Goal: The patient safely receives medication via the subcutaneous route.
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. If necessary, withdraw medication from an ampule or vial as described in Skills 5-3 and 5-4.
10. When all medications for one patient have been prepared, recheck the label with the MAR before taking medications 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 for the second source.
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. Put on clean gloves.
20. Select an appropriate administration site.
21. Assist the patient to the appropriate position for the site chosen. Drape, as needed, to expose only area of site to be used.
22. Identify the appropriate landmarks for the site chosen.
23. Cleanse the area around the injection site with an antimicrobial swab. Use a firm, circular motion while moving outward from the injection site. Allow area to dry.
24. Remove the needle cap with the nondominant hand, pulling it straight off.
25. Grasp and bunch the area surrounding the injection site or spread the skin taut at the site.
26. Hold the syringe in the dominant hand between the thumb and forefinger. Inject the needle quickly at a 45- to 90-degree angle.
27. After the needle is in place, release the tissue. If you have a large skin fold pinched up, ensure that the needle stays in place as the skin is released. Immediately move your nondominant hand to steady the lower end of the syringe. Slide your dominant hand to the end of the plunger. Avoid moving the syringe.
28. Inject the medication slowly (at a rate of 10 sec/mL).
29. Withdraw the needle quickly at the same angle at which it was inserted, while supporting the surrounding tissue with your nondominant hand.
30. Using a gauze square, apply gentle pressure to the site after the needle is withdrawn. Do not massage the site.
31. Do not recap the used needle. Engage the safety shield or needle guard. Discard the needle and syringe in the appropriate receptacle.
32. Assist the patient to a position of comfort.
33. Remove gloves and additional PPE, if used. Perform hand hygiene.
34. Document the administration of the medication immediately after administration.
35. Evaluate the patient’s response to the medication within an appropriate time frame for the particular medication.
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