Shot-day checklist: before, during and after the injection

Most injection errors are not technique errors. They are a vial from the wrong fill, a pen that spent a week in a hot car, a syringe drawn to the wrong mark because the concentration changed, or a needle in the kitchen bin. A checklist catches those in the thirty seconds before the needle goes in. Pilots use one for the same reason: not because they forget how to fly, but because the cost of a skipped step is high and the cost of the list is nothing.

Before

The first check is the only one that matters if you get nothing else right: the dose on your prescription label matches what you are about to prepare. For a pen, that is the strength printed on it. For a compounded vial, it is the units on your pharmacy's instructions, drawn in the syringe size the pharmacy specified. If a new vial has a different concentration from the last one, the units change even though the dose does not; ask the pharmacy before you draw up, and use the dose unit converter only to check their answer, never to replace it.

Then the physical checks. Expiry date, and for a compounded vial the beyond-use date the pharmacy assigned. The solution should be clear and colourless; both the Wegovy and Zepbound instructions for use say not to use the product if it has been frozen, is cloudy or discoloured, or has particles in it. Storage should have stayed within the label's range; the travel checklist prints the unrefrigerated allowances for each brand product.

During

Follow the device or pharmacy instructions step by step. The pens differ in how long to hold after pressing, and the instructions are the authority, not memory. Choose a site that has not been used recently and that is not bruised, tender, red or hard. The labels name the abdomen, thigh and upper arm; the Zepbound label says the back of the upper arm should be injected by another person.

After

Needle or pen into an FDA-cleared sharps container immediately; the Wegovy medication guide and the FDA's sharps page are both explicit that used sharps do not go in household trash unless local rules allow it, and that a full container is not recycled. Then the dose log: date, dose as prescribed, site, time. Then the medication back into the refrigerator, or a note of the date it came out. If anything unusual happened, a leak, a bleed, a sting that lasted, it goes in the side-effect diary.

Why the list is short

A checklist that takes five minutes gets abandoned in week three. This one fits on half a page and can be run in under a minute once you know it. Print several; they are meant to be used up.