NURSING SKILLS AND
MEDICATION ADMINISTRATION
CHECKLIST (NSMAC)
SCHOOL OF NURSING, RN PROGRAM
SHEPHERD UNIVERSITY
Rev. 01/2014
Page 1 / 45
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
SKILLS MODULES CHECKLIST FOR MEDICATION ADMINISTRATION 3 ................................ 37
SKILLS MODULES CHECKLIST FOR MEDICATION ADMINISTRATION 4 ................................ 42
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
NR201 Med-surgical Nursing 2
NR202 OB
NR203 Peds
NR301 Med-surgical Nursing 3
NR302 Psychiatric Nursing
NR401 Med-surgical Nursing 4
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
Observer Initials Evaluation
(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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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)
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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)
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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)
Legends: Demonstrates (D), Explains (E), Observes (O)
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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
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
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 19 / 45
Course Skill
Date of Lab
Return Demo
Observer Initials
Date of Clinical
Observer Initials Evaluation
(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
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 20 / 45
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)
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 21 / 45
Course Skill
Date of Lab
Return Demo
Observer Initials
Date of Clinical
Observer Initials Evaluation
(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
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 22 / 45
Course Skill
Date of Lab
Return Demo
Observer Initials
Date of Clinical
Observer Initials Evaluation
(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
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 23 / 45
Course Skill
Date of Lab
Return Demo
Observer Initials
Date of Clinical
Observer Initials Evaluation
(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
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 24 / 45
Course Skill
Date of Lab
Return Demo
Observer Initials
Date of Clinical
Observer Initials Evaluation
(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
Legends: Demonstrates (D), Explains (E), Observes (O)
Page 25 / 45
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
Page 26 / 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.
Perform medication label check #2.
Take MAR and medication to bedside.
Perform medication label check #3.
Preparing narcotic
medications
Access MAR.
Determine which medications to give.
Consult drug guide or pharmacist
as needed.
Use medication distribution system.
Count pills, ampules, or prefilled syringes.
Compare your count to count on
narcotic form.
If same, remove drug; if different,
correct discrepancy.
Perform medication label check #1.
Prepare medication according to
prescribed route.
Perform calculations as needed.
Perform medication label check #2.
Take MAR and medication to bedside.
Perform medication label check #3.
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.
Page 27 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering narcotic
medications Place MAR and medications near bedside.
Assess patients pain.
Identify patient.
Perform medication checks.
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
Page 28 / 45
SKILLS MODULES CHECKLIST FOR MEDICATION
ADMINISTRATION 2
Students Name : ___________________________________ Date _________________
Item Check/
initial
Comments
Verify order Patient record
Assess for procedure need
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
(MAR, medication, medicine cup)
Administering liquid medications
(MAR, medication, medicine cup)
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
Personal protective equipment
Disposal of waste
Communicate
effectively
Privacy
Patient identification
Patient teaching
Item Check/
initial
Comments
Provide for a safe
environment
Body mechanics
Equipment placement
Patient safety
Page 29 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering
ophthalmic ointment Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Perform medication checks.
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.
Perform medication checks.
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.
Page 30 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering
otic medications
(continued)
Infants and children
Page 31 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering oral
medications buccally Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Perform medication checks.
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.
Perform medication checks.
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.
Perform medication checks.
Administer the medication.
Stay at bedside until patient swallows all
medication.
If patient refuses medication, discard it.
Page 32 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering topical
medications Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Perform medication checks.
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.
Perform medication checks.
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.
Page 33 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Using a metered-
dose inhaler Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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
Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Page 34 / 45
Demonstrate procedural steps
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 adminis- tration
(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
Any drainage: amount, color, odor
Page 35 / 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
Any drainage: amount, color, odor
If instilled in one ear only (and which one)
Any changes in hearing
Nasal medications:
Appearance of inside and outside of nose
Any drainage: amount, color, odor
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
Page 36 / 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
Page 37 / 45
SKILLS MODULES CHECKLIST FOR MEDICATION
ADMINISTRATION 3
Students Name : ___________________________________ Date _________________
Item Check/
initial
Comments
Verify order Patient record
Assess for procedure need
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
(MAR, medication in syringe with needle,
antimicrobial wipe, dry gauze or cotton,
adhesive bandage)
Administering intramuscular injections -
ventrogluteal
(MAR, medication in syringe with needle,
antimicrobial wipe, dry gauze or cotton,
adhesive bandage)
Administering subcutaneous injections
(MAR, medication in syringe with needle,
antimicrobial wipe, dry gauze or cotton,
adhesive bandage)
Apply principles of
aseptic practice
Hand hygiene
Personal protective equipment
Disposal of waste
Communicate
effectively
Privacy
Patient identification
Patient teaching
Ensure consent form has been signed
Item Check/
initial
Comments
Provide for a safe
environment
Body mechanics
Equipment placement
Patient safety
Page 38 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering
intradermal injections Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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
Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Cleanse site with antimicrobial wipe in circular
motion from center working outward 2 inches.
Allow skin to dry.
Uncap needle.
Page 39 / 45
Demonstrate procedural steps
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.
Apply cotton or gauze to injection site.
Activate safety device on needle and
discard in sharps container.
Apply an adhesive bandage.
Administering
intramuscular
injections vastus lateralis
Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Cleanse site with antimicrobial wipe in circular
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.
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.
Apply cotton or gauze to injection site.
Page 40 / 45
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Administering
intramuscular
injections
vastus lateralis
(continued)
Activate safety device on needle and discard in
sharps container.
Apply an adhesive bandage.
Administering
intramuscular
injections ventrogluteal
Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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.
Cleanse site with antimicrobial wipe in circular
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.
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.
Apply cotton or gauze to injection site.
Activate safety device on needle and discard in
sharps container.
Apply an adhesive bandage.
Page 41 / 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:
Dose or amount of medication
Site
Route
Date, times, signature
Appearance of the skin at site
Teaching about expected outcomes
Subcutaneous and intramuscular injections:
Dose or amount of medication
Site
Route
Date, times, signature
Teaching self-administration
Comments
Reference: ATI Skills Modules Checklist for Medication Administration 3
Page 42 / 45
SKILLS MODULES CHECKLIST FOR MEDICATION
ADMINISTRATION 4
Students name Date
Item Check/
initial
Comments
Verify order Patient record
Assess for procedure need
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
(MAR, medication in syringe with needle,
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
Personal protective equipment
Disposal of waste
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Preparing
intravenous
injectable
medications
Preparing intravenous bolus (push) medications:
Access MAR.
Perform medication checks.
Review patients profile.
Use medication distribution system.
Page 43 / 45
Perform medication label check #1.
Choose syringe size appropriate for volume of medication.
Inspect medication for color, clarity, and expiration date.
Perform calculations as needed.
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.
Perform medication label check #2.
Take medication and flush solution to bedside.
Preparing large-volume intravenous medication solutions:
Access MAR.
Perform medication checks.
Review patients profile.
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.
Use medication distribution system.
Perform medication checks.
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.
Perform medication checks.
Demonstrate procedural steps
Item
Task Check/
initial
Comments
Preparing
intravenous
injectable
medications
(continued)
Preparing "piggyback" intravenous medications:
Access MAR.
Perform medication checks.
Review patients profile.
Page 44 / 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.
Use medication distribution system.
Perform medication checks.
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.
Perform medication checks.
Administering
intravenous bolus
(push) medications
Place medication near bedside.
Access MAR.
Identify patient.
Perform medication checks.
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
Page 45 / 45
COURSES AND FACULTY SIGN OFF
Course Number Faculty Print Name Faculty Signature Initials