Flu vaccine pitfalls


vaccine vaccination needle

The most common reason pharmacists are reported over flu vaccination is regarding the age of the recipient, says PDL

In its latest practice alert, PDL has taken a look at the aspects of influenza vaccine supply and administration which are more likely to lead to an incident being reported.

The first of these is age-related incidents, which can be divided into three sub-groups: prescriptions for children, clients aged 65 and over, and clients vaccinated in the pharmacy who do not meet the state-legislated minimum age.

“The most common of the age-related incidents involve influenza vaccine prescriptions for children,” PDL observes.

“Often these prescriptions are written generically for influenza vaccine. If the age of the patient ie the child, is not identified then there is a risk that the vaccine supplied is not approved for the child’s age.

“Understandably, parents may be upset when informed the child has received a vaccine that is not approved for their child’s age. This may see a formal complaint being lodged with the regulator, to which the pharmacist must respond.”

PDL says it is important for pharmacists who are members to provide a notification of incident report to PDL, “no matter how inconsequential the situation may seem at the time”.

“To limit the risk of an incident occurring, pharmacists and assistants receiving or processing prescriptions for influenza vaccines, must confirm the age of ALL patients,” PDL cautions.

“Furthermore, identifying vaccines stocked by the pharmacy with the approved age ranges, by way of a note or laminate for example, can prevent this oversight leading to an error.”

PDL also provides a table illustrating the quadrivalent vaccines available in 2019.

Seasonal influenza vaccines available in Australia in 2019, by age (extract from ATAGI advice) Quadrivalent

Trivalent (for age ≥65 years only)

Registered

age group

FluQuadri Junior*

0.25 mL

(Sanofi)

Fluarix Tetra*

0.50 mL

(GSK)

FluQuadri*

0.50 mL

(Sanofi)

Afluria Quad*

0.50 mL

(Seqirus)

Influvac Tetra

0.50 mL

(Mylan)

Fluzone High-Dose

0.50 mL

(Sanofi)

Fluad*

0.50 mL

(Seqirus)

<6 months

x

x

x

x

x

x

x

6 to 35 months (<3 years)

Y

Y

x

x

x

x

x

≥3 to <5 years

x

Y

Y

x

x

x

x

≥5 to 17 years

x

Y

Y

Y

x

x

x

≥18 years

x

Y

Y

Y

Y

x

x

≥65 years

x

Y

Y

Y

Y

Y

Y

 

The second-most common age-related report relates to patients 65 years of age and over, receiving pharmacist-administered quadrivalent influenza vaccines without the opportunity to consider or discuss the option of the high-dose trivalent vaccine.

“In some reports, the patient’s GP believed the patient should be vaccinated with the high-dose trivalent vaccine,” says PDL. “This situation may lead to concern for the patient and conflict with the GP.”

PDL advises that pharmacists refer to the ATAGI Clinical Advice 2019 and ensure any patient 65 years or over is advised of the availability of the trivalent vaccine and an appropriate discussion is undertaken to consider the options available to the patient.

“The quadrivalent may still be considered a suitable option in certain situations. Documentation of the discussion and decision is valuable in such cases.”

The two vaccines available in 2019 for people 65 years or over are:

  • Fluad® is available to these clients under the NIP at no charge
  • Fluzone High Dose® is NOT available under NIP, i.e. a non-PBS prescription item

“Several cases have been identified whereby patients fall below the State-legislated minimum age for pharmacist vaccination,” warns PDL.

“It is apparent that some of the patient consent proformas request a date of birth but not an age in years.

“PDL has made representations to providers of these forms regarding this aspect and the PSA consent form has been amended to incorporate this field. Update your pharmacy’s consent form to request the patient’s age in years.”

There are also occasions when a parent may provide false information regarding the age of a child to facilitate vaccination in the pharmacy.

“If a pharmacist becomes aware after vaccination that the patient’s age has been misrepresented, then they are not responsible for this aspect.

“Refer to State legislation regarding recent changes to the minimum age for pharmacist-administered vaccination for influenza and other vaccines in several jurisdictions.”

At the time of publication, the minimum age for vaccination is:

State

Minimum Age

Pharmacist-administered Vaccines

Qld

16

DTP (DTP-Polio if DTP unavailable), Influenza, MMR

NSW

16

DTP, Influenza, MMR

ACT

16

DTP, Influenza

Vic

16

DTP, Influenza (16 yrs & over following NIP guidelines i.e. Quad or Tri as per age, 16–64 yrs -non-NIP i.e. Quad only), MMR

Tas

18

Influenza

SA

16

DTP, DTP-Polio, Influenza, MMR (as per SA Health requirements)

NT

16

DTP, Influenza, MMR

WA

18

Influenza

 

What about injury?

The most common injury reported to PDL with respect to pharmacist-administered vaccines is a condition known as SIRVA: Shoulder Injury Related to Vaccine Administration.

“This adverse outcome is known to all healthcare practitioners administering an injection into the deltoid muscle,” says PDL.

“While this condition is usually resolved relatively quickly, the consequence for some patients can be significant and may include time off work. A small number of formal complaints to the regulators and/or claims for lost income have been seen with this injury.

“Prompt action and appropriate referral is important if this adverse outcome is suspected. Pharmacists must administer vaccines as per their vaccination training and refer to the Immunisation Handbook.”

Administration technique leading to leakage from the injection site, unsuitable or unprofessional area for vaccination and administration of expired vaccines are other areas of incident reported to PDL.

Administration of expired vaccines is unlikely to occur unless stock from the previous year has not been removed or quarantined.

PDL says it encourages members who have concerns about any of the issues raised to contact it on 1300 854 838 for 24/7 access to a professional officer.

Previous How pharmacy closures affect compliance
Next World news wrapup: 25 April 2019

NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.