Purpose
To reduce morbidity and mortality from tetanus, diphtheria, and (where indicated) pertussis by vaccinating
all adults who meet the criteria established by the Centers for Disease Control and Prevention's Advisory Committee
on Immunization Practices.
Policy
Under these standing orders, eligible nurses may vaccinate adults who meet the criteria below.
Procedure
| 1.
|
Identify
adults in need of vaccination against tetanus, diphtheria, and
(where indicated) pertussis based on the following criteria: |
| |
-
lack of documentation of at least 3 doses of tetanus- and diphtheria-containing toxoids
- younger than age 65 years with
no history of pertussis-containing vaccine given since age 10
years
- completion of a 3-dose primary series of tetanus- and diphtheria-containing toxoids with receipt of the last dose being
10 years ago or longer
- recent deep and dirty wound (e.g., contaminated with dirt, feces, saliva) and lack of evidence of having received tetanus toxoid-containing vaccine in the previous 5 years
|
| 2.
|
Screen
all patients for contraindications and precautions to tetanus and
diphtheria toxoids (Td) and, if applicable, pertussis
vaccine (Tdap): |
| |
- Contraindications:
- Precautions:
|
|
3.
|
Provide all patients with a copy of the
most current federal Vaccine Information Statement (VIS). You must document, in
the patient's medical record or office log, the publication date of the VIS and the date it was given to the patient. Provide
non-English speaking patients with a copy of the VIS in their native language, if available; these can be found at
www.immunize.org/vis
|
| 4.
|
Administer 0.5 mL Td (or Tdap, if appropriate) vaccine intramuscularly (22–25g, 1–1½" needle) in the deltoid muscle.
|
| 5.
|
Provide subsequent doses of Td (a one-time dose of Tdap may be substituted for Td if younger than 65 years) to adults as follows: |
| |
- to complete the primary 3-dose schedule: observe a minimum interval of 4 weeks between the first and second doses, and
6 months between the second and third doses.
- to boost after primary schedule is complete: observe a 10-year interval since previous dose of Td/Tdap; if protection against
pertussis is needed, an interval of 5 years is recommended and intervals as shorts as 2 years or less can be observed for
parents and caregivers of infants younger than age 12 months, healthcare workers having direct patient contact, and adults
in a pertussis outbreak setting.
- In pregnancy, when indicated, give Td or Tdap in 2nd or
3rd trimester. If not administered during pregnancy, give
Tdap in immediate postpartum period.
|
| 6.
|
Document each patient's vaccine administration information and
follow up in the following places: |
| |
- Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site
and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reason(s) for
non-receipt of the vaccine (e.g., medical contraindication, patient refusal).
- Personal immunization record
card: Record the date of vaccination and the name/location of the administering clinic.
|
| 7.
|
Be
prepared for management of a medical emergency related to
the administration of vaccine by having a written emergency
medical protocol available, as well as equipment and
medications.
|
| 8. |
Report all adverse reactions to Td and Tdap vaccines to the federal Vaccine Adverse Event Reporting System (VAERS) at
www.vaers.hhs.gov or (800) 822-7967. VAERS report forms are available at
www.vaers.hhs.gov |
This policy and procedure shall remain in effect for all patients of the___________________
(name of practice or clinic) until rescinded or
until __________________ (date). Medical
Director's signature: _______________________________ Effective date:
______________
Item #P3078 (9/06)
www.immunize.org/catg.d/p3078.pdf |
1573
Selby Avenue