injections II

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

1. when removing from fridge

2. when preparing product for administration

3. 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