Give your pharmacy staff a checklist of steps for administering vaccines

Last week, I accompanied an older relative to an appointment to get their spring COVID-19 dose. Their usual pharmacy was out of stock of COVID-19 vaccine, so to avoid any delay in immunization, I made an appointment for them at another pharmacy. All of the prevaccination questions were answered online at the time of appointment booking.At the new pharmacy, a pharmacy student was tasked with giving COVID-19 vaccines. As my relative was not a regular patient at this pharmacy, the pharmacy student first had to create patient profile. This involved several minutes at the keyboard entering information and then preparing (and handling) the paperwork for vaccine administration. With all of that completed, the student began to immediately prepare the vaccine without first washing her hands. When I asked the student “Shouldn’t you be washing your hands before you prepare the injection?” she assured me that this wasn’t necessary because she would be putting on gloves before she administered the vaccine. I was quite surprised by this response, as performing proper hand hygiene (with soap and water, or alcohol-based hand sanitizer) is a key initial step prior to aseptically preparing a vaccine for administration.1-3 The student correctly cleaned the rubber septum (stopper) of the vial with a sterile alcohol swab prior to piercing it with the needle, and correctly landmarked the intramuscular (deltoid) injection site. She then donned a pair of gloves and proceeded to attempt to inject the dose without first swabbing the skin with alcohol. Prepping the injection site with an alcohol wipe is recommended prior to vaccination.1,3 Before she punctured the skin, I stopped her and advised her to swab first before injection. I could tell by her facial expression that she usually did this, but had forgotten that step. At this point, with two key steps in proper procedure missing, I was hoping that she had checked the expiry date on the vaccine. I asked to see the vaccine vial to make sure that my relative was getting the proper vaccine and dose. I casually told the student that I always ask to see the vial or syringe before injection as a second check to ensure the correct vaccine and dose are being given. (In my experience, nurses at COVID vaccination clinics are trained to show the patient the vaccine vial or syringe before injection, and I think it’s a great idea to help prevent errors.The pharmacy student did a good job of advising about vaccine side effects and what to do about them. My relative was also pleased that the injection was quite painless. I hope that this pharmacy student reflected on my comments after we left the pharmacy (I did not identify myself as a pharmacist). Perhaps my comments stimulated her to review her vaccine administration practices. After this vaccination experience, I contacted Sherilyn Houle, BSP, PhD, Associate Professor and coordinator of injections training for pharmacy students at the School of Pharmacy, University of Waterloo. She assured me that students are taught to wash their hands before each patient. Students are instructed on the “7 Rights of Injection,” meaning that before administering any injection, healthcare providers must be sure to confirm: 1. Right drug (including expiry date and appearance), 2. Right dose, 3. Right patient, 4. Right route (and injection site), 5. Right reason, 6. Right time (especially for vaccines on a schedule), and 7. Right documentation.4 An “8th Right” (Right infection control) is also presented as a consideration when administering injections. The first point that students are asked to remember in the infection control process is to wash their hands before each patient.4 Every patient deserves to be immunized according to best practices. I encourage pharmacist supervisors/preceptors to periodically review proper aseptic technique with all injectors (pharmacists, pharmacy technicians where within scope, and pharmacy students) and to conduct periodic assessments of their immunization skills. It might be advisable to create a short checklist for vaccine preparation and administration, and post it in the immunization area, so immunizers do not miss any key steps. A checklist for your pharmacy could be developed based on information provided in the references below.1-3 References:Immunize.org. Skills checklist for vaccine administration. (accessed May 9, 2024). Canadian Immunization Guide. Vaccine administration practices. For health professionals. (accessed May 9, 2024).Nova Scotia Health. Skills checklist for immunization. (accessed May 9, 2024).Personal (e-mail) communication with Dr. Sherilyn Houle, Associate Professor, School of Pharmacy, University of Waterloo. May 8, 2024.

Give your pharmacy staff a checklist of steps for administering vaccines

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