DOCUMENTATION PROTOCOL:
1) Review In Basket Orders folder on left-hand side of screen for messages of laboratory orders that have already been signed by the attending.
2) Prepare and perform the immunization/injection. MAKE SURE YOU HOLD ON TO THE VIAL AND THE BOX!!!
3) Document the shot in the patient’s chart in Epic
- Open the patient encounter from the schedule
- Click on the Immunizations tab on the left-hand side of the screen (or Immunizations/Injections from the More menu)
- The immunization(s)/injection(s) ordered by the attending should be listed in the Imm/Inj section
- Click on Administer for the immunization/injection that was administered.
- Fill in any lines that have exclamation points enclosed in a red circle, including the following information ⇨ Lot #, Mfg (manufacturer), Expires (expiration date), Dose, Site.
- Click Accept
4) Once all labs are complete, select the messages corresponding to the immunization(s)/injection(s) and click Done to remove those messages from the In Basket.
IF you forgot to document an immunization or notice that patient received a vaccine but it was never documented (this happens when the “Administer vaccine” order is not placed along with the actual vaccine itself), you can still document that it was given. To do so, click on Snapshot –> Immunizations –> Historical Admins –> Select Adult Immunization Log from the drop down menu –> Enter the information into the appropriate columns.
Confirm your addition by clicking Accept. Now click on the individual vaccine (blue link) and you should see the new result you placed. You should only do this if you know the lot number and site of injection for the patient. You may now edit the result by clicking on each vaccine administration date.
PPD PLACEMENT
PPD = 25 gauge needle in the skin (intradermal). 18 gauge needle to load the vial (larger needles needed to penetrate the rubber stopper). 1cc vial (0.1 cc incremental markings on the side).
1) Review In Basket Orders folder on left-hand side of screen for messages of laboratory orders that have already been signed by the attending.
2) Prepare and perform the PPD; MAKE SURE YOU HOLD ON TO THE VIAL AND THE BOX! The LOT # and manufacturer is printed on the vial and box and you will need to document them.
3) Send a staff message through your In Basket by clicking on New Message, then clicking on the To: button and type in “IMA Firm A” in the Pools section. Select “IMA Firm A Nurse Pool” and then click on the Add ‘To’ button. Repeat this same process for IMA Firms B, C, and D. (Send this email to all 4 pools). Notify them in the message that you are from EHHOP and you have just planted a PPD in the patient’s arm; note in which arm the PPD was placed, and inform them that they should expect the patient to follow-up at IMA on Monday/Tuesday to have the test read.
Regular staff message
Add nurse pools
4) Document the shot in the patient’s chart in EPIC
- Open the patient encounter from the schedule
- Click on the Immunizations tab on the left-hand side of the screen (or Immunizations/Injections from the More menu)
- The PPD ordered by the attending should be listed in the Imm/Inj section. If it is not, you have to go back and make sure that an order was signed to “administer the vaccine” and not just an order for the tuberculin medicine
- Click on Administer for the PPD that was placed.
- Fill in any lines that have exclamation points enclosed in a red circle, including the following information ⇨ Lot #, Mfg (manufacturer), Expires (expiration date), Dose, Site.
- Click Accept
- Mark the In Basket message that was just completed as Done.
- The nurse will read the test on the following Monday/Tuesday and enter the result in EPIC; results will be sent back to the student via their In Basket.
ALL OTHER Immunizations/Injections
Tdap, Hep A, Hep B: Given as IM injections. Some come in prefilled syringes, while others come in single use vials that require you to load the syringe.
In general, IM injections need a 23-25 gauge, 1 inch needle – depending on the weight of your patient (use 1.5 inch as specified depending on BMI)**
Flu Shot:
If age 65+ yrs:
- Procedure: Administer HIGH DOSE INFLUENZA VIRUS VACCINE, IM - 90662
- Medication: influenza vaccine 2017-18, 65 YEARS+,, PF, 180 mcg/0.5 mL syringe
- Labs TS: get FLUZONE from fridge
If age 6 mo to 64 yrs:
- Procedure: Admin Flu Vaccine,3 Yrs&Older,IM,No Preservative - 90686
- Medication: influenza vaccine 2017-18, 6 MONTHS+,, PF, 60 mcg (15 mcg x 4)/0.5 mL syringe
- Labs TS: get FLULAVAL from fridge
MMR Vaccine: Comes in two parts as a powder and a sterile solution. It must be reconstituted in the sterile solution before injecting. Usually, in the fridge you will find a box of the sterile solution (it does not have to match the lot number). You must use a syringe to transfer the sterile solution from the vial (single use) to the vaccine (single use). Mix the vaccine until the solution is clear, yellow in color. This vaccine must be injected SUBCUTANEOUSLY. Usually the easiest site is the biceps, using a 30 degree angle (to avoid the muscle and not give the injection intradermally). ASK THE ATTENDING, if you have questions!
Zoster vaccine: Available in the IMA fridge. You can find videos on how to reconstitute the two part solution on youtube!
Gardasil vaccine: As of 7/2013, this 3-part vaccination is now available for EHHOP patients through IMA. They are recommended from ages 9-26 for males and females. The schedule is 0, 1, and 6 months.
Consult the CDC website for more specific questions!