Injection skill to be demonstrated in NMC OSCE can be a subcutaneous injection or an intramuscular injection. Time for this skill is now 12 minutes instead of 15 minutes. It is important to verbalize various things while demonstrating this procedure. This includes verbalizing of doctors order, noting of batch number and expiry date, technique of giving injection etc. In this article, we will see step by step how to administer or demonstrate Injection Procedure as a skill in your OSCE exam for NMC Registration in UK.

Injection Procedure for Skills Demonstration in NMC OSCE

We can broadly classify injection procedure under the following headings. Please note that while reading the steps you should assume that you are doing the procedure during exam. Lets start,

Introductory Phase

• Entering the patient room, checking for scene safety, ensuring that scene is safe to approach
• Closing curtains and door to protect privacy and dignity of patient
• Doing hand rub using seven steps of hand hygiene
• Hello, myself ‘Name of the candidate’ am your attending nurse today.
• Can you tell me your name please?
• Can you tell me your date of birth?
• Can i confirm your details with your id band? (name, date of birth, hospital number)
• I am here to administer your injection (name of the drug – lets say insulin)
• Have you taken insulin before?
• If yes, when had you taken, do you know the sites of administering, where would you like it this time?
• If answer is no, Insulin is administered to lower your high glucose level
• Insulin can be administered via subcutaneous injection at outer aspect of your both arms, around umblicus/abdomen and also outer mid thigh region
• Where would you like to have your insulin now?
• Check the site for infection, inflammation and lesions
• Confirm with the examiner what was the last blood sugar value of the patient?
• Tell to the patient that his or her food is on the way as insulin is administered prior to your food (30 minutes)
• Are you in any pain? (If in pain, score pain using pain assessment tool)
• Do you have any allergies?
• This procedure will take another 15 minutes, Do you need to use the toilet now?
• Are you comfortable in this position?
• So now i will be going to assemble things needed for your injection, call me or press the call bell if you need any assistance, i will be happy to help you.

Assembling of Things

 

• Do a hand rub, wear an apron and gloves (after checking expiry)
• Confirm with the examiner whether the tray is cleaned with soap and water in past 24 hours?
• Clean the tray inside to outside area using clinell wipes (after checking expiry date) for 30 seconds (if tray available is disposable, cleaning not required)
• Allow it to dry for 30 seconds, remove apron and gloves
• Do a proper hand washing using seven steps of hand hygiene at the wash basin provided
• Dry your hand using paper towels from fingers to wrist
• Confirm with the examiner that whether the tray is dry (Examiner confirms it)
• Wear an apron and read aloud the prescription (Drug, dose, route, time, doctors name and bleep number)
• Correctly checks ALL of the following:
  • validity of prescription
  • signature of prescriber
  • prescription is legible.
  If any of these pieces of information is missing, unclear or illegible, the nurse should not
  proceed with administration and should consult the prescriber.
• Take Insulin ( Verbalize that there is no precipitate and is within expiry date) – Document the expiry date and batch number in the prescription
• Assemble articles – Sharps bin, 25 Gauge needle to administer (or insulin syringe), 18 gauge to withdraw medicine (not needed in case of insulin syringe), 21 or 23 Gauge needle (for IM injections), two alcohol wipe (after checking expiry), a sterile gauze, syringe depending on IM/SC(if insulin syringe not available) and a pair of gloves
• Wear a gloves and load medicine in the syringe (insulin), show to the examiner how much units loaded and there is no air bubbles, Don’t discard the medicine ampule (keep it in tray – usually plastic but consider it as sharp)
• Change loading needle to administration needle in case of IM before showing to examiner
• Discard loading needle by closing it using scoop method into the sharp bin (verbalize that sharp bin is not 2/3rd full)
• Also Discard gloves
• Proceed to the patient side after taking the tray in hand, do a hand rub

Procedure

 

• Identify the patient again using 3 checks
• Ask patient whether he is comfortable and can you proceed with the injection
• Expose site, wear a glove
• Verbalize that you are not going to clean the injection site with alcohol swab as site is clean and patient is not immuno-compromised
• Take the syringe in your hand, pinch the skin into a fold (verbalize that its more than 2 inches and safe to administer), hold injection like a dart
• Tell patient that you are going to prick the needle and tell to take a deep breath and exhale
• Insert needle after telling, free the skin fold, inject medicine 90 degree (insulin) or 45 degree (dalteparin) at a rate of 1ml/10seconds, keep the needle there for another 10 seconds and then remove needle swiftly
• Inspect for any ooze, press the site with sterile gauze gently (don’t massage), Put plaster if required or verbalize there is no ooze and you are not applying any plaster
• Discard the needle, ampule along with syringe in the sharp container and remove your gloves
• Hand rub and tell patient procedure is over and ask whether he is comfortable

Post Procedural Phase

• Give the call bell to patient and ask the patient to press the call bell in case of any adverse reaction or need for assistance, tell the patient that you will be around for another 30 minutes
• Take all the used items back and discard in clinical waste
• Verbalize that you will clean the tray (if not disposible) and keep it ready for next use
• Document that insulin in specified units given subcutaneous route with sign, date and time
• Reopen the curtains
• Do a hand wash or hand rub before leaving the room

In case of IM Injection

In case of IM Injection, load medicine using aspiration needle (18 gauge) and administer using administration needle (21 or 23 gauge), Don’t forget to wipe the injection site for 30 seconds and letting it dry for another 30 seconds

You have to give injection by spreading the site using two fingers of your non dominant hand, holding syringe like a dart in your dominant hand, administering injection at 90 degrees (verbalize everything while doing)

• You have to aspirate and see for any blood before giving IM Injection,
• You also need to apply a plaster on the sterile gauze applied after injection.
• You need to double check patient’s identity
• Also You need to tell the use of medication and possible side – effects before administering injection.

Injection Steps PDF Article – Injection Final Article

Pitfalls in Injection – Safety of administration of medication. This should include checking the prescription against the patient, and checking right dose/right time/right patient/right route/right drug. The chart should be timed and signed.

Conclusion

Subcutaneous or Intramuscular Injection is a simple procedure if done properly. Important things to note is double checking the patients identity, Injection technique, Noting of Expiry date and batch number and discarding of sharp.

We are adding a video detailing flow chart of injection procedure so that nurses can remember better which you can watch here. Time limit is now only 12 minutes not 15 minutes.

Hopes that this article is useful for nurses who are preparing for NMC OSCE Exam. If you liked this article and thinks that it is worth to share this article with your friends preparing for NMC OSCE, please feel free to do so by clicking any of the icons below.