step V Administering Vaccines

1 Ou have your vaccination supplies, and youhave properly stored your vaccine inventory. As you start to assess your patients vaccinationstatus and history, the gaps in their records remindyou why your practice is now incorporating vacci-nation services. It s time to administer vaccine . Chances are, many of your patients are behind ontheir vaccinations and they are grateful that you arehelping them get up to date. Even if you are newatadministering Vaccines , don t be intimidated this will soon be second nature to you. Determine who can administer Vaccines (either independently or under standingorders)Every state has regulations that specify who canadminister Vaccines .

2 All states allow physicians,nurse practitioners, and physician assistants to bothassess the need for and to admin-ister Vaccines . All states allow RNsand LPNs to administer states allow medical assis-tants (MAs) to give injections afterproper training and with supervi-sion. All states allow pharmaciststo assess the need for and admin-ister one or more Vaccines if theyhave been properly trained andcertified. However, you ll need tocheck to see if there are restrictionson the particular vaccine (s) theymay administer in your state or ifvaccines can be administeredunder standing orders.

3 For moreVaccinatingAdults:A step -by- step Guide Immunization Action Coalition : Administering VaccinesYStep-by- step : vaccine Administration Tasks Determine who can administer Vaccines (either independ-ently or under standing orders) Always provide a vaccine Information Statement (VIS) Administer the vaccine properly Use the proper site for injection Prepare the vaccine (and diluent, if needed) Use the proper needle gauge and length Administer injections by the correct route intramuscular(IM) or subcutaneous (Subcut) Know how to deliver nasal spray vaccine (when recommended)

4 Administer all needed Vaccines at the same visit Safely dispose of the needle and syringe and nasal sprayer Avoid vaccine administration errors Prepare and watch for an allergic reaction (anaphylaxis) aftervaccination Always report anaphylaxis and other adverse events aftervaccination to VAERS Prepare and watch for syncope (fainting) Communicate about appointments for subsequent doses Understand proper spacing of dosesYou ll need to check to see if there are restrictionson the particular vaccine (s)they may administer inyour state or if Vaccines canbe administered understanding ordersinformation about standing orders and who is eli-gible to provide vaccination services using them,which might include RNs, pharmacists, and MAs,see the Immunization Action Coalition s (IAC)UsingStanding Orders for Administering Vaccines : WhatYou Should Knowat You also should check with your statemedical licensing board for the regulations in yourpractice location.

5 Another great resource is IAC s10 Steps to Implementing Standing Orders for Immunization in Your Practice Settingavailable of the local regulations, proper vaccineadministration technique is a skill that requirespractice. If you have not administered injectable ornasal spray Vaccines recently, you should refreshyour skills. In addition to watching a vaccine admin-istration video (one example is discussed later inthis chapter), you should consider contacting yourlocal health department. Staff there may be able to provide hands-on training with this importantprocedure, or they can head you in the right directionfor provide a vaccine Information Statement (VIS)Since 1994, healthcare providers who administerany vaccine covered bythe NationalChildhoodVaccineInjury Act(Section 2125 of the Public Health Service Act [ 300aa-26]) are required to provide a copy ofthe relevant federal vaccine Information Statement(VIS) beforeadministering most Vaccines to a person of any age, including adults.

6 VISs are avail-able for all Vaccines licensed in the United States,and many are available in multiple languages onthe IAC website at A listingof the most current versions for each VIS also maybe found on this website. Patients must be offered a copy (which can be an electronic copy) of the VIS to take home with them, though the recipientmay decline. (You can learn more about this federalrequirement in step 6 Documentation and RelatedIssues.) You probably will want to give patients evenmore information aboutthe disease that the vac-cine prevents, as well as answer any questionsthey may have.

7 Administer the vaccine properlyRemember if you don t administer the vaccineproperly, you might as well not give it at all. You vegone to a lot of trouble to keep your Vaccines viable, and your patients need this a waste it would be for the vaccine not to beadministered properly! One common mistake is that too short a needle isused a subcutaneous Subcut needle rather thanan intramuscular IM needle. When this happens,the vaccine can be injected into fat instead of into muscle. You may hear that some Vaccines willVaccinating Adults: A step -by- step Guide Immunization Action Coalition : Administering Depar tment of Health and Human Ser vices Centers for Disease Control and Prevention vaccine INFORMATION STATEMENTMany vaccine Information Statements are available in Spanish and other languages.

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