ce CONTINUING EDUCATION Table 1: Steps for Proper Intramuscular Vaccination Step Action
TECHN I QUE Proper vaccine injection technique must focus on the safety of both the patient and the person administering the vaccine. The 23 steps to completing a proper intra-muscular injec- tion are listed in Table 1. For example, steps to ensure the safety of vaccinating personnel include cleaning hands, don- ning gloves, positioning the sharps container, and positioning the patient. Other steps ensure the safety of a patient; those steps will be discussed in the section on patient safety. Finally, additional steps assure that the mandatory record-keeping is in order. Skipping any step can place a pharmacy techni- cian or a patient in an unsafe situation and can jeopardize the facility where vaccines are being provided. Each of the steps to safety is interlinked and should be carefully followed As with many skills, a pharmacy technician’s technique will improve over time. A pharmacy technician must be accurate and safe from the very first vaccination, but improvements in workflow will naturally occur with experience. A technician may find a smoother way to complete paperwork or a better way to incorporate the verification of vaccination history into the patient interview process. The key elements of pharmacy tech- nician and patient safety, however, must be present at all times. PATIENT POSITIONING Patient positioning is a patient safety issue, but it is also a safety issue for the person administering the vaccine. While fainting during a vaccination is rare, a patient who faints while standing will fall quickly. Although a professional’s temptation is to catch the falling patient, this can injure the professional and may not help the patient. Therefore, patients must be seated or lying down when vaccines are injected, for their own safety and the administrator’s safety, as well. Finally, a pharmacy technician refines mechanics based on practice. Consistent positioning of the patient will allow for consistent mechanics, increasing safety for the administering pharmacy technician and for the patient.
1
Ask, “May I have your name?” (Correct patient)
2 Ask, “What vaccine are you receiving today?” (Right drug)
3 Ask, “Did you receive the VIS for this vaccine?”
4 Check the answers to the screening questions (Correct drug)
5 Set up sharps container
6 Verify you have a source of epinephrine readily available
7
Position patient – sitting or lying down
8 Wash hands or use hand sanitizer
9 Don gloves
10 Visualize target (Correct route)
11
Clean injection site with alcohol, allow to air dry
12 Measure 3 finger-widths from acromion (Correct route)
13 Apply injection safety patch, if available
14 Check syringe for proper vaccine and bubbles (Correct dose)
15 Ask, “Are there are any remaining questions?”
16 Position yourself to inject
17 Remove the needle cover and throw in garbage
18 Complete the injection
19 Activate safety device
20 Go straight to sharps
21
Properly doff gloves
22 Wash hands or use hand sanitizer
23 Complete paperwork
P A T I E N T S A F E T Y
should have access to vaccine schedules to review for patient safety, as well as to recommend the timing of the requested vaccine and other vaccines that may have been overlooked. SCREENING QUESTIONS Carefully screening patients before a vaccination is the best way to prevent vaccine-related adverse events. Screening questions identify previous vaccine reactions. They provide the patient’s age to screen for dosing the correct vaccine based on age. Screening questions identify existing conditions that may put the patient at risk, including allergies, current medica- tions, immune status, and pregnancy. Well-written screening questions are vaccine specific. For example, they include a number of questions that are asked before providing a live-at- tenuated vaccine such as Measles, Mumps, Rubella, and
VACCINE SCHEDULES The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) publish recommendations for vaccinations based on age and existing diseases or conditions. This information is pre- sented in vaccine schedules. Schedules exist for childhood vaccinations, adolescent vaccinations, adult vaccinations, and vaccinations necessary for certain medical conditions. The schedules also list precautions and contraindications to vaccinating and help guide members of a health care team in advising patients on which vaccines should be administered to protect their health and the health of the community. They also guide health care providers regarding which patients should not receive vaccines. All facilities administering vaccines
CPhT CONNECT www.pharmacy technician.org
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