NORTHEAST HOSPITAL CORPORATION

Transcription

1 NORTHEAST HOSPITAL CORPORATION Title: Influenza and Pneumococcal Immunization Date Effective: 11/04 Date Revised: 7/08, 2/6/12, 3/15/13; 9/13/13 Date Reviewed: Joint Commission Chapter: Provision of Care, Treatment and Services I. Purpose or Intent Recognizing the major impact and mortality of both influenza and pneumococcal disease on inpatients and the effectiveness of vaccines for reducing health care costs and in preventing illness, hospitalization, and death, Northeast Hospitals has adopted the following vaccination policy. II. Policy or General Principles A. The Standing Order for Pneumococcal and Influenza serves as a standing physician order and is ordered using a communication to nursing to screen patient for vaccine eligibility. B. All inpatients admitted to our facilities will be screened to determine if they meet the indications C. All inpatients who meet the indications and do not have any contraindications will be given influenza and pneumococcal vaccine D. These vaccines may be administered by any appropriately qualified hospital personnel without the need for an individual physician order for the vaccine E. Beginning each October and going through February, any patient admitted to our facilities will be offered the influenza vaccine, unless there is documentation or verbal acknowledgment by patient of previous immunization for that season or the patient has a documented contraindication, or patient refuses F. Pneumococcal immunization status of all patients will be determined on admission regardless of the time of year 1. Vaccination will be offered to all patients who cannot provide documentation or verbal acknowledgement of previous vaccination status 2. Those patients who are unsure of or do not know their vaccination status will be immunized G. The first pneumococcal immunization is, by far, the most important. CDC's current recommendations for the second immunization are 1. If given before age 65, and patient is now 65, give after a 5 or more year interval 2. If first dose given after age 65, no need to repeat. III. Definition(s) N/A

2 IV. Applies to RN V. This policy and procedure stands alone VI. Procedure A. Every patient admitted to inpatient/observation services will be asked by the nurse about immunization status (influenza, pneumococcal). This history is documented in Immunization History, found on the Process Intervention screen. B. The nurse will identify patient's eligibility for vaccination based on defined criteria at the time. Concerns by the nurse on patient's eligibility should consult with the attending physician. C. Based on eligibility for the vaccinations, an automatic physician order will print in the pharmacy at the end of the screening process if the patient is found to be eligible to receive the vaccine this admission. Order will be entered onto emar at the pharmacy. 1. If using the paper process, the order is faxed to the pharmacy; a one-time order is placed on the patient's MAR in utilizing the preprinted vaccine stickers. D. Vaccination will be obtained from the Pyxis machine. E. Nurse will administer the appropriate immunization. F. The patient will receive the vaccine information fact sheet by RN. If the patient is less than 18 years of age, parental or guardian consent will be obtained. G. Documentation of the vaccine administration will be completed in emar or MAR. H. Patient's immunization status will be identified by the RN on the discharge instruction sheet I. Pneumococcal Vaccine 1. Indications a. All persons 65 years of age or older not current on adult immunizations b. Persons aged 6 years to 64 years of age with high risk conditions i. Cardiovascular disease ii. Chronic pulmonary disease (excluding asthma) iii. Diabetes iv. Alcoholism or chronic liver disease v. Cerebrospinal fluid leaks vi. Sickle cell disease

3 vii. Cochlear implant viii. HIV ix. Nephrotic syndrome x. End stage renal disease 2. Contraindications a. Previous anaphylactic reaction to vaccine b. Pregnancy c. Hypersensitivity to Thimerosal d. > 10.2cm local reaction at injection site e. Received shingles vaccine within last 4 weeks f. Bone marrow transplant within the last 12 months g. Received chemotherapy or radiation < 2 weeks prior to admission h. Received a conjugate vaccine within previous 8 weeks 3. Administration of pneumococcal polyvalent vaccine for adults Adult Needle Injection Site 5/ Male or female < Deltoid 25 gauge 130 lbs (< 60 kg) 5/ SC Female lbs (60-90 kg) Male lbs ( /2 Deltoid 118 kg) Female > 200 lbs (>90 kg) Male > 260 lbs (> 118 kg) 4. Guidelines for pediatric administration of pneumococcal vaccine. Refer to product package insert for dose information. Age Vaccination History Recommended PCV13 Regimen1 Needle and Injection Site 0 doses 3 doses, 8 weeks apart; fourth dose at age mos. 2-6 Mos. 1 dose 2 doses 2 doses, 8 weeks apart; fourth dose at age mos. 1 dose, 8 weeks apart; fourth dose at age mos gauge Length appropriate to age and body mass, anterolateral thigh muscle 7-11 Mos. 0 doses 2 doses, 8 weeks apart; third dose at age

4 1 or 2 doses before age 7 mos. 0 doses 1 dose before age 12 mos mos 1 dose at age 7-11 mos, with a second dose at mos. (> 8 weeks later) 2 doses, >8 weeks apart 2 doses, >8 weeks apart gauge 1 1y anterolateral thigh muscle 5/8 1 deltoid muscle Mos Mos Mos. >72 Mos. 1 dose at >12 1 dose, >8 weeks after the most mos. recent dose 2 2 or 3 doses before age 12 mos. 4 doses of PCV7 or other ageappropriate complete PCV7 schedule Healthy children, any incomplete schedule 4 doses of PCV7 or other ageappropriate complete PCV7 schedule Children at high risk 3 Any incomplete schedule of <2 doses Any incomplete schedule of 3 doses 4 doses of PCV7 or other ageappropriate PCV7 schedule 1 dose, >8 weeks after the most recent dose 2 1 supplemental dose, >8 weeks after the most recent dose* 1 dose, >8 weeks after the most recent dose 2 1 supplemental dose, >8 weeks after the most recent dose* 2 doses, one >8 weeks after the most recent dose and another dose >8 weeks later 1 dose, >8 weeks after the most recent dose 1 supplemental dose, >8 weeks after the most recent dose* gauge 1 1y anterolateral thigh muscle 5/8 1 deltoid muscle 5/8 may be used in deltoid < 130 lbs 1 1 1/2 >130 lbs

5 Footnotes: 1) Minimum interval between doses is 8 weeks except for children vaccinated at age <1 year, for whom minimum interval between doses is 4 weeks 2) No additional PCV13 doses are indicated for children 12 through 23 months of age who have received 2 or 3 doses of PCV7 before age 12 months and at least 1 dose of PCV13 at age 12 months or older 3) For children with underlying medical conditions, PCV13 is indicated through 71 months of age 4) For injection in the deltoid muscle, skin must be stretched tight, subcutaneous tissue is not bunched and the injection is made at a 90º angle * A single supplemental dose of PCV13 given at least 8 weeks after the dose of PCV7 is recommended for all children 14 through 59 months of age who have received 4 doses of PCV7 or other age-appropriate, complete PCV7 schedule (fully vaccinated with PCV7). For children who have underlying medical conditions, a supplemental dose is recommended through 71 months of age. Children 6 through 18 years of age: a single dose of PCV13 may be administered for children 6 through 18 years of age who are not increased risk for invasive pneumococcal disease because of anatomic or functional asplenia, including sickle cell disease, HIV-infection or other immunocompromising condition, cochlear implant, or cerebrospinal fluid leak, regardless of whether they have previously received PCV7 or PPSV23. J. Influenza Virus Vaccine 1. Indications a. All patients aged 6 35 months receive 0.25 ml intramuscular b. All patients aged 36 months 18 years, aged 65 or greater, or who are pregnant and breastfeeding receive 0.5 ml intramuscular c. All patients aged years receive 0.1 ml intradermal microinjection 2. Contraindications a. Previously vaccinated influenza this immunization season b. Allergic to eggs, thimerosal (contact lens solution) merthiolate, latex. Egg allergy should be a systemic reaction and/or anaphalaxis; Flu Block can be available if egg allergic c. Prior severe reaction to influenza vaccine d. History of Guillain-Barre Syndrome

6 3. Guidelines: shake IM vial well before withdrawing each dose. Adults Aged >65, or Pregnant or Breastfeeding Needle Length Injection Site Male and female < 130 lbs (< 60 kg) 1 Deltoid Female lbs (60-90 kg) 1 1 1/2 Deltoid Male lbs ( kg) Female > 200 lbs (>90 kg) Male > 260 lbs (> 118 kg) Dosage 0.5mL IM Deltoid Adults Aged <65, Not Pregnant or Breastfeeding 0.1mL Intradermal microinjection Deltoid Pediatric Infants (6-12 months) Toddlers (12 months 35 months) Children (3-18 y/o ) Needle Length Injection Site 1 Anterolateral thigh 1 11/4 Anterolateral thigh (preferred) 5/8 1 Deltoid 5/8 * 1 Deltoid (preferred) 1 11/4 Anterolateral thigh * A 5/8 needle may be used only if the skin is stretched tight, the subcutaneous tissue is not bunched, and the injection is made at a 90- degree angle. Pediatric Dosage Age Group Dose No. of Doses 6 35 months 0.25 ml 1 or years 0.5 ml 1 or 21 > 9 years 0.5 ml 1

7 VII. VIII. IX. Documentation Documentation of the vaccine administration will be completed in emar or MAR (one time order section) expiration date, lot number, site of injection and Vaccine Information Sheet (VIS) given to patient. Orientation / Training Unit-based orientation. Monitoring Infection Control Committee and Pneumonia Team X. References CDC Guidelines 2011 XI. Storage, Retention and Destruction A. All policies are able to be retrieved upon request. Policies are stored in MCN Policy Manager and in paper format. B. This policy will be reviewed at least every three years C. Previous versions of this policy are archived in MCN Policy Manager. Policies in paper format are retained for 7 years, or 9 years if related to obstetric and newborn care.