Insulin Skills Checklist

Using a Glucometer For Blood Sugar Monitoring

1. Assemble equipment. 2. Identify individual and explain procedure. 3. Wash hands and apply gloves. 4. Have Individual wash their hands and use an alcohol wipe to clean selected finger 5. Place lancet in pen if a pen is used for the procedure with this client. 6. Set up glucometer, by placing testing strip into machine 7. Turn the glucometer on, then apply lancet to side of finger (never the finger pad). 8. When glucometer is ready to accept blood then, Point finger downward and gently squeeze to get an adequate blood sample. 9. Place blood drop on test strip and wipe finger with gauze pad and hold in place, applying gentle pressure until bleeding stops. 10. Read and record result or store result in the glucometer if this option is available. 11. Clean equipment and dispose of used supplies appropriately. 12. Remove and dispose of gloves appropriately and wash hands. 13. Follow process for medication administration or request assistance if necessary.

*With some glucometers, sites other than the side of the finger may be used. If using the fingers, be sure to use the sides of the finger, never the pads. Rotate finger sites to avoid formation of calluses. Be sure to document finger site used.

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Delegating Nurse Initials

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Place a check mark before each step completed by the trainee. Must be checked off on all steps to pass (can demonstrate per simulation or verbalize in classroom setting only)

Giving the injection:

12. Locate the injection site. (Same as sites for insulin) 13. Clean the site with alcohol. Make sure site is clean and dry before injecting. 14. Pick up syringe and remove cap from needle. 15. Hold the needle in your dominant hand (hand you write with). 16. Placed thumb and forefinger of other hand on either side of the injection site, about 2 inches apart, and pinch up the skin. 17. With a darting motion of the wrist, quickly insert needle at a 45-90 degree angle into the pinched up skin between your thumb and forefinger. Insert needle all the way into skin. 18. Keeping your thumb and forefinger on the skin, slide your thumb and forefinger apart, releasing the skin. Keep thumb and forefinger on either side of the injection site while holding the syringe in place with your writing hand. 19. SLOWLY push down on the plunger until all the glucagon has been injected.

Removing the needle from the injection site

20. While holding the syringe in place with your writing hand, count to 5 and then quickly pull the needle straight out. If there is bleeding at the site, use a clean Band Aid, gauze, or cotton ball to apply gentle pressure until bleeding stops.

After the procedure is completed

21. As soon as the injection is completed and the needle removed, turn the client on his side to help prevent choking because Glucagon can cause nausea and vomiting. 22. Call emergency medical personnel (911). 23. If client becomes alert, and can eat, drink and swallow, give food or beverage as directed by the nurse, doctor or emergency medical personnel. 24. If the client does not become alert, wait for emergency medical personnel; do not attempt to feed the client and do not leave the client alone. 25. Dispose of the glucagon syringe in a sharps container per your agency's policy and procedure for disposal of sharps.

Documentation

26. Document per agency policy and procedure.

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1. Washes hands with soap and water. 2. Gathers equipment needed:

* Vial of insulin * Alcohol swab * Sterile disposable syringe * Sharps (puncture proof) container

3. Identifies insulin by comparing MAR / Med Log to label on vial.

4. Clear Insulin:

Check Insulin for floaters, discoloration, or cloudiness. Discard if any of these are observed

Cloudy Insulin:

Check Insulin for floaters and white lumps. Discard if either of these is observed

5. Checks expiration date on insulin vial 6. If using cloudy insulin, gently rolls insulin between hands to mix well 7. Removes cap from vial and cleans top of vial with alcohol swab 8. Removes syringe from package. Removes cap from needle and checks needle for any bends or barbs. Checks syringe by pushing plunger back and forth to make sure it moves freely. 9. Pulls back plunger, drawing air into syringe. The amount of air should be the same as the amount of insulin ordered by the physician. 10. Pushes the needle into the rubber stopper while turning the vial upside down, making sure the tip of the needle remains in the insulin. 11. Keeps the needle in the rubber stopper while turning the vial upside down, making sure the tip of the needle remains in the insulin. 12. Fills the syringe with the correct dose of insulin by drawing back on the plunger.

* If too much insulin is drawn into the syringe, pushes plunger in , returning insulin to vial

* If too little insulin is drawn into the syringe, continues pulling on the plunger

13. Checks syringe for air bubbles.

* If there are air bubbles, gently tap the syringe barrel while the needle remains in the rubber stopper of the vial. Air bubbles will move to the top of the syringe and back into the vial. Continues to tap until all air bubbles are gone.

14. Checks the syringe for the correct dose of insulin. Makes sure there are no air bubbles. If air bubbles persist, pushes all medication back into the vial and begins to redraw the correct dose of insulin. 15. Checks the syringe once more to ensure that the correct amount of insulin has been drawn up before pulling the needle from vial. 16. Carefully recaps needle as taught.

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1. Washes hands with soap and water and puts on gloves. 2. Chooses the injection site.

* Makes sure the site is clean by using an alcohol swab or washing the area with soap and water.

* Avoids areas that are red, swollen or bruised.

3. Informs the client that he will be given his / her insulin injection. 4. Checks to be sure the right insulin is being given in the right dose to the right person at the right time. 5. Places thumb and forefinger on either side of the injection site, about 2 inches apart, and pinches up the skin 6. With a darting motion, inserts the needle into the pinched up skin between the thumb and forefinger. Makes sure the needle enters at a 45 or 90 degree angle. 7. Releases the skin, holding the syringe in place. 8.While holding the syringe in place, pushes down on the plunger, injecting the insulin at a slow, steady pace, until all insulin has been injected. This takes about 3-5 seconds.

* The syringe can be held in place with one hand and the other hand used to inject, or a one handed technique may be used.

9. Places a cotton ball or clean gauze next to the needle where the needle has entered the skin and with a smooth motion, carefully removes the needle from the client's skin. 10. Holds the cotton ball or gauze over the injection site for a few seconds.

* If bleeding occurs, holds the cotton ball or gauze over the injection site until bleeding stops.

11. DOES NOT RECAP THE NEEDLE. Disposes of the syringe in the sharps container. 12. Removes gloves and washes hands. 13. Stays with the client, ensuring the client is safe and comfortable. 14. Secures the medication area making sure all equipment and medication is put away according to agency policy and procedure. 15. Documents per agency policy and procedure.

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1. Wash hands with soap and water. 2. Gather Supplies:

* Alcohol Swabs

* Insulin Pen

* Sharps Container

* Gloves

* Needles

3. Compare label on insulin container with MAR 3 times:

* Before Assembling

* After Assembling

* Before Administering

4. Remove cap of pen. Check insulin in pen for floaters and / or discoloration 5. Wipe off area the needle is inserted (screwed in) 6. Screw the needle into top of pen (Remove outer cap at this point, but leave second cap) 7. Turn dial at bottom of pen to "2". Remove needle protector. Push up on plunger to release air - several small drops will come out of needle. 8. Put on gloves. 9. Turn dial to correct number for correct dosage. 10. Place outer needle cap lightly over needle. Lay pen down without contaminating. 11. Select appropriate injection site and wipe with alcohol. 12.

1. Pick up pen.

2. Remove cap.

3. Hold pen in fist leaving thumb loose.

4. Pinch fold of skin.

5. Inject pen into pinched up skin.

6. Push plunger with thumb until it stops.

7. Release fold of skin.

8. Count to five and remove needle from skin.

13. Clean area with alcohol. 14. Recap needle with outer cap. Unscrew needle from top. Put needle into sharps container. 15. Wash hands and replace insulin in locked storage container in refrigerator. 16. Document according to agency procedure and policy.

Please select all the skills completed with staff*

1. Glucometer 2. Glucagon 3. Filling the Syringe 4. Giving Insulin with Syringe 5. Insulin Injection for Insulin Pen

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Health-Related Activities Skills Checklist

*With some glucometers, sites other than the side of the finger may be used. If using the fingers, be sure to use the sides of the finger, never the pads. Rotate finger sites to avoid formation of calluses. Be sure to document finger site used.

Page 1

Skills Checklist: Administering Glucagon

Place a check mark before each step completed by the trainee. Must be checked off on all steps to pass (can demonstrate per simulation or verbalize in classroom setting only)

Page 2

Skills Checklist/Procedure for Insulin Injection - Filling the Syringe

* If too much insulin is drawn into the syringe, pushes plunger in , returning insulin to vial

* If too little insulin is drawn into the syringe, continues pulling on the plunger

* If there are air bubbles, gently tap the syringe barrel while the needle remains in the rubber stopper of the vial. Air bubbles will move to the top of the syringe and back into the vial. Continues to tap until all air bubbles are gone.

Page 3

Skills Checklist / Procedure Insulin Injection - Giving the Insulin:

* Makes sure the site is clean by using an alcohol swab or washing the area with soap and water.

* Dries the site.

* Avoids areas that are red, swollen or bruised.

* The syringe can be held in place with one hand and the other hand used to inject, or a one handed technique may be used.

* If bleeding occurs, holds the cotton ball or gauze over the injection site until bleeding stops.

Page 4

Skills Checklist for Insulin Injection per Insulin Pen

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