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ASO Medprep & Admin
Injections Med Skills (Prep., Pulse., Resp., 2-Step BP, and Post Procedure)
| Steps | Detail |
|---|---|
| Step 1 | Review patient’s chart for Provider’s orders, patient history and allergies. Discuss any noted concerns with provider before proceeding |
| Step 2 | Perform hand hygiene |
| Step 3 | ***Select the correct medication and demonstrate O-ICE (Order, Integrity, Consistency, Expiration date) |
| Step 4 | ***Firmly and briskly wipe the top of vials with an alcohol pad for each vial. Allow to air dry |
| Step 5 | ***Attach sleeved needles to syringe. Note that "there is no contamination" |
| Step 6 | ***Draw plunger back to take in the equivalent amount of air to the medication orders [EX: 5ml ordered, 5ml of air], then remove needle cap. NOTE "THERE IS NO CONTAMINATION" |
| Step 7 | Insert aerated needle into vial while it is on a flat surface, inject the air into the vial, invert the vial with needle still inserted while firmly holding the plunger |
| Step 8 | Pull back plunger to take the needed amount of medication into syringe. Take a very small amount over the ordered amount to allow for air removal |
| Step 9 | With needle in the vials air space, tap syringe to remove air bubbles |
| Step 10 | Eject remaining air out of the top of syringe into the vial without losing medication |
| Step 11 | Recap the needle with one-handed scoop method or engage safety device and get new needle |
| Step 12 | Tilt the needle 90 degrees to see what air/bubbles remain to be removed and confirm the proper volume of medication is present |
| Step 13 | ***Label syringes for injection type and medication before leaving the preparation area |
| Step 14 | ***Have another staff member check your work - confirm the Provider’s orders, syringe with drawn medication, and the medication vial |
| Step 15 | ***Ensure the correct needle size was used for each injection (IM is 1 inch, SQ is 5/8th inches, and PPD syringe already has needle attached) |
| Step 16 | ***Ensure each drawn dose is correct for the injection |
| Step 17 | Perform hand hygiene |
| Step 18 | Introduce self to patient |
| Step 19 | Confirm patient's identity with full first and last name, and date of birth |
| Step 20 | ***Provide VIS sheet to patient and confirm they understand they'll be receiving vaccination (VIS, TB, and Screening questionnaire) |
| Step 21 | Determine patient’s comfort with procedure |
| Step 22 | Don proper sized gloves |
| Step 23 | ***For Intramuscular Injections (IM), the deltoid, located 2-3 fingers below the Acromion Process, is used. |
| Step 24 | ***Cleanse the site with alcohol in a circular motion and allow to air dry |
| Step 25 | ***Ensure skin is taut at intended sight of injection |
| Step 26 | ***Insert needle at 90 degree angle |
| Step 27 | ***Aspirate all IM injections save for vaccines |
| Step 28 | Inject medication slowly (at 0.5ml per second) |
| Step 29 | Slowly and steadily withdraw needle, release skin, and apply cotton ball or 2x2 pad |
| Step 30 | Engage safety mechanism correctly |
| Step 31 | ***Do not massage injection site, apply band aid if needed |
| Step 32 | Properly dispose of needle and syringe |
| Step 33 | ***For Subcutaneous Injections (SQ), the fatty tissue on the back of the arm is used |
| Step 34 | ***Cleanse site with alcohol swab and allow to air dry |
| Step 35 | ***To properly inject, pinch up on the fatty tissue at back of arm and insert at 45 degree angle. DO NOT ASPIRATE |
| Step 36 | You may release the skin once needle is inserted or maintain pinching up, and inject the medication slowly (at 0.5ml per second) |
| Step 37 | Withdraw needle at proper at 45 degree angle and cover injection site with cotton ball or gauze |
| Step 38 | Engage safety mechanism |
| Step 39 | ***Do not massage the injections site, cover with band aid if needed |
| Step 40 | Dispose of needle and supplies |
| Step 41 | ***Using proper landmarks of 4 finger widths below antecubital area and one hand width above the wrist, select the injection site. Avoid any areas with rashes, bruises, knots, etc |
| Step 42 | ***Cleanse the site with alcohol and let air dry |
| Step 43 | With non-dominant hand, stretch skin taut with C-hold, hold syringe between thumb and forefinger of dominant hand with bevel pointed pointed up |
| Step 44 | ***Insert needle at 5-15 degree angle with bevel up until resistance is felt |
| Step 45 | ***Advance the needle 1/8th inch below the skin's surface. Needle tip should be visible under the skin. |
| Step 46 | Inject solution slowly to obtain a wheel (6-10mm) |
| Step 47 | ***“If the medication leaks out or no wheal is obtained, I would attempt the test again 2 inches from the first site distal from the elbow, or preferably switch to the other arm” |
| Step 48 | Withdraw the needle at the same angle of insertion |
| Step 49 | Engage safety device |
| Step 50 | Gently dab the site with gauze if blood appears. Do not apply pressure by massaging, nor a band aid |
| Step 51 | Dispose of used supplies properly |
| Step 52 | Perform hand hygiene |
| Step 53 | Observe for any adverse reactions |
| Step 54 | Report any undesirable effects to provider |
| Step 55 | Document procedure |
Created by:
MrsLaceUp
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