CPhT CONNECT™ Magazine - Jan/Feb 2021


vaccine administration: ASSURING SAFETY

Varicella that are not asked when providing an inactive vac- cine. When screening for the tetanus, diphtheria, and pertussis vaccine, it is common to ask which hand the patient writes with; this question is not routinely asked with other vaccines. A pharmacy technician has multiple roles in patient screen- ing to assure that the patient receives the Vaccine Information Statement (VIS) before completing the screening questions.18 VISs are vaccine specific. The pharmacy technician must ensure that the correct VIS has been provided to the patient or the caregiver and that the screening questions asked are matched to the correct vaccine. Before administering a vac- cine, the pharmacy technician should review the screening questions and confirm any concerns or unexpected answers with the pharmacist before injecting the patient. Copies of the patient’s answers to the screening questions should be maintained in the patient’s medical record at the pharmacy. EPINEPHRINE On rare occasions, patients can have a severe allergic reaction to a vaccine. These reactions are often not predictable but put the patient at immediate risk. In order to protect against death or severe injury from a vaccine reaction, epinephrine must be immediately available at all times when vaccines are being administered. The pharmacy technician administering vac- cines must also be trained to administer epinephrine if required. Training in basic cardio-pulmonary resuscitation (CPR) is also recommended and is required in some jurisdictions. All mem- bers of a health care team need to have the ability to save lives if the service they are providing can cause a serious reac- tion. If epinephrine is not immediately available, or if there is uncertainty concerning the administration of epinephrine, the pharmacy technician should refuse to administer the vaccine. A severe allergic reaction to a vaccine will be an emergency, but it does not need to become a crisis. Careful planning on the part of the facility can mitigate much of the risk. An emergency plan should be developed and practiced prior to administering any vaccine. Assure that every member of the health care team providing vaccines knows their role in managing an emergency. It is the duty of the person administering the vaccine to guarantee that epinephrine is immediately available. A process should be in place to immedi- ately notify the pharmacist that an allergic reaction is suspected. The steps for notifying emergency medical services (EMS) and calling an ambulance should be outlined with every team member understanding who will make the call, what information needs to be provided to EMS, and where that information can be quickly located. Who will stay with the patient until EMS can arrive? Who will keep curious on-look- ers away from the emergency setting? Who will guide EMS to the patient’s location? Each of these decisions MUST be made and practiced in advance of giving the first vaccine. The use of an epinephrine autoinjector device is the only excep- tion to the rule that all sharps should immediately be placed into a sharps container. The activated autoinjector should be placed beside the patient for presentation to EMS upon arrival. If there is a delay in the arrival of EMS and multiple doses of epinephrine are used, this will help in remembering how many doses were administered. It will also provide the EMS personnel with the lot number and expiration date of all

SIRVA SIRVA, an acronym for Shoulder Injury Related to Vaccine Administration, is the most common preventable technique error in the administration of vaccines. Errors in selecting or reconstituting a vaccine are not considered to be technique errors. The injury occurs when a vaccine is injected too high on the deltoid and the shoulder joint is damaged. Proper land- marking will help avoid the shoulder joint and long-term injury to the patient. The techniques for landmarking are simple but only prevent injury if used for every injection. Locate the acromion at the top of the shoulder and mea- sure down three finger-widths to locate the top of the target zone for the injection. After cleaning the skin over the deltoid muscle, the measurement should be repeated to assure the injection will avoid the shoulder joint. Landmarking must be conducted for each injection. Even with a large arm, it is improper to estimate the target by sight. An injec- tion protection patch, applied to the arm and injected through, can help clearly define the target for the injection. To use these patches, clean the arm as normal using an expanding concen- tric circular motion. After allowing the skin to air dry (never fan the skin to increase drying speed), measure from the acromion and apply the injection protection patch, being careful not to touch the surface of the patch where the needle will be injected. The patch then clearly defines the injection site. Additionally, the patch will retain any blood from the injection, thus serv- ing as additional protection for the vaccinator. The vaccinator must still wear gloves while using an injection protection patch. The entire target area must be visualized. If the admin- istrator is unable to see the target area because of a sleeve, the garment should be removed. Do not push a sleeve up so that it becomes as tight as a tourni- quet. Do not allow the patient to tug on the neck of a garment in an attempt to pull it down to expose the shoulder. Often, these attempts to access the upper del- toid via the neck of a garment results in SIRVA. Consideration should be given to protecting patient dig- nity for those circumstances where partial disrobing will be required to visualize the entire target area. Patient safety and accurate vaccine placement are the phar- macy technician’s primary concern; do not allow patient reluctance to bare the entire deltoid cause poor technique. ISMP Report A report on vaccination errors from the Institute for Safe Medication Practices (ISMP) highlights errors reported regarding vaccine administration. Most of the errors in the November 2020 report focused on wrong prod- uct, wrong diluent, or wrong patient (based on age). A review of the Patient’s 5 Rights is appropriate based on this information. There are 5 components of vaccine administration that must be correct. “The 5Rights,” or the five com- ponents of vaccine administration that must be correct, include: epinephrine used. The pharmacy technician can be helpful not only in administering the epinephrine but in documenting the use. What time was the epinephrine administered? Which muscle was it injected into? How did the patient respond?

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