Skills Checklist Medication Checklist RN Program Rev 1.2014

NURSING SKILLS AND

MEDICATION ADMINISTRATION

CHECKLIST (NSMAC)

SCHOOL OF NURSING, RN PROGRAM

SHEPHERD UNIVERSITY

Rev. 01/2014

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Shepherd University Mission Statement:

The mission of Shepherd University is to educate men and women to be leaders who serve the church and

improve the world through excellent programs of Christian higher education.

General Information:

The Nursing Skills and Medication Administration Checklist (NSMAC) is an ongoing validation record

of a students performance of observed skilled by faculty. It is to be used throughout the program. Faculty members assigned to the students in the skills lab, class, or clinical setting, will date and initial skills

completed skills as they are demonstrated.

Faculty Responsibilities:

Faculty will date and initial the skills as they observe the student doing the listed procedures. The faculty

is to list the course number, print name, sign, and provide initial at the end of this checklist. The checks

off methods are following:

1) Student demonstrates direct clinical skill performance (D) 2) Student is provided explanation and discussion about the clinical skill performance (E) 3) Student observes the clinical skill performance from other staff nurses or other students (O)

Student Responsibilities:

Students are responsible for their own learning and completed NSMAC. Students are responsible for

ensuring faculty is dating and signing off on skills completed. Student need to bring the checklist to all

classes, lab, and clinical settings. Student may use this checklist to present to future employers as

validation of skills completed.

Shepherd University Student Nurse

SID

Name

Phone

Number

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Copyright by Shepherd University School of Nursing

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Table of Contents STUDENT REQUIREMENT ITEMS .......................................................................................................... 5

COURSE CODE &TITLE ............................................................................................................................ 5

NURSING SKILLLS CHECKLIST ............................................................................................................. 6

Vital Signs ............................................................................................................................................. 6

Hygiene ................................................................................................................................................. 6

Oral Hygiene ......................................................................................................................................... 7

Bed-Making .......................................................................................................................................... 7

Body Mechanics .................................................................................................................................... 7

Transfers ............................................................................................................................................... 7

Elimination ............................................................................................................................................ 7

Ambulation ........................................................................................................................................... 8

ROM Exercises ..................................................................................................................................... 8

Positioning ............................................................................................................................................ 8

Safety Measures .................................................................................................................................... 8

Fall Prevention ...................................................................................................................................... 9

Physical Assessment ............................................................................................................................. 9

Neurological Assessment ...................................................................................................................... 9

Documentation .................................................................................................................................... 10

Shift Report ......................................................................................................................................... 10

Infection Control ................................................................................................................................. 11

Specimen Collection ........................................................................................................................... 11

Skin Integrity and Wound Care .......................................................................................................... 12

Pressure Ulcers .................................................................................................................................... 13

Oxygen Therapy .................................................................................................................................. 13

Tracheostomy Care ............................................................................................................................. 14

Suctioning ........................................................................................................................................... 14

Chest Drainage System ....................................................................................................................... 14

Enteral Tubes ...................................................................................................................................... 15

Bowel Elimination .............................................................................................................................. 15

Urinary Catheterization ....................................................................................................................... 16

Diabetes Monitoring ........................................................................................................................... 17

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Perioperative Care ............................................................................................................................... 17

Orthopedic Care .................................................................................................................................. 18

Pediatrics ............................................................................................................................................. 18

Obstetrics ............................................................................................................................................ 19

Therapeutic Communication ............................................................................................................... 20

Bioterrorism ........................................................................................................................................ 20

Administrative ..................................................................................................................................... 20

Critical Care ........................................................................................................................................ 21

Oral and Topical Medications ............................................................................................................. 21

Injectable Medications ........................................................................................................................ 22

Intravenous Medications ..................................................................................................................... 22

Intravenous Therapy ........................................................................................................................... 23

Central Venous Access Devices ......................................................................................................... 23

Medication Calculations ..................................................................................................................... 24

SKILLS MODULES CHECKLIST FOR MEDICATION ADMINISTRATION 1 .............................. 25

SKILLS MODULES CHECKLIST FOR MEDICATION ADMINISTRATION 2 ................................ 28



COURSES AND FACULTY SIGN OFF ................................................................................................... 45

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STUDENT REQUIREMENT ITEMS

Student Requirement Items Date on File Expiration

Physical Exam

2-step TB testing

Rubella

Rubeola

Mumps

Varicella titer

Hep B #1

Hep B#2

Hep B#3

Hep B titer

Td/Tdap

Annual Flu Vaccination

CPR

Malpractice for Student Registered

Nurse

Fire Card

FIT Testing (N-95)

HIPAA

COURSE CODE &TITLE

Course Code Course Title

NR101 Fundamentals of Nursing

NR102 Pharmacology

NR103 Med-surgical Nursing 1

NR310 Health Assessment


NR202 OB

NR203 Peds


NR302 Psychiatric Nursing


NR402 Geriatric/Community Health Nursing

NR403 Professional Role Transition

NR104 Role Transition

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NURSING SKILLLS CHECKLIST

Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical

Observer Initials Evaluation

(Pass/Fail)

Comments

Check off Methods

D

E

O

Vital Signs

NR 101

NR 103

NR 201

NR 202

NR 203

NR 301

NR 401

NR 402

Temperature:

Axillary

Oral

Rectal

Tympanic

Pulses:

Apical

Radial

Pedal

Blood Pressure:

Manual B/P

Automatic

Electronic Device

Orthostatic

(B/P & P)

Respiration

Pulse Oximetry

Pain Scale

Hygiene

NR 101

NR 402 Bed Bath:

Complete Bath

Partial Bath

Assisted Bath

Perineal Care (Female & Male)

Catheter Care

Legends: Demonstrates (D), Explains (E), Observes (O)

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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off Methods

D

E

O

Oral Hygiene

NR 101

NR 402 Conscious Patient

Unconscious Patient

Dentures/Partials

Bed-Making

NR 101

NR 103

NR 402

Unoccupied

Occupied

Body Mechanics

NR 101

NR 103

NR 402

Lifting Techniques

Turning Techniques

Transfers

NR 101

NR 402 Bed to Chair

Chair to Bed

Bed to Gurney

Gurney to Bed

Lifts

Transfer Board

Elimination

NR101

NR 402 Regular Bedpan

Fracture Bedpan

Urinal

Condom Catheter

Rectal Tube

Adult Brief/Diaper

Bedside Commode


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Course

Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off Methods

D

E

O

Ambulation

NR 101

NR 103

NR 402

Gait Belt

Cane

Walker

Crutches

Assisting a Fall

ROM Exercises

NR 101

NR 103

NR 402

Passive

Active

Positioning

NR 101

NR 103

NR 201

NR 402

Lateral

Prone

Supine

Fowlers

Sims

Dorsal Recumbent

Lithotomy

Logrolling

Safety Measures

NR 101

NR 203

NR 402

Alternatives

Restraints:

Vest/Jacket

Wrists/Ankles

Mittens

Restraint Charting


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Course

Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments Check off Methods

D E O

Fall Prevention

NR 101

NR 402 Risk Factors

Causes of Falls

Prevention (Measures)

Physical Assessment

NR 103

NR 201

NR 301

NR 401

NR 310

General Survey

Head-to-Toe

Lungs Sounds

Heart Sounds

(Cardiac Landmarks)

Peripheral Vascular

Abdomen:

Inspection

Auscultation

(Bowel sounds)

Palpation

Percussion

Muscle Strength

Scale

Neurological Assessment

NR 310

NR 301

NR 401

Pupils Sizes

Pupils Reaction

Glasgow Coma

Scale

Dysphagia Screen

F.A.S.T. (Stroke)


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical

Observer Initials

Evaluation

(Pass/Fail)

Comments

Check off Methods

D

E

O

Documentation

NR 101

NR 103

NR 201

NR 301

NR 401

NR 402

Narrative

POMR:

Nursing Diagnosis

NCP (Nursing CarePlan)

DAR (Data, Action, Response)

PIE

SOAPIE

Electronic

Abbreviations

Shift Report

NR 103

NR 201

NR 301

NR 401

NR 202

NR 203

NR 302

NR 402

SBAR

Nursing Treatments

Physician Orders

Critical/Pending

Test Results

Special Needs

Patient Teachings


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments Check off Methods

D E O

Infection Control

NR 103

NR 201

NR 203

NR 301

NR 401

NR 302

NR 402

Standard Precautions:

Alcohol-Based

Hand Rub

Hand washing

PPE:

*Gloves

*Mask/Face Shield

*Gown

*Goggles

Contact Precautions

MRSA, VRE, MDRO

Droplet Precautions

Airborne Precautions

Reverse Isolation

Biohazard Waste

Sharp Safety

Sterile

Gloving/Removing

Sterile Field

Adding Sterile Items to

a Sterile Field

Specimen Collection

NR 103

NR 201

NR 203

NR 301

NR 401

NR 302

NR 402

Urine:

*Random

*Clean Catch

*24 Hour Collection

*Sterile Catheter

*Indwelling FC


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Specimen Collection

NR 103

NR 201

NR 203

NR 301

NR 401

NR 302

NR 402

Stool:

*Regular (Culture, WBCs, C-Diff, OB)

*O & P

Sputum:

*Regular

(Culture, AFB)

*Sputum Trap

Wound Culture

Nasal Swab

Blood (Venous)

Skin Integrity and Wound Care

NR 103

NR 201

NR 301

NR 401

NR 402

Types of Wounds

Measuring a Wound

Cleaning a Wound

Dry Sterile Dressing

Irrigating a Wound

NS Wet-to-Dry

Dressing

Hydrocolloid Dressing

Removing Sutures

Removing Surgical

Staples

Using Steri-Strips

Montgomery Straps

Abdominal Binder

Negative Pressure

Wound Therapy


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Skin Integrity and Wound Care

NR 103

NR 201

NR 203

NR 301

NR 401

NR 402

Drains:

*Penrose

*Jackson Pratt

*Hemovac

*Davol

*T-Tube

Pressure Ulcers

NR 103

NR 201

NR 203

NR 301

NR 401

NR 302

NR 402

Risk Factors

Prevention Measures

Assessing/Classifying

Treatments According

to Types

Documentation

Oxygen Therapy

NR103

NR 201

NR301

NR 401

NR402

Pulse Oximetry

Nasal Cannula

Mask:

*Regular

*Non Rebreather

Venti Mask

Incentive Spirometer

Chest physiotherapy

Handheld Resuscitation Bag & Mask (Ambu)


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Tracheostomy Care

NR 101

NR 103

NR 201

NR 301

NR 401

NR 104

Tracheostomy Care

*Disposable Inner

Cannula

*Non-disposable Inner

Cannula

Tying Methods:

*Two Tie

*Posey

Suctioning

NR101, 103,

201, 301, 401,

104

Oropharyngeal

Nasopharyngeal

Tracheostomy:

*Open System

*Closed System

Endotracheal Tube:

*Open System

*Closed System

Chest Drainage System

NR 101

NR 103

NR 201

NR 301

NR 401

NR 104

Operation & Care

Measuring Output

Troubleshooting

Patient Teachings


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Enteral Tubes

NR 101

NR 301

NR 401

NR104

NGT Insertion &

Removal:

*Levine Tube

*Salem Sump

*Flexi Tube

Gastric Decompression

Irrigating an NGT

NGT Feeding:

*Continuous

*Intermittent (Syringe & Bag)

GT Site Care/Dressing

GT Feeding:

*Continuous

*Bolus/Intermittent

Jejunostomy Tube

Care

JT Feeding

Bowel Elimination

NR 101

NR 202

NR 401

NR 402

Enemas:

*Cleansing Enema (Large Volume)

*Fleets enema

*Retention Enema

*Harris Flush


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Bowel Elimination

NR 101

NR 103

NR 201

NR 301

NR 401

NR 402

NR 104

Fecal Incontinence

Pouch

Ostomy Appliance:

*Stoma Site Care

*Emptying

*Applying/Changing

Irrigating a Colostomy

Urinary Catheterization

NR 101

NR 103

NR 201

NR 301

NR 401

NR 402

Straight Catheter: (Intermittent Catheter)

*Female

*Male

Indwelling Catheter: (Foley Catheter)

*Female

*Male

Removal of a FC

Bladder Irrigation:

*Intermittent Closed

*Continuous Closed

Ileal Conduit:

*Site Care

*Emptying

*Applying/Changing

Suprapubic Catheter Care


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Diabetes Monitoring

NR 101

NR 201

NR 301

NR 401

NR 402

Capillary Blood Sugar Test (FSBS)

Sliding Scale Insulin

Hypoglycemic:

*Signs/Symptoms

*Interventions

Hyperglycemic:

*Signs/symptoms

*Interventions

Perioperative Care

NR 201

NR 301

NR 401

NR 104

Preoperative:

*Informed Consent

*Surgical Checklist

*Teachings:

Deep Breathing

Exercise

Splinting &

Coughing

Incentive Spirometry

Leg Exercise

Turning/Getting Up

Properly

Postoperative:

*V/S & O2 Sat.

*Sedation Rating

*Pain management

(PCA)


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Perioperative Care

NR 201

NR 301

NR 401

NR 104

Postoperative Care:

*Nausea Management

*Diet

*Intake & Output

*SCDS

Orthopedic Care

NR 101

NR 201

NR 301

NR 401

NR 402

Pin care

Cast care

Abduction pillows

Braces

Traction

*Bucks

*Russell

*Bryant

Pediatrics

NR 203 Vital sign differences

Immunizations

Growth chart

Normal growth &

development

Special assessment

techniques


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Obstetrics

NR 202 Antepartum:

*EDD/OB History

* Fetal Position

*Contractions/

Cervix Dilation

*FHR monitoring

*Stages of labor

Postpartum:

*Fundal

Massage/Height

*Lochia/

Pad measurement

* Bonding

*Breastfeeding/Bottle

*RhoGam

Administration

Newborn Care:

*APGAR

* Ballard Score /

Gestational Age

*PKU testing

*Newborn

Assessment

*Special Nursing

Skills

(O2, Suctioning)

*Newborn

Medication


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Course Skill

Date of Lab

Return Demo

Observer Initials

Evaluation Evaluation

(Pass/Fail)

Comments

(Pass/Fail)

Comments

D E O

Therapeutic Communication

All Classes Patient

Family

Grief/Loss

Crisis Intervention

Other Health team

members

Bioterrorism

NR 402 Identifying agents

Decontamination

PPE

Public Health

Parameters

FIT testing

Spiritual care

Organ procurement

Post mortem care

Administrative

NR 103

NR 201

NR 202

NR 203

NR 301

NR 401

NR 401

HIPAA

Occurrence reporting

Advanced Directives

DPOA

Consents

Delegation

(CNAs/LVNs)


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Administrative

NR 103

NR 201

NR 202

NR 203

NR 301

NR 401

NR 401

Admission to Floor

Inpatient Transfer

Discharge:

*To Home

*To Another Facility

Critical Care

NR 301

NR 401

NR 401

Obtaining an EKG

Applying a Cardiac

Monitor

Recognition of

dysrythmias

Care of the Ventilator

patient

Oral and Topical Medications

NR 103

NR 201

NR 301

NR 401

NR 203

NR 302

NR 402

Medication Orders

MAR/Recording (Med. Administration Record)

Six Medication Rights

The Three Checks

Preparing Unit-Dose

Packaged Medications

Removing a Medication

Tablet From a Bottle

Splitting Tablet

Preparing Liquid

Medicine

Administering Oral

Medications

Applying a

Transdermal Patch


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

NR 103

NR 201

NR 301

NR 401

NR 203

NR 302

NR 402

Administering Eye

Drops

Administering Ear

Drops

Administering a Rectal

Suppository

Administering MDI

Administering Dry

Powder Inhaler

Injectable Medications

NR 103

NR 201

NR 301

NR 401

NR 203

NR 302

NR 402

Preparing Medications

From:

*Ampule

*Vial

Mixing Two Insulins in

One Syringe

Intradermal Injection

Subcutaneous Injection

Locating Intramuscular

Sites

Intramuscular Injection

Intravenous Medications

NR 104

NR 201

NR 203

NR 301

NR 401

NR 402

IV Piggy Back by IV

Pump

IV Piggy Back by

Gravity

Mini Infusion Pump

Volume Control

Administration Set

IV Bolus through SL

IV Bolus through an IV

Primary Running


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail) Comments Check off

Methods

D E O

Intravenous Therapy

NR 104

NR 201

NR 202

NR 203

NR 301

NR 401

NR 402

Peripheral IV

Insertion:

*IV Site Selections

*IV Catheter Gauges

*Saline Lock

*Extension Tubing

*Labelling tubings &

bags

Changing an IV

Solution Container

Changing an IV

Administration Set

Regulating IV drops by

Gravity Infusion

Use of IV Pumps for

Primary & Secondary

Rates

Monitoring an IV site

and Infusion

Changing of PVA

Dressing

Capping an IV Line for

Intermittent Use

Administering a Blood

Transfusion

Central Venous Access Devices

NR 301

NR 401

NR 402

NR 104

Types of CVAD

Changing a CVAD

Dressing

CVADS Care

Flushing Guidelines

Obtaining Blood

Samples From a CVAD

Removing allowed

CVADS


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Course Skill

Date of Lab

Return Demo

Observer Initials

Date of Clinical


(Pass/Fail)

Comments

Check off

Methods

D E O

Medication Calculations

NR 102 PO Medications

Injectable Medications

IV Medications

Pediatric Dose

Calculations

IV Fluids Rates using

Drop Factor

Calculating Dose Using

BSA

Conversion of Units


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SKILLS MODULES CHECKLIST FOR MEDICATION

ADMINISTRATION 1

Students Name : ___________________________________ Date _________________

Item Check/

initial

Comments

Verify order Patient record

Assess for procedure need

Identify, gather,

and prepare

equipment and

supplies

Preparing medications

(MAR, drug reference book, medication

distribution system)

Preparing narcotic medications

(MAR, drug reference book, medication

distribution system)

Administering medications

(MAR, medication, cup of water)

Administering narcotic medications

(MAR, medication, cup of water)

Apply principles of

aseptic practice

Hand hygiene

Personal protective equipment

Disposal of waste

Communicate

effectively

Privacy

Patient identification

Patient teaching

Provide for a safe

environment

Body mechanics

Equipment placement

Patient safety

/ 45

Demonstrate procedural steps

Item

Task Check/

initial

Comments

Preparing

medications Access MAR.

Determine which medications to give.

Consult drug guide or pharmacist

as needed.

Use medication distribution system.

Perform medication label check #1.

Perform calculations as needed.

Prepare medication according to

prescribed route.


Take MAR and medication to bedside.


Preparing narcotic

medications

Access MAR.

Determine which medications to give.

Consult drug guide or pharmacist

as needed.


Count pills, ampules, or prefilled syringes.

Compare your count to count on

narcotic form.

If same, remove drug; if different,

correct discrepancy.


Prepare medication according to

prescribed route.



Take MAR and medication to bedside.


Administering

medications Place MAR and medications near bedside.

Identify patient.

Perform medication checks.

Provide cup of water.

Give patient medication.

Make sure patient swallows medication.

If patient refuses medication,

consult provider.

Return packaged medications to storage

area; discard if not in intact packaging.

/ 45


Item

Task Check/

initial

Comments

Administering narcotic

medications Place MAR and medications near bedside.

Assess patients pain.

Identify patient.


Provide cup of water.

Give patient medication.

Make sure patient swallows medication.

If patient refuses narcotic medication, discard

with another nurse witness and document

per policy.

Documentation

Item

Task Check/

initial

Comments

Document per

facility policy

Drug name

Dose

Route

Time

Assessment data collected at administration

(blood pressure, apical pulse)

Your signature or initials

Any medications withheld and why

Patients response to medication

For medication errors:

Patient information

Location and time of incident

Detailed description of what happened

What was done about it

Patients condition

Your signature

Comments

Reference: ATI Skills Modules Checklist for Medication Administration

/ 45


ADMINISTRATION 2


Item Check/

initial

Comments



Identify, gather,

and prepare

equipment and

supplies

Administering ophthalmic ointment

(MAR, medication, washcloth, facial tissues)

Administering ophthalmic drops

(MAR, medication, washcloth, facial tissues)

Administering otic medications

(MAR, medication, cotton-tipped applicator,

cotton ball)

Administering nasal medications

(MAR, medication, facial tissues)

Administering oral medications

(MAR, medication, medicine cup, cup of water)

Administering oral medications buccally

(MAR, medication, medicine cup)

Administering oral medications sublingually


Administering liquid medications


Administering topical medications

(MAR, medication, facial tissue,

transparent dressing)

Using a metered-dose inhaler

(MAR, inhaler, spacer, cup of water, emesis basin)

Apply principles of

aseptic practice

Hand hygiene


Disposal of waste

Communicate

effectively

Privacy


Patient teaching

Item Check/

initial

Comments

Provide for a safe

environment

Body mechanics

Equipment placement

Patient safety

/ 45


Item

Task Check/

initial

Comments

Administering

ophthalmic ointment Place medication near bedside.

Access MAR.

Identify patient.


Position patient supine with head slightly

hyperextended.

Use warm, moist washcloth to remove drainage or

crusts from eyelids.

Pull down lower eyelid to expose conjunctival sac.

Have patient look upward.

Instill ointment along inner edge of lower eyelid

onto conjunctiva, moving from inner to

outer canthus.

Have patient blink to distribute medication.

Use facial tissue to remove excess medication.

Administering

ophthalmic drops Place medication near bedside.

Access MAR.

Identify patient.


Position patient supine with head slightly

hyperextended.

Use warm, moist washcloth to remove drainage or

crusts from eyelids.

Place facial tissue on patients cheekbone just

below lower eyelid.

Pull down lower eyelid to expose conjunctival sac.

Have patient look upward.

Place prescribed number of drops in center of

conjunctival sac.

Have patient close eye gently.

Use facial tissue to remove excess medication.

Administering otic

medications Place medication near bedside.

Access MAR.

Identify patient.


Position patient side-lying or sitting with ear to be

treated facing up.

Warm medication to body temperature.

Adults and children >3 years: Pull pinna up and

back.

/ 45


Item

Task Check/

initial

Comments

Administering

otic medications

(continued)

Infants and children

/ 45


Item

Task Check/

initial

Comments

Administering oral

medications buccally Place medication near bedside.

Access MAR.

Identify patient.


Have patient open mouth.

Place medication toward back of mouth

against mucous membranes of cheek.

Instruct patient not to chew or swallow but

keep in place until dissolved.

Administering oral

medications

sublingually

Place medication near bedside.

Access MAR.

Identify patient.


Instruct patient to lift tongue.

Place medication on mucous membranes

under tongue.

Instruct patient not to chew or swallow but

keep in place until dissolved.

Administering

liquid medications Access MAR.


Gently shake medication.

Multi-dose container: Remove lid and place upside

down on work surface. Hold bottle with label

toward palm. With medication cup at eye level,

pour medication, measuring at base of meniscus.

Recap container.

Unit-dose container: No further preparation

required.

Take medication and MAR to bedside.

Identify patient.


Administer the medication.

Stay at bedside until patient swallows all

medication.

If patient refuses medication, discard it.

/ 45


Item

Task Check/

initial

Comments

Administering topical

medications Place medication near bedside.

Access MAR.

Identify patient.


Squeeze appropriate amount of medication onto

gloved finger.

Apply medication evenly to skin surface.

If not for single use, recap container and store it.

Nitroglycerin

ointment Access MAR.

Identify patient.


Remove previous dressing and guide.

Wipe skin.

Discard waste.

Write date and initials on tape or label.

Place appropriate amount of medication on

measuring guide.

Apply measuring guide, ointment side

facing the skin.

Secure with transparent dressing.

Apply label to dressing.

Transdermal patch Access MAR.

Identify patient.


Remove previous patch.

Wipe skin.

Discard waste.

Remove patch from wrapper, touching only

edges of patch.

Apply to hair-free skin area.

Press patch firmly with hand for at least

10 seconds.

/ 45


Item

Task Check/

initial

Comments

Using a metered-

dose inhaler Place medication near bedside.

Access MAR.

Identify patient.


Have patient in sitting position.

Shake inhaler several times.

Remove mouthpiece cover.

If new inhaler, prime by pumping into air once or

twice.

Hold inhaler 1 to 2 inches from mouth.

Ask patient to take a deep breath then

exhale completely.

Ask patient to inhale slowly and deeply

through mouth.

While patient inhales, depress inhaler completely.

Instruct patient to continue breathing slowly for 2 to 3

seconds, then hold breath for 10 seconds.

Tell patient to exhale slowly through nose or

pursed lips.

Using a metered-

dose inhaler with

spacer


Access MAR.

Identify patient.


Have patient in sitting position.

Remove cover from mouthpiece of inhaler and

mouthpiece of spacer.

Insert inhaler into end of spacer.

Shake inhaler several times.

Place spacer mouthpiece into mouth.

Instruct patient to breathe normally through the

spacer.

Ask patient to breathe slowly and deeply

through mouth.

While patient inhales, depress inhaler completely.

Instruct patient to continue breathing slowly for 2 to 3

seconds, then hold breath for 10 seconds.

Tell patient to exhale slowly through nose or

pursed lips.

If more puffs prescribed, wait 20 to 30 seconds

between puffs.

/ 45


Item

Task Check/

initial

Comments

Using a metered-

dose inhaler with

spacer

(Continued)

If administering another inhaled medication, wait 2

minutes before giving the next puff.

Instruct patient to rinse mouth with water.

Documentation

Item

Task Check/

initial

Comments

Document per

facility policy

For all medications:

Drug name

Dose

Route

Time

Any assessment data collected at administration

(blood pressure, apical pulse)

Your signature or initials

Any medications withheld and why

Patients response to medication

Oral, sublingual, and buccal medications:

Appearance of sublingual or buccal area

Any problems patient has with swallowing

If medication was crushed or mixed with liquid or

with food

Topical medications:

Appearance of skin before applying topical medication

Site of application of medication

Time medication is to be removed, if it is to be removed

If removed, appearance of skin after removal

Ophthalmic medications:

Appearance of eye(s) (redness, swelling)

Any drainage: amount, color, odor

If instilled in one eye only (and which one)

Any changes in vision

Otic medications:

Appearance of outer ear and ear canal


/ 45

If instilled in one ear only (and which one)

Any changes in hearing

Item

Task Check/

initial

Comments

Document per

facility policy

Otic irrigations :

Appearance of outer ear and ear canal


If instilled in one ear only (and which one)

Any changes in hearing

Nasal medications:

Appearance of inside and outside of nose


Nasogastric tube medications:

Method used to confirm placement of

nasogastric tube

Amount of residual

Appearance and pH of gastric contents

Total amount of fluid used for administering

medication(s)

Metered-dose inhaler (MDI):

Lungs sounds before and after medication is

administered

Respiratory rate and rhythm before and after

medication is administered

Color and consistency of sputum

Teaching done for proper use of device

Small-volume nebulizer:

Lungs sounds before and after treatment

Respiratory rate and rhythm before and after

treatment

Color and consistency of sputum

Peak-flow measurement before and after

treatment

Vaginal medications:

Appearance of genitalia and vaginal canal

Any discharge: amount, color, odor, consistency

Teaching done for self-administration of

medication

of medication

/ 45

Documentation

Item

Task Check/

initial

Comments

Document per

facility policy

Rectal medications:

Appearance of anus (redness, swelling,

hemorrhoids)

Any pain, bleeding, or discharge

Teaching done for self-administration of

medication

Comments

Reference: ATI Skills Modules Checklist for Medication Administration 2

/ 45


ADMINISTRATION 3


Item Check/

initial

Comments



Identify, gather,

and prepare

equipment and

supplies

Administering intradermal injections (MAR,

medication in syringe with needle, antimicrobial

wipe, dry gauze or cotton, pen)

Administering intramuscular injections -

deltoid

(MAR, medication in syringe with needle,

antimicrobial wipe, dry gauze or cotton,

adhesive bandage)

Administering intramuscular injections

vastus lateralis



adhesive bandage)

Administering intramuscular injections -

ventrogluteal



adhesive bandage)

Administering subcutaneous injections



adhesive bandage)

Apply principles of

aseptic practice

Hand hygiene


Disposal of waste

Communicate

effectively

Privacy


Patient teaching

Ensure consent form has been signed

Item Check/

initial

Comments

Provide for a safe

environment

Body mechanics

Equipment placement

Patient safety

/ 45


Item

Task Check/

initial

Comments

Administering

intradermal injections Place medication near bedside.

Access MAR.

Identify patient.


Help patient position arm on stable surface

with injection site accessible.

Adjust clothing to expose site.

Locate correct area for injection.

Inspect site for excessive hair, lesions, and

cleanliness.

Cleanse site with antimicrobial wipe in circular

motion from center working outward

2 inches.

Allow skin to dry.

Uncap needle.

Use two fingers to stretch skin taut across

injection site.

With bevel up, insert needle 1/8 inch at 5 to

15 angle.

Slowly inject medication, observing for wheal

and blanching.

Withdraw needle at same angle as insertion.

Apply cotton or gauze to injection site.

Activate safety device on needle and discard in

sharps container.

Draw circle around injection site.

Administering

intramuscular

injections - deltoid


Access MAR.

Identify patient.


Help patient turn so injection site is accessible.

Move clothing to expose site.

Inspect site for lesions, trauma, inflammation,

bony prominences, and adequate muscle tissue.

To locate landmarks, measure two to three

finger widths down from acromion process

and identify area of bulk in deltoid muscle

above axillary line.


motion from center working outward 2 inches.

Allow skin to dry.

Uncap needle.

/ 45


Item

Task Check/

initial

Comments

Administering

intramuscular

injections - deltoid

(continued)

Use z-track technique to displace skin and

subcutaneous tissue 1 to 1 inches away from

injection site and hold skin in place.

With a darting motion, insert needle at a

90 angle.

While stabilizing syringe, aspirate to check for

blood return.

If no blood return, slowly inject medication at a

rate of 1 mL per 10 seconds.

After waiting 10 seconds, withdraw needle at

same angle as insertion.


Activate safety device on needle and

discard in sharps container.

Apply an adhesive bandage.

Administering

intramuscular

injections vastus lateralis


Access MAR.

Identify patient.


Adjust patients bedding and clothing to

expose injection site.

Inspect site for lesions, trauma, inflammation,

bony prominences, and adequate muscle tissue.

To locate landmarks, measure one hand width

below greater trochanter, then measure one hand

width above knee and identify area of bulk in

middle third of vastus lateralis muscle in

anterolateral area of thigh.


motion from center working outward

2 inches.

Allow skin to dry.

Uncap needle.

Displace skin and subcutaneous tissue 1 to

1 inches away from injection site and hold

skin in place.

Encourage patient to relax muscle.

With a darting motion, insert needle at 90

angle.


blood return.

If no blood return, slowly inject medication at a

rate of 1 mL per 10 seconds.




/ 45


Item

Task Check/

initial

Comments

Administering

intramuscular

injections

vastus lateralis

(continued)


sharps container.


Administering

intramuscular

injections ventrogluteal


Access MAR.

Identify patient.


Position patient side-lying with hip area

accessible and knee and hip slightly flexed.

Move clothing to expose site.

Inspect site for lesions, trauma, inflammation, bony

prominences, and adequate muscle tissue.

To locate landmarks, place heel of hand on greater

trochanter with thumb pointing toward patients

abdomen. Point index finger up toward anterior

superior iliac spine, then spread other fingers back

along iliac crest.

Identify area of bulk in ventrogluteal muscle in V

between index and third fingers. Plan to inject in

center of triangle.


motion from center working outward 2 inches.

Allow skin to dry.

Uncap needle.

Displace skin and subcutaneous tissue 1 to 1 inches

away from injection site and hold skin in place.

Encourage patient to relax muscle.

With a darting motion, insert needle at a 90

angle.


blood return.

If no blood return, slowly inject medication at a rate

of 1 mL per 10 seconds.





sharps container.


/ 45

Documentation

Item

Task Check/

initial

Comments

Document per

facility policy

All medication by injection:

Dose or amount of medication

Site

Route

Date, times, signature

Intradermal injections:


Site

Route


Appearance of the skin at site

Teaching about expected outcomes

Subcutaneous and intramuscular injections:


Site

Route


Teaching self-administration

Comments

Reference: ATI Skills Modules Checklist for Medication Administration 3

/ 45


ADMINISTRATION 4

Students name Date

Item Check/

initial

Comments



Identify, gather,

and prepare

equipment and

supplies

Preparing intravenous injectable medications

Preparing intravenous bolus (push) medications

(MAR, medication, syringe with needle,

antimicrobial wipe)

Preparing large-volume intravenous medication

solutions

(MAR, IV fluid, IV tubing, medication, syringe

with needle, antimicrobial wipes, label)

Preparing piggyback intravenous medications

(MAR, IV fluid, secondary IV tubing, medication,

syringe with needle, antimicrobial wipes, label)

Administering intravenous bolus (push)

medications


antimicrobial wipes, flush syringe)

Administering large-volume intravenous

medication solutions

(MAR, medication in IV solution bag, IV tubing,

antimicrobial wipe)

Administering piggyback intravenous

medications

(MAR, medication in piggyback IV solution bag,

secondary IV tubing)

Apply principles of

aseptic practice

Hand hygiene


Disposal of waste


Item

Task Check/

initial

Comments

Preparing

intravenous

injectable

medications

Preparing intravenous bolus (push) medications:

Access MAR.


Review patients profile.


/ 45


Choose syringe size appropriate for volume of medication.

Inspect medication for color, clarity, and expiration date.


Open vial and cleanse aspiration port.

Inject air equal to amount to withdraw.

Invert vial and withdraw slightly more than dose volume.

Tap syringe to raise air bubbles and slowly express them.

Withdraw needle and express excess medication.

Confirm medication volume by visualizing at base of meniscus.

Use safety device to cover needle.


Take medication and flush solution to bedside.

Preparing large-volume intravenous medication solutions:

Access MAR.



If adding more than one medication to infusion, check drug and

solution compatibility.

Select prescribed IV fluid, checking it for color, clarity, and

expiration date.

Compare solution with MAR.



Prepare medication.

Cleanse injection port on IV solution bag.

Remove cap and insert needle or needleless device through center

of port and inject medication.

Withdraw syringe and secure safety device.

Discard in sharps container.

Mix by gently turning bag end to end.

Label bag.



Item

Task Check/

initial

Comments

Preparing

intravenous

injectable

medications

(continued)

Preparing "piggyback" intravenous medications:

Access MAR.



/ 45

If adding more than one medication to piggyback

solution, check drug and solution compatibility.

Select prescribed IV fluid, checking it for color, clarity,

and expiration date.

Compare solution with MAR.



Prepare medication.

Cleanse injection port on IV solution bag.

Remove cap and insert needle or needleless device

through center of port and inject medication.

Withdraw syringe and secure safety device.

Discard in sharps container.

Mix by gently turning bag end to end.

Label bag.


Administering

intravenous bolus

(push) medications


Access MAR.

Identify patient.


Confirm patency by accessing and aspirating for

blood return.

Gently flush with sterile normal saline.

Inspect and palpate site for occlusion, infiltration, or

venous irritation.

Cleanse injection port and allow it to dry.

Secure medication syringe to Luer-Lok port and inject

medication into line at appropriate rate.

Dispose of syringe.

Cleanse injection port.

Flush with sterile normal saline.

Secure the saline lock clamp if needed.

Comments

Reference: ATI Skills Modules Checklist for Medication Administration

/ 45

COURSES AND FACULTY SIGN OFF

Course Number Faculty Print Name Faculty Signature Initials

Documents

Skills Checklist Medication Checklist RN Program Rev 1.2014