PDL Professional Officers often receive incident reports involving administration or supply of vaccines that may have been prevented by thorough review of the patient needs and clinical guidelines. Pharmacists are encouraged to review the following case and reflect on how they can mitigate the risk of an incident in their own practice.
Case Study: A 28-year-old patient presented a prescription for ‘varicella’ vaccine, requesting in-pharmacy administration. The pharmacist dispensed and administered Shingrix after pre-screening checks, review of the Australian Immunisation Register (AIR) and obtaining consent.
Weeks later, the patient learned from their GP that Shingrix was the incorrect vaccine – they required a chickenpox vaccine to commence a new job. They are now at risk of not completing both doses in time for their commencement date.
Following any incident, it is important to reflect upon how and why the error occurred. In this case, the pharmacist identified the following as potential contributing factors:
- A selection error occurred during dispensing. They confused the ‘varicella’ vaccine with varicella zoster.
- While they discussed the indication of the selected vaccine, they had not confirmed the intended indication. In this case, vaccination was required before commencing a new job. Shingrix is not typically needed for protection in an employment setting.
- They had not confirmed whether the vaccine they were administering was clinically appropriate for the patient. The Australian Immunisation Handbook (AIH) outlines that Shingrix is typically recommended in this age cohort for immunocompromised patients only. This would have prompted further discussion with the patient to understand their needs.
Despite a dispensing error being made, there were several checkpoints that were missed that could have identified the selection error before administration to the patient.
Risk mitigation tips
Many of the incidents involving vaccination reported to PDL may have been prevented by including several checkpoints in pre-administration procedures. The Professional Officers remind pharmacists to complete the following steps BEFORE administering a vaccine:
- Confirm the intended indication with the patient and/or prescriber.
- Review the clinical appropriateness of the selected vaccine for the patient.
- Thoroughly review the patient’s Australian Immunisation Register (AIR) record.
- Confirm patient eligibility for NIP/NIPVIP.
- Obtain informed consent.
- Check regulatory authorisation and requirements in the relevant jurisdiction.
- Consider your individual scope of practice.
Resources
- Guide to Medicines by Injection
- PDL Risk Management Guide for Pharmacists
- Scope of Practice Checklist
- PSA Practice Guidelines for pharmacists providing immunisation services
- NCIRS Vaccination from community pharmacy – at a glance (this provides details of all vaccines available from community pharmacies and respective legislation and regulations for each state and territory).
Cold Chain update
The updated Strive for 5 guideline (4th Edition) is now available and offers expanded guidance for pharmacists on vaccine storage, transport and administration.
Temperature-monitoring devices
Immunisation providers must, at a minimum, have all the following.
- A digital thermometer (inbuilt or portable) with a digital display showing minimum, maximum and current temperatures. Minimum and maximum temperatures must be manually recorded twice daily.
- A downloadable data logger set to continuously measure PBVR temperatures at minimum 5-minute intervals or automated temperature monitoring systems in the PBVR.
- A portable minimum/maximum thermometer for use in vaccine transportation or in the event of a PBVR failure.
Advice to patients
The guideline also outlines that if administration in the pharmacy is not possible or appropriate, the pharmacist must advise the client that:
- The vaccine must be taken directly to the administering healthcare professional or kept in the pharmacy’s refrigerator.
- The vaccine should not be left in a car or stored in a domestic refrigerator in alfoil bags.
- If there is concern that a vaccine provided by a patient may have been stored outside the recommended +2°C to +8°C range, the vaccine must not be administered. The patient may need to purchase a replacement vaccine dose.
PDL members can call 1300 854 838 for advice and incident support from one of our Professional Officers.
