Im, Id Injection Checklist
Im, Id Injection Checklist
Name:
Date:
Able to
Able to Unable to
ASSESSMENT Perform w/
Perform Perform
Assistance
3 2 1
1. Verify doctor’s orders for the medication and prepare materials
and solution for injection and applies and sterile
technique during in the entire procedure.
2. Identifies the patient and explains the procedure, reads the
medicine cards.
3. Allay any tears/anxiety clients may have.
COMMENTS: GRADE:
Name:
Date:
Able to
Able to Unable to
ASSESSMENT Perform w/
Perform Assistance Perform
3 2 1
1. Check doctor’s order for medication administration and prepare
materials and solution for injection and applies and
sterile technique during in the entire procedure.
2. Identifies the patient and explain the procedure read the
medication card.
TOTAL
COMMENTS: GRADE: