Goal: The device is applied successfully and medication is administered.
1. Gather equipment. Check each medication order against the original order in the medical record, according to facility policy. Clarify any inconsistencies. Check the patient’s chart for allergies.
2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.
3. Perform hand hygiene.
4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.
5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.
6. Prepare medications for one patient at a time.
7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.
8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.
9. Attach a blunt-ended needle or a small-gauge needle to a syringe. Follow Skill 5-4 to remove insulin from vial, if necessary. Remove enough insulin to last patient 2 to 3 days, plus 30 units for priming tubing. If using prepackaged insulin syringe or cartridge, remove from packaging.
10. When all medications for one patient have been prepared, recheck the label with the MAR before taking them to the patient.
11. Lock the medication cart before leaving it.
12. Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times.
13. Ensure that the patient receives the medications at the correct time.
14. Perform hand hygiene and put on PPE, if indicated.
15. Identify the patient. Usually, the patient should be identified using two methods. Compare information with the CMAR/MAR.
a. Check the name and identification number on the patient’s identification band.
b. Ask the patient to state his or her name and birth date, based on facility policy.
c. If the patient cannot identify him- or herself, verify the patient’s identification with a staff member who knows the patient.
16. Close the door to the room or pull the bedside curtain.
17. Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about allergies. Explain the purpose and action of the medication to the patient.
18. Scan the patient’s bar code on the identification band, if required.
19. Perform hand hygiene. Put on gloves.
20. Remove the cap from the syringe or insulin cartridge. Attach sterile tubing to syringe or insulin cartridge. Open the pump and place the syringe or cartridge in compartment according to manufacturer’s directions. Close the pump.
21. Initiate priming of the tubing, according to manufacturer’s directions. Program the pump according to manufacturer’s recommendations following primary care provider’s orders. Check for any bubbles in the tubing.
22. Activate the delivery device. Place the needle between prongs of the insertion device with the sharp edge facing out. Push insertion set down until a click is heard.
23. Select an appropriate administration site.
24. Assist the patient to the appropriate position for the site chosen. Drape, as needed, to expose only area of site to be used.
25. Identify the appropriate landmarks for the site chosen.
26. Cleanse area around injection site with antimicrobial swab. Use a firm, circular motion while moving outward from insertion site. Allow antiseptic to dry.
27. Remove paper from adhesive backing. Remove the needle guard. Pinch skin at insertion site, press insertion device on site, and press release button to insert needle. Remove triggering device.
28. Apply sterile occlusive dressing over insertion site, if not part of insertion device. Attach the pump to patient’s clothing, as desired.
29. Assist the patient to a position of comfort.
30. Discard the needle and syringe in the appropriate receptacle.
31. Remove gloves and additional PPE, if used. Perform hand hygiene.
32. Document the administration of the medication immediately after administration.
33. Evaluate the patient’s response to medication within appropriate time frame. Monitor the patient’s blood
glucose levels, as appropriate, or as ordered.
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