Technically Speaking: Do You Use These 5 Vaccine Administration Tools?
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Vaccine Update for Healthcare ProvidersPublished on
Vaccine Update for Healthcare ProvidersWhen I was a pediatric resident, I received a little training on vaccine administration. I believe that someone had to observe me deliver one intramuscular (IM) vaccine and one subcutaneous vaccine using proper technique. The training was minimal because vaccine administration was, and remains, primarily a function of the nursing and other clinically trained staff. Nonetheless, vaccine administration is a key component of quality vaccine delivery. For this reason, even if you do not administer vaccines yourself, you need to know how to assess the appropriateness of the vaccine administration procedures in your practice. This month, I want to introduce you to (or remind you of) a few tools from Immunize.org designed to help your team deliver vaccines safely and effectively.
Periodic assessment of vaccine administration skills is of value, especially if there has been a lot of turnover among the nursing and other clinically trained staff. Keeping current is also important because vaccine administration recommendations change. For example, recently, the U.S. Food and Drug Administration approved IM administration for three of Merck's vaccines as an alternative to subcutaneous administration. These included measles, mumps, rubella vaccine (MMR, brand name M-M-R®II), varicella (Varivax®), and MMRV (ProQuad®). GSK’s MMR (Priorix™) remains approved for subcutaneous administration only.
The Skills Checklist for Vaccine Administration is not a stand-alone document; the person checking the skills needs to “know the answers.” For example, one of the skills is to select the correct needle size for IM and subcutaneous vaccinations based on various patient factors. For this, tool #2 comes in handy.
Maybe you are unsure of:
Immunize.org offers this resource to help answer these questions, along with a second, related, print-ready document specific to administering vaccines to adults, Administering Vaccines to Adults: Dose, Route, Site, and Needle Size. Both resources can be used for some quick scenario-based teaching during a huddle or in service.
Immunize.org also offers documents that show how to administer vaccines. In addition to the one above, a second version, How to Administer Intramuscular and Subcutaneous Vaccine Injections to Adults, is specific for administering adult vaccines. One useful aspect of these resources is that they group vaccines into categories of IM only, IM or subcutaneous, subcutaneous only, and subcutaneous or intradermal routes.
In addition to answering common and difficult general questions about vaccine administration, this webpage addresses vaccine administration errors, such as what to do if:
The vaccine champion at each practice will stay a step ahead by knowing the answers to these questions.
Everything that can go wrong has gone wrong at some time. This four-page downloadable resource highlights vaccination errors that have been reported (e.g., using the wrong diluent or administering the diluent only). For each error, tips are offered on how to avoid making this error, what to do if you discover that the error has been made, and where to find helpful resources. A section also provides information on two places to report vaccination errors: the Institute for Safe Medication Practices (ISMP) and the Vaccine Adverse Events Reporting System (VAERS). The benefit of reporting vaccination errors is that others can learn from the error and change procedures or packaging in a way that will make it more difficult for others to make the same error.
This week is National Infant Immunization Week, an annual observance that highlights the importance of protecting children 2 years and younger from vaccine-preventable diseases. However, in practice, every week should be immunization week, so set aside time to take a close look at the vaccination practices in your office. This will help you ensure that the right patient receives the right dose of the right vaccine at the right time via the right route — every time.
Contributed by: Sharon G. Humiston, MD, MPH, FAAP
Categories: Vaccine Update April 2023, Technically Speaking