Part II: Vaccine Administration

Objectives Participants will gain

knowledge and enhance skills of current immunization issues by: Identifying common

administration errors and strategies to prevent them from occurring.

Who is susceptible to a vaccine preventable disease?

Time to Vaccinate? What are the vaccine needs of your client?

General ContraindicationsPermanent Contraindications: All

vaccines Anaphylactic reaction to prior dose of

vaccine

Anaphylactic reaction to a component of the vaccine

General Contraindications/ Precautions

Temporary Contraindications or Precautions Moderate-to-severe illness (all vaccines) Pregnancy /possibility of pregnancy in

next 4 weeks Immunosuppression Administration of blood products within

the last year Long term steroid use

Note: additional contraindications and precautions apply to specific vaccines

Contraindications & Precautions

Vaccine Information Statements (VISs)

What are VISs? CDC-developed Standardized Mandatory

Required by federal law: Most current VIS

Record date the VIS was given

Record publication date of VIS

Vaccine Information Statements

Vaccine Information Statements

Email notification www.cdc.gov/vaccines/Pubs/vis/default.htmwww.cdc.gov/vaccines/Pubs/vis/default.htm

Vaccine Information Statements

Are VISs "informed consent" forms? No – there is no Federal or State requirement for an

informed consent form.

Must the patient or parent/guardian physically take away a copy of each VIS, or can we simply let them read a copy?

Ideally the person getting the shot, or their representative, should actually take each VIS home.

Patients may choose not to take the VIS, but the provider should offer them the opportunity to do so.

Frequently Asked Questions - VISs

Does the Immunization Branch still laminate or provide VISs? No

Where can I get VISs in other languages? Immunization Action Coalition’s (IAC) website

www.immunize.org

Frequently Asked Questions - VISs

Administering Vaccines: IM & SC Injections

Intramuscular (IM)

InjectionSubcutaneous (SC)

Injection

45° angle90° angle

Skin

Subcutaneous tissue

Muscle

Resource: Vaccine Administration

Resource: Immunization Site Map

Resource: Immunization Site Map

Be Prepared to Administer Vaccines Correctly

Ensure staff are adequately trained Provide current immunization education Rights of Medication Administration

Right patient Right medication Right time Right dosage Right manner/route Right documentation

HELP!HELP! “A community health center in “A community health center in our area inadvertently gave a 5-year-old our area inadvertently gave a 5-year-old a dose of Tdap, instead of a DTaP. What a dose of Tdap, instead of a DTaP. What is their next best step to take under this is their next best step to take under this circumstance? circumstance? 

HELP!HELP! “Someone in our clinic gave a “Someone in our clinic gave a 50-year-old DTaP instead of Tdap. How 50-year-old DTaP instead of Tdap. How should this be handled?should this be handled?””

What to do About DTaP and Tdap Errors

DTaP/Tdap Error Action Needed

DTaP given to person ≥7yrs Count dose as valid

Tdap given to child <7yrs asDTaP #1, 2, or 3

Do not count dose; give DTaP now

Tdap given to child <7yrs asDTaP #4 or 5

Count dose as valid

Tdap given to child 7-9 yrs Count dose as valid

Another Source of Confusion: Varicella-Containing Vaccines

Varivax (chickenpox)(12 mos of age and older)

Zostavax (shingles)(60 yrs of age and older)

HELP! “One of the nurses gave a 1-year-old Zostavax vaccine.  She knew it was not Varivax, but the physician told her it was ‘basically the same thing’ and to give it. I know this was a HUGE medication error. Does the dose count?”

ANSWER: Yes, this is a serious vaccine administration error. The dose should be counted as valid.

HELP!HELP! “A 60-year-old patient was given “A 60-year-old patient was given varicella instead of zoster vaccine. Does the varicella instead of zoster vaccine. Does the patient still need zoster vaccine? If so, how patient still need zoster vaccine? If so, how long an interval should we wait after varicella long an interval should we wait after varicella vaccine before the zoster vaccine?”vaccine before the zoster vaccine?”

ANSWER:ANSWER: The dose is not valid and the patient should be The dose is not valid and the patient should be given a dose of zoster vaccine during the same visit.given a dose of zoster vaccine during the same visit. If the error is not immediately detected, a dose of If the error is not immediately detected, a dose of zoster vaccine should be administered as soon as zoster vaccine should be administered as soon as feasible but not within 28 days of the varicella vaccine feasible but not within 28 days of the varicella vaccine dose to prevent potential interference of 2 doses of dose to prevent potential interference of 2 doses of live attenuated virus. live attenuated virus.

Diluents are NOT Interchangeable

Wrong diluent is inadvertently used, the immunization may need to be repeated.

The diluent for MMR, MMRV, Varicella, and Zoster are the same

HELP! “One of the nursing staff reconstituted ActHib with the diluent from MMR instead. Does it need to be repeated or will it be okay?”

ANSWER: If the wrong diluent is mistakenly used, the vaccination needs to be repeated.

Giving the Wrong Vaccine will Rarely Cause a Serious Complication, but…

Extra dose may lead to more vigorous local reaction

Patient may be left unprotected against disease

Additional cost for wrong dose

Inconvenience to patient or parent

May cause loss of confidence in provider or a dissatisfied parent

HELP! “If an adult patient got a child’s dose of hepatitis B vaccine, should he be given an adult dose? If so, how soon?”

ANSWER: If you give less than a full age-appropriate dose of any vaccine, the dose is invalid. You should revaccinate the person with the appropriate dose as soon as feasible.

Administrative Error: Combining Vaccines into one Syringe that Shouldn’t be Together

Two different vaccines should NEVER be combined in the same syringe unless FDA licensed for use in this way

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Administration Error:Using Expired Vaccine

ANSWER: The dose should be repeated.

HELP!HELP! “ “A physician just called and gave a child a dose of expired vaccine. I am assuming the dose should be re-administered. Please advise.”

HELP! “One of our nurses accidentally gave Zostavax IM instead of SC. Can you tell me what we need to do?”

ANSWER: CDC says vaccines given by the wrong route can be counted as valid with two exceptions -- HepB or rabies vaccine -- if not given IM should be repeated.

Medical Management of Vaccine Reactions

The Vaccine Adverse Event Reporting System (VAERS)

http://www.immunizenc.org/VAERS.htm

VAERShttp://vaers.hhs.gov/index

Table of Reportable Eventshttp://vaers.hhs.gov/resources/VAERS_RET.pdf

Vaccine Administration Resourcehttp://www.immunize.org/askexperts/

Questions about

Vaccine Administration?

Put Your Knowledge into Practice!Put Your Knowledge into Practice!

QuestionQuestion: : You have a 6 month You have a 6 month old infant in today old infant in today who needs: DTaP #3, who needs: DTaP #3, HiB #3, Hep B #3, HiB #3, Hep B #3, PCV #3, and PCV #3, and Rotavirus #3. Into Rotavirus #3. Into which site (indicated which site (indicated on the chart) would on the chart) would you administer each you administer each vaccine dose?vaccine dose?