Wellness & HealthCare Flu Clinics by Tammy Marie Baker- Ortega R.N. The Wellness Series
Sanofi – Fluzone Multidose Vials ~ PEDS: Prefilled .25 ml ~ Adult: Prefilled 25 mcg/0.5Multi dose vial thimerosal content: 25mcg/0.5mL dose.Prefilled Indicated for individuals Age 6 months and older•Maxim Standing policy 4 years and older•Prefilled syringes are Thimerisol free
Novartis – Fluvirin• MDV’s and pre filled syringes Indicated for individuals Age 4 years and older.• Maxim Standing policy 4 years and older• MDV :Thimerosal content: 25mcg/0.5 mL dose• Prefilled syringe: Thimerosal content: ≤ 1 mcg mercury per 0.5-mL dose.• Needles are supplied separately for pre filled doses
GSK – FluLaval**Indicated for individuals Age 18 years and older ONLY**• DO NOT GIVE TO PEDIATRIC PATIENTS!!• 10 dose Vials• Thimerosal content: 25mcg/0.5 mL dose
MedImmune – FluMist• Live attenuated influenza virus vaccine• indicated for individuals Age 2 – 49 years• Maxim policy: ages 4 - 49 unless stated otherwise on protocol• Contraindications: Pregnancy, Asthma and Immune Compromised• Do not to be used to immunize pregnant women in any state• INTRANASAL ADMINISTRATION ONLY -Never injected
Flumist• DO NOT GIVE TO PREGNANT WOMEN• MAXIM POLICY IS 4 YRS TO 49• DO NOT INJECT THIS IS INTRANASAL ADMINISTRATION ONLY• ADMINISTERED 0.1 ML PER NOSTRIL Total dosage = 0.2 mL• No active sniffing when administered• LIVE ATTENUATED VACCINE
What is the Maxim Policy? Pregnant Woman Can be given in ANY TRIMESTER PER CDC Standard Policy is RECOMMENDATIONS Only Children >4 yrs old with parental consent (6 mos and up in controlled specializedNo Flumist for pregnant women in any clinics)State Standard Policy – We immunize individuals ages 4 and older with parental Consent if under 18 unless otherwise stated on protocol.
TDAP :Tetnus~Diptheria~Pertusis• NEW 2010• Tetnus~Diptheria~Pertusis Booster• Indications 10-64 years old• Boostrix :Indications 10-64 years old » Prefiled syringes• Adacel : Indications 11- 64 years » Single dose vials• Pregnant woman check with MD
Pneumovax 23 Was the person aged > 65 years at the time of last vaccination? Yes* or No or unsure???•NO the Vaccination is indicated•If YES then Vaccination Not indicated•Unless? >5 years elapsed since the firstdose? then Vaccination indicated Yes Note: For any person who has received a dose of pneumococcal vaccine a age( >or = 65) years, revaccination is not indicated.
Pneumovax 23• Do not pre fill syringes• Do not give to children under 18 with out MD order• Recommended once before 65• Once after if 5 years since last vaccine.• Check label before you administer• Keep refrigerated• Pregnant woman with specific Doctor Prescription only**
Pre filing Syringes• Pre filling syringes is STRONGLY DISCOURAGED• Pre filled syringes can lead to mistakes.• Pre filled syringes can not be returned or used at another clinic and must be wasted at end of clinic in sharps box• If you are at a very a large clinic and clients are lined up out the door you may only pre fill 10 syringes at time.• They must be place in a zip lock bag ,labeled ,dated and initialed with lot number.• The must be wasted and witnessed if not used at the end of clinic.• DO NOT MIX VACCINATIONS TOGETHER
? Question your Client ? DO NOT ADMINISTER IF:• Sensitivity to latex?• Do not give if answer is yes• Allergy to chicken eggs or egg products?• Allergy to thimerosal?• Symptoms other than mild cough, runny nose or diarrhea.?• History of Guillian Barre• History of serious reaction to previous flu or pneumovax?
GIVING MORE THAN ONE VACCINE RECOMMEND ONE INJECTION PER ARM OR 1 INCH APART ON SAME ARM 15 MINUTES APART Special precautions FYI mastectomy or dialysis Dialysis Shuntmastectomy DO NOT GIVE ON AFFECTED SIDE. Bilateral mastectomy must go to their physician MAXIMS POLICY IS DELTOID ONLY
SPECIAL PRECAUTIONS FYI mastectomy or dialysis DO NOT GIVE ON AFFECTED SIDE. Bilateral Mastectomy must “GO TO THEIR PHYSICIAN” MAXIMS POLICY IS DELTOID ONLY Apologize to the Patient And refer them back to their MDMastectomy Dialysis Shunt
Reactions ? Vasovagal Syncope versus Anaphalaxis Did the client faint or are they having an Allergic reaction? AnaphylaxisSymptoms Feeling of impending doom, flushed, rash, difficulty breathing, wheezing, low BP , increased HR Emergency Kit ready and on site. Epinephrine solution 1:1000 Adults 0.1 mL per 10 kg ( 10 kg = 22 lbs) subcutaneousDosage may be repeated in 5-10 minutes if initial dose was 0.5 mL x one dosageChildren Administer 0.01 ml per kg ( 10 kg = 22 lbs) maximum dose = 0.5 subcutaneous DO NOT REPEAT DOSE.
Cold Chain Policy -Do not Freeze the Vaccine -Keep Vaccine in hard plastic Cooler -WARM MARIK TEMPERTURE CARDS IN COOLER -Keep above 36-46 degrees F -Temp log on Refrigerator BID -No food in Medication Refrigerator BMW STICKER ON REFRIDGE
NEW COLD CHAIN 2010 Warm Mark Time Temperature Labels Adhesive backed tag records warming temperatures for shipping and storage. •Monitors temperatures from 8 to 48 hours, depending on model. •Red coloring indicates exposure to warmer-than-acceptable conditions •Available in a variety of response temperatures ranging from -18°C (0°F) to 37°C (99°F) HARD •Accuracy ± 1°CCOOLERS •Dimensions: 1.81” x 0.75” x 0.06” (Length x Width x Thickness) WarmMark Time Temp Tags are a convenient, accurate tool for monitoring temperature during shipping and storage of drug and WARM MARK medical products, vaccines, blood, plasma, diagnostics, gelatin capsule products, chemicals, paint, and temperature sensitive food TEMP CARDS products. Response temperatures and run-out times (length of exposure time to a certain temperature) vary with each Warm Mark model. The red coloring indicates exposure to temperatures above the rated temperature for that tag. Color movement through the windows indicates passage of time. If the temperature cools below the threshold, the color stops moving.
THE 5 RIGHTS• Drug- check the vaccine vial twice• Patient – ID and insurance or paid• Dosage - 0.5 ml• Route IM in Deltoid• Time – Patient must stay 15 minutes after injection to rule out reaction.
BD Integra™ Syringe Retracting Syringes• What sets the BD Integra™ Syringe apart from other syringes on the market? Its design. The BD Integra™ Syringe with Retracting BD Precision Glide™ Needle was designed to provide clinicians with superior clinical benefits.• Detachable Needle*• Low Waste Space... Maximize Medication... Experience It!• Low Waste Space*• Dosing Accuracy*• BD Precision Glide™ Needle Technology*• NEEDLE SAFETY Possible to obtain 11 to 12 doses from a Single Influenza Vial
The Injection Technique, Accuracy, and Nursing Skill – Maxim Nurses are on the Mark• Tighten needle• Check vaccine type and brand twice , Avoid medication Errors• Wipe off vial with alcohol• Inject .05 ml of air into vaccine vial before drawing up• Draw up vaccine• Inoculate client at 90 degree angle into Deltoid muscle• Retract needle downward and away from client after the injection• Properly Dispose of the syringe into the sharps box
BIOHAZARD DISPOSAL• Wear gloves• Make sure lid is snapped on tightly “Lock and Load”• Do not over fill container.• Proper tight Syringe disposal• Empty Vaccine vials are returned to office biohazard drop site• Any left over Pre filled vaccine syringes are discarded in a biohazard container on site• All gloves and garbage is properly bagged at site and returned to Office bio hazard drop site
Verify and Validate VERIFY AND VALIDATE Check your Vaccine vials three times 1. arrival at clinic 2. drawing up 3. Administration 4. Initial and Date your vaccine vials when opened• Keep your vaccinations in Separate coolers if possible• Label vials in Zip locks Know your Medications A SMART NURSE IS SAFE NURSE Be Cautious and Proactive Prevents Mistakes
2010 STRAINSPandemic H1N1 a poor yielding strain Now included in the Seasonal vaccine an A/California/7/2009 (H1N1)–like virusPerth first time being produced – As of 6/14, yielding good results an A/Perth/16/2009 (H3N2)–like virusB Brisbane very poor yielding strain that caused much of the seasonal delay in 2009 a B/Brisbane/60/2008–like virus 25
Honesty~ Integrity ~ Professionalism You Represent The Profession of Nurses Compliance is our Hallmark Please carry and conduct yourself accordingly•Dress Appropriately •Treat the client with respect•No eating in the clinic •Be polite•No smoking on site •Be courteous