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15.15 Medication: injection administration

Essential equipment

  • Personal protective equipment
  • Clean tray or receiver in which to place the drug and equipment
  • 21 G needle(s) to ease reconstitution and drawing up; 23 G if from a glass ampoule
  • 21, 23 or 25 G needle, size dependent on route of administration
  • Syringe(s) of appropriate size for the amount of drug to be given
  • Swabs saturated with isopropyl alcohol 70%
  • Sterile topical swab, if the drug is presented in ampoule form
  • Drug(s) to be administered
  • Patient's prescription chart, to check dose, route and so on
  • Recording sheet or book as required by law or hospital policy
  • Electronic identity check equipment, where relevant

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (Griffith and Jordan [110], E; NMC [257], C).
  2. 2.
    Collect and check all equipment.
    To prevent delays and enable full concentration on the procedure. E.
  3. 3.
    Check that the packaging of all equipment is intact.
    To ensure sterility. If any seal is damaged, discard (NPSA [268], C).
  4. 4.
    Wash hands with bactericidal soap and water or an alcohol‐based handrub.
    To prevent contamination of medication and equipment (DH [64], C).

Procedure

  1. 5.
    Prepare needle(s), syringe(s) and other necessary materials, placing them on a tray or receiver.
    To contain all items in a clean area. E
  2. 6.
    Inspect all equipment.
    To check that none is damaged; if so, discard or report to the MHRA. C
  3. 7.
    Before administering any prescribed drug, look at the patient's prescription chart and check the following:
    1. the correct patient is being given the drug
    2. drug
    3. dose
    4. date and time of administration
    5. route and method of administration
    6. diluent as appropriate
    7. validity of prescription
    8. signature of prescriber
    9. the prescription is legible.
    To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317], C).
    To protect the patient from harm (DH [61], C).
    If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
    To prevent any errors occurring. E
  4. 8.
    Check the patient's allergy status with the patient and the patient's records.
    To prevent an adverse allergic reaction. C
  5. 9.
    Check all details with another nurse if required by hospital policy.
    To minimize any risk of error (RPS [317], C).
  6. 10.
    Select the drug in the appropriate volume, dilution or dosage and check the expiry date.
    To reduce wastage. Treatment with medication that is outside the expiry date is dangerous. Drugs deteriorate with storage. The expiry date indicates when a particular drug is no longer pharmacologically efficacious (NPSA [268], C).
  7. 11.
    Proceed with the preparation of the drug, using protective clothing if advisable.
    To protect the practitioner during preparation (NPSA [268], C).
  8. 12.
    Take the prepared dose to the patient and close the door or curtains as appropriate.
    To ensure patient privacy and dignity. E
  9. 13.
    Check the patient's identity. If an electronic identity check system for patient and/or medicine identification is in place, then use in accordance with hospital policy and procedures.
    To prevent error and confirm the patient's identity (NPSA [262], C).
  10. 14.
    Evaluate the patient's knowledge of the medication being offered. If this knowledge appears to be faulty or incorrect, offer an explanation of the use, action, dose and potential side‐effects of the drug or drugs involved.
    Patients have a right to information about treatment (NMC [257], C).
  11. 15.
    Administer the drug as prescribed.
    To ensure the patient receives treatment. E

Post‐procedure

  1. 16.
    Dispose of all equipment in the appropriate waste containers and sharps bins.
    To ensure safe disposal of all equipment. C
  2. 17.
    Record the administration on the appropriate charts.
    To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NPSA [268], C; RPS [317], C).
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