Managing Acute Vaccine Reactions and Strategies to Prevent Administration Errors
Severe, life-threatening anaphylactic reactions following vaccination are rare. Thorough screening for contraindications and precautions prior to vaccination can often prevent reactions. Staff must have in place and be familiar with procedures for managing a reaction. Staff should be familiar with the signs and symptoms of anaphylaxis because they usually begin within minutes of vaccination.
These signs and symptoms can include, but are not limited to: flushing, facial edema, urticaria, itching, swelling of the mouth or throat, wheezing, and difficulty breathing. Each staff member should know their role in the event of an emergency and all vaccination providers should be certified in cardiopulmonary resuscitation (CPR).
Epinephrine and equipment for maintaining an airway should be available for immediate use. After the patient is stabilized, arrangements should be made for immediate transfer to an emergency facility for additional evaluation and treatment
Documentation
All vaccines administered should be fully documented in the patient’s permanent medical record. Healthcare providers who administer vaccines covered by the National Childhood Vaccine Injury Act are required to ensure that the permanent medical record of the recipient indicates:
Date of administration
Vaccine manufacturer
Vaccine lot number
Name and title of the person who administered the vaccine and the address of the facility where the permanent record will reside
Vaccine information statement (VIS) date printed on the VIS date VIS given to patient or parent/guardian
Best practice documentation guidelines for medications also include the vaccine type. The ACIP U.S. Vaccine Abbreviations list can be found a http://www.cdc.gov vaccines/acip/committee/guidance/vac-abbrev.html ), route, dosage (volume), and site. Accurate documentation can help prevent administration errors and curtail the number and costs of excess vaccine doses administered.
Providers also should update patients’ permanent medical records to reflect any documented episodes of adverse events after vaccination and any serologic test results related to vaccine-preventable diseases (e.g., those for rubella screening and antibody to hepatitis B surface antigen). Participation in immunization information systems is encouraged.
Additional documentation resources are located at http://www. immunize.org/handouts/document-vaccines.asp. The patient or parent/guardian should be provided with an immunization record that includes the vaccines administered, including the dates of administration.
Although there is no national law, it is also important to document when parents or adult patients refuse vaccine despite the immunization providers’ recommendation. Many professional organizations such as the American Academy of Pediatrics Immunization information systems (IIS) or registries are confidential, population-based, computerized databases in which immunization doses administered by participating providers to persons residing within a given geopolitical area can be documented. All immunization providers are encouraged to participate and document administered vaccines in an IIS. For additional information regarding Immunization Information Systems, see http://www.cdc. gov/vaccines/programs/iis/index.html.
Some states’ IIS are able to utilize barcoding technology. Implementation of a 2D barcode on vaccine vials and VISs will allow for rapid, accurate, and automatic capture of certain data, including vaccine product identifier, lot number, and expiration date, and VIS edition date using a handheld imaging device, or scanner, which could populate these fields in an electronic health record (EHR) and/or an IIS. For additional information on barcoding and vaccines, see http://www.cdc.gov/vaccines/programs/iis/2d-vaccine-barcodes/index.html.
Strategies to Prevent Administration Errors
Vaccine administration errors can result in a patient receiving an ineffective immunization. This can leave the person vulnerable to infection. Vaccine administration errors may also diminish patient confidence in their healthcare providers. Common vaccine administration errors include:
Doses administered too early (before the minimum age or interval has been met)
Wrong vaccine (e.g., Tdap instead of DTaP)
Wrong dosage (e.g., pediatric formulation of hepatitis B vaccine administered to an adult)
Wrong route
Vaccine administered outside the approved age range
Expired vaccine or diluent administered
Vaccine which was not stored properly administered
Vaccine administered to a patient with a contraindication for that vaccine
Wrong diluent used to reconstitute the vaccine or only the diluent was administered
In addition to strict adherence to the “Rights of Medication Administration” and ongoing training and education of staff, there are other strategies that can be implemented to help prevent administration errors.
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