8. Guidelines for Completing the Demonstration of Competency Basic and Intermediate Skills Checklist.





  Utilized proper hand washing technique and infection control principles

  Training participant must demonstrate good hand washing techniques

which include washing hands with soap and water or using an alcohol-based

hand sanitizer:

  • Remove rings;
  • Wet hands with warm, running water and apply liquid soap;
  • Lather well;
  • Scrub all surfaces, including the backs of hands, wrists, between fingers

and under fingernails;

  • Rub hands together for 20 seconds (sing “Happy Birthday” twice);
  • With water running, dry hands with a paper towel;
  • Use paper towel to turn of the faucet;
  • Dispose of paper towel.


  Appropriate equipment


  The basic supplies that needed for medication administration include:

  1. Medication administration record;
  2. Medication cups for oral meds including tablets, capsules, and liquids;
  3. Sufficient fluids;
  4. Soap and water or appropriate antiseptic must available for use.
  Medication Administration Record utilized properly


  Training participant must be able to describe a medication administration record

and know how to use it properly.


Read the medication label and checked against order on MAR

  Training participant must identify that the medication label must be compared

to the MAR 3 times;

1. when removing the medication from the storage area, prior to pouring
the medication;
2. After pouring the medication and returning it to storage. The information

on the label and the information on the MAR must match.


List /recognize the components of a complete medication order


  The components of a complete medication order include:

  1. Medication name;
  2. Strength of medication;
  3. Dosage of medication to be administered;
  4. Route of administration;
  5. Specific directions for use, including frequency of administration;
  6. PRN orders must clearly state the reason for administration


  Observed 6 rights of medication administration


   The training participant must be able to list the 6 rights of

medication administration:

Right client

Right medication

Right dose

Right route

Right time

Right documentation



  Used clean technique when pouring and preparing medications into appropriate container


  The training participant must identify that medications are not to be touched or

handled by their hands. Medication is poured from the container which has the

   medication label into a medication cup or a cup designed to administer liquid

   medication and given to the person. 

   Must tell the instructor that cannot set all the person’s medications up

   prior to administering.


  Offered sufficient fluids with medications


  The training participant must be able to describe that a person is to be offered

4 ounces of water or other fluids when administering medications



  Described methods used to monitor a person’s condition and reactions to medications and what to do when there appears to be a change in his or her condition or health status

  Training participant must be able to identify the following potential side effects

when a medication has been administered:

Change in behavior

Change in alertness

Change in eating or swallowing

Change in mobility

Skin rash develops They must be able to tell the instructor what action is to be taken

when they identify that a person may be experiencing a side effect of a medication.

They also must identify where the side effect


  Initialed the MAR immediately after medications are administered and prior to the administration of medications to another person. Equivalent signature for initials is documented.

  The training participant must identify that they are to sign the MAR only after

they observe the person take the medication.

(No pre-charting of medications prior to them being administered.). Must be

done immediately after medication is administered to each person. (No charting

  after all medication is administered).


  Documented medications that are refused, held, or not administered appropriately


   The training participant is to be knowledgeable to Method of documenting why

  a medication not administered. Such as (example) H = Held, R = Refused,

  Circling their initials on MAR. They must also know how to document in the 

  person’s record what occurred and why.


  Administered and documented PRN medications appropriately


  Training participant must document PRN medications that include:

Amount administered

Time administered

Reason administered

Effectiveness of medication


  Returned medication to proper storage unit


  Training participant must return the medication for each person to the appropriate

medication storage   area prior to administering the next person’s medication.

  Must identify that medication cart, cabinet, closet is to be locked at all times  



 1. Oral tablets and capsules


  Position the person with the head elevated

Uncoated tablets can be scored to allow for splitting

Coated Tablets should not be scored or split

Do not break or crush any medications without a licensed practitioner’s order

More than one tablet or capsule may be placed in the same medication cup

 2. Pouring & Measuring Liquid Medication

  1 tsp


  1 Ounce

  30 cc

  5 cc


  The major concern with liquid medications is measuring accurate dosage. To insure

accurate dosage of liquid medications using a plastic marked cup, oral syringe or

  dropper, pay close attention to the markings to ensure accurate dosage. Some

  are suspension and must be shaken well. Place the medication cup on a flat surface

  and measure the liquid medication at eye level. Medication should be poured away

  from the container label. To do this, hold the medication bottle or container in the

  palm of your hand with label against your palm, to prevent spillage, causing label 

  to become illegible.


 3. Sublingual


  Place the medication under the person’s tongue. Instruct them to allow the sublingual

medication to dissolve   under their tongue and not to swallow or chew the medication. 

  (Verbally explain a technique/procedure in lieu of actually performing it).  


 4. Instilling eye drops


  Prior to applying eye drops, wash your hands. Person should be sitting up straight

and looking at the ceiling. Pull down on the lower lid with the hand not holding the bottle.

  Place one drop inside the lower eyelid. If you are not sure that a drop went in,

  WAIT 5 minutes before instilling another drop. Dropper must not touch the eye.







  5. Instilling ear drops


  Store ear drops at room temperature. Prior to applying ear drops, wash your

 hands and dry completely. Gently shake the bottle before using. Hold the

  bottle in your hands for a few minutes to warm drops. The dropper should be

  held with the dropper tip down at all times. This prevents the medicine from flowing

  back to the bulb where there may be germs. Avoid touching the dropper against

  anything else. Ask the person to lie down or tilt their head to one side. In adults,

  the earlobe should be held up and back. For children, the earlobe should be held

  down and back. Holding the ear with one hand and the dropper in the other, place

  the correct number of drops into the ear – DO NOT SQUEEZE THE DROPPER

  TOO HARD. Replace the dropper in the medicine bottle right away – DO NOT

  RINSE OFF. Press the ear flap and have the client keep their head tilted back for

  several minutes to give the drops ample time to coat the ear. You may want to insert

  a cotton plug. Wash your hands.



6. Nasal sprays


  Ask the person to hold their head erect. Have them blow their nose as needed.

Spray the nasal spray forcefully into the nose and ask the person to sniff

  the medication into their nose. May tilt their head back to help them absorb the

  medication. Wipe the tip of the nasal spray with a clean tissue prior to replacing

  the cap.




7. Application of topical ointment/cream


  Use universal precautions at all times when applying ophthalmic or dermal

ointments. Cleanse skin prior to application of dermal ointment.

  As always, observe for any adverse effects such as worsening of the condition.

Wear gloves. Use a new tongue blade or cotton tipped applicator to remove the

medication from its  container and to apply the ointment or cream. Lay the lid of

  the container with the top facing up, so it will not contaminate the medication in

  the container.  






8. Rectal suppository


  If the suppository is soft, hold it under cool water to harden it before removing the

wrapper. Remove the wrapper. If you are to use half of the suppository,

  cut it lengthwise. Put on a finger cot or a disposable glove. Lubricate the

  suppository tip with a water-soluble lubricant such as KY Jelly. Ask the person

  to lie on their side with their lower leg straightened out and upper leg bent

  forward toward their stomach. Lift upper buttock to expose the rectal area. Insert

  the suppository, pointed end first, with your finger until it passes the muscular

  sphincter of the rectum, about 1 inch in adults. If not inserted past the sphincter,

  the suppository may pop out. Hold buttocks together for a few seconds. Remain

  lying down for about 15 minutes to avoid having the suppository come out.

  Discard used materials and wash your hands thoroughly. (Verbally explain

  a technique/procedure in lieu of actually performing it). 






9. Application of vaginal cream/ suppository


  To use vaginal cream or suppository, first wash your hands thoroughly. To use

the cream, fill the applicator that comes with the cream to thelevel indicated.

  To use the suppository, unwrap it, wet it with lukewarm water, and place it

  on the applicator shown with the accompanying instructions. Have the woman

  lie on their back with their knees drawn upward and spread apart. Insert the

  applicator high into the vagina (unless she is pregnant), and then push the

  plunger to release the medication. If pregnant, insert the applicator gently.

  If you feel resistance (hard to insert), do not try to insert if further; call the

  doctor. Withdraw the applicator. Pull the applicator apart and clean it with

  soap and warm water after each use. Wash your hands thoroughly. (Verbally

  explain a technique/procedure in lieu of actually performing it).




  10. Use of metered dose inhaler


  Wash hands. Shake the inhaler several times. Have the person hold their head

up straight or stand. Have them exhale all the way until can’t breathe out anymore

  and then place the mouthpiece of inhaler between teeth and close lips around the

  mouth piece. Press down on the canister to release a dose of the medication and

  ask the person to breathe in. Hold breath for 10 seconds. If more than one puff is

  required, wait 2 minutes before administering second puff.




Medication error.


  Describe what constitutes a medication error and actions to take when a

medication error is made or detected. Must verbalize that it is very important to

  familiarize yourself with any medication that is being administered. Pharmacies

  are required to provide a “medication” education sheet with each drug dispensed.

  The sheet contains the most common side effects of that medication. Another way

  to learn the side effects of medications is to review the medication in a current

  Drug Handbook.