Barbara K. Wolicki BSN, RN Immunization Nurse Consultant MDCH Division of Immunization

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1 Barbara K. Wolicki BSN, RN Immunization Nurse Consultant MDCH Division of Immunization Immunization Process Assess the Immunization Record Check the Recommended Schedule Ask the Screening Questions Educate the Client Administer the Vaccines Document What You Have Done

2 Immunization Process: Steps 1 & 2 Patient s Chart Paper or EMR (electronic medical record) Record Card(s) Michigan Care Improvement Registry (MCIR)

3 4.3 million adults have a MCIR record 29 million individual vaccines recorded MCIR can: Accept data transferred from approved EMRs and EHRs Provide immediate patient immunization history Offer quick and easy-to-print official record Determine valid dose Assess for needed vaccines Forecast for next dose Measure clinical coverage levels

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5 Y button indicates invalid dose

6 Open to all Michigan Providers Need: computer and internet access Free training available for all staff Information available on-line

7 Immunization Process: Step 3 Key to preventing serious adverse reactions Screen at every vaccine visit Follow only valid precautions and contraindications

8 Immunization Process: Step 4 Give prior to administering any vaccine Must include MCIR consent language Obtain VISs from Your local health department MDCH website Available in foreign languages

9 MCIR Consent Revision Date After Care Instructions

10 Immunization Process: Step 5 89 reports of administration errors included 50 (56%) citing vaccine administered in an inappropriate site 49/50 (98%) reported an Adverse Health Event Pain in extremity (43%); Injection site pain (37%); Pain (28%); Musculoskeletal pain (18 %); Injected limb mobility decreased (16%); Bursitis (10%) Two reports were considered serious ; both cases requiring surgical intervention Vaccine Errors (Oops!) Reported to the Vaccine Adverse Event Reporting System, Beth Hibbs RN, MPH, CDC, NIC 2012

11 41/50 (82%) vaccine was given too high in the arm 26/41 (63%) stated pain/symptoms lasted more than one week 18/26 stated pain lasted more than 3 weeks or several weeks Location of immunization administration 50% in retail settings; 20% in hospital or public health clinics; 8% in physician offices; 8% employee health; 8% other & 6% unknown Vaccine Errors (Oops!) Reported to the Vaccine Adverse Event Reporting System, , Beth Hibbs RN, MPH, CDC NCIRD, NIC Key to vaccine safety is well-trained staff Ensure all staff are prepared to administer vaccines Have a competency checklist ready

12 Routine Injectable Vaccine Administration for Adults; Quick Reference to Combination and/or Reconstituted Vaccines: Adult or Immunization Process: Step 6

13 Six required elements of documentation: 1. Date vaccine dose given 2. Date Vaccine Information Statement (VIS) given 3. Date on VIS 4. Vaccine manufacturer 5. Vaccine lot number 6. Signature of person administering the vaccine Best practice: Record the site and route Document all vaccines administered in: - MCIR -Chart or EMR Give an updated MCIR record or vaccine record card to the patient Provides free on-site trainings for all staff physician, nurse, medical assistants, others Instructors: Immunization Nurse Educators (INE) Modules on: Vaccine Recommendations (Adult, Adolescent) Vaccine Management: Storage and Handling Vaccine Administration and Pain Management Contact MDCH/Carlene Lockwood lockwoodc@michigan.gov

14 Thank you for your continued partnership in protecting Michigan citizens from Vaccine Preventable Diseases