Home OSCE Practical Examination INJECTION PROCEDURE – NMC Osce Clinical Station

INJECTION PROCEDURE – NMC Osce Clinical Station

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SUBCUTANEOUS INJECTION

Entering the patient’s room, ensuring the safety of the surroundings before proceeding.

Nurse (N): Hello, I’m your attending nurse today. Can you please tell me your name? and how may I call you?

Patient (P): My name is John Smith. You can call me Smith

N: Thank you, Mr. Smith. And can you confirm your date of birth?

P: Sure, it’s January 15, 1965.

N: Great, I see your ID band matches the information you provided—your name, date of birth, and hospital number. Assessor please I can confirm, I am with the right patient. Now, I’m here to administer your insulin injection. Have you taken insulin before?

P: Yes, I have. I usually take it in my abdomen.

N: Alright, Mr. Smith. Do you remember when you last took insulin, and is there a specific spot you’d prefer for the injection this time?

P: I took it yesterday, and you can give it in my abdomen again.

N: Perfect. Before we proceed, let’s check the injection site for any signs of infection, inflammation, or lesions. And I will make sure I inject at least 2-3 cm away from the previous injection site. Also, can you recall your last recorded blood sugar level?

Assessor: The last reading was 9.8 mmol/L.

N: Thank you for sharing, that’s above the normal level. Your meal is on its way because insulin is administered before eating, usually about 30 minutes prior. Are you currently experiencing any pain? If so, could you rate it on a scale of 1 to 10?

P: No, I’m not in any pain.

N: Good to know. Do you have any allergies we should be aware of?

P: No allergies.

N: Alright, Mr. Smith, this procedure will take approximately 15 minutes. Would you like to use the restroom before we begin? Are you comfortable in your current position?

P: I’m fine, and I don’t need to use the restroom.

N: Very well. I’ll now gather the necessary supplies for your injection. Please don’t hesitate to call me or use the call bell if you require any assistance. I’m here to help.

[The nurse assembles the required items.]

N: I’ve completed the hand rub, put on an apron and gloves. I’ll confirm with the examiner whether the tray has been cleaned with soap and water in the past 24 hours.

[The nurse proceeds to clean the tray with alcohol wipe.]

N: The tray has been cleaned and dried, so I’ll remove the apron and gloves and perform proper hand washing following the seven steps recommended by the World Health Organization.

N: The tray is now dry, and I’ll put on an apron and read aloud the prescription, verifying the drug, dose, route, date, time, doctor’s name and signature, and bleep number. It all appears correct.

N: I’ll take the insulin, confirming that there’s no precipitate, not lumpy and it is not frosted, and it’s within the expiry date. I’ll call out the date and batch number as mentioned in the prescription.

[The nurse continues to assemble the articles.] here is alcohol wipes intact and in date, my insulin syringe intact and in date, sterile gauze intact and in date and a sharp container which is not filled more than 1/3 of the volume

N: I’ve loaded the insulin into the syringe, ensuring there are no air bubbles. I’ll keep the medicine ampule in the tray. Now, I’ll change the loading needle to the administration needle (if not insulin syringe) and dispose of the loading needle safely into the sharp bin.

[The nurse proceeds to the patient.]

N: After performing a hand rub, I’ll confirm your identity once again, can you tell me your name and date of birth. Are you comfortable proceeding with the injection?

P: Yes, my name is John Smith and DoB is January 15, 1965. Please go ahead.

N: Ok, I got the right patient

N: Alright, may I uncover your abdomen? (Expose the area) Assessor, I can verify that there are no indications of redness, swelling, infection, or any skin issues at the injection site. Next, I’ll cleanse the area with a 70% alcohol wipe for 30 seconds and wait for an additional 30 seconds for it to dry. I’m ready to proceed. Smith, this will only take a few moments. I’m going to gently pinch your skin and insert the needle, is that okay with you? Alright, you’ll feel a sharp scratch as I insert the needle. Now, I’ll slowly administer the medication over 10-30 seconds and then swiftly remove the needle. I’ll place a sterile gauze here and dispose of the syringe in the sharps container. Okay, Smith, I’ve completed the insulin dose administration. I’ll ensure your meal is on its way; it should arrive within the next 30 minutes. Are you feeling comfortable now? Is there anything you need before I leave? Call me or use the call bell when you need me

P: No, thank you

N: I’ll clean the tray (if it’s not disposable) and prepare it for future use.

N: I’ll document that you received insulin subcutaneously in the specified units, noting the date and time and sign

N: Let’s open the curtains for you.

[The nurse performs hand washing or hand rub before leaving the room.]

N: Assessor, please I have finished the administration of subcutaneous/intramuscular injection to Mr. Smith. Thank you.

IN CASE OF AN IM INJECTION (note the following;)

N: If we were administering an IM injection, two needles needed. Loading and administering needles, we would use an administering needle to check for blood aspiration before giving the injection at the dorsogluteal muscles, wipe the injection site for 30 seconds, and let it dry for another 30 seconds.

N: We’d spread the site using two fingers, hold the syringe like a dart, and administer the injection at a 90-degree angle leaving 1 cm of the needle out. Depress the plunger at least 1 ml every 10 sec. apply small gauze and plaster on the punctured site.

N: Before giving the injection, we’d also inform you of the medication’s use and possible side effects, ensuring your full understanding.

N: Lastly, double-check patient’s identity to ensure his safety.

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