Vaccine Administration Part 1: Schedules, Screening & Administering

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Part II Vaccine Administration
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Objectives

• Participants will gain knowledge and enhance
  skills of current immunization issues by
• Identifying common administration errors and
  strategies to prevent them from occurring.

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Who is susceptible to a vaccine preventable
disease?
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Time to Vaccinate? What are the vaccine needs of
your client?
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General Contraindications

• Permanent Contraindications All vaccines
• Anaphylactic reaction to prior dose of vaccine
• Anaphylactic reaction to a component of the
  vaccine

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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
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Contraindications Precautions
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Vaccine Information Statements (VISs)

• What are VISs?
• CDC-developed
• Standardized
• Mandatory

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Vaccine Information Statements

• Required by federal law
• Most current VIS
• Record date the VIS was given
• Record publication date of VIS

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Vaccine Information Statements
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Vaccine Information Statements

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

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Frequently Asked Questions - VISs

• 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.

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Frequently Asked Questions - VISs

• Does the Immunization Branch still laminate or
  provide VISs?
• No
• Where can I get VISs in other languages?
• Immunization Action Coalitions (IAC) website
  www.immunize.org

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Administering Vaccines IM SC Injections
45 angle
90 angle
Skin
Subcutaneous tissue
Muscle
Subcutaneous (SC) Injection
Intramuscular (IM) Injection
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Resource Vaccine Administration
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Resource Immunization Site Map
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Resource Immunization Site Map
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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

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• 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?

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What to do About DTaP and Tdap Errors
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Another Source of Confusion Varicella-Containing
Vaccines
Varivax (chickenpox) (12 mos of age and older)
Zostavax (shingles) (60 yrs of age and older)
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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.

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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.
• 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.

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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

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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.
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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

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• HELP! If an adult patient got a childs 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.
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Administrative Error Combining Vaccines into one
Syringe that Shouldnt 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 ErrorUsing Expired Vaccine
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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.
ANSWER The dose should be repeated.
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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.

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Medical Management of Vaccine Reactions
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The Vaccine Adverse Event Reporting System
(VAERS)http//www.immunizenc.org/VAERS.htm
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VAERShttp//vaers.hhs.gov/index
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Table of Reportable Eventshttp//vaers.hhs.gov/re
sources/VAERS_RET.pdf
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Vaccine Administration Resourcehttp//www.immuniz
e.org/askexperts/
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Questions about Vaccine Administration?
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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?