CHECK LIST FOR DMPA INJECTION
CLINICAL SKILLS
Use the following rating scale (0, 1 or 2):
2 - Competently performed: Step or task performed correctly and in proper sequence
1 - Needs Improvement: Step or task performed correctly but out of sequence
0 - Not done or done incorrectly: Step or task omitted or not performed correctly
Name _____________________ Course- Family Planning Date: _____________________
CHECK LIST FOR DMPA INJECTION: CLINICAL SKILLS
CASES
STEP/TASK
M0 1 2 Remark
PRE-INSERTION MEDICAL ASSESSMENT
1. Greet client, introduce one-self, offer a seat and ensure privacy.
2. Ask client if she still wants the DMPA.
3. Review client information in her record and ensure that she has
been appropriately counseled; ask client what questions she has.
4. Review reproductive goal and medical history. Confirm that
DMPA is an appropriate choice; Use checklist or HCG to rule out
pregnancy and identify conditions requiring special precautions.
5. Perform (or refer for) further evaluation, if indicated.
6. Provide more detailed information about DMPA
How it works,
Its effectiveness,
How it is inserted,
Its characteristics,
Common side effects,
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CHECK LIST FOR DMPA INJECTION: CLINICAL SKILLS
CASES
STEP/TASK
M0 1 2 Remark
When to return.
7. Show the client the vial of DMPA, and using a training model,
show her how the DMPA is injected.
8. Ask the client to repeat information to ensure that she
understands.
9. Describe the injection procedure and what to expect.
PRE-INSERTION TASKS
10. Ensure needed supplies and equipment are available and ready:
The Depo, and syringe with needle, NS or soap.
11. Check to be sure that the client has thoroughly washed and rinsed
her entire non-dominant arm.
12. Help the client to sit.
13. Explaining what you are doing at each step; remind her to tell you
if she experiences discomfort and to take deep breaths and relax.
14. Prepare and withdraw 1ml in to the syringe
15. Locate the site of injection
16. Inject in appropriate site preferably deltoid
17. Do not massage the injection site
18. Dispose all materials accordingly ( syringe in to safety box, vial in
dust bin)
19. Give her post injection counselling and appointment card
20. Document all in the family planning registration book
Total score______/40 % ________/15%
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