Although it would be great if mistakes never ever happened, the best we can do is to understand that mistakes do sometimes happen and take steps to avoid them.
How can we avoid mistakes and errors about vaccines?
Avoiding Vaccine Errors
It can help to:
- understand the 7 Rights of vaccine administration, including that you give the Right vaccine to the Right patient at the Right time by the Right route at the Right injection site and then follow it with the Right documentation
- use a 2d barcoding system with your EMR to help catch vaccine errors before administration
- use a screening checklist to help avoid giving vaccines that are contraindicated
- double check vaccines that look alike or have names that sound like, such as DTaP and Tdap
- double check expiration dates
- make sure you aren’t giving live vaccines within 28 days of each other, unless they are given at the same time
- make sure you aren’t giving the wrong dosage amount for the patient’s age, as some vaccines have different formulations depending on the age of the patient, including flu shots, hepatitis A, and hepatitis B vaccines
- be careful so that you don’t give a combination vaccine, such as Pediarix, Pentacel, Kinrix, Quadracel, or ProQuad, inappropriately
- be careful when giving vaccines like Hib (3 or 4 doses) and rotavirus (2 or 3 doses) that have different schedules depending on the brand you are giving
That we are have a 4-day grace period does help avoid the need to revaccinate some kids when vaccines are given a little too early.
“With the exception of rabies vaccine, ACIP allows a grace period of 4 days (i.e., vaccine doses administered up to 4 days before the recommended minimum interval or age can be counted as valid). However, if a dose was administered 5 or more days earlier than the recommended minimum interval between doses, it is not valid and must be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval.”
Ask the Experts About Scheduling Vaccines
In many cases, as long as vaccine doses were administered less than or equal to 4 days before the minimum interval or age, then they can still be counted and are considered valid.
Common Vaccine Errors
It’s easier than you think to prevent vaccine errors.
When are you most likely to make a vaccine error?
When you are doing something that isn’t routine, which most commonly happens when folks delay or skip some vaccines and are now playing catch-up.
In addition to the tips above, remember that:
- the first dose of the rotavirus vaccines must be given by 15 weeks
- the rotavirus vaccine series must be completed by 8 months (32 weeks)
- ProQuad, the MMR and chicken pox combination vaccine, is not licensed for kids who are older than 12 years, although if a teen or adult did get ProQuad, it could be considered an off-label dose and could still count.
- Kinrix and Quadracel, the DTaP and polio combination vaccines are only licensed for the 5th dose of DTaP and 4th dose of polio in children who are 4 to 6 years old, so wouldn’t be appropriate for an 18-month-old, even if he needs both (DTaP and polio) vaccines. Earlier doses can sometimes count as off-label doses though.
- the combination vaccines Pediarix and Pentacel are only licensed up through age six years, but don’t necessarily need to be repeated if given to older kids.
- children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis A vaccine, while older teens, who are at least 19-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis A or even realize that there is a different version.
- children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis B vaccine, while older teens, who are at least 20-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis B vaccine or even realize that there is a different version.
Most importantly, even when giving vaccines on schedule, be sure to triple check everything. This is especially important if multiple kids in the same room are getting immunizations.
Also remember that vaccine errors should be reported to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS, with the correct dose repeated if necessary.
What to Know About Common Vaccine Errors
Although none of these vaccine errors are very common (hundreds of millions of doses of vaccines are given in the United States each year), understanding which ones occur the most often can help to make sure that they don’t happen in your office.
More on Common Vaccine Errors
- Know the “7 Rights” of Vaccine Administration
- Ask the Experts About Administering Vaccines
- Ask the Experts About Scheduling Vaccines
- To Err Is Human; Not To Err Is Better!
- Tips for Finding Vaccine Records
- CDC – Vaccine Administration
- ACIP – Timing and Spacing of Immunobiologics
- Be sure your staff is not making any of these frequently reported vaccine administration errors
- Administering Just the Diluent or One of Two Vaccine Components Leaves Patients Unprotected
- Confusion abounds! 2-year summary of the ISMP National Vaccine Errors Reporting Program (Part I)
- Recommendations for Practitioners to Prevent Vaccine Errors Part 2: Analysis of ISMP Vaccine Errors Reporting Program (ISMP VERP)
- ISMP National Vaccine Errors Reporting Program: One in Three Vaccine Errors Associated with Age-Related Factors
- First Annual Review of Data Submitted to the ISMP National Vaccine Errors Reporting Program (ISMP VERP)
- DTaP, LAIV, MCV4, PPSV23, HZV, 9vHPV… Alphabet Soup Vaccine Abbreviations and Acronyms Lead to Errors
- Recommendations for Practitioners and Manufacturers to Address System-Based Causes of Vaccine Errors
- Skills Checklist for Vaccine Administration
- Implementation Guide for Decision Makers – 2D Vaccine Barcode Scanning
- Adopting 2D Vaccine Barcodes