site
• Obtain assistance in holding an
uncooperative client

5. Explain the purpose of the medication

and how it will help, using language
that the client can understand. Include
relevant information about effects of
the medication
6. Select, locate, and clean the site
• Select a site free of skin lesion,
tenderness, hardness, swelling,
scarring, or localized inflammation, and
one that has not been used frequently
• Locate the exact site for the injection

• Put on clean gloves

• Clean the site with an antiseptic swab.
Using a circular motion start at the
center and move outward about 5cm (2
inches)
• Transfer and hold the swab between
the third and fourth fingers of your
nondominant hand in readiness for
needle withdrawal, or position the
swab on the client’s skin above the
intended site. Allow the skin to dry
prior to injecting medication
7. Prepare the syringe for injection

• Remove the needle cover and discard

without contaminating the needle.
• If using a prefilled unit-dose
medication, take caution to avoid
dripping medication on the needle
prior to injection. If this does occur,
wipe the medication off the needle
with sterilize gauze
8. Inject the medication using a Z-track technique
• Use the ulnar side of the nondominant
hand to pull the skin approximately
2.5cm (1inch) to the side
• Holding the syringe between the thumb
and forefinger, pierce the skin quickly
and smoothly at 90-degree angle, and
insert the needle into the muscle
• Hold the barrel of the syringe steady
with your nondominant hand, and
aspirate by pulling back on the plunger
with your dominant hand. Aspirate for
5-10 seconds. If blood appears in the
syringe, withdraw the needle, discard

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
the syringe, and prepare a new
injection
• If blood does not appear, inject the
medication steadily and slowly
(approximately 10 seconds per
milliliter) while holding the syringe
steady
• After injection, wait for 10 seconds.
9. Withdraw the needle
• Withdraw the needle smoothly at the
same angle of insertion. Release the
skin
• Apply gentle pressure at the site with a
dry sponge
• It is not necessary to massage the area
at the site of injection. If bleeding
occurs, apply pressure with a dry,
sterile gauze until it stops
10. Activate the needle device, or discard 12. 13.
the uncapped needle and attached
syringe into the proper receptacle.
Remove gloves. Perform hand hygiene
11. Document all relevant information
• Document all relevant information.
• Name of drug, amount, time, route,
and date and time administered
• Assessment data relevant to purpose of
medication
• Assessment of site before and after
injection
• Assess the effectiveness of the
medication at the time it is expected to
act

Initially Prepared by: Prof. Maria Andrea L. Endeno

Modified and reupdated by: Dr. Jennifer P. Reyes and Prof. Leizel Pandi, 2nd Semester 2020-2021

Total Deduction or Demerit: ______________ TOTAL SCORE: _____________

• Prescribed Hair (__)
• Prescribed Uniform (__)
• Completeness of paraphernalia/equipment/supplies (__)

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

____________________________
Student’s FULLNAME & Signature
Date: _______________________

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

___________________________________
Clinical Instructor FULLNAME & Signature

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)
Date: _________________________

PLM-CN (NUR 102 - Basic Concepts in Nursing - SKILLS Laboratory Checklist on Administering an Intramuscular Injection)