Published on in Vaccine Update for Healthcare Providers
Unfortunately, it is all too easy to make a vaccine administration error. And even more unfortunately, the error is likely impossible to undo. Although some improperly administered doses may be considered valid, all such errors open the possibility of patients being unprotected against disease, losing faith in the provider, or even experiencing a serious adverse event following vaccination. You can’t simply hit the delete key to go back in time. So be careful to do the “right” thing the first time.
Make sure you know and adhere to the "7 Rights” of vaccine administration:
#1 The right patient
You don't want to administer the vaccine dose on your vaccine tray to the wrong patient! Make sure you're vaccinating the right person by verifying the patient’s name and date of birth before you administer vaccine to them. And while you're at it, make sure you've screened for contraindications and precautions for that vaccination.
#2 The right time
Sometimes vaccines are not administered according to the official U.S. immunization schedule. They are given to the wrong age patient or they're administered earlier than they should be. Be sure the patient is the appropriate age for the vaccine you plan to administer and that the appropriate interval has passed since a previous dose of the same vaccine or between two live vaccines.
#3 The right vaccine (and diluent)
Errors have occurred administering the wrong vaccine product to a patient. Check the vial label three times to be sure you have chosen the correct vaccine product (and diluent, when applicable). Check the expiration date of the vaccine (and diluent) before using to be sure they are not out of date.
#4 The right dosage
Errors have been made giving a wrong amount of vaccine to a person, such as giving a pediatric vaccine to an adult or vice versa. Vaccine dosages are usually guided by the patient’s age (and are not based on the patient's weight). Check the package insert or an appropriate guidance document (see resources below) to confirm the appropriate dose for your patient's age.
#5 The right route, needle, and technique
Errors are often made administering vaccines using the wrong route, needle, or technique. Be sure you know the appropriate route of administration (oral, intranasal, subcutaneous, intramuscular (IM), or intradermal) for the vaccine you are using. Needle selection should be based on the prescribed route, size of the individual, volume and viscosity of vaccine, and injection technique. Follow CDC guidance to confirm you are adhering to the correct route, needle, and technique.
Deviation from recommendations can reduce vaccine efficacy or increase local adverse reactions.
#6 The right injection site
Errors often happen administering vaccine into the wrong site, such as giving an IM injection subcutaneously or vice versa, or, for example, giving an IM injection below or lateral to the deltoid muscle, rather than into its thick central portion. Make sure you use the appropriate injection site for the specific vaccine you are administering.
#7 The right documentation
It's best to follow federal law and fully document each immunization in your patient’s chart. Be sure to include the vaccine manufacturer; vaccine lot number; date of vaccine administration; name, office address, and title of the healthcare provider administering the vaccine; the date printed on the VIS; and the date the VIS was given to the patient, parent or guardian. And while you're at it, make sure to give your patient an immunization record. Don't forget to submit vaccine information to the appropriate state or local immunization information system.
And finally, here are just a few of the many resources available to help you “do the right thing!”
From the Centers for Disease Control and Prevention (CDC)
- Recommended Immunization Schedules for Persons Aged 0 Through 18 Years
- Recommended Adult Immunization Schedule, United States 2014
- Vaccine Administration: Recommendations and Guidelines
- Vaccine Administration Guidance (from the Pink Book)
- Make No Mistake: Vaccine Administration, Storage, and Handling
- Recommendations and Minimum Ages and Intervals Between Doses
From the Immunization Action Coalition (IAC)
- Administering Vaccines: Dose, Route, Site, and Needle Size
- Guide to Contraindications and Precautions to Commonly Used Vaccines
- How to Administer IM and SC Injections
- How to Administer Intradermal, Intranasal, and Oral Vaccinations
- Vaccines with Diluents: How to Use Them
“Site Maps” to help your practice standardize sites of injection
Contributed by: Deborah Wexler, MD
Categories: Technically Speaking
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.