AMA 250 Immunization Assignment

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					                       AMA 250 Immunization Assignment

After reading the attached handouts and researching and reviewing all links on the
handouts and the additional resources pages if needed, (Standard Immunization
Training Module Level I and Additional Resources attached), answer the following
questions:


      1. Describe how to store vaccines correctly (include: Hep B, Hep A, DTap, HIB,
         MMR, Varicella, IPV and Pneumococcal, Rotavirus). Why is it important for
         the receptionist or front desk person to be aware of this info when vaccines
         are delivered to the office?




      2. Why is it critical to maintain temperature logs for vaccines and how is this
         done?




      3. Why must you report out-of-range temperatures and how is this done? How
         often must you check the temperature of the refrigerator or freezer where
         the vaccine is stored? Where do you document this? What if you checked the
         temperature and it was out of range for safe storage and use? What would
         you do? Could you still use this vaccine? Why or why not?




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4. What length needles are used for infants for subcutaneous and IM injections
   in the vastus lateralis muscle as recommended/required by the CDC?




5. List 3 contraindications (when a vaccine cannot be given) as listed on the
   CDC website link in the handouts (Standard Immunization Training Module).
   For each contraindication listed, what question(s) would you ask or how
   would you find out if that contraindication applied to your patient(s)?




6. What is required by Federal Law to be given to the patient/parent prior to
   giving any vaccination? What is available for those who do not speak English?
   Where can you find this information? (include the web link/URL)




7. List and describe the 3 aspects of patient/client observation required as listed
   in the handout. (Standard Immunization Training Module).




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8. List the 7 components or pieces of information that MUST be documented
   when administering vaccinations according to the CDC link.




9. Which vaccines must be administered in separate anatomical sites according
   to the CDC link information in the handouts? (Standard Immunization
   Training Module). Why?




10. Describe how to properly restrain/hold a child/infant when giving vaccinations
    according to the CDC link in the handouts. (Standard Immunization Training
    Module). What would you do if you didn’t think/feel the parent would
    properly help to restrain the child?




11. Which vaccines require reconstitution? What is important about this and why?




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12. Why must you use specific diluents for each type of reconstituted vaccine?
    What would you do if you did not reconstitute the vaccine and only injected
    the child with diluent? How can you avoid this serious mistake?




13. Which vaccines are sensitive to light? How can you avoid exposing vaccines
    to light when you store them? Which vaccines must be injected within 20-30
    minutes of reconstitution and why? How can you protect a light-sensitive
    vaccine once you have drawn it up into a syringe as you transport it to the
    patient?




14. Which vaccines are required to be stored frozen? Why is this important? What
    must you monitor and why?




15. Which vaccines are live-virus vaccines? What are the special storage and
    usage requirements for these?




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16. Why is it important to administer a vaccine by the correct route?




17. List the steps you would take if a parent refused to immunize their child.
    After you follow those steps, and they still refused, how would you document
    the refusal? Why is this important? List a reliable website you might give the
    parent to access information about immunizations so that they may get more
    information. What would you do if the parent told you they were concerned
    that the vaccine may cause autism?




18. Why is it important to note the site of where each vaccination is given?




19. How would you document an adverse reaction to an immunization? Give an
    example of an adverse reaction and your chart note.




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20. Attach the pediatric immunization documentation form from your classroom
    handouts with the correct immunizations filled out as if a child of 12 months
    of age was current for all immunizations. You can make up dates and other
    information (but use the correct VIS dates, injection sites and amounts; Look
    it up!). Go to the CDC website, print and attach the appropriate VIS for each
    immunization (1 for each vaccine) that is current to date. Also fill out the
    lifetime immunization record card in your handouts for the same information
    and attach that as well to this assignment.


21. Go to the following site: http://www.childprofile.org/irdemo/default.html
    Investigate the patient record demonstration and the reports demonstration.
    You may have to use this online resource on externship or on the job. Be
    familiar with what it offers and how to use it. Write a short paragraph on
    what you learned.




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           STANDARDIZED IMMUNIZATION TRAINING MODULE
                           LEVEL ONE
INSTRUCTOR NOTES
This training outline is designed to introduce health profession students to best
practices in vaccine administration and management.

     This icon means that the link will direct you to a student handout.

I. GENERAL VACCINATION INFORMATION
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/prinvac.pdf

   A. Brief History of Vaccines
      http://www.cdc.gov/vaccines/pubs/downloads/p_vacc-timeline.pdf

   B. Community Immunity
      http://www.cdc.gov/vaccines/about/terms/glossary.htm
      ―Having a large percentage of the population vaccinated in order to prevent the spread
      of certain infectious diseases. Even individuals not vaccinated (such as newborns and
      those with chronic illnesses) are offered some protection because the disease has little
      opportunity to spread within the community. Also known as herd immunity.‖
      1. General Population
          http://www.cdc.gov/vaccines/recs/schedules/default.htm
      2. Health Care Workers
          http://www.immunize.org/hcw/
              a. Maintain personal immunization/serology record

II. VACCINE MANAGEMENT

   A. Vaccine Storage and Handling
      http://www.cdc.gov/vaccines/pubs/downloads/bk-vac-mgt.pdf
      22. Store vaccine correctly
      23. Maintain temperature logs
      24. Report out-of-range temperatures


III. PRINCIPLES OF VACCINE ADMINISTRATION
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-full-a.pdf

   A. Five Rights of Drug Administration
      http://www.lllfornurses.lv/discourse/drugadministration.htm
      1. Right patient
      2. Right vaccine
      3. Right dose
      4. Right time/interval
      5. Right route

   B. Routes and Sites of Administration
      http://www.immunize.org/catg.d/p3085.pdf



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     http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-full-d.pdf
     1. Subcutaneous
             b. Needle gauge, length, and angle
             c. Sites

     2. Intramuscular
            a. Needle gauge, length, and angle
            b. Sites
            c. No ‗z‘ track
     3. Intranasal
     4. Oral
     5. Intradermal (used for TB skin test, not for vaccine)
            a. Needle gauge, length, and angle
            b. Sites

  C. Simultaneous Administration of Vaccines
     http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/genrec.pdf
             a. Administering all recommended, age-appropriate vaccines
             b. Intervals for administering live vaccines/TB skin test (TST), formerly known
                as PPD

IV. BEFORE GIVING VACCINE

  A. Identify what vaccines are due based on age and immunization history

     1. Review patient shot record(s) and screening questionnaire.
        Child and Teen: http://www.immunize.org/catg.d/p4060.pdf
        Adult: http://www.immunize.org/catg.d/p4065.pdf
            a. An immunization record generated or verified (by phone or in writing) by a
                health care provider or provider‘s office
            b. A patient-held immunization record that has been signed or documented by a
                provider or provider‘s office
            c. An official vaccination record from another country
            d. State Immunization Registry records
            e. Unverified patient/parent report of immunization, such as the Certificate of
                Immunization Status form (CIS) is not acceptable

     2. Contraindications and Precautions
        http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/genrec.pdf

  B. Patient/Parent Education

         Vaccine Information Statements (VISs): http://www.immunize.org/vis/
                  Give all VISs in the appropriate language
                  Review normal reactions/side effects
                  Address questions/concerns
                  Give after-care instructions
                  Be cultural sensitive
                  Accept a patient‘s right to refuse
         ―It‘s Federal Law:‖ http://www.immunize.org/catg.d/p2027.pdf



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   C. Observation of Client
         1. Physical
                 Site evaluation
                 Body types (thin, obese, debilitated)
                 Pale, clammy
         2. Medical (per screening questionnaire, refer to provider)
         3. Emotional
                 Reaction history, such as fainting
                 Crying, anxious, hysterical
                 Quiet/combative


V. GIVING VACCINE
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/vacc_admin.pdf

   A. Prepare Vaccine
      1. Check the vial/syringe x3
      2. Use a method to identify antigen(s) in the syringe
      3. Review 5 rights of drug administration (see IIIA above)
      4. Do not change the needle on the syringe

   B. Prepare Client
      http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/comforting-
      restraint.pdf
      1. Comfort tips
      2. Restraint/holding techniques

   C. Administer Vaccine
      1. Aspiration is not recommended for vaccines
      2. Engage safety device on syringes
      3. Dispose of syringe and other vaccine equipment including vials in sharps container


VI. AFTER VACCINE IS GIVEN

   A. Repeat After-Care Instructions
      http://www.immunize.org/catg.d/p4015.pdf

   B. Documentation
      1. Office chart
             a. Vaccine Administration Record
                 http://www.doh.wa.gov/cfh/immunize/documents/vacadminrecord.pdf
                 Required Documentation
                     1. Date of vaccine administration
                     2. Name or common abbreviation of vaccine
                     3. Vaccine lot number
                     4. Vaccine manufacturer
                     5. Administration site
                     6. VIS date



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                    7. Name and title of vaccine administrator
                    8. Address of facility where record is kept

             b. Lifetime Immunization Record Card
                http://www.doh.wa.gov/cfh/immunize/forms/default.htm

             c. CHILD Profile Immunization Registry
                http://www.childprofile.org

             d. Reminder/Recall (date when next immunization is due)

             e. Documenting Refusal to Vaccinate
                http://www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_revised%204-11-
                06.pdf




  Medical Management of Adverse Reactions
    http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx-full-f.pdf

     Medical Management of Vaccine Reactions in Adult Patients
     http://www.immunize.org/catg.d/p3082.pdf

     Medical Management of Vaccine Reactions in Children and Teens
     http://www.immunize.org/catg.d/p3082a.pdf
     1. Anaphylactic shock
     2. Vaccine Adverse Events Reporting System (VAERS)
         http://vaers.hhs.gov/


VII. VACCINATION PRACTICE ISSUES

  A. Scope of Practice

     Revised Code of Washington (RCW)
     The RCW is the compilation of all permanent laws now in effect.
     1.   RN: 18.79.260     http://apps.leg.wa.gov/RCW/default.aspx?cite=18.79.260
     2.   LPN: 18.79.270    http://apps.leg.wa.gov/RCW/default.aspx?cite=18.79.270
     3.   NA: 18.88A        http://apps.leg.wa.gov/RCW/default.aspx?cite=18.88A.030
     4.   HCA: 18.135       http://apps.leg.wa.gov/RCW/default.aspx?cite=18.135

     Washington Administrative Code (WAC)
     The WAC is the compilation of Washington State agency rules.
     1. RN & LPN: 246-840           http://apps.leg.wa.gov/WAC/default.aspx?cite=246-840
     2. NA: 246-841                 http://apps.leg.wa.gov/WAC/default.aspx?cite=246-841

  B. Vaccine Ethics
     http://www.immunize.org/catg.d/4038myth.htm



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C. Check Standing Orders/Office Policy
   http://www.immunize.org/standingorders/

D. Needle Sticks (blood borne pathogen exposure)
   1. Occupational exposure to blood borne pathogens
      http://apps.leg.wa.gov/WAC/default.aspx?cite=296-823
   2. CDC HIV/AIDS Guidelines and Recommendations
      http://www.cdcnpin.org/scripts/hiv/cdc.asp




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   STANDARDIZED IMMUNIZATION TRAINING MODULE LEVEL ONE
                  ADDITIONAL RESOURCES

 INSTRUCTOR NOTES
 These resources are in addition to the links included in the training outline.


I. GENERAL VACCINATION INFORMATION

Centers for Disease Control and Preventions (CDC)
Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book)
http://www.cdc.gov/vaccines/pubs/pinkbook/default.htm

Standards for Pediatric Immunization Practices
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/H/standards-pediatric.pdf

Standards for Adult Immunization Practice
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/H/standards-adult.pdf

CDC/NIPINFO
nipinfo@cdc.gov
1-800-232-4636

Morbidity & Mortality Weekly Report
http://www.cdc.gov/MMWR/

General Recommendations
www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm - Vol 55, No 15;1

Health Care Worker Recommended Immunizations
www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm - Vol 46, No 18;001

Vaccines for Children (VFC)
http://www.cdc.gov/vaccines/programs/vfc/default.htm


Washington State Department of Health (DOH)
Immunization Program CHILD Profile
www.doh.wa.gov/cfh/immunize
360-236-3595

Guidelines for the Use of State Supplied Vaccines
http://www.doh.wa.gov/cfh/immunize/documents/vacusage.pdf

Immunization Program CHILD Profile Accountability and Relationships
http://www.doh.wa.gov/cfh/immunize (to be posted)

Immunization Action Coalition
http://www.immunize.org/


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Children’s Hospital of Philadelphia
http://www.chop.edu/consumer/jsp/microsite/microsite.jsp?id=75918


National Network of Immunization Information (NNii)
http://www.immunizationinfo.org/

National Foundation of Infectious Diseases (NFID)
http://www.nfid.org/

Health Care Careers
http://nursing.about.com/od/patienteducation/a/teachfiverights.htm
http://nursing.about.com/b/2006/10/03/more-rights-of-medication-administration.htm

Local Health Jurisdictions (LHJs)
http://www.doh.wa.gov/LHJMap/LHJMap.htm


II. VACCINE MANAGEMENT

Centers for Disease Control and Prevention (CDC)
Storage and Handling video
http://www2a.cdc.gov/nip/isd/shtoolkit/splash.html


III. PRINCIPLES OF VACCINE ADMINISTRATION

Centers of Disease Control (CDC)
Recommended Immunization Schedule for Children and Adolescents Aged 0–18 years, United
States, 2007
http://www.cdc.gov/vaccines/recs/schedules/default.htm

Recommended Immunization Schedule for Adults (19+ years), United States, October 2007–
September 2008
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

Immunization Action Coalition
Vaccine Administration Training video
http://www.immunize.org/iztech/index.htm


IV. BEFORE GIVING VACCINE

   A. Identify what vaccines are due based upon age and immunization history
      Centers for Disease Control and Prevention (CDC) screening forms
      http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm#avacs

   B. Patient/Parent Education

       Centers for Disease Control and Prevention (CDC)


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       Publications
       http://www.cdc.gov/vaccines/pubs/default.htm

       Department of Health (DOH)
       Forms and Publications
       http://www.doh.wa.gov/cfh/Immunize/forms/default.htm




V. GIVING VACCINE
   No additional resources available


VI. AFTER VACCINE IS GIVEN

Centers for Disease Control and Prevention (CDC)
Vaccine Administration Record (VAR)
http://www.cdc.gov/vaccines/recs/immuniz-records.htm#recording


VII. VACCINATION PRACTICE ISSUES

Centers for Disease Control and Prevention (CDC)
Continuing Education Opportunities http://www.cdc.gov/vaccines/ed/default.htm
       1. You Call the Shots
       2. Vaccine Update—4-part Web cast
       3. Annual Vaccine Update
       4. Storage and Handling



     Standardized Immunization Training modules 2 and 3 are
                      being developed.




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