Giving a flu shot to patients without a signed consent?

[Double-Helix]

My PICU recently decided that we will be offering flu and pneumococcal vaccines to all of our eligible patients. This is a state requirement to reduce the number of children who are not vaccinated. The policy itself is fine.

However, what is concerning a lot of the nurses is that we can administer the vaccine with verbal consent from the parent/guardian. The guardian can also refuse verbally. Many of us feel that without the signed form verifiying consent and acknowledgement of risks, it sets the hospital up for potential problems or even lawsuits down the line.

Example: We administer an immunization with verbal consent. Child has a vaccine reaction. Parents claim they were not informed of the potential risk. No documentation to support that they were.

Example: We administer a vaccine to a young child with verbal consent. Child is later diagnosed with autism. Parents claim they never gave permission for their child to receive the vaccine.

What do you think? Are we too paranoid? Or should we refuse to give the vaccine unless there is a signed consent form that remains part of the chart?

[Double-Helix, BSN, RN]

My only issue with your post is trying to link autism and the flu vaccine. Hasn't this been laid to rest yet??

Maybe among health care providers, but it's certainly still a rather prevalent believe in the general community. I wasn't attempting to link it, but it's a very real possibility that some parent, somewhere in the country, would.

[MN-Nurse, ASN, RN]

What do you think? Are we too paranoid? Or should we refuse to give the vaccine unless there is a signed consent form that remains part of the chart?

Yes, you are too paranoid - and you may be (purposefully or accidentally) adding to anti-vaccine hysteria.

Why just vaccines? What about antibiotics? Beta Blockers? Diuretics? Opiates? Lunch? Water? (people drown or aspirate or get water borne illnesses every day ya know.)

[TonyaM73, ASN, RN]

I personally would not give it without a concent signed and in the chart. Everything else could be argued that it was covered under the general admission concent of the hospital, but if they did not come in for flu and are given the immunization for prevention, what is one more piece of paper signed to CYA.

[lulusoccer]

I work in a Pediatric Center at a hospital, and we are also screening for Influenza and Pneumococcal vaccinations (or else the hospital doesn't get reimbursed - and I am sure if the hospital accepts medicaid then they will be starting to screen as well since it's a national thing). Our hospital has created a sheet to give consent for the influenza vaccinations for the parents to sign prior to giving the vaccination. Part of it I think says that they received the VIS and know the potential risk of the vaccine.

[canoehead, BSN, RN]

In the ICU you are doing/giving things with a much greater risk, and are much more unpleasant. Any medication can have an adverse reaction.

My question would be why are you giving vaccines when the patient's body is already under stress, and fighting off various hospital bugs? Doesn't seem like it's in the patients' best interest.

[NicuGal, MSN, RN]

We don't get written consents for immunizations either. The doc or NNP talk to them, obtain verbal consent and document it in the order for the immunization. Our pharmacists will not release the order unless the verbal consent is in there. We have the info sheets from the CDC that we give them also. I have not ever signed a consent for any of my kids immunizations, just received the CDC sheets and gave verbal consent.

If you are on computerized MARS, it will populate to their immunization record, if not, it will generate to their discharge sheets and show up there.

[Double-Helix, BSN, RN]

Yes, you are too paranoid - and you may be (purposefully or accidentally) adding to anti-vaccine hysteria.

Why just vaccines? What about antibiotics? Beta Blockers? Diuretics? Opiates? Lunch? Water? (people drown or aspirate or get water borne illnesses every day ya know.)

As I stated in the previous post, those sorts of medications would fall under the general consent for treatment. They are medications and interventions specifically related to their stay/admission diagnosis. A flu vaccine is not related to their admission.

In the ICU you are doing/giving things with a much greater risk, and are much more unpleasant. Any medication can have an adverse reaction.

My question would be why are you giving vaccines when the patient's body is already under stress, and fighting off various hospital bugs? Doesn't seem like it's in the patients' best interest.

This is a state-wide initiative to increase vaccination rates. Starting in January, the state will begin monitoring our facility's compliance and collecting data. Our facility has to offer the vaccine to eligible patients to be in compliance with the state. Eligible means that the patient does not have any diagnoses that would contra-indicate a vaccine, such as our heme-onc or immunocompromised patients. The vaccine is also given on the day of discharge, when the patient is in a stable condition. If they are not discharged, but transfered to the general floor, the vaccine is offered when they are discharged home.

....The doc or NNP talk to them, obtain verbal consent and document it in the order for the immunization. Our pharmacists will not release the order unless the verbal consent is in there....

If you are on computerized MARS, it will populate to their immunization record, if not, it will generate to their discharge sheets and show up there.

*shortened for brevity*

According to the state guidelines, we do not need a physician's order to administer the vaccine. It is offered to parent/guardian, and if accepted, we administer the vaccine and document that it was given. The documentation sheet is also a MAR, so it is my understanding that the administration of the vaccine is not documented in the main MAR, nor does documentation of education or consent appear unless we include it in our notes (which I certainly will). I'm also not positive if the record of vaccine administration stays in the permanent chart. I believe it may be removed for our data collection.

[PediNurse3]

Yes, you are too paranoid - and you may be (purposefully or accidentally) adding to anti-vaccine hysteria.

Why just vaccines? What about antibiotics? Beta Blockers? Diuretics? Opiates? Lunch? Water? (people drown or aspirate or get water borne illnesses every day ya know.)

A flu vaccine and antibiotic are hardly the same thing. Antibiotics, beta blockers, diuretics, etc may be a necessary part of treatment. The flu shot isn't part of a patient's treatment plan, and it certainally is not medically necessary.

We offer the flu shot at our clinic. We are a specialty clinic so we probably administer a fraction of what a primary care office would, but it is available. The consent is filled out and signed and the parent/guardian is given the VIS before we give the shot, and the consent is later scanned into the patient's electronic chart.

I have always had to sign a consent before my children get their immunizations.

[NicuGal, MSN, RN]

On our peds floors it is the same thing for the flu vaccine, all our floors for that matter. We just had a meeting about this and it is done hospital wide for us as I wrote, verbal consent, order in EMR with consent documented by doc, we get it and the VIS sheet, give it and it is documented under their MAR. We also don't keep it on our floors, it has to come from pharmacy as they document all the info into the EMR for us (ie exp date, lot number) Anything you do while they are still a patient has to be documented somewhere in that chart. If it isn't, then that is a whole nother kettle of fish.

[Otessa, BSN, RN]

I have never signed a consent for the immunizations of my children. Do parents sign a consent for every single medication they receive while in the hospital?

Not a Pedi. nurse so not sure.