Evaluation Tool for Return Demonstration
Name of Student: __________________________ Date_______________
Encircle the number corresponding to your rating, with 5 as the highest.
Legend for Rating and Interpretation:
Scale Interval Description
5 4.21 – 5.00 Outstanding (O)
4 3.41 – 4.20 Very Satisfactory (VS)
3 2.61 – 3.40 Satisfactory (S)
2 1.81 – 2.60 Fair (F)
1 1.00 – 1.80 Unsatisfactory (US)
ADMINISTERING ORAL MEDICATIONS
Definition: Administering oral medications involves giving prescribed drugs or
substances to a patient by mouth, typically in the form of tablets, capsules, liquids,
or suspensions, as directed by a healthcare provider to treat a medical condition
or alleviate symptoms.
Purposes: The purpose of administering oral medications is to deliver prescribed
drugs or substances through the mouth to be absorbed into the bloodstream,
thereby treating medical conditions, alleviating symptoms, preventing disease
progression, or promoting overall health and well-being.
Equipment required:
Gloves
Soap and Water
Fresh Gown
Face Mask
Protective Glasses
Medication Administration Record (MAR)
Medicine cups
Stock containers for tablets or capsules
Disposable cups
Bottles for liquid medications
Oral syringe for measuring liquid medications
Narcotic control record (if applicable)
Paper towels
Medication cart
1
Water or preferred juice for the client to swallow medication
Disposable supplies for disposal
ADMINISTERING ORAL MEDICATIONS RATING
I. INTERPERSONAL SKILLS
1. Made an introduction and confirmed the client's identity such 5 4 3 2 1
as full name, birthday, and verify it to the patient’s the wrist
band.
2. Explain the procedure to the patient clear, concise and with 5 4 3 2 1
respect and dignity according to the patient’s level of
understanding.
3. Enhance cultural awareness and sensitivity. 5 4 3 2 1
4. Ensure patient privacy is maintained before conducting any 5 4 3 2 1
procedure.
Rating:
II. INFECTION CONTROL
1. Hand washing
a. Before touching a patient 5 4 3 2 1
b. Before a procedure 5 4 3 2 1
c. After a procedure or body fluids exposure risk 5 4 3 2 1
d. After touching a patient 5 4 3 2 1
e. After touching a patient’s surrounding 5 4 3 2 1
2. Personal Protective Equipment
a. Donn a fresh gown 5 4 3 2 1
b. Put the face mask on 5 4 3 2 1
c. Wear protective glasses 5 4 3 2 1
d. Apply clean gloves. 5 4 3 2 1
Rating:
III. PSYCHOMOTOR SKILLS
1. Performed hand hygiene and observed other appropriate 5 4 3 2 1
infection prevention procedures.
2. Unlocked the dispensing system. 5 4 3 2 1
3. Obtained appropriate medication. 5 4 3 2 1
A. Read the MAR and took the appropriate medication. 5 4 3 2 1
2
B. Compared the label of the medication against the order on 5 4 3 2 1
the MAR
C. Checked the expiration date of the medication. Returned 5 4 3 2 1
expired medications to Pharmacy.
D. Used only medications that had clear, legible labels. 5 4 3 2 1
4. Prepared the medication: 5 4 3 2 1
A. Calculated medication dosage accurately. 5 4 3 2 1
B. Prepared correct amount of medication for required dose, 5 4 3 2 1
without contaminating medication.
C. Rechecked each prepared drug and container with MAR 5 4 3 2 1
again.
TABLETS OR CAPSULES
A. Placed package unit-dose capsules or tablets directly into 5 4 3 2 1
medicine cup
B. If using a stock container, poured required number into 5 4 3 2 1
bottle cap and then transferred medication to disposable
cup without touching tablets.
C. Kept narcotics and medications that required specific 5 4 3 2 1
assessments separate from others.
D. Broke scored tablets only if necessary to obtain correct 5 4 3 2 1
dosage.
LIQUID MEDICATION
A. Thoroughly mixed medication before pouring. Discarded 5 4 3 2 1
any medication that had changed color or turned cloudy.
B. Removed cap and placed upside down on countertop. 5 4 3 2 1
C. Held bottle so label was next to palm of hand and poured 5 4 3 2 1
medication away from label.
D. Placed medication cup on flat surface at eye level and 5 4 3 2 1
filled it to desired level.
E. Wiped lid with paper towel before capping. 5 4 3 2 1
F. If medication less than 5 mL, prepared the medication in a 5 4 3 2 1
specially designed oral syringe.
G. Labeled the syringe with the name of the medication and 5 4 3 2 1
the route (PO)
ORAL NARCOTICS
A. If agency uses manual recording system for controlled 5 4 3 2 1
substances, checked narcotic record for previous drug
count and compared it with supply available.
B. Removed next available tablet and dropped it in medicine 5 4 3 2 1
cup.
C. After removing tablet, recorded necessary information on 5 4 3 2 1
appropriate narcotic control record and signed it.
ALL MEDICATIONS: 5 4 3 2 1
A. Placed prepared medication and MAR together on 5 4 3 2 1
medication cart.
3
B. Rechecked label on container before returning bottle , box, 5 4 3 2 1
or-envelope to its storage place.
C. Avoided leaving prepared medications unattended. 5 4 3 2 1
D. Locked medication cart before entering client's room. 5 4 3 2 1
E. Checked room number against MAR if agency does not 5 4 3 2 1
allow MAR to be removed from medication cart.
5. Provided for client privacy 5 4 3 2 1
6. Prepared the client. 5 4 3 2 1
A. Introduced self and verified client's identity. 5 4 3 2 1
B. Assisted the client to a sitting position. 5 4 3 2 1
C. Took the required assessment measures. 5 4 3 2 1
7. Explained the purpose of the medication. 5 4 3 2 1
8. Administered the medication at correct time. 5 4 3 2 1
A. Took medication to client within guidelines of the agency. 5 4 3 2 1
B. Gave client sufficient water or preferred juice to swallow 5 4 3 2 1
medication
C. Stayed with client until all medications were swallowed. 5 4 3 2 1
9. Disposed of all supplies appropriately. 5 4 3 2 1
A. Replenished stock and returned cart to appropriate place. 5 4 3 2 1
B. Discarded used disposable supplies. 5 4 3 2 1
10. Used effective bod mechanics throughout procedure. 5 4 3 2 1
11. Communicated appropriately with the client. 5 4 3 2 1
IV. Documentation
a. Document all pertinent information and other appropriate 5 4 3 2 1
nursing forms
Rating:
V. Critical Thinking
a. Explain the concept of holistic nursing care related to the 5 4 3 2 1
patient.
b. Respond to the scenario/question presented 5 4 3 2 1
Rating:
4
Final Rating: ______________________
Remarks:
_____________________________________________________________________
_____________________________________________________________________
______________________________ ______________________
Clinical Instructor’s Full Name & Signature Signature of Student
