Immunization Competencies Education Program

Size: px
Start display at page:

Download "Immunization Competencies Education Program"

Transcription

1 Immunizatin Cmpetencies Educatin Prgram Adapted by: Michael Bivin, B Pharm Susan Bwles, BSc Phm, PharmD, MSc Danielle Grenier, MD, FRCPC Ian Gemmill, MD, CCFP, FCFP, FRCPC Alex Henteleff, BN, Med Expert vide cmmentary by: Uptn Allen, MD, FRCPC, MBBS, FAAP Maryanne Crckett, MD, MPH Andrea Derban, BScN Simn Dbsn, MD Janne Embree, MD Ian Gemmill, MD, CCFP, FCFP, FRCPC Carl McCnnery, MD Shelly McNeil, MD Carline Quach, MD, FRCPC, MSc David Scheifele, MD Accreditatin: This versin f the prgram is unaccredited and intended fr infrmatinal purpses nly. An accredited versin is available nline at until July 31, Spnsr: This prgram is develped in cllabratin with the Canadian Paediatric Sciety, the Public Health Agency f Canada and Health Canada.

2 Cntents Learning Objectives... 3 Test Yur Current Knwledge... 3 Immunizing yur Patients... 4 Pre-Immunizatin Cunselling Eligibility fr immunizatin Cunsel the patient regarding the fact that immunizatin is nt mandatry Discuss the benefits f immunizatin Discuss the risk f nt getting vaccinated Assess fr true cntraindicatins t immunizatin Discuss cmmn adverse effects and any serius effects Cnfirm understanding f the infrmatin and prvide an pprtunity fr Questins Cnfirm Cnsent Vaccine Preparatin Vaccine Inspectin Adding the Diluent Drawing up Bilgical Prducts in Vial Presentatin Drawing up Bilgical Prducts in Ampule Presentatin Prelading Vaccines Injecting the Vaccine Selecting the Right Syringe and Needle Selecting the Site fr Administratin Multiple Injectins Techniques t help with the immunizatin Cmmunicating the Immunizatin Prcess t the Child Prepping the Child fr the Immunizatin Calming, Distracting and Managing the Pain Mnitring after Immunizatin Prtecting Yurself and yur Patient Key Learning Pints Pst-Test Discussin Frum References Appendix 1 Cmmn Public Funded Vaccines Used in Canada 1, versin is available nline at until July 31, Page 2

3 Cmpetency: Prepares and administers immunizatin agents crrectly. Learning Objectives Upn successful cmpletin f this cntinuing educatin lessn, yu will be better able t: 1. Prepare a checklist fr pre-immunizatin patient assessment, including precautins, cntraindicatins, and indicatins fr rescheduling. 2. Ensure the seven Rights f immunizatin: right drug, right client, right dse, right time, right rute, right reasn, and right dcumentatin. 3. Demnstrate the steps invlved in vaccine preparatin, including recnstitutin, if apprpriate, administratin, and dispsal. 4. Name the resurces that are used t guide the immunizatin administratin prcess and decisin making. 5. Develp a table listing the vaccine, age, dse, rute, site, cntraindicatins and precautins, and side effects fr each vaccine used in the practice setting. 6. Demnstrate the age-apprpriate injectin sites and prper client psitining used fr immunizatin. 7. Chse the crrect needle length and gauge fr the age and size f the client. 8. Describe actins taken t increase safety in immunizatin clinics related t the prvider, the recipient, and the envirnment. 9. Demnstrate the apprpriate technique fr immunizatin. 10. Describe techniques t reduce the pain assciated with immunizatin. Test Yur Current Knwledge Based n yur current knwledge, determine if the fllwing statements are true r false. 1. Pre-immunizatin cunselling serves t infrm the patient f the prcedure and ensures cnsent. a. True b. False 2. There are very few cntraindicatins t vaccines. a. True b. False 3. Bld transfusin is a ptential reasn fr deferral f immunizing with certain vaccines. a. True b. False 4. If the patient has a severe gastrintestinal reactin t eggs, they shuld nt be given the influenza vaccine. a. True versin is available nline at until July 31, Page 3

4 b. False 5. A patient that is currently taking amxicillin fr titis media shuld have their immunizatin deferred until they have cmpleted the antibitic. a. True b. False 6. Mst diluents just cntain sterile water fr injectin. a. True b. False 7. The immunizer shuld check the name f the immunizatin 3 times prir t administering it. a. True b. False 8. Fr mst subcutaneus injectins a 22 gauge 1 & ½ inch needle is apprpriate t use. a. True b. False 9. When injecting a subcutaneus injectin yu shuld insert the needle at a 45 angle. a. True b. False 10. Yu shuld limit the number f injectins t a maximum f tw per visit, ne fr each arm. a. True b. False Immunizing yur Patients Apprpriate vaccine administratin is a key element t ensuring the ptimal safety and efficacy f vaccines. 1 Immunizing a patient is nt as simple as drawing up a prduct and injecting it int the patient s arm. Prper immunizatin invlves the steps f pre-immunizatin cunselling, vaccine preparatin, and vaccine injectin, and is fllwed with a pst-immunizatin prcedure. The Rights f Yur Patients When administering any bilgical prduct, cnsider the 7 Rights f Immunizatin: 1. Right prduct 2. Right client 3. Right dse 4. Right time 5. Right rute 6. Right reasn 7. Right dcumentatin Pre-Immunizatin Cunselling Prir t immunizatin, the immunizer shuld ensure the patient is infrmed f the prcedure and prvides cnsent. 1 A systematic apprach is exceptinally valuable t immunizatin cunselling. This versin is available nline at until July 31, Page 4

5 apprach ensures the clinician is prviding the key infrmatin t the patient in such a way that they can becme infrmed f the immunizatin prcedures. 1. Eligibility fr immunizatin Each encunter with a health care prvider is an pprtunity t review immunizatin status and, if indicated, administer needed vaccines. 1 Practitiners shuld never miss an pprtunity t prtect the patient and the ppulatin against a vaccine-preventable disease. 2. Cunsel the patient regarding the fact that immunizatin is nt mandatry 2 Vaccinatin in Canada is a vluntary prcedure. 2 As patients have a right t refuse immunizatin, immunizers have a respnsibility t prvide patients with the infrmatin necessary t allw them t make the infrmed chice t immunize. Pssible statements t utilize culd include: I believe in the imprtance f immunizing all f my patients. Vaccines are effective and safe. Based n ur immunizatin schedule, yur sn is due fr his first sht this week. Wuld yu like us t administer it tday? Mrs. Smith, I see that yur daughter is due fr her next immunizatin sht. Wuld yu like us t take care f that tday? 3. Discuss the benefits f immunizatin 2 Immunizers are in a psitin f trust and are readily able t prvide patients with an evidence-based discussin n the benefits f immunizatin. This discussin culd include scientific data r persnal stries n the benefit f immunizatin (see Mdule 6). Pssible statements t utilize culd include: Mrs. Thmas, yur sn is due fr his chickenpx vaccine tday. Althugh we all had this infectin when we were kids, this vaccine prevents yur sn frm develping it. Many peple are nt wrried abut chickenpx, but the main reasns that we immunize is because f related cmplicatins such as pneumnia, brain inflammatin, scarring and even the flesh-eating disease. Mr. Singh, yur daughter is due fr her secnd dse f the 1 in 5 vaccine. This immunizatin is crucial, as it will prtect her against 5 diseases at the time when she is mst vulnerable and, with bsters, will prtect her int adulthd. 4. Discuss the risk f nt getting vaccinated 2 Immunizers need t be prficient in their knwledge f each f the vaccine-preventable disease, s they can prvide apprpriate infrmatin n the disease if asked (see Mdule 2). Pssible statements t utilize culd include: Mr. Chen, yur daughter is ging t be immunized against a variety f diseases tday. One f the cmpnents f the vaccine is prtectin against Haemphilus influenza type B, als called Hib. This bacterium was the majr cause f meningitis in yung children yur daughter s age until the vaccine was available t prvide prtectin. We encurage the vaccine, as Hib is still in the cmmunity and this vaccine is highly effective. versin is available nline at until July 31, Page 5

6 Mr. Jnes yur sn is being immunized against a bacterium called Strep. pneumnia. This bacterium used t be a majr cause f pneumnia, ear infectins, bld infectins and even meningitis. I recmmend that yu give yur sn the vaccine t prtect him frm these majr prblems. 5. Assess fr true cntraindicatins t immunizatin. There are very few cntraindicatins t vaccines. Many clinicians and patients will frg immunizatin due t mild illness. 1 This deferral is unfrtunate as it is a missed pprtunity t prtect the patient and the ppulatin frm a vaccine-preventable disease. 1 Belw are sme screening questins yu can ask yur patients t determine if they have any cntraindicatins t immunizatins. Table 1 prvides a quick verview f cnditins that are cntraindicatins t immunizatin. Table 2 prvides cnditins where immunizatin is nt cntraindicated. 1. Is the child (r are yu) sick tday? There is n evidence that acute illness reduces vaccine efficacy r increases vaccine adverse events. 3 Mild illnesses (such as titis media, upper respiratry infectins, and diarrhea) are NOT cntraindicatins t mst vaccinatin. 3 D nt withhld vaccinatin if a persn is taking antibitics Des the child have allergies t medicatins, fd r any vaccine? A histry f anaphylactic reactin such as hives (urticaria), wheezing r difficulty breathing, r circulatry cllapse r shck (nt fainting) frm a previus dse f vaccine r vaccine cmpnent is a cntraindicatin fr further dses, until further assessed by an allergist. 3 It may be mre beneficial fr clinicians t ask fr allergies t specific cmpnents f the vaccine. 3 Fr example, checking fr severe egg allergy prir t immunizing with the influenza vaccine. It wuld warrant an assessment by an allergist if the egg allergy is severe. 3. Has the child had a serius reactin t a vaccine in the past? A lcal reactin (redness r swelling at the site f injectin) is NOT a cntraindicatin t subsequent dses Fr live virus vaccines - Des yur child have any prblems with his r her immune system r have they taken prednisne r cancer drugs in the last 3 mnths? Live-virus vaccines are usually cntraindicated in immuncmprmised patients. 3 Live-virus vaccines shuld be pstpned until after chemtherapy r lng-term, highdse sterid therapy has ended Fr live virus vaccines - Has the child received a transfusin f bld r bld prducts in the past year? Certain live virus vaccines may need t be deferred, depending n the type f bld prduct and the interval since the bld prduct was administered. 3 versin is available nline at until July 31, Page 6

7 Table 1 Canadian Immunizatin Guide List f Cntraindicatins t Vaccine Administratin 1 Type f vaccine Issue f cncern Inactivated/subunit Live Allergy t vaccine cmpnent Cntraindicatin if the specific vaccine cntains that particular cmpnent Severely immuncmprmised Precautin Cntraindicatin Pregnancy Nne Cntraindicatin Recent administratin f bld prduct cntaining antibdies Recent administratin f live virus vaccine Nne Nne Precautin Precautin Severe bleeding disrder Precautin Precautin Table 2 Cnditins that are nt Cntraindicatins t Immunizatin 1 Premature birth Premature infants: Respnd adequately t vaccines used in infancy Are nt at significantly increased risk f adverse events Immunize n schedule, accrding t child's chrnlgical age. EXCEPTION: Hepatitis B vaccine fr infants weighing < 2000 g Breast-feeding After immunizatin f either a mther r her infant, during breast-feeding there is: N reductin in maternal r infant respnse t vaccines N increase in the risk f adverse events fr either mther r breast-feeding infant, fllwing immunizatin f either Pregnancy (inactivated vaccines) All inactivated vaccines are safe in pregnancy and shuld be administered if indicated. Sme are specifically indicated in pregnancy (influenza, pertussis). Neurlgic disrder N evidence f increased risk f any adverse event fllwing immunizatin. versin is available nline at until July 31, Page 7

8 Cancer (inactivated vaccines) Minr acute illness (with r withut fever f 39.5 C) Such persns may be at increased risk f cmplicatins frm vaccine-preventable diseases such as influenza and shuld be immunized apprpriately. N increased incidence f adverse reactins t inactivated vaccines. N interference between treatment f cancer and inactivated vaccine. The immune respnse may be less than that f healthy adults and children, but any prtectin fllwing immunizatin is imprtant because f the increased risk f infectin and assciated cmplicatins. N interference with respnse t vaccine. N increase in risk f adverse event(s) fllwing immunizatin. Antibitic therapy N effect n respnse t mst inactivated r live vaccines used in Canada. Pregnant r immunsuppressed individuals living in husehld with vaccinee Gastrintestinal intlerance t eggs Histry f allergy that des nt invlve vaccine r cmpnent f vaccine Cncern regarding past adverse reactin N risk frm any vaccine marketed in Canada t husehld cntacts f vaccinees. Immunizatin f husehld cntacts f immunsuppressed patients and nenates prvides imprtant prtectin against transmissin f disease in the husehld. Vaccinatin pprtunities in such persns shuld nt be missed. The inability t eat eggs fr reasns ther than allergy is nt assciated with an increase f adverse events t any vaccine. It is safe t immunize peple with any f the fllwing: nn-specific allergies envirnmental allergies family histries f allergies administratin f allergy shts (desensitizatin therapy fr allergy) allergies t cmmnly used antibitics (exceptin is nemycin and/r plymyxin B) Histry f large lcal reactin fllwing immunizatin A large lcal reactin t ne vaccine is nt assciated with an increased risk f lcal reactins t ther vaccines. In ther circumstances, repeating a dse f a vaccine that previusly gave a large lcal reactin may result in anther large lcal reactin. Hwever, there is n increased risk f systemic adverse events. versin is available nline at until July 31, Page 8

9 Febrile seizures Childhd vaccines prevent serius diseases that pse a much greater risk t mst children's health than seizures that might be assciated with a febrile reactin after vaccinatin. Family histry f adverse reactins t vaccines Adverse reactins t vaccines are nt knwn t be inherited. EXCEPTION: a family histry f an verwhelming infectin r fatality after administratin f a live vaccine may suggest inheritable severe immundeficiency, which shuld be ruled ut befre administering live vaccines. 6. Discuss cmmn adverse effects and any serius effects 2 Patients shuld be infrmed f cmmn adverse effects. Mst immunizers will discuss the cmmn adverse effects such as lcal site reactins and mild fever. Adverse effects fall int three main categries. These include: Lcal 3 Systemic 3 Anaphylaxis 3 The least severe and mst frequent Pain, swelling, and redness at the site f injectin May ccur with up t 80% f vaccine dses, depending n the type f vaccine Mst cmmn with inactivated vaccines, particularly thse cntaining an adjuvant Generally ccur within a few hurs f the injectin and are usually mild and self-limited Mre generalized reactins and can include fever, malaise, myalgias (muscle pain), headache, and/r lss f appetite These symptms are nnspecific; they may ccur in vaccinated persns because f the vaccine r may be caused by smething unrelated t the vaccine, like a cncurrent viral infectin, stress, r excessive alchl cnsumptin Live attenuated vaccines can cause symptms such as fever r a rash. These symptms result frm viral replicatin and are similar t a mild frm f the natural disease. Systemic adverse reactins fllwing live vaccines are usually mild, self-limited and ccur 7 21 days after the vaccine was given A very rare severe allergic reactin May be caused by the vaccine antigen itself r sme ther cmpnent f the vaccine, such as cell culture material, stabilizer, preservative, r antibitic used t inhibit bacterial grwth Occur in apprximately 2 cases fr every millin dses f vaccines given The risk f an allergic reactin can be minimized by gd screening prir t vaccinatin All prviders wh administer vaccines must have an emergency prtcl and supplies t treat anaphylaxis versin is available nline at until July 31, Page 9

10 7. Cnfirm understanding f the infrmatin and prvide an pprtunity fr Questins Immunizers shuld assess the level f understanding by watching fr nn-verbal cues, assessing questins asked and clarifying the reasns fr silence r refusal t engage in discussin. 2 Many patient issues with immunizatin can be addressed by prviding the patient the pprtunity t ask questins and answering them apprpriately. 8. Cnfirm Cnsent The last step is t cnfirm the cnsent f immunizatin. Pssible statements t use include: D yu have any mre questins befre I prepare the immunizatins? If there are n further questins, we are ready t prceed? Based n the infrmatin we discussed, can I give the immunizatin? Vaccine Preparatin Once it has been determined the patient requires the vaccine and has cnsented t immunizatin, it becmes time t prepare fr immunizatin. This prcess invlves several steps. 1. Vaccine Inspectin Immunizers shuld at this pint take the indicated vaccine frm the vaccine strage unit and fllw the inspectin checklist: Check the name f the vaccine t ensure it matches the type required by the patient. Check the expiratin date. Even if the prduct has expired ne day earlier, it is inapprpriate t inject t a patient. 1 Check the appearance f the vial fr any irregularities (e.g. particulate matter, damage t the vaccine). If using a previusly pened multi-dse vials, check the date when the vial was first punctured (as this shuld be recrded n the label). Multi-dse vials shuld be used within 30 days f pening, unless the manufacturer specifies a shrter perid. 1 Mix the vaccine with a careful swirling mtin until a unifrm suspensin is achieved. 2. Adding the Diluent Many f the cmmnly used vaccines are prvided as lyphilized (freeze dried) pwders. When a vaccine requires recnstitutin, these pwders must be mixed with a liquid called the diluent immediately prir t immunizatin. 4 Diluents vary in their vlume. The vlume f the diluent depends n whether the prduct is in a single use r multi-dse vial. 4 Diluents als vary in their ingredients. 4 Sme cntain nly sterile water fr injectin, but thers cntain a variety f ingredients that help t disslve the pwder int a liquid, stabilize the vaccine r maintain sterility f the vaccine. 4 Table 3 lists the instructins fr recnstituting with a diluent. versin is available nline at until July 31, Page 10

11 Once a vaccine is recnstituted, its shelf life is limited and it must be stred under apprpriate temperature and light cnditins. 4 The life f each recnstituted vaccine varies frm prduct t prduct. Cnsult the prduct package insert (prduct mngraph) fr the mst up-t-date infrmatin abut expiratin dates and times fllwing recnstitutin. 4 Table 3 Instructins fr Recnstitutin Lyphilized Vaccines with Diluent 4 Refer t the package insert fr instructins n a specific vaccine. In general fllw the fllwing steps: 1. Recnstitute vaccine immediately prir t use. 2. D nt allw vaccines t sit ut and warm up during the recnstitutin prcess. Limit the time live virus vaccines are expsed t light. 3. Check the diluent label t be sure that the vial cntains: The crrect diluent prvided by the manufacturer fr that specific vaccine. The crrect vlume f diluent fr recnstitutin s that the prper number f dses per vaccine vial is btained. 4. Check the labels n bth the diluent vial and the lyphilized (freeze-dried) vaccine vial t make sure they have nt expired. D nt administer expired vaccine. D nt use expired diluent. 5. Remve the prtective caps frm the diluent and lyphilized vaccine vials and wipe the stppers with an alchl swab. 6. Select a dispsable syringe and a needle f the prper length fr the vaccine and rute f administratin (the details are discussed further under vaccine administratin) Fr single-dse recnstituted vials, the needle used fr drawing up the diluent is the same needle yu will use fr vaccine administratin. There is n need t change the needle. Only change the needle if it has been damaged r cntaminated during the recnstitutin and drawing up prcess. Fr multi-dse recnstituted vials, use ne needle and syringe t recnstitute the vaccine. Use a separate needle and syringe fr each dse f recnstituted vaccine administered. 7. Insert the needle int the diluent vial and withdraw the entire cntents. 8. Inject all f the diluent int the lyphilized vaccine vial and agitate r rtate the vial t ensure thrugh mixing (fllw the specific instructin given in the vaccine package inserts). 9. Observe the recnstituted vaccine fr clur and appearance and verify that the appearance matches the descriptin in the package insert. If the lyphilized vaccine cannt be resuspended r if the recnstituted vaccine des nt lk as it shuld (e.g., disclratin, extraneus particulate matter), mark the vial as DO NOT USE and return it t prper strage cnditins. Cntact the lcal public health agency t prvide further guidance. Get anther diluent vial and anther lyphilized vaccine vial and begin the recnstitutin prcess again. versin is available nline at until July 31, Page 11

12 10. Fr multi-dse vials, recrd the date and time f recnstitutin n the vaccine vial. Fr singledse vials, recrd the date and time f recnstitutin n the vaccine vial if it is nt administered immediately after recnstitutin. 11. Fr single-dse vials, withdraw the entire cntents f the recnstituted vaccine int the syringe. Fr multi-dse vials, withdraw the crrect vlume f vaccine int the syringe. Recheck the vial cntents and the expiratin date. Clinical Tip Diluents are specifically designed fr a particular vaccine t allw fr ptimal immune respnse. Vaccine diluents are NOT interchangeable, unless specified frm the manufacturer. 3. Drawing up Bilgical Prducts in Vial Presentatin Prper prcedure must be fllwed when drawing up vaccines in a vial t ensure aseptic technique is met. The fllwing is a checklist fr drawing up a bilgical prduct frm a vial: 2 1. Wash hands r cleanse with a sanitizer. 2. Remve the plastic cap cvering the vial. 3. Cleanse the surface f the rubber stpper using a cttn pad r swab mistened with 70% isprpyl alchl. Allw t air dry. 4. Gently swirl the vial immediately befre remving each dse t ensure that the cntents are fully dispersed. 5. Fr a prduct in a ready t g liquid presentatin, draw int the syringe a vlume f air equal t the quantity f bilgical prduct t be remved. 6. Fr lyphilized r freeze-dried prducts having t be recnstituted, the diluent acts as the air in the syringe s there is n need t draw air int the diluent syringe. 7. Hld r place the vial right side up and insert the needle thrugh the centre f the rubber stpper. 8. Slwly inject the air r diluent frm the syringe. 9. If the bilgical prduct was recnstituted, gently swirl the vial t ensure that the cntents are fully dispersed. 10. Hld the vial upside dwn and withdraw the required quantity f bilgical prduct int the syringe. 11. Remve the needle frm the vial and expel the air bubble(s). 12. It is nt necessary t change needles between drawing up the bilgical prduct int the syringe and immunizing the client. Change the needle nly if it is damaged, r becmes cntaminated. 13. If it is the first entry int a multi-dse vial, recrd the date (include day, mnth and year) n the label f the vial. 14. Immediately return multi-dse vials t the refrigeratr r bilgical cler. Ensure that the date pened and the expiry date are clearly marked n the vial. versin is available nline at until July 31, Page 12

13 Clinical Tip The prduct type and expiratin date shuld be checked 3 times befre injecting a patient: 1. When remving it frm the vaccine strage unit 2. When drawing up r recnstituting 3. Just prir t administratin 4. Drawing up Bilgical Prducts in Ampule Presentatin The use f an ampule requires a slightly different apprach than drawing up frm a vial. Several steps fr drawing frm an ampule include: 1. Gently swirl the ampule immediately befre remving the cntents t ensure that the cntents are fully dispersed. 2. Tap the ampule lightly t ensure that the cntents are in the lwer part f the ampule. 3. Using a swab mistened with isprpyl alchl, wipe the neck area f the ampule prir t pening t prevent bacterial cntaminatin f ampule cntents. 4. Break the neck f the ampule using the alchl swab, a clean cttn ball r gauze. If yu cut yurself in breaking the ampule, discard the ampule, since the prduct may be cntaminated. Wash yur hands and care fr the cut befre cntinuing. 5. Withdraw the cntents f the ampule using a sterile syringe and 25-gauge needle. It is nt necessary t change needles between drawing up the bilgical prduct int the syringe and administering it t the client. 6. Discard the ampule int a hard sided, labelled sharps cntainer. 7. Expel the air bubble(s) frm the syringe. 8. Filter needles are nt indicated fr the rutine administratin f bilgical prducts frm ampules. 5. Prelading Vaccines A vaccine shuld ideally be withdrawn frm the vial by the vaccine prvider administering the vaccine. 1 Pre-lading syringes with vaccine is discuraged because f: 1 The uncertainty f vaccine stability in syringes Risk f cntaminatin Increased ptential fr vaccine administratin errrs Increased risk f vaccine wastage Injecting the Vaccine Like preparing the vaccine, there are several steps t ensuring the vaccine is administered apprpriately. versin is available nline at until July 31, Page 13

14 1. Selecting the Right Syringe and Needle A separate, sterile syringe shuld be used fr each injectin, and different vaccines shuld nt be mixed in the same syringe unless specified by the manufacturer as part f the recnstitutin and administratin prcedure. 1 Depending n the dsage, a 3 ml r 1 ml syringe shuld be selected. The Canadian Immunizatin Guide prvides sme recmmendatins n the needle size t select when administering vaccines. 1 The needle size and gauge is based n the rute f administratin, individual s age, size f the muscle mass and the viscsity f the vaccine. 1 The needle shuld be inserted as far as pssible int the muscle. The Guide s recmmendatins are as fllwed: 1 Fr subcutaneus (SC) injectins, a 25 gauge, 1.6 cm (5/8") needle is recmmended Fr intramuscular (IM) injectins a gauge needle that is lng enugh t reach muscle is recmmended: 2.2 cm (7/8"') t 2.5 cm (1") fr infants, tddlers and lder children 2.5 cm (1") t 3.8 cm (1½") fr adlescents and adults A lwer gauge needle (e.g., 22 gauge) may be required when administering viscus r larger vlume prducts such as immune glbulin Selecting the Site fr Administratin The Canadian Immunizatin Guide has recmmendatins fr immunizatin sites, based n the age f the vaccinee and the type f vaccine. Table 4 has sme tips fr administering SC IM, ID and intranasal immunizatins. Appendix 1 has specific recmmendatins fr the individual vaccines n the Canadian market. The recmmendatins are as fllws: 1 Vaccines and ther bilgic prducts are injected via SC, ID, intranasally r IM rutes: SC injectins: SC injectins are usually given at a 45 angle int subcutaneus tissue f the upper triceps area f the arm. IM injectins: IM injectins are administered at a 90 angle int: The vastus lateralis muscle (anterlateral thigh) in infants < 1 year f age. Have the parent/caregiver hld the infant in a "cuddle" r semi-recumbent psitin n their lap. 2 The deltid muscle f anyne 1 year f age (unless the muscle mass is nt adequate). This site is used fr IM injectins nly. Have the child sit sideways n the lap f the parent/caregiver. The injectin arm shuld be held clse t the infant's bdy while the ther arm is tucked behind the parent's/caregiver's back. 2 Have the lder client sit with their elbw bent and their frearm resting n the arm f a chair and internally rtated. 2 versin is available nline at until July 31, Page 14

15 Apprpriate site selectin is imprtant t avid inadvertent injectin int a bld vessel r injury t a nerve. Table 4 Prper Subcutaneus and Intramuscular Injectin Prcedure 2 Subcutaneus (SC) Injectins Prcedure Use crrect length and size f needle. Grasp a skin fld f fatty tissue at site with thumb and frefinger. Measure skin fld frm tp t bttm; be sure needle is apprximately ne half this length. Clean the site with a cttn pad, swab, r ball mistened with 70% isprpyl alchl. Insert the needle quickly and firmly, with the bevel facing upwards, at a cnstant angle f 45. Fr an bese client, use a lnger needle and inject at a 90 angle t reach SC tissue. Imprtant Pints Pinching skin elevates SC tissue and ensures that needle will be injected int SC tissue. Allw the skin t air dry prir t injectin t avid a burning sensatin n insertin f the needle. Quick, firm insertin minimizes discmfrt. Release the skin. Injecting int cmpressed tissue irritates nerve fibres. Rapidly inject the bilgical prduct. Rapid injectin reduces pain. Remve the needle in ne swift mtin, immediately applying pressure t the injectin site with a dry cttn pad/swab/ball. D nt massage the injectin site. Minimizes discmfrt during needle withdrawal. Alchl n a cttn pad/swab can irritate nn-intact skin. D nt massage the area after injectin due t a ptential increase in the underlying tissue. Intramuscular (IM) Injectins Prcedure Use crrect length and size f needle. Clean the site with a cttn pad, swab, r ball mistened with 70% isprpyl alchl. Imprtant Pints Allw skin t air dry after the applicatin f alchl t avid a burning sensatin n insertin f the needle. versin is available nline at until July 31, Page 15

16 Insert needle quickly at a 90 angle int muscle. If client s muscle mass is small, grasp bdy f muscle between thumb and fingers befre and during the injectin. Ensures that bilgical prduct reaches the muscle mass. Rapidly inject the bilgical prduct Remve the needle in ne swift mtin, immediately applying pressure t the injectin site with a dry cttn pad/swab/ball. Cntinue t apply pressure fr 30 secnds. D nt massage injectin site. Intradermal (ID) injectin 5 Prcedure The current ID influenza vaccine is distributed in a specialized micrinjectin device. This vaccine is administered intradermally in the regin f the deltid. Hld the micrinjectin system between thumb and middle finger. Insert needle rapidly perpendicular t the skin. Use the index finger t push the plunger. Remve needle. Fully depress plunger t activate needle shield. Intranasal Administratin 6 Rapid injectin reduces pain. Minimizes discmfrt during needle withdrawal. Alchl n a cttn pad/swab can irritate nn-intact skin. Pressure minimizes bruising. Massage can damage underlying tissue. Imprtant Pints The micrinjectin device is ready fr injectin. D nt shake device D nt attempt t remve air bubbles. Maintain light pressure n skin t ensure intradermal injectin. D NOT aspirate. Administratin instructins are cvered in the Intanza prduct mngraph. Prcedure Remve rubber tip prtectr. D NOT remve dse-divider clip at the ther end f the sprayer. With the patient in the upright psitin, place the tip just inside the nstril. With a single mtin, depress the plunger as rapidly as pssible until the Imprtant Pints Needle shuld nt be added t sprayer. Live vaccine, and shuld either be administered at the same time as ther live vaccines r spaced 4 weeks apart Shuld be avided in patients with severe asthma r active wheezing. versin is available nline at until July 31, Page 16

17 dse-divider clip prevents yu frm ging further. Pinch and remve the dse-divider clip frm plunger. Place the tip just inside the ther nstril and with a single mtin, depress plunger as rapidly as pssible t deliver the remaining vaccine. Administratin instructins are cvered in the Flumist prduct mngraph. 3. Multiple Injectins There are n cntraindicatins t giving multiple vaccines at the same clinic visit, and all pprtunities t immunize shuld be utilized. 1 Giving multiple injectins at ne visit helps t ensure that children are up t date with the vaccines required fr their age. 1 The Canadian Immunizatin Guide prvides sme tips fr the administratin f multiple injectins: 1 Vaccines prepared in separate syringes shuld be labelled t identify clearly which vaccine each syringe cntains. The site f administratin f each vaccine shuld be recrded. Separate limbs shuld be used if tw IM injectins are required. If mre than tw injectins are required, tw injectins may be administered int the same muscle separated by at least 2.5 cm (1"). Vaccines that are knwn t cause mre stinging r pain shuld be given last. 4. Techniques t help with the immunizatin The British Clumbia Centre f Disease Cntrl (BC CDC) and the Canadian Immunizatin Guide have sme practical tips t make the prcess f immunizatin as successful as pssible. Cmmunicating the Immunizatin Prcess t the Child The BC CDC has sme tips when talking t the child and parent during an immunizatin appintment. These include: 2 Ask abut the child s previus experiences with needles. Individual respnses t stress are influenced by temperament, envirnment and past experience. Acknwledge the child s feelings. Give permissin t cry. D nt give false reassurance (i.e., it wn t hurt ). Hnest reassurance is it may hurt a bit, but I think yu can handle it. D nt tlerate threats, shaming, r manipulatin frm the child s parent/guardian r caregiver. When a parent threatens a child, the mst helpful respnse is t ffer empathy t the parent, state a neutral fact r principle and ffer hpe (e.g., This must be frustrating fr yu. Immunizatins are never emergencies. I think we can wrk ut smething we can all live with ). Discurage the use f bribes, and encurage effrt n matter hw small. Remain firm as yu manage the prcess. At the same time, shw respect fr the child. Prepping the Child fr the Immunizatin The BC CDC has sme tips n preparing the child fr the vaccine administratin. These steps include: 2 versin is available nline at until July 31, Page 17

18 If a parent presents with mre than ne child, immunize the mst anxius ne first (usually the eldest), even if the parent thinks therwise. The needle is the fcus f the child s fear and watching while smene else is immunized may increase fear and anxiety. Prvide privacy and prepare the immunizatin ahead, if pssible, always ut f sight f the child. If the child asks t see the needle, explain yu will shw it after the prcedure. Describe what yu plan t d, thereby displaying respect fr a child s right t knw, cnfidence in their ability t manage, and interest in addressing cncerns. The child may wnder hw lng the needle will be in their arm r hw quickly it will g in. Threatened lss f cntrl is a factr in needle fear. Cnsider the use f practice dlls with children under 6. Offer t immunize a stuffed ty r dll, and invite the child t hld the patient. Use a syringe withut a needle and g thrugh all the steps, explaining each ne as yur prceed. Prvide limited, realistic chices and let the child decide (e.g., Wuld yu like t use yur right r left arm? Wuld yu prefer t sit r stand? ). Offering realistic chices creates a setting where the child can maintain sme persnal cntrl and cntributes t an atmsphere f mutual respect. Supprtive, secure psitining can be achieved with a child (depending upn age) either standing r sitting. The parent r guardian shuld hld a child with specific instructins n restraint psitining. Failed restraint can result in inaccurate dse, inapprpriate depth f injectin r injury t the individual being immunized r vaccine prvider. 1 Cnsider prviding the parents with the 3Ps (Pharmaclgical, Physical and Psychlgical) f helping during vaccinatins: Fr babies up t 1 year ld Fr children ver 1 year ld Practical Tip Techniques t decrease anxiety in adlescents and adults are imprtant t minimize the risk f fainting. They include: Ensuring that the temperature in the rm is cmfrtable Aviding lng line-ups in mass immunizatin clinics Administering the vaccine while the persn is seated. Patients wh appear very anxius shuld be bserved while seated until anxiety has reslved after the immunizatin. Calming, Distracting and Managing the Pain Distractin techniques are effective in decreasing pain respnse in infants, tddlers, and children during and fllwing immunizatin. Regardless f the type f distractin, the mre the child is invlved in the distractin, the lwer their pain. 2 versin is available nline at until July 31, Page 18

19 Evidence-based clinical practice guidelines have been published n methds t reduce the pain f childhd immunizatins. 7 The recmmendatins frm these guidelines are listed in Table 5. Table 5 Guideline Recmmendatins t Reduce the Pain f Childhd Immunizatins 7 1. T reduce pain at the time f injectin, encurage breastfeeding mthers t breastfeed their infants during vaccinatin. 2. T reduce pain at the time f injectin amng infants up t 12 mnths f age wh cannt be breastfed during vaccinatin, administer a sweet-tasting slutin during vaccinatin. 3. If mre than ne cmmercial brand f a vaccine is available, and the brands are interchangeable, inject the least painful brand during vaccinatin f children, t reduce pain at the time f injectin. 4. T reduce pain at the time f injectin, d NOT place children in a supine psitin during vaccinatin. 5. T reduce pain at the time f injectin, administer intramuscular vaccines t children using a rapid injectin technique withut aspiratin. 6. When administering multiple vaccine injectins t children sequentially, inject the mst painful vaccine last t reduce pain at the time f injectin. 7. T reduce pain at the time f injectin amng children fur years f age and lder, ffer t rub r strke the skin near the injectin site with mderate intensity befre and during vaccinatin. 8. Althugh there is insufficient evidence fr r against the use f parent-led distractin r parent caching during vaccinatin f children as a way t reduce pain at the time f injectin, clinicians may ffer this interventin t parents t reduce pain-related distress. 9. T reduce pain at the time f injectin, encurage parents t use tpical anesthetics during vaccinatin f children. 10. T reduce pain at the time f injectin, encurage parents t use tpical anesthetics during vaccinatin f children. These include EMLA (eutectic mixture f lcal anesthesia, cnsisting f 2.5% lidcaine and 2.5% prilcaine), Ametp gel (4% amethcaine), and Maxilene (lipsmal lidcaine 4% cream). Studies have demnstrated that EMLA des nt affect the immunlgic respnse t MMR, DTaP-IPV-Hib (Pentacel ), hepatitis B (Recmbivax ) r Bacille Calmett-Guérin (BCG) vaccinatins. 1 EMLA needs t be applied at the immunizatin site apprximately 60 minutes befre the injectin. Ametp gel prduces anesthesia within 30 t 40 minutes and has been shwn nt t interfere with the immunlgic respnse t MMR vaccine. 11. T reduce pain at the time f injectin amng children three years f age and lder, use childled distractin techniques during vaccinatin. 12. T reduce pain at the time f injectin, have children three years f age and lder engage in slw, deep breathing r blwing during vaccinatin. versin is available nline at until July 31, Page 19

20 13. T reduce pain at the time f injectin amng children three years f age and lder, use cmbined psychlgical interventins during vaccinatin. 14. D NOT tell children that it wn t hurt, as this type f statement, when used alne, has been shwn t be ineffective in reducing pain at the time f injectin. 15. Fr children underging vaccinatin, there is insufficient evidence fr r against the use f skin-cling techniques (vapclants, ice, cl/cld packs) t reduce pain at the time f injectin. 16. Fr children underging vaccinatin, there is insufficient evidence fr r against the use f simultaneus injectins rather than sequential injectins t reduce pain at the time f injectin. 17. Fr children underging vaccinatin, there is insufficient evidence t recmmend fr r against the use f a specific rute f administratin fr vaccines that can be administered intramuscularly r subcutaneusly t reduce pain at the time f injectin. 18. Fr children underging vaccinatin, there is currently n demnstrated benefit f administering acetaminphen r ibuprfen t reduce pain at the time f injectin. Mnitring after Immunizatin After vaccinatin, vaccine recipients shuld be cunselled n cmmn side effects and the reprting and management f these reactins. 1 Vaccine prviders shuld identify and bserve individuals wh are particularly anxius abut receiving the vaccine. Individuals with presyncpal symptms such as pallr r sweating shuld sit r lie dwn until symptms reslve. A study using the American Vaccine Adverse Reprting System fund that 63% f syncpal (fainting) events ccurred within 5 minutes f vaccinatin, and 89% ccurred within 15 minutes. 1 It is therefre prudent t keep the persn in the clinic fr 15 minutes after vaccinatin. This will als facilitate the management f the rare anaphylactic event. The treatment f adverse effects is discussed in Mdule 9. Prtecting Yurself and yur Patient Standard infectin cntrl practices shuld be implemented by immunizatin prviders. These recmmendatins include: 1 Glves are nt required when administering bilgical prducts unless the vaccinatr has pen hand lesins r will cme int cntact with ptentially infectius bdy fluids. Wash hands well between vaccine recipients. Alchl-based hand sanitizers are an alternative t hand washing with sap and water. T prevent accidental needle stick injury, d nt recap standard needles. When safety needles are used, engage safety mechanism immediately fllwing administratin f the bilgical prduct. Immediately discard needle and attached syringe in hard sided, labelled sharps cntainer. Place sharps cntainer s as t avid reaching r having t reach in frnt f the patient. Cautin versin is available nline at until July 31, Page 20

21 shuld als be taken s that the sharps cntainer cannt be reached by children in the clinic setting. D nt empty used needles and syringes frm ne sharps cntainer t anther. Reprt percutaneus (needle stick) injuries immediately t supervisr fr cnsideratin f pssible pst-expsure immunprphylaxis. All immunizatin prviders shuld have cmpleted a full series f hepatitis B vaccine. Key Learning Pints 1. Pre-immunizatin cunselling is crucial fr the patient t understand the prcedure, including the risks and benefits, as well as prviding infrmed cnsent. 2. Assessment f cntraindicatins fr immunizatin can be dne by asking nly a few questins: Is the child (r are yu) sick tday? Des the child have allergies t medicatins, fd r any vaccine? Has the child had a serius reactin t a vaccine in the past? Fr live vaccines: Des yur child have any prblems with his r her immune system r have they taken prednisne r any cancer drugs in the last 3 mnths? Has the child received a transfusin f bld r bld prducts in the past year? 3. There are very few cntraindicatins t immunizatin. 4. Althugh vaccines can cause adverse effects mst are mild and self-limiting such as injectin site reactins. 5. Vaccine preparatin may invlve the use f a diluent t add t lyphilized pwders. These diluents: Are NOT interchangeable (unless specifically recmmended by the manufacturer) Have varying vlumes Can vary in their ingredients May help t stabilize the vaccine r t maintain sterility 6. Prper syringe selectin is imprtant fr apprpriate SC and IM administratin. The general recmmendatins are: Fr subcutaneus (SC) injectins, a 25 gauge, 1.6 cm (5/8") needle Fr intramuscular injectins (IM) a gauge needle that is lng enugh t reach the muscle: 2.2 cm (7/8"') t 2.5 cm (1") fr infants, tddlers and lder children 2.5 cm (1") t 3.8 cm (1½") fr adlescents and adult 7. Immunizatin prcedures can be imprved with sme cmmunicatin and sme practical tips. 8. There are several methds t reduce pain and discmfrt frm immunizatin. 9. Patients shuld remain fr bservatin fr 15 minutes after immunizatin. 10. Standard infectin cntrl and rutine precautins can minimize risks t the immunizer and the patient. versin is available nline at until July 31, Page 21

22 Pst-Test Mrs. McCann is in fr an immunizatin fr her 2 mnth ld daughter Sara. This is the first set f immunizatins and althugh she is a strng supprter f the immunizatin prgram, she is still nervus abut her daughter getting an injectin. Tday Sara is due fr her first immunizatin with the 1 in 6 vaccine (Infanrix hexa ). 1. When discussing the benefits f the injectin with Mrs. McCann, which f the fllwing statements is the MOST apprpriate t include? a. This vaccine prtects against a large number f cnditins but we have t give extra immunizatins as the bdy can nly handle s many immunizatins at a single time b. I like this vaccine as this ne sht will prtect yur daughter against 6 cnditins and it minimizes the number f needles given t children c. This is the first immunizatin and she will need 2 mre, ne at 6 mnths and ne at 18 mnths d. This vaccine prtects against quite a few diseases but it has a slightly higher risk f adverse effects cmpared t giving each immunizatin alne 2. Which f the fllwing vaccine-preventable diseases are NOT included in the 1 in 6 vaccine series? a. Diphtheria b. Pli c. Hepatitis A d. Haemphilus influenza type b 3. Which wuld be the best site fr administering this vaccine t Sara? a. Subcutaneusly in the deltid regin b. Subcutaneusly in the thigh regin c. Intramuscularly in the deltid regin d. Intramuscularly in the thigh regin 4. When discussing the mst cmmn side effects f 1 in 6 vaccine, which f the fllwing is imprtant t list? a. Fever > 40 C b. Redness and pain at the injectin site c. Increase in appetite d. All f the abve 5. Which f the fllwing wuld be the mst apprpriate needle tip t use fr the 1 in 6 vaccine injectin fr Sara? a. 22 gauge, 3.8 cm (1.5 inch) b. 25 gauge, 1.6 cm (5/8 inch) c. 25 gauge, 2.5 cm (1 inch) d. 20 gauge, 2.5 cm (1 inch) versin is available nline at until July 31, Page 22

23 6. Which f the fllwing recmmendatins wuld NOT be apprpriate t recmmend t Mrs. McCann t reduce immunizatin pain? a. Blwing bubbles t distract b. Administer acetaminphen just prir t the immunizatin c. Breastfeeding Sara at the time f injectin d. Cuddling and rcking the infant 7. Apprximately hw lng shuld yu keep Sara in the immunizatin clinic after the immunizatin? a. 1 minute b. 5 minutes c. 15 minutes d. 40 minutes Discussin Frum 1. This mdule presented sme examples f cunselling statements yu can use with yur patients n immunizatins. Are there any cunselling lines that yu have fund wrk well in yur clinical practice that yu can share with yur clleagues? 2. Many clinicians feel uncmfrtable administering a vaccine t a patient with a perceived cntraindicatin (e.g. mild infectin, pregnancy). What d yu feel can be dne t imprve this situatin? 3. Parents and children s stress can be a prblem when administering a vaccine. Are there any tips that yu can share frm yur clinical practice that have helped make immunizatin easier fr the child and parent? 4. This mdule presented the steps f vaccine administratin. Are there any tips yu can share frm yur clinical practice that yu fund were very effective in imprving yur delivery f immunizatins t yur patients? versin is available nline at until July 31, Page 23

24 References 1. Natinal Advisry Cmmittee n Immunizatin. Canadian Immunizatin Guide. Seventh editin. Ottawa, Ontari: Public Health Agency f Canada; BC Centre fr Disease Cntrl. Immunizatin Manual Available at: Accessed July 13, NCIRD. Pubs/PinkBk/Chapters. Available at: Accessed February 28, Center fr Disease Cntrl. Vaccine Strage and Handling Tlkit. Available at: Accessed April 23, Sanfi Pasteur. Intanza - Prduct Mngraph Available at: Accessed May 2, Astra Zeneca. Flumist - Prduct Mngraph Available at: ame1=cntent-dispsitin&blbheadername2=mdt- Type&blbheadervalue1=inline%3B+filename%3DPrduct- Mngraph.pdf&blbheadervalue2=abinary%3B+charset%3DUTF- 8&blbkey=id&blbtable=MungBlbs&blbwhere= &ssbinary=true. Accessed May 2, Taddi A, Appletn M, Brtlussi R, et al. Reducing the pain f childhd vaccinatin: an evidencebased clinical practice guideline. CMAJ. 2010;182(18):E843 E855. versin is available nline at until July 31, Page 24

25 Appendix 1 Cmmn Public Funded Vaccines Used in Canada 1,2 Vaccine Age Dse Rute Site Cntraindicatins/ Precautins Adverse Effects Pediacel DTaP-IPV-Hib 2,4,6,18 mnths Immunizatin series is 4 dses f 0.5 ml IM < 1 year ld - anterlateral thigh > 1 year ld - Deltid Histry f anaphylactic reactin t a previus dse f DPT, DTaP, IPV r Hib--cntaining vaccine Children age 7 years and lder Histry f Guillain-Barré syndrme (GBS) within 8 weeks f receipt f a tetanus-cntaining vaccine Lcal: Redness, tenderness, swelling Systemic: Irritability, crying, fever >38.3 C, drwsiness, decreased activity and appetite, vmiting, diarrhea Quadracel DTaP-IPV Schl entry bster 0.5 ml Aged 4-6 years IM Deltid muscle as child is > 1 year f age Same as Pediacel Lcal: Redness, tenderness, swelling, pain Systemic: Infanrix Hexa DTap-HB-IPV- Hib 2,4,6 mnths Immunizatin is series f 3 dses f 0.5 ml Bster at 18 mnths wuld be Pediacel IM < 1 year ld - anterlateral thigh > 1 year ld Deltid Histry f anaphylactic reactin t a previus dse f DPT, DTaP, IPV HB r Hib--cntaining vaccine Children age 7 years and lder Histry f Guillain-Barré syndrme (GBS) within 8 weeks f receipt f a tetanus-cntaining vaccine fever > 38.3 C, anrexia, vmiting, irritability, drwsiness, listlessness, fretfulness, persistent r unusual crying Lcal: Redness, swelling, pain Systemic: fever > 38.3 C, anrexia, irritability, persistent r unusual crying Adacel DTap Bster dse: years r grade ml IM Deltid Histry f an anaphylactic reactin t a previus dse f any tetanus, diphtheria, r pertussiscntaining vaccine Histry f Guillain-Barré syndrme (GBS) ccurring within 8 weeks f receipt f a tetanus cntaining vaccine Lcal: Redness, tenderness, swelling, induratin, pain Systemic: versin is available nline at until July 31, Page 25

Instructions for Use INTRON A (In-tron-aye) (Interferon alfa-2b, recombinant) Powder for Solution

Instructions for Use INTRON A (In-tron-aye) (Interferon alfa-2b, recombinant) Powder for Solution Instructins fr Use INTRON A (In-trn-aye) (Interfern alfa-2b, recmbinant) Pwder fr Slutin Be sure that yu read, understand, and fllw these instructins befre injecting INTRON A. Yur healthcare prvider shuld

More information

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE

Vaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

Vaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE

Vaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE Vaccine Infrmatin Statement: LIVE INTRANASAL INFLUENZA VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están

More information

INSTRUCTIONS FOR USE ZINBRYTA (zin-bry-tuh) (daclizumab) Injection, for Subcutaneous Use Single-Dose Prefilled Syringe 150 mg

INSTRUCTIONS FOR USE ZINBRYTA (zin-bry-tuh) (daclizumab) Injection, for Subcutaneous Use Single-Dose Prefilled Syringe 150 mg INSTRUCTIONS FOR USE ZINBRYTA (zin-bry-tuh) (daclizumab) Injectin, fr Subcutaneus Use Single-Dse Prefilled Syringe 150 mg Read this Instructins fr Use befre yu start using ZINBRYTA and each time yu get

More information

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year

Health Screening Record: Entry Level Due: August 1st MWF 150 Entry Year Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic

More information

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION

CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,

More information

Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-Polio-Haemophilus Influenzae type b Conjugate Combined Vaccine Biological Page (DTaP-IPV-Hib-HB)

Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-Polio-Haemophilus Influenzae type b Conjugate Combined Vaccine Biological Page (DTaP-IPV-Hib-HB) Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-Pli-Haemphilus Influenzae type b Cnjugate Cmbined Vaccine Bilgical Page (DTaP-IPV-Hib-HB) Sectin 7: Bilgical Prduct Infrmatin Standard #: 07.214 Created

More information

Completing the NPA online Patient Safety Incident Report form: 2016

Completing the NPA online Patient Safety Incident Report form: 2016 Cmpleting the NPA nline Patient Safety Incident Reprt frm: 2016 The infrmatin cntained within this dcument is in line with the current Data Prtectin Act (DPA) requirements. This infrmatin may be subject

More information

Influenza (Flu) Fact Sheet

Influenza (Flu) Fact Sheet Influenza (Flu) Fact Sheet What is the flu? The flu is a cntagius respiratry illness caused by influenza viruses. It can cause mild t severe illness, and at times can lead t death. Sme peple, such as lder

More information

BLOOD BORNE PATHOGENS

BLOOD BORNE PATHOGENS BLOOD BORNE PATHOGENS GALVESTON ISD ANNUAL TRAINING 2018-2019 Galvestn Independent Schl District Special Prgrams/ECH Health Services Required Training Ò Training is required by the Texas Department f Health

More information

Tick fever is a cattle disease caused by any one of the following blood parasites:

Tick fever is a cattle disease caused by any one of the following blood parasites: Tick fever Tick fever is a cattle disease caused by any ne f the fllwing bld parasites: Babesia bvis Babesia bigemina Anaplasma marginale These parasites are all transmitted by the cattle tick (Bphilus

More information

Childhood Immunization Status (NQF 0038)

Childhood Immunization Status (NQF 0038) Childhd Immunizatin Status (NQF 0038) EMeasure Name Childhd Immunizatin EMeasure Id Pending Status Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December

More information

ALCAT FREQUENTLY ASKED QUESTIONS

ALCAT FREQUENTLY ASKED QUESTIONS 1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age

More information

Immunisation and Disease Prevention Policy

Immunisation and Disease Prevention Policy Immunisatin and Disease Preventin Plicy Quality Area 2: Children s Health and Safety 2.1 Each child s health is prmted 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries

More information

Medication Guide SIGNIFOR [sig-na-for] (pasireotide) Injection

Medication Guide SIGNIFOR [sig-na-for] (pasireotide) Injection Medicatin Guide SIGNIFOR [sig-na-fr] (pasiretide) Injectin Read this Medicatin Guide befre yu start using SIGNIFOR and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take

More information

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams

Assessment Field Activity Collaborative Assessment, Planning, and Support: Safety and Risk in Teams Assessment Field Activity Cllabrative Assessment, Planning, and Supprt: Safety and Risk in Teams OBSERVATION Identify a case fr which a team meeting t discuss safety and/r safety planning is needed r scheduled.

More information

Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-Polio-Haemophilus Influenzae type b Conjugate Combined Vaccine Biological Page (DTaP-IPV-Hib-HB)

Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-Polio-Haemophilus Influenzae type b Conjugate Combined Vaccine Biological Page (DTaP-IPV-Hib-HB) Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-Pli-Haemphilus Influenzae type b Cnjugate Cmbined Vaccine Bilgical Page (DTaP-IPV-Hib-HB) Sectin 7: Bilgical Prduct Infrmatin Standard #: 07.214 Created

More information

Human papillomavirus (HPV) refers to a group of more than 150 related viruses.

Human papillomavirus (HPV) refers to a group of more than 150 related viruses. HUMAN PAPILLOMAVIRUS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between

More information

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)

Breast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018) Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages

More information

CDC Influenza Division Key Points MMWR Updates February 20, 2014

CDC Influenza Division Key Points MMWR Updates February 20, 2014 CDC Influenza Divisin Key Pints MMWR Updates In this dcument: Summary Key Messages Seasnal Influenza Vaccine Effectiveness: Interim Adjusted Estimates Influenza Surveillance Update: September 29, 2013-February

More information

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher:

Year 10 Food Technology. Assessment Task 1: Foods for Special Needs. Name: Teacher: Year 10 Fd Technlgy Assessment Task 1: Fds fr Special Needs Name: Teacher: Due Date: Term 2, Week 1 Type f Task: Design Task Planning Fd Requirements Cllectin f Assessment: Submit in Class Assessment Plicy:

More information

Health for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y

Health for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y Health fr Life Chirpractic At Clverdale Mall Unit #143-250 The East Mall Etbicke, ON, M9B 3Y8 416-232-1822 416-232-0060 Child and Adlescent Health Questinnaire Name:_ Birth date: Address:_ Telephne: Medical

More information

Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft

Infection Control Guidelines for Cabin Crew Members on Commercial Aircraft Infectin Cntrl Guidelines fr Cabin Crew Members n Cmmercial Aircraft PURPOSE These guidelines prvide cabin crew members (flight attendants) with practical measures t prtect themselves, passengers, and

More information

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.

A Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol. SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument

More information

Childhood Immunization Status (NQF 0038)

Childhood Immunization Status (NQF 0038) Childhd Immunizatin Status (NQF 0038) EMeasure Name Childhd Immunizatin EMeasure Id Pending Status Versin Number 1 Set Id Pending Available Date N infrmatin Measurement Perid January 1, 20xx thrugh December

More information

Pediatric and adolescent preventive care and HEDIS *

Pediatric and adolescent preventive care and HEDIS * Pediatric and adlescent preventive care and HEDIS * * HEDIS is a registered trademark f the Natinal Cmmittee fr Quality Assurance (NCQA). UniCare Health Plan f West Virginia, Inc. Healthcare Effectiveness

More information

BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:

BROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised: Page 1 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 PROTOCOL FOR: All trained staff PURPOSE: Range f Mtin (ROM) exercises are very imprtant if an individual has t stay in bed r in a wheelchair.

More information

RoActemra (tocilizumab) for Giant Cell Arteritis (GCA) subcutaneous (SC) formulation

RoActemra (tocilizumab) for Giant Cell Arteritis (GCA) subcutaneous (SC) formulation RActemra (tcilizumab) fr Giant Cell Arteritis (GCA) subcutaneus (SC) frmulatin What yu shuld knw abut RActemra This brchure prvides key infrmatin t assist in the patient s understanding f the benefits

More information

CONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS

CONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS CONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS Yu want t take teststerne t masculinize yur bdy. Befre taking it, there are several things yu need t knw abut. They are the pssible advantages, disadvantages,

More information

H1N1 Influenza 09 Guidance for Residential Aged Care

H1N1 Influenza 09 Guidance for Residential Aged Care H1N1 Influenza 09 Guidance fr Residential Aged Care 11 June 2009 As knwledge abut H1N1 Influenza 09 develps, further advice will be prvided. Please check www.healthemergency.gv.au fr the latest infrmatin.

More information

BRCA1 and BRCA2 Mutations

BRCA1 and BRCA2 Mutations BRCA1 and BRCA2 Mutatins ROBERT LEVITT, MD JESSICA BERGER-WEISS, MD ADRIENNE POTTS, MD HARTAJ POWELL, MD, MPH COURTNEY LEVENSON, MD LAUREN BURNS, MSN, RN, WHNP OBGYNCWC.COM v Cancer is a cmplex disease

More information

PART III: CONSUMER INFORMATION

PART III: CONSUMER INFORMATION IMPORTANT: PLEASE READ PART III: CONSUMER INFORMATION Pr ZERIT Stavudine This leaflet is Part III f a three-part Prduct Mngaph published when ZERIT was apprved fr sale in Canada and is designed specifically

More information

PATIENT INFORMATION. effective for the treatment of the flu in people with long-time (chronic) heart problems or breathing problems.

PATIENT INFORMATION. effective for the treatment of the flu in people with long-time (chronic) heart problems or breathing problems. PATIENT INFORMATION capsules, fr ral use fr ral suspensin What is TAMIFLU? TAMIFLU is a prescriptin medicine used t: treat the flu (influenza) in peple 2 weeks f age and lder wh have had flu symptms fr

More information

Swindon Joint Strategic Needs Assessment Bulletin

Swindon Joint Strategic Needs Assessment Bulletin Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical

More information

Screening Questions to Ask Patients

Screening Questions to Ask Patients Screening Questins t Ask Patients 1. Have yu ever had TB (Tuberculsis)? Yes N 2. Have yu been living with anyne in the past tw years that has been diagnsed with TB? Yes N 3. Have yu ever had a Persistent

More information

You may have a higher risk of bleeding if you take warfarin sodium tablets and:

You may have a higher risk of bleeding if you take warfarin sodium tablets and: MEDICATION GUIDE Warfarin (WAR-far-in) Sdium (SO-dee-um) Tablets USP The 7.5 mg tablets cntain FD&C Yellw N. 5 (tartrazine), which may cause allergic-type reactins (including brnchial asthma) in certain

More information

Section 6 Students School District No. 71 (Comox Valley)

Section 6 Students School District No. 71 (Comox Valley) Sectin 6 Students Schl District N. 71 (Cmx Valley) Administrative Prcedure 6011 MR2 Allergies and Anaphylaxis 1. Intrductin The Bard f Educatin expects schls t reasnably accmmdate students with medically

More information

FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES

FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES Appendix h STUDY NUMBER: COST OF UNSAFE ABORTION FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES T be administered abut 2-3 weeks after leaving the health facility 1. IDENTIFICATION 101. Patient identificatin

More information

US Public Health Service Clinical Practice Guidelines for PrEP

US Public Health Service Clinical Practice Guidelines for PrEP Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S

More information

Flu Season Key Points ( )

Flu Season Key Points ( ) 2014-2015 Flu Seasn Key Pints (10-31-14) Cntents Overarching Framewrk f CDC Influenza Messaging... 3 Take 3 Messages... 3 Statements fr General Audiences... 4 Disease... 4 Vaccinatin... 6 Vaccinatin Timing...

More information

CDC Influenza Division Key Points November 7, 2014

CDC Influenza Division Key Points November 7, 2014 In this dcument: Summary Key Messages FluView Activity Update LAIV Effectiveness and Vaccinatin f Children H3N2 Match and Vaccinatin Vaccine Supply Summary Key Messages This week s FluView reprt indicates

More information

Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) Percutaneus Nephrlithtmy (PCNL) What is a percutaneus nephrlithtmy? is the mst effective f the cmmnly perfrmed prcedures fr kidney stnes. It is the best prcedure fr large and cmplex stnes. T perfrm this

More information

Ministry of Health and Long-Term Care

Ministry of Health and Long-Term Care Ministry f Health and Lng-Term Care Infrmatin n Nvel H1N1 Influenza A - Frequently Asked Questins fr Primary Care Practitiners May 7, 2009 This infrmatin is subject t change based n evlving infrmatin n

More information

Imaging tests allow the cancer care team to check for cancer and other problems inside the body.

Imaging tests allow the cancer care team to check for cancer and other problems inside the body. IMAGING TESTS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu

More information

Adult Preventive Care Guidelines

Adult Preventive Care Guidelines Adult Preventive Care Guidelines Gundersen is yur partner fr better health. We want t wrk with yu t make sure that yu and yur family are as healthy as pssible. That can be accmplished best if we wrk tgether

More information

Before Your Visit: Mohs Skin Cancer Surgery

Before Your Visit: Mohs Skin Cancer Surgery Befre Yur Visit: Mhs Skin Cancer Surgery Yur Kaiser Permanente Care Instructins Skin Cancer Infrmatin What is skin cancer? Skin cancers are tumrs, r malignancies, f the skin. Skin cancer is assciated with

More information

Frequently asked questions: Influenza A (H1N1)v

Frequently asked questions: Influenza A (H1N1)v July 30 th 2009 V1.0 Frequently asked questins: Influenza A (H1N1)v (Swine Flu) infrmatin fr parents The fllwing advice is fr parents f children in all educatinal institutins, including crèches, childcare,

More information

Frequently Asked Questions: IS RT-Q-PCR Testing

Frequently Asked Questions: IS RT-Q-PCR Testing Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld

More information

Thank you for committing to engage pharmacists regarding the incredible opportunity for them to prevent opioid overdose deaths by providing naloxone!

Thank you for committing to engage pharmacists regarding the incredible opportunity for them to prevent opioid overdose deaths by providing naloxone! Thank yu fr cmmitting t engage pharmacists regarding the incredible pprtunity fr them t prevent piid verdse deaths by prviding nalxne! If yu encunter cmplicated questins that yu are unable t answer, please

More information

Pain relief after surgery

Pain relief after surgery Pain relief after surgery Imprtant infrmatin fr patients www.mchft.nhs.uk We care because yu matter This leaflet is designed t help yu cntrl any pain yu may have at hme fllwing yur peratin. Please read

More information

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH

GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH GUIDANCE DOCUMENT FOR ENROLLING SUBJECTS WHO DO NOT SPEAK ENGLISH Aurra Health Care s Research Subject Prtectin Prgram (RSPP) This guidance dcument will utline the prper prcedures fr btaining and dcumenting

More information

Package leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate

Package leaflet: Information for the user. Dacepton 5 mg/ml Solution for infusion Apomorphine hydrochloride hemihydrate Package leaflet: Infrmatin fr the user Daceptn 5 mg/ml Slutin fr infusin Apmrphine hydrchlride hemihydrate Read all f this leaflet carefully befre yu start using this medicine because it cntains imprtant

More information

PATIENT INFORMATION. (methotrexate) injection, for subcutaneous use

PATIENT INFORMATION. (methotrexate) injection, for subcutaneous use What is Rasuv? PATIENT INFORMATION RASUVO (ruh-soo-vh) (methtrexate) injectin, fr subcutaneus use Rasuv is a single-dse manually-triggered aut-injectr cntaining a prescriptin medicine, methtrexate. Methtrexate

More information

Little Angels Schoolhouse

Little Angels Schoolhouse Little Angels Schlhuse Sickness and Illness Plicy Aim Early Years Fundatin Stage Statutry Guidance The Prvider must prmte the gd health f the children, take necessary steps t prevent the spread f infectin

More information

2017 Optum, Inc. All rights reserved BH1124_112017

2017 Optum, Inc. All rights reserved BH1124_112017 1) What are the benefits t clients f encuraging the use f MAT? Withut MAT, 90% f individuals with Opiid Use Disrder (OUD) will relapse within ne year. With MAT, the relapse rate fr thse with OUD decreases

More information

Hospital Preparedness Checklist

Hospital Preparedness Checklist Hspital Preparedness Checklist http://pandemicflu.gv Preparedness Subject 1. Structure fr planning and decisin making An internal, multidisciplinary planning cmmittee fr influenza preparedness has been

More information

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red. Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. The United States is currently experiencing a natinwide utbreak f entervirus D68 (EV-D68) assciated with severe

More information

Recommendations for Risk Management at Swine Exhibitions and for Show Pigs August 2012

Recommendations for Risk Management at Swine Exhibitions and for Show Pigs August 2012 Recmmendatins fr Risk Management at Swine Exhibitins and fr Shw Pigs August 2012 Backgrund: The Natinal Prk Bard facilitated in develping this dcument. These recmmendatins were develped by a wrking grup

More information

ANXIETY SYMPTOMS INTERVENTION SESSION HANDOUTS. Introduction to Fighting Fear by Facing Fear. Making a Fears and Worries List

ANXIETY SYMPTOMS INTERVENTION SESSION HANDOUTS. Introduction to Fighting Fear by Facing Fear. Making a Fears and Worries List SESSION ANXIETY SYMPTOMS INTERVENTION 5 SESSION HANDOUTS Handut 5.1: Handut 5.2: Handut 5.3: Handut 5.4: Handut 5.5: Handut 5.6: When Yu Face Yur Fears STOP! Intrductin t Fighting Fear by Facing Fear The

More information

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.

Key Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red. Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. Over the last several mnths, the United States has experienced a natinwide utbreak f entervirus D68 (EV- D68) assciated

More information

PILI Ohana Facilitator s Guide

PILI Ohana Facilitator s Guide Previus Versin: September 10, 2007 Updated Versin: Octber 2, 2007 PILI Ohana Facilitatr s Guide Lessn 5: Managing and Reducing Negative Thughts and Emtins. Questin/Tpic Script Reminder/Activity Welcming

More information

3903 Fair Ridge Drive, Suite 209, Fairfax, VA Harry Byrd Hwy, Suite 285, Ashburn, VA *How did you hear about our program?

3903 Fair Ridge Drive, Suite 209, Fairfax, VA Harry Byrd Hwy, Suite 285, Ashburn, VA *How did you hear about our program? 3903 Fair Ridge Drive, Suite 209, Fairfax, VA 22033 44121 Harry Byrd Hwy, Suite 285, Ashburn, VA 220147 *Hw did yu hear abut ur prgram? Patient Histry Patient Name: First Middle: Last: Address: City: State:

More information

Diphtheria-Tetanus-Acellular Pertussis Combined Vaccine Biological Page (dtap)

Diphtheria-Tetanus-Acellular Pertussis Combined Vaccine Biological Page (dtap) Diphtheria-Tetanus-Acellular Pertussis Cmbined Vaccine Bilgical Page (dtap) Sectin 7: Bilgical Prduct Infrmatin Standard #: 07.210 Created by: Apprved by: Prvince-wide Immunizatin Prgram Standards and

More information

HSC 106 Personal Health Plan for Learning Activities & Assessment linked to Michigan Teacher Preparation Standards

HSC 106 Personal Health Plan for Learning Activities & Assessment linked to Michigan Teacher Preparation Standards HSC 106 Persnal Health Plan fr Learning Activities & Assessment linked t Michigan Teacher Preparatin Standards Standard 1 Cmpetency 1.1 Understand basic health cntent as it relates t schl health educatin.

More information

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by

The estimator, X, is unbiased and, if one assumes that the variance of X7 is constant from week to week, then the variance of X7 is given by ESTIMATION PROCEDURES USED TO PRODUCE WEEKLY FLU STATISTICS FROM THE HEALTH INTERVIEW SURVEY James T. Massey, Gail S. Pe, Walt R. Simmns Natinal Center fr Health Statistics. INTRODUCTION In April 97, the

More information

Podcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10

Podcast Transcript Title: Common Miscoding of LARC Services Impacting Revenue Speaker Name: Ann Finn Duration: 00:16:10 Pdcast Transcript Title: Cmmn Miscding f LARC Services Impacting Revenue Speaker Name: Ann Finn Duratin: 00:16:10 NCTCFP: Welcme t this pdcast spnsred by the Natinal Clinical Training Center fr Family

More information

Dear Student, IMMUNIZATION RECORD INSTRUCTIONS

Dear Student, IMMUNIZATION RECORD INSTRUCTIONS Dear Student, Welcme t the University f Chicag! The State f Illinis and University regulatins require students t prvide prf f required immunizatins prir t registratin fr classes. In rder t cmplete this

More information

requisitions and computerized or addressograph labels for patient 2% Chlorexidine with 70% alcohol wipes (CHG/alcohol)

requisitions and computerized or addressograph labels for patient 2% Chlorexidine with 70% alcohol wipes (CHG/alcohol) PURPOSE Prcedure fr btaining a peripheral bld sample via venipuncture. POLICY STATEMENTS Bld sampling requires a prescriber s rder indicating bld samples t be drawn. The chice f site and prcedure (venepuncture,

More information

Patrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction Surgery Instructions Hip

Patrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction Surgery Instructions Hip Patrick J McGahan, MD Orthpaedic Surgen Specializing in Sprts Medicine/Shulder Recnstructin 2801 K St, Ste 330, Sacrament, CA, 95816 (p) 916-733-5049 (f) 916-733-8914 www.patrickmcgahanmd.cm Befre Surgery

More information

Who is eligible for LifeCare? What services are available?

Who is eligible for LifeCare? What services are available? Wh is eligible fr LifeCare? What services are available? LifeCare is an emplyer prvided wrk/life benefit frm The University f Texas at Austin available t all benefits eligible emplyees and their husehld

More information

Medical Student Immunization Requirements

Medical Student Immunization Requirements Medical Student Immunizatin Requirements The State f Illinis cde, Reference: (110 ILCS 20) Cllege Student Immunizatin Act, requires students t prvide prf f immunity: Measles (Rubela), Mumps, Rubella (German

More information

DRAFT Policy for the Management of Ear Wax

DRAFT Policy for the Management of Ear Wax Clinical Cmmissining Grup (CCG) Treatment Plicy NHS Birmingham and Slihull Clinical Cmmissining Grup NHS Sandwell and West Birmingham Clinical Cmmissining Grup DRAFT Plicy fr the Management f Ear Wax 1

More information

Medication Guide MORPHINE SULFATE (mor-pheen) Oral Solution (CII)

Medication Guide MORPHINE SULFATE (mor-pheen) Oral Solution (CII) Medicatin Guide MORPHINE SULFATE (mr-pheen) Oral Slutin (CII) IMPORTANT: Keep Mrphine Sulfate Oral Slutin in a safe place away frm children. Accidental use by a child is a medical emergency and can cause

More information

454-8 (Insert) MEDICATION GUIDE ZUBSOLV (Zub-solve) (buprenorphine and naloxone) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place

454-8 (Insert) MEDICATION GUIDE ZUBSOLV (Zub-solve) (buprenorphine and naloxone) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place MEDICATION GUIDE ZUBSOLV (Zub-slve) (buprenrphine and nalxne) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place away frm children. Accidental use by a child is a medical emergency and

More information

The principles of evidence-based medicine

The principles of evidence-based medicine The principles f evidence-based medicine By the end f this mdule yu shuld be able t: Describe what evidence based medicine is Knw where t find quality evidenced based medicine n the internet Be able t

More information

CONSUMER MEDICINE INFORMATION

CONSUMER MEDICINE INFORMATION CONSUMER MEDICINE INFORMATION What is in this leaflet This leaflet answers sme cmmn questins abut CEFTRIAXONE lcp. It des nt cntain all the available infrmatin. It des nt take the place f talking t yur

More information

Zika Virus. Where has Zika virus been found? Zika in the United States and its territories:

Zika Virus. Where has Zika virus been found? Zika in the United States and its territories: Where has Zika virus been fund? Zika Virus Prir t 2015, Zika virus utbreaks have ccurred in areas f Africa, Sutheast Asia, and the Pacific Islands. In May 2015, the Pan American Health Organizatin (PAHO)

More information

The Mental Capacity Act 2005; a short guide for the carers and relatives of those who may need support. Ian Burgess MCA Lead 13 February 2017

The Mental Capacity Act 2005; a short guide for the carers and relatives of those who may need support. Ian Burgess MCA Lead 13 February 2017 The Mental Capacity Act 2005; a shrt guide fr the carers and relatives f thse wh may need supprt Ian Burgess MCA Lead 13 February 2017 Agenda Overview f the MCA The 5 Principles and the legal definitin

More information

SECTION O. MEDICATIONS

SECTION O. MEDICATIONS SECTION O. MEDICATIONS 1. NUMBER OF MEDICA TIONS (Recrd the number f different medicatins used in the last 7 days; enter "0" if nne used) O1. Number f Medicatins (7-day lk back) Intent: Prcess: Cding:

More information

Annex III. Amendments to relevant sections of the Product Information

Annex III. Amendments to relevant sections of the Product Information Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t

More information

MEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injection for intravenous infusion

MEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injection for intravenous infusion MEDICATION GUIDE LEMTRADA (lem-tra-da) (alemtuzumab) Injectin fr intravenus infusin Read this Medicatin Guide befre yu start receiving LEMTRADA and befre yu begin each treatment curse. There may be new

More information

Pandemic H1N1 2009: DrillSafe Update. David Blizzard BD Manager, Energy Mining and Infrastructure

Pandemic H1N1 2009: DrillSafe Update. David Blizzard BD Manager, Energy Mining and Infrastructure Pandemic H1N1 2009: DrillSafe Update David Blizzard BD Manager, Energy Mining and Infrastructure Pandemic H1N1 Update CDC.Gv USA Pandemic H1N1 Summary Pints Virus cntinues t spread with nearly all WHO

More information

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?

Q 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder? updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health

More information

EMDR EUROPE ACCREDITED PRACTITIONER COMPETENCY BASED FRAMEWORK

EMDR EUROPE ACCREDITED PRACTITIONER COMPETENCY BASED FRAMEWORK EMDR EUROPE ACCREDITED PRACTITIONER COMPETENCY BASED FRAMEWORK Guidelines fr Accreditatin as an EMDR Eurpe Accredited Practitiner Applicants must have cmpleted EMDR Basic training by a recgnised EMDR Eurpe

More information

Tetanus Prevention, Prophylaxis and Wound/Injury Management Standard

Tetanus Prevention, Prophylaxis and Wound/Injury Management Standard Tetanus Preventin, Prphylaxis and Wund/Injury Management Standard Sectin 8: Immunizatin f Special Ppulatins Standard #: 08.400 Created by: Apprved by: Prvince-wide Immunizatin Prgram, Standards and Quality

More information

ACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals.

ACSQHC National Consensus Statement: Essential Elements for High Quality End-oflife Care in Acute Hospitals. 27 March 2014 Prfessr Debra Picne Chief Executive Officer Australian Cmmissin n Safety and Quality in Health Care c/ Ms Jennifer Hill, Senir Prject Officer Level 5, 255 Elizabeth Street SYDNEY NSW 2000

More information

Advantage EAP Employee Assistance Program

Advantage EAP Employee Assistance Program Advantage EAP Emplyee Assistance Prgram July 2014 In This Issue What might we face? Symptms f SAD Seasnal changes in biplar disrder Tips fr cmbating summer truble When t seek help Tips fr helping thse

More information

Initial Postoperative Knee Care Patella or Quadriceps Tendon Repairs: - Videos are available on Dr. Witty s website: drjeffreywitty.

Initial Postoperative Knee Care Patella or Quadriceps Tendon Repairs: - Videos are available on Dr. Witty s website: drjeffreywitty. Initial Pstperative Knee Care Patella r Quadriceps Tendn Repairs: - Vides are available n Dr. Witty s website: drjeffreywitty.cm Imprtant Phne Numbers: - Please see the cntact infrmatin abve fr imprtant

More information

Patrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction

Patrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction Patrick J McGahan, MD Orthpaedic Surgen Specializing in Sprts Medicine/Shulder Recnstructin 2801 K St, Ste 330, Sacrament, CA, 95816 (p) 916-733-5049 (f) 916-733-8914 www.patrickmcgahanmd.cm Befre Surgery

More information

CoaguChek Outpatient Clinic: Quality Control Test Procedure. Action

CoaguChek Outpatient Clinic: Quality Control Test Procedure. Action PHSA Labratries CW Site - Pint f Care Title: CWPC_INR_0130 CaguChek Outpatient Clinic Quality Cntrl Test Prcedure CaguChek Outpatient Clinic: Quality Cntrl Test Prcedure PURPOSE: This prcedure prvides

More information

Individual Assessments for Couples Treatment with HFCA

Individual Assessments for Couples Treatment with HFCA Individual Assessments fr Cuples Treatment with HFCA Jennifer S. Ripley, Ph.D. Many appraches t cuples therapy include an individual assessment whenever a cuple cmes fr treatment. Therapists shuld be aware

More information

Section IA-Introduction

Section IA-Introduction Immunizatin Prgrams and Vaccine Preventable Diseases Service 655 West 12th Avenue Vancuver, BC V5Z 4R4 Tel 604.707.2548 Fax 604.707.2515 www.bccdc.ca Date: May 15, 2017 Administrative Circular: 2017:07

More information

Annual Principal Investigator Worksheet About Local Context

Annual Principal Investigator Worksheet About Local Context Cmpleting the NCI CIRB Annual Principal Investigatr Wrksheet Abut Lcal Cntext and the Study-Specific Wrksheet Abut Lcal Cntext at the University f Iwa All investigatrs cnducting research with the Natinal

More information

FDA Dietary Supplement cgmp

FDA Dietary Supplement cgmp FDA Dietary Supplement cgmp FEBRUARY 2009 OVERVIEW Summary The Fd and Drug Administratin (FDA) has issued a final rule regarding current gd manufacturing practices (cgmp) fr dietary supplements that establishes

More information

Glaucoma Interviews: Due Tuesday, May 22 nd

Glaucoma Interviews: Due Tuesday, May 22 nd Glaucma Interviews: Due Tuesday, May 22 nd 1) Read the glaucma article well! It will explain what it is, plus tell yu sme symptms and risk factrs. Yu may want t use a highlighter r pen t mark imprtant

More information

I am having a Rotator Cuff Repair

I am having a Rotator Cuff Repair I am having a Rtatr Cuff Repair A rtatr cuff repair is surgery t repair a trn tendn in the shulder. The rtatr cuff is a grup f muscles and tendns that frm a cuff ver the shulder jint. The muscles and tendns

More information

Hepatitis B Vaccine Biological Page

Hepatitis B Vaccine Biological Page Hepatitis B Vaccine Bilgical Page Sectin 7: Bilgical Prduct Infrmatin Standard #: 07.234 Created by: Apprved by: Prvince-wide Immunizatin Prgram Standards and Quality Prvince-wide Immunizatin Prgram, Standards

More information

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT

1.11 INSULIN INFUSION PUMP MANAGEMENT INPATIENT WOMEN AND NEWBORN HEALTH SERVICE CLINICAL GUIDELINES SECTION A: GUIDELINES RELEVANT TO OBSTETRICS AND GYNAECOLOGY 1 STANDARD PROTOCOLS 1.11 INSULIN INFUSION PUMP MANAGEMENT - INPATIENT Authrised by: OGCCU

More information

CDC Influenza Technical Key Points February 15, 2018

CDC Influenza Technical Key Points February 15, 2018 CDC Influenza Technical Key Pints In this dcument: Summary Key Pints U.S. Vaccine Effectiveness U.S. Flu Activity Update Summary Key Pints On Thursday, tw influenza-related reprts appeared in the Mrbidity

More information

Protocol. Preparation Protocol for the Non-Targeted Vevo MicroMarker Contrast Agent

Protocol. Preparation Protocol for the Non-Targeted Vevo MicroMarker Contrast Agent Prtcl Preparatin Prtcl fr the Nn-Targeted Vev MicrMarker Cntrast Agent System Cmpatibility: This guide cntains instructins and suggestins fr wrk n the Vev2100, VevLAZR, Vev 3100 systems and transducers

More information