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why is it important to properly store and handle vaccines
many vaccines contain biologic material- these agents experience a gradual loss of potency over time, which can be accelerated by various handling, storage and transportation conditions
exposure to adverse conditions (ex: extremes of temperature such as heat and freezing, exposure to light), are cumulative
loss of potency may lead to an inadequate immune response, resulting in lower levels of protection against and possible recurrence or re emergence of the disease
refrigerator requirements
must maintain required internal temp regardless of exterior temp
must be exclusively used for storage of pharmaceutical products
must be located in the dispensary or a secure area (away from public access)
must be monitored either with a continuous temperature monitor or a min/max thermometer that can be read from outside of the unit
cold chain requirements
refrigerated products must be kept between 2-8 celsius
frozen products should be kept at -15 or lower
what kind of baskets must vaccines be stored in
breathable mesh baskets, clearly labeled (do not use solid plastic trays or containers)
how often must temperature of fridge be checked and logged
twice a day
where should you not place vaccines in the fridge
in the drawers or on the floor
how to maintain cold chain when doing home delivery/off site use
use an insulated and temperature monitored container
do not transport in the car trunk
keep out of direct sunlight and direct contact with care heater/air conditioning units
how to manage a break in the cold chain
place all affected vaccine together and quarantine them within a functional storage unit or cooler, labeling them with a “quarantine” sign and the date in which the break in the cold chain occured
investigate the break in the cold chain
document the event
for direction on how to proceed go to public health or vaccine manufacturer/supplier
how to prevent med incidents
separate products into storage bins according to vaccine type and formulation
store products with similar packaging or names on different shelves
routine inventory checks
frequent rotation- first in first out
affix labels to bins drawing attention to specific ages
separate/segregate storage areas for pediatric and adult formulations
setting requirements
ensure the environment is clean, safe, private and comfortable
provide a waiting/monitoring area for patients
have all supplies and materials needed for the injection readily available
minimize pt anxiety by providing:
a well ventilated area at room temp
a welcoming and professional environment
short wait times
injection prep out of view
NLPB standards of practice setting requirements
private area (visually and acoustically)
clean, safe and comfortably furnished
space for post admin observation- equipped with emergency support materials
list the 5 P’s for reducing pain and anxiety
procedural
physical
pharmacological
psychological
process
procedural ways to reduce pain and anxiety
minimize waiting time
inject with no aspiration
if multiple inj- give most painful last
physical ways to reduce pain and anxiety
sit upright or hold in a hug position
tactile stimulation (Buzzy)
process ways to reduce pain and anxiety
education of clinicians, adults, and caregivers on appropriate pain management
provide info on what will happen and how it will feel
psychological ways to reduce pain and anxiety
distraction
pharmacological ways to reduce pain and anxiety
topical anesthetic (lidocaine, prilocaine) apply 30-60min prior to injection
avoid analgesics or ice before i
patient assessment questions
physical characteristics/measurements (age, weight)
allergies/intolerances
pregnancy/breast feeding
current list of meds (including OTCs)
overall health
comorbidities
receipt of blood transfusion/blood products
immunization status
past rxns to injections/vaccines
does the patient have an indication for the med to be injected?
does the patient have any precautions or CI to the drug product?
are there any other individual circumstances that need to be taken into consideration (practical needs, values, beliefs, anxiety, stress?)
can people with egg allergies get immunized
an egg allergy is not a CI or precaution to influenza, measles-mumps rubella (MMR), measles-mumps-rubella-varicella (MMRV), or Imvamune smallpox vaccination
can you get vaccinated with a mild acute illness
yes- does not increase the risk of AE following vaccination or interfere with immune response
can you get vaccinated with a moderate to severe acute illness
benefits and risks must be assessed- check canadian immunization guide for specific CI/precautions
which types of vaccines can and can’t you get in pregnancy
inactivated vaccines are safe
most live vaccines CI/not recommended
standard for giving immunizations to those with anticoagulation and coagulation disorders
no CI, not necessary to hold, optimize control of bleeding disorders prior to vaccination
consider using a smaller needle diameter
apply direct pressure over the site for >/=2min
standards regarding immunization in immunocompromised pts
immunize at a time when max immune response is expected
immunize prior to any planned immunosuppression (if possible)
vaccinate family members and other close contacts
monitor serologic response
avoid live vaccines in severely immunocomprimised patients, may be considered in pts with milder degree of immunosuppresion
standards regarding immunization in elderly patients
may have muscle atrophy and require shorter and smaller gauge needles for IM injection
less muscle mass may result in increased pain
landmarking may be more difficult
skin is more fragile and less elastic
requirements for informed consent to be considered valid
must be given by an individual with authority to provide consent - directly from the patient unless it is considered appropriate and in the patient’s best interests to communicate with the patients agent on their behalf
must be informed
must be voluntary and genuine
individual must also have the capacity to understand the info provided to them and distinguish between consent and refusal
individual must be given the oppurtunity to ask questions
what information must the pharmacist provide to the patient to allow them to make an informed decision regarding the administration
the drug therapy being administered
purpose, expected benefits, and risks of the drug therapy
the expected reaction/response and related time frame
common and rare side effects
rationale for the required observation period following the inhalation or injection
any other monitoring or follow up
details of planned communications
the 5 rights of product administration
right patient
right product
right time
right dose
right route
what to verify for “right patient”
verify patient identity, medical conditions, allergies, immunization record, etc
how to verify for “right product”
the label and name of product should be checked and verified three times
when removing from fridge
when preparing product for administration
just prior to administration
how to verify for “right time”
confirm pts are receiving at the correct time based on vaccine schedule and at the correct interval
how to verify for “right dose”
consult resources such as the provincial immunization schedule and product monograph
how to verify for “right route”
including the correct injection site (if applicable, and the correct technique, needle length, and needle gauge
