COVID-19: Vaccination Administration Question

[Rosie Cotton, BSN]

I am an RN who works for an agency that runs group homes. I am the only nurse and my position is administration and primarily training. In the 15 years I have been there I have never done direct patient care. They want me to go to individual homes and administer the covid vaccination. I have not ever, even in nursing school given a vaccination. I am sure that I can, but I am a little nervous. I watched videos and even though it has been years since I have given an IM I am sure I can. But, they want the pharmacy to draw up syringes of vaccine and then I would drive to each house and administer them. I am not sure that I should be giving a vaccine that I did not prepare, and I am not sure about the time frame. It will be just me, so by the time I drive from the pharmacy to the group home, give the vaccine, wait 15-20 minutes to watch for side effects and then drive to the next house a decent amount of time will have passed. The clients I would be vaccinating would be ones who are home bound, but how do I check vaccine against an order? How do I document that I gave it, I am wondering if I am way overthinking this. They just want me to pick up the shots and go give them, but I have all these what if's. I told my boss (not a nurse) my concerns and was told that I should email the CEO! Ugh. I do not know if I should try to find a diplomatic way to refuse, I said I would be happy to go around with the pharmacist, but I am not comfortable giving meds/vaccine I have not prepared. We have our own pharmacy, but only one nurse in my department (me) So I don't even have any nurses at work I can ask their opinion because it is just me. So I am asking you guys, am I overthinking this?  Should I just get the vaccine and give it because we are in the middle of a pandemic, or I am risking my license if something goes wrong. I don't even know about consent, my boss said yes the are clients are consenting but they have ID so I wonder if their families will try to blame me if there is a reaction to the vaccination and say that the clients weren't able to consent.  Do I go by verbal consent? No one to ask at work so I feel trapped into doing it or looking like I am either not competent to do it or like I am refusing. I don't want to refuse, I just want to make sure it is done right. 

 

[CampyCamp, RN]

I'm just going to stick to one part of your question because the rest of the logistics seem tricky. You can give a vaccine that the pharmacist prepared. Nearly everything we give is something a pharmacist prepared. Meds in blister packs sorted into the pyxis or nursing home cart. Antibiotic piggybacks. In some hospitals I've worked in, prefilled injection syringes of Lantus or solu medrol or prefilled oral syringes of Tylenol calculated to a child's weight. Allergy shots at home. They are licences to dispense so we can give things they prepare. Nurses cannot dispense so likewise, we cannot give something another nurse prepares. 

[Hoosier_RN, MSN]

As far as the rest of the question, your company should have P&P to address this and provide clear guidelines. If they don't,  please ask that this be done prior to 1st dose being given to anyone. This way, you have clear guidance for every step, especially if there are any issues/adverse reactions

[nursebert, MSN]

We have recently administered the Pfizer COVID vaccines and it was a complicated process as far as reconstitution and administration.  There were 5 doses per vial and once the vial was reconstituted it was only good for 2 hours.  Once it was drawn up into the syringe it had to be given within 30 minutes.

We are a government facility and the military came to our facility and reconstituted the vaccine and also drew up the doses and then our staff administered.  The doses were carefully counted and recorded and the line was stopped periodically to reassess and make sure no doses were wasted.

 

 

 

[toomuchbaloney]

Documentation will occur on the vaccination record of the recipient.  It will include the lot number and specifics of the vaccine and delivery technique/site. You can fill those out with the vaccine info ahead of time to save time in the home.  I imagine that you will need to obtain informed consent.  

[vintagemother, BSN, CNA, LVN, RN]

When I give vaccinations, in a hospital setting, we 1. Review the order to assure that the pt meets criteria/ doesn’t fall in the exclusion category 2. Give a paper handout on the vax 3. Educate the pt on normal side effects 

I haven’t given the covid vax, but do give flu shots and pneumonia vaccinations.

[CommunityRNBSN, BSN, RN]

I can tell you're nervous, and part of that is that you haven't given vaccines in the past.  All of your concerns are valid, and I agree that you need written procedures.  But just off the record, I will tell you, I spend my days in outpatient and I've given thousands of vaccines in the past two years, and probably 200 Covid vaccines in the past few weeks.  I've never had anyone have a severe reaction to anything.  The chances are infinitesimal that you will run into an adverse reaction, other than someone feeling a bit dizzy from anxiety or needle phobia.  I'm not saying you shouldn't be prepared-- we have EpiPens in the room just in case-- but I don't want you going in there thinking you're doing something super dangerous.

Think about those big flu clinics that they do: A nurse stands there with a cooler of 200 syringes, and people walk through and the nurse goes "Inject-- next!  Inject-- next!"  In my state they are giving the Covid vaccines at the sports arena in town.

[NRSKarenRN, BSN, RN]

CDC's  COVID-19 Vaccine FAQs for Healthcare Professionals  has info to help you - See the section re vaccine administration

https://www.CDC.gov/vaccines/covid-19/hcp/faq.html

COVID fact sheets to leave in each group home available here:

https://www.CDC.gov/vaccines/covid-19/eua/index.html

Review  Pre-vaccination Screening needed:

CDC COVID-19 Vaccine Pre-Vaccination Screening Form

 

Several states have a COVID-19 Immunization Screening and Consent Form:

NYhttps://www.yai.org/sites/default/files/final-covid-19-vaccine-consent-form-inc.-fda-eua-and-acip-12.13.2020.pdf

FL http://brevard.floridahealth.gov/_files/_documents/events/2020/12/_documents/covid19-vaccine-screening-and-consent-form-moderna.pdf

 

Suggest you call your facility pharmacy to see what they can provide your organization then discuss P+ P needed for this to be a success.

If you already know all group home clients, I'd start screening tool ahead of each visit to cut down on time.

[1gr8trnstudent, ADN, BSN, RN]

Hello, I have to say you are overthinking this. I currently give the vaccine to nursing home through cvs. There are 2 forms thr patients have to fill as consent to get the vaccine. They basically fill in their demographics, and the form asks if they have any comorbidities. You document the date, time, temperature of the pt., location of injection, sign, print, title. The pharmacy drawing up the vaccine is good because that's the part that needs good timing. The vaccines have to stay frozen at a spec. Temp. Once they are out to thaw, for 30 mins, they must be diluted with normal saline and 6 shots drawn. Once the shots are drawn in a syringe, they are good for 1 hr. If you leave the diluted  vaccine in the vial, it's good for 6 hours. It is easier to have pharmacy handle that whiles you focus on injections. It's simple. Ask any questions, I'll answer if I know.