Medication Administration - Intramuscular Medications Policy

Medication Administration - Intramuscular Medications Policy 

Purpose: 

To ensure safe and effective administration of intramuscular (IM) medications to residents in compliance with CMS guidelines and maintaining proper injection practices. 

Procedure: 

I. Intramuscular Injection Sites: 

• Deltoids (arms) 

• Dorsogluteal (back buttock) 

• Vastus Lateralis (upper lateral area of leg) 

• Rectus Femoris (medial upper leg) 

II. Preparation: 

• Calculate the correct amount of medication. If the drug is a suspension, mix well before withdrawing. Check with the pharmacy if there is any question about the appearance of the drug. 

• Prepare the syringe and needle. 

• Swab the rubber cap of the medication vial with an alcohol sponge. 

• Pull back the plunger to draw a volume of air into the syringe equal to the volume of medication to be given. Inject air into the vial. 

• Withdraw the correct amount of medication. 

• Obtain an alcohol sponge for skin preparation. 

III. Documentation: 

• Document medication administration along with the site used on the Medication Administration Record (MAR) as follows: 

• Left buttock: LB 

• Right buttock: RB 

• Left arm: LA 

• Right arm: RA 

• Left thigh: LT 

• Right thigh: RT 

IV. Administration: 

• Select an appropriate site for injection. Ensure the medication is given in the muscle as opposed to subcutaneous tissue. 

• Adjust the resident’s position. 

• Cleanse the skin with an alcohol sponge, using a circular motion from the center of the chosen site until an area about 3 inches in diameter has been prepared. 

• Expel air from the syringe. 

• Expose the site to be injected. 

• Wipe a 2-inch area designated as the injection site moving from inward to outward in a circular motion to decrease the chance of pathogens being introduced into the tissue. 

• Stretch the skin so that it is taut. 

• Using the other hand to hold the syringe, insert the needle at a 90-degree angle with a quick, dart-like thrust. 

• Pull back on the plunger to see if the needle is in a blood vessel. If so, withdraw the needle, secure new equipment and medication, and repeat the procedure. 

• Hold the needle steady and inject the medication at a slow, even rate. 

• Withdraw the needle rapidly. 

• Swab the area with an alcohol wipe in a circular motion. 

• Discard the syringe and needle in the designated area. Do not recap the needle. 

References: 

• Centers for Medicare & Medicaid Services (CMS), Requirements of Participation for Long-Term Care Facilities. 

• State Operations Manual (SOM), CMS.