INTRODUCTION Administering Injections and Immunizations Preparation Course Authors: Rene A. Day, PhD, RN, Professor Emerita, Faculty of Nursing, University of Alberta, 2010. Heather Scarlett-Ferguson, BSP, MDE, RPh. Instructor, Grant MacEwan University, 2010. Updated By: Betty Golightly, BScPharm, RPh, Foundation in Travel Medicine (RCPHS-Glasgow), Certificate in Travel Health, 2015
Copyright, 2014, The Alberta Pharmacists Association All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopy, recording or otherwise, without the prior written permission of the publisher, the Alberta Pharmacists Association. Published by the Alberta Pharmacists Association 1725, 10303 Jasper Avenue NW Edmonton, AB T5J 3N6 Telephone: 780.990.0326 Fax: 780.990.1236 The materials, Administering Injections and Immunizations Preparation Course are the property of, and subject to the copyright of the Alberta Pharmacists Association, and are provided to you solely for your personal use and education, and may not be reproduced, digitized or distributed by you without permission of the Alberta Pharmacists Association. If your organization would like to receive permission to use these materials for its own educational programs, please contact the Alberta Pharmacists Association to discuss the necessary arrangements. 2
Administering Injections and Immunizations Preparation Course This Course is Divided into Two Parts: PART 1 (9.0 CEU S) PRE-STUDY The Pre-Study includes pre-study reading material and a multiple choice test. To successfully complete the Pre-Study, participants must achieve at least 70% on the multiple choice test. This is a prerequisite for attending Part 2 The Workshop. PART 2 (7.25 CEU S) WORKSHOP The Workshop includes theory, discussion, demonstration, guided practice, and assessment in relation to delivering medication and/or immunization via injections. To successfully complete the Workshop, participants must: 1. Correctly demonstrate preparing a medication from a vial. 2. Working in pairs, correctly administer one subcutaneous injection (locate site and inject into each other) and record. 3. Working in pairs, correctly administer one intramuscular injection into the deltoid muscle (locate site and inject into each other) and record. 3
Objectives PART 1 PRE-STUDY: Upon completion of the Pre-Study, participants will be able to do the following: Module One: Diseases and Vaccines 1. Examine current status of vaccine-preventable illness in the world, and specifically in Alberta 2. Review general principles of vaccination including: a. Immunity b. Role of antibodies c. Indication for immunization d. Classification e. Types of common immunization agents f. Numbers of doses g. Spacing and timing of vaccines 3. Utilize Immunization Schedules with patient s age and immunization record to establish immunization status of patient: a. Alberta: Government of Alberta Routine Immunization Schedule b. Canada: Canadian Immunization Guide c. Immunizations recommended for travel outside of Canada 4. Describe the use of vaccines including: a. Precautions b. Contraindications c. Adverse reactions to vaccines d. Signs and symptoms e. Treatment of anaphylaxis 5. Identify the role of the pharmacist in: a. Administering injections b. Vaccination programs 6. Review pandemics, pandemic preparedness and the role of the pharmacist 4
Module Two: Practical Considerations 1. Explain principles and procedures for: a. Vaccine procurement b. Vaccine storage and handling (cold chain) 2. Review the standards of practice guiding injection administration 3. Describe a system for administering and recording injections 4. Explain procedures for medication error and adverse drug reaction reporting 5. Discuss other injectable medications that may be administered 6. Explore non-vaccine injectables that pharmacists might administer 7. Use of emergency medications for adverse reactions to injectables 8. Latex allergy (hypersensitivity) and management for: a. Patients b. Health care personnel 9. Recognize the concept of asepsis as it relates to preparing and injecting medications 10. List criteria to use in selecting an appropriate needle and syringe for injections/immunizations 11. Discuss the advantages and disadvantages of using subcutaneous, intramuscular and intradermal sites for injections Evaluation Objectives: To successfully complete the Pre-Study and receive a Statement of Completion and continuing education units, participants must achieve at least 70% on the home based multiple choice test. The multiple choice test is based on the pre-study material and must be completed prior to the Workshop. 5
PART 2 WORKSHOP: Upon completion of the Workshop, participants will be able to: 1. Describe the process of deciding that an immunization/an injection is required a. Check for an order (physician s or pharmacist s) b. Review patient s medication record c. Review pharmacy s record 2. Discuss the elements to include in obtaining informed consent as it relates to giving injections/ immunizations 3. List the 7 rights, 2 considerations, and 3 checks of medication administration 4. Describe the requirements of routine practices and additional precautions for infection control according to Health Canada (2012) 5. Recognize the concept of asepsis as it relates to: a. Handwashing b. Use of sterile and nonsterile gloves (have PVC gloves available) c. Preparing injectable drugs and solutions d. Preparing injection site e. Injecting medications and vaccines f. Disposing of syringe, needle and swabs 6. List key elements to assess for children, adults, and older adults prior to giving injections: a. Patient history b. Determine need for immunization or injection of other medication c. Identify possible latex hypersensitivity d. Injection requirements for patients with disease states such as diabetes, cardiac, autoimmune and blood disorders, and cancer e. Contraindications for immunization 7. List criteria to use in selecting an appropriate needle and syringe for injections/immunizations 8. Describe how to withdraw medication from an ampule and a vial 9. Discuss the advantages and disadvantages of using subcutaneous, intramuscular and intradermal sites for injections 10. Describe needlestick injuries in terms of: a. Prevention b. Treatment/management c. Proper disposal of needles 6
11. Describe a system for administering and recording injections within the pharmacy practice setting 12. Describe an appropriate environment for providing injections to patients 13. Demonstrate the skill of injections: a. Discuss preparation of medications for intradermal, subcutaneous and intramuscular injections b. Discuss how to evaluate potential injection sites c. Demonstrate the location of appropriate sites for intradermal, subcutaneous, and intramuscular injections d. Describe differences in technique in giving intradermal, subcutaneous, and intramuscular injections 14. Explore ways to decrease patient anxiety/discomfort related to injections 15. Describe care of patients following injections/immunizations (including monitoring) 16. Describe the process of identifying and treating emergencies such as anaphylaxis a. Policies b. Procedures c. Equipment 17. Assess patient teaching related to injections/immunizations 18. Describe plans for follow-up with the patient EVALUATION: To successfully complete the Workshop and receive a Certificate of Completion and continuing education credits, a workshop participant will: 1. Correctly demonstrate preparing a medication from a vial 2. Working in pairs, correctly administer one subcutaneous injection (locate site and inject into each other) and record 3. Working in pairs, correctly administer one intramuscular injection into the deltoid muscle (locate site and inject into each other) and record 7
Now you are ready to begin the Pre-Study! THE PRE-STUDY HAS BEEN ORGANIZED INTO THE FOLLOWING CATEGORIES: 1. Module 1 2. Module 2 3. Appendices of Forms 4. Glossary, Resources and References for Module 1 & 2 5. Additional Required Reading 6. PowerPoint Presentation Information about preparing and administering injections 7. Documentation Form & Injection Assessment Guide 8. Pre-Study Multiple Choice Test 9. Evaluation Form for Part 1 10. Waiver of Liability Agreement Note: During the Pre-Study you will be directed to additional linked resources. If the link does not open immediately, please copy and paste the web url into a browser of your choice. 8