Pre‐procedure

ActionRationale

1. 1.Show
   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 (NMC [257], C).
2. 2.Show
   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 correct patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; NMC [257], 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
3. 3.Show
   Wash hands and apply an apron.
   To prevent contamination of medication and equipment (DH [64], C).

   To prevent cross‐contamination (Fraise and Bradley [98], E).

Procedure

1. 4.Show
   Close the curtains or door and assist the patient into the required position.
   To ensure the patient's privacy and dignity. E

   To allow access to the appropriate injection site (Ostendorf [277], E).
2. 5.Show
   Take the medication and the prescription chart to the patient. Check the patient's identity by asking them to state their full name and date of birth. If the patient is unable to confirm these details, then check the patient identity band against the prescription chart. If an electronic identity check system for the patient and/or medicine identification is in place, then use it in accordance with hospital policy and procedures. Check the patient's allergy status by asking them or by checking the name band.
   To ensure that the medication is administered to the correct patient and prevent any errors related to drug allergies (NPSA [262], C).
3. 6.Show
   Assist the patient to remove the appropriate garments to expose the injection site.
   To gain access for the injection. E
4. 7.Show
   Assess the injection site for signs of inflammation, oedema, infection and skin lesions.
   To promote the effectiveness of the administration (Ostendorf [277], E).

   To reduce the risk of infection (Fraise and Bradley [98], E; Workman [376], E).

   To avoid skin lesions and possible trauma to the patient (Ostendorf [277], E).
5. 8.Show
   Wash and dry hands and apply non‐sterile gloves.
   To prevent contamination of medication and equipment (DH [64], C).

   To prevent possible cross‐contamination (Fraise and Bradley [98], E).
6. 9.Show
   Select the appropriate needle size.
   To minimize the risk of missing the subcutaneous tissue and any ensuing pain (FIT [95], C; Ostendorf [277], E).
7. 10.Show
   Where appropriate, clean the injection site with a swab saturated with isopropyl alcohol 70%.
   To reduce the number of pathogens introduced into the skin by the needle at the time of insertion (FIT [95], C). (For further information on this action see ‘Skin preparation’ below.)
8. 11.Show
   Remove the needle sheath.
   To prepare the syringe for use. E
9. 12.Show
   Consider whether pinching a skin fold is required.
   To elevate the subcutaneous tissue and lift the adipose tissue away from the underlying muscle (FIT [95], C; Ostendorf [277], E).
10. 13.Show
    Hold the syringe between thumb and forefinger of the dominant hand as if grasping a dart.
    To enable a quick, smooth injection (Ostendorf [277], E).
11. 14.Show
    Insert the needle into the skin at an angle of 45° and release the grasped skin (unless administering insulin, when an angle of 90° should usually be used). Inject the drug slowly over 10–30 seconds.
    Injecting medication into compressed tissue irritates nerve fibres and causes discomfort (Ostendorf [277], E).

    The introduction of shorter insulin needles makes 90° the more appropriate angle (FIT [95], C; Trounce and Gould [354], E).
12. 15.Show
    Withdraw the needle rapidly. Apply gentle pressure with sterile gauze. Do not massage the area.
    To aid absorption. Massage can injure the underlying tissue (Ostendorf [277], E).

Post‐procedure

1. 16.Show
   Ensure that all sharps and non‐sharp waste are disposed of safely and in accordance with locally approved procedures.
   To ensure safe disposal and to avoid laceration or other injury to staff (HWR [137], C; MHRA [201], C).
2. 17.Show
   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).