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Technically Speaking
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November 2014
Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children's Hospital of Philadelphia Vaccine Education Center’s (VEC's) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
TECHNICALLY SPEAKING
Know the "7 Rights" of Vaccine Administration
Published November 2014
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 patientís 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 patientís 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
Site Map for Infants and Toddlers (California Department of Public Health, Immunization Branch)
Site Map for Adolescents (Philadelphia Department of Public Health)
Site Map for Adults (California Department of Public Health, Immunization Branch)
2014 ISSUES >> view all
DECEMBER 2014
Use this Handy Checklist to Help Improve your Practiceís Vaccination Rates
NOVEMBER 2014
Know the "7 Rights"Ē of Vaccine Administration
OCTOBER 2014
CDC Issues New Pneumococcal Vaccine Recommendations for Adults Age 65 Years and Older
SEPTEMBER 2014
What's New in the 2014–15 CDC Influenza Vaccine Recommendations
AUGUST 2014
Make Sure You Choose the Proper Needle Length When Vaccinating Your Patients
JULY 2014
Protect Your Significant Investment in Vaccines So That They Can Protect Your Patients
JUNE 2014
Immunization Action Coalition Launches “Question of the Week” in its Free Weekly Newsletter
MAY 2014
Use These Resources to Help you Avoid Vaccine Administration Errors in Your Practice
APRIL 2014
Resources to Help Assure Competency of Clinic Staff Administering Vaccines
MARCH 2014
Simple Tips to Expedite Vaccination in Your Practice
FEBRUARY 2014
Newly Updated! CDCís 2014 Immunization Schedules and IACís Easy-to-Use Summaries
JANUARY 2014
A Strong Provider Recommendation Matters. Donít Just "Offer" HPV Vaccine to Parents for Preteens. Recommend It!
 
This page was reviewed on January 7, 2015
 
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.