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 Contraindications  Permanent 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

  notification 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 Frequently Asked Questions - VISs

Administering Vaccines: IM & SC Injections Intramuscular (IM) Injection Subcutaneous (SC) Injection 45° angle 90° angle Skin Subcutaneous tissue Muscle

Resource: Vaccine Administration

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! “A community health center in our area inadvertently gave a 5-year-old a dose of Tdap, instead of a DTaP. What is their next best step to take under this circumstance? HELP! “A community health center in our area inadvertently gave a 5-year-old a dose of Tdap, instead of a DTaP. What is their next best step to take under this circumstance? HELP! “Someone in our clinic gave a 50-year-old DTaP instead of Tdap. How should this be handled?”

What to do About DTaP and Tdap Errors DTaP/Tdap ErrorAction Needed DTaP given to person ≥7yrsCount dose as valid Tdap given to child <7yrs as DTaP #1, 2, or 3 Do not count dose; give DTaP now Tdap given to child <7yrs as DTaP #4 or 5 Count dose as valid Tdap given to child 7-9 yrsCount 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! “A 60-year-old patient was given varicella instead of zoster vaccine. Does the patient still need zoster vaccine? If so, how long an interval should we wait after varicella vaccine before the zoster vaccine?” ANSWER:  The dose is not valid and the patient should be given a dose of zoster vaccine during the same visit.  The dose is not valid and the patient should be given a dose of zoster vaccine during the same visit.  If the error is not immediately detected, a dose of zoster vaccine should be administered as soon as feasible but not within 28 days of the varicella vaccine dose to prevent potential interference of 2 doses of 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 +

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)

VAERS vaers.hhs.gov/index vaers.hhs.gov/index

Table of Reportable Events

Vaccine Administration Resource / /

Questions about Vaccine Administration?

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