The Medical Council has received an increasing number of complaints from patients whose doctors’ have made preventable errors during vaccine administration. Although some of these errors are much more serious than others, good practice should ensure that no errors occur. This article provides a quick and easy guide to good vaccination practice.
Last year a complaint was referred to the Medical Council by the Health Care Complaints Commission (HCCC) about a general practitioner’s vaccination of a 12 month old baby.
The doctor undertook the baby’s growth check, checked for fever and prepared the vaccines for the patient. The doctor and their nurse injected a needle into each thigh simultaneously. Shortly thereafter, the GP realised that the child had received MMRII and Priorix, amounting to a double dose of the same vaccine. As expected, the baby’s mother was extremely distressed. Appropriately, the doctor reported the error to other GPs in the practice, the practice manager, and the practice owner.
In addressing the complaint with the Medical Council, the doctor issued an unreserved apology to the patient and their family, and noted they had made changes to their vaccination practices to avoid this mistake happening in future. Changes included:
- Only one medical professional preparing vaccines per patient;
- Only one brand of MMR vaccine in the basket of “12 month old” vaccines;
- Matching the vaccines to be administered with the blue book or the NSW Immunisation Schedule poster before administration; and
- The name of the vaccine being double checked by both the doctor and the nurse prior to administration.
What can go wrong when immunising?
When a child receives 18 or more scheduled vaccinations before their 18th birthday, the opportunities for vaccine-related errors are numerous. In addition, there are adult vaccines, optional vaccines and travel vaccinations with generic and trade names that sound alike.
The World Health Organisation emphasises that adverse events due to vaccine errors are more common than adverse events due to the vaccine themselves. A seemingly day-to-day practice can easily go wrong when you:
- Select an incorrect age-specific formulation of a vaccine;
- Are unfamiliar with the dose, dosing schedule, age specification or route of administration of a vaccine;
- Fail to check the patient’s age and vaccinations already received;
- Are confused by similar vaccine names and abbreviations; or
- Store similar-looking vaccines close to one another.
What can I do to avoid these common errors and what do I do if there’s a mistake?
Naturally, where humans are involved there is potential for error. To avoid the pitfalls above and the impact on patients;
- Check the schedule. Know the minimum intervals for vaccines and keep an easy to read guide handy for staff. Confirm which vaccines are indicated, including any missed doses and that the minimum time interval has passed since the patient received any previous vaccine. Doses administered five days or more earlier than the recommended minimum interval will need to be repeated. Doses administered five days or more before the minimum age should be repeated on or after the patient reaches the minimum age. However, if the incorrectly administered vaccine was a live vaccine, a waiting period of at least 28 days must be followed after the invalid dose.
- Check any contraindications.
- Check the vial three times.
- Prepare vaccines for one person at a time if more than one person is being vaccinated in the same appointment (for example, family members),
- Check you’re using the correct diluent. Diluent errors can affect the potency of the vaccine antigen and the patient may not get the full benefit of the vaccine. If the wrong diluent is used, the vaccine needs to be repeated in most cases.
- Check the expiration date. Rotate stock in your storage unit and put vaccines expiring first at the front. If a dose of expired vaccine is given, it should be repeated. However, if it is a live virus vaccine, a four week delay will be required.
- Confirm the correct vaccination site. Is this an intramuscular injection or subcutaneous injection? Is this an oral vaccine? If a vaccine is given via an incorrect technique, refer to the product information for next steps.
- Make notes. If a patient is receiving multiple vaccines, record the location of each injection so the vaccine can be identified if there is an adverse local reaction.
If you give the wrong vaccine, immediately advise the patient (or their parent) and ensure the correct vaccine is provided if necessary, with the correct spacing.