When 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.

Tool #1: Skills Checklist for Vaccine Administration

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.

Tool #2: Administering Vaccines: Dose, Route, Site, and Needle Size

Maybe you are unsure of:

  • The volume of hepatitis A vaccine to give to an 18-year-old (0.5 mL) versus a 19-year-old (1.0 mL)
  • The needle angle for a subcutaneous vaccination (45 degrees)
  • The recommended needle length for a 19-year-old female who weighs more than 200 lbs (1.5 inches)

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.

Tool #3: How to Administer Intramuscular and Subcutaneous Vaccine Injections

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.

Tool #4: Ask the Experts — Administering Vaccines

In addition to answering common and difficult general questions about vaccine administration, this webpage addresses vaccine administration errors, such as what to do if:

  • An injection was given by the wrong route (subcutaneous instead of IM).
  • A dose of expired vaccine was administered.
  • Both the pneumococcal conjugate (PCV) and pneumococcal polysaccharide (PPSV) vaccines were given at the same visit.

The vaccine champion at each practice will stay a step ahead by knowing the answers to these questions.

Tool #5: Don’t Be Guilty of These Preventable Errors in Vaccine Administration!

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.