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Child with Flu — Influenza Vaccination for Discharged Children — Clinical Pathway: Emergency

Influenza/Flu Clinical Pathway — Emergency Department

Influenza Vaccination for Discharged Children

Process for Flu Vaccine Administration

1 BPA for eligible patients alerts RN and HP Epic Flu Vaccine Order interface screenshot

© 2024 Epic Systems Corporation

2 Assess eligibility, likely discharge
3 Review contraindications
4
  • Offer flu vaccine to guardian
    • Review Epic SnapShot Tab under immunization list if question about flu vaccine reviewed
5 Family scans QR code on screensaver to review the Vaccine Information Statement (VIS) before vaccine administration, Spanish version available in LexicompCDC flu vaccine information QR code
6 HP orders vaccine
7 RN administers vaccine at any time during ED stay
8
  • AVS includes flu vaccine administration:
    • Vaccination included in Immunization Registration automatically for CHOP patients
    • Non-CHOP patients can share with their PCP
    • Vaccine information for discharge, CDC AVS  

Discharged ED Patients Eligible for Flu Vaccine

  • Minor illnesses with or without fever are not contraindications
  • Confirmed COVID-19 infection if acute illness has resolved is not a contraindication
  • Egg allergy: no longer requires 30 min observation after receiving a flu vaccine
  • Full Recommendations  
ESI 3,4,5
  • Mild/moderate to febrile illness
    • Hospitalization necessary
    • Clinician judgment to defer vaccination until resolution of the illness
Age
  • > 6 mos
  • Second dose recommended
    • Ages 6 mos to 8 yrs for those who have not received a dose in the past
    • Refer back to PCP for 2nd dose after at least 4 wks
  • Some CVS, Walgreens, Rite Aid pharmacies can vaccinate children > 3 yrs
  • Some CVS MinuteClinic can vaccinate children > 18 mos
High-risk
  • Respiratory diseases, asthma
  • Cardiac disease, hemodynamically significant
  • Immunosuppressive disorder or therapy
  • HIV infection
  • SCD, other hemoglobinopathies
  • Long-term aspirin therapy
    • e.g., Kawasaki disease, some with JIA
  • Chronic renal dysfunction
  • Chronic metabolic diseases including diabetes mellitus
  • Any condition that compromises:
    • Respiratory function
    • Handling of secretions
    • Increase risk of aspiration
      • Neurodevelopmental disorders
      • Spinal cord injuries
      • Seizure disorders
      • Neuromuscular abnormalities
Contraindications
  • See contraindications table below

ED Influenza Vaccine Contraindications

Age < 6 mos
Allergy
  • Severe life-threatening allergy to:
    • Vaccine
    • Any ingredient in the vaccine
GBS Refer children with history of GBS to discuss with their PCP
Illness Hospitalization required
COVID Current, symptomatic COVID infection

Vaccine Vouchers

  • Offer to family members > 18 yrs interested in flu vaccination
  • See charge nurse or print out from email
  • Potential future goals

 

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