advice on giving flu shot

[angelkim63]

I'm a med-surg / acute physical rehab nurse at a fairly large hospital where I live. Part of the admission process includes immunization screening for the flu and pneumonia shot. It is part of the nursing standardized order set to screen for these 2 shots, and if the patient meets criteria, then it is okay to be given. I had a patient who was admitted a few weeks ago, and never received an immunization screening. My charge nurse asked me to do one for this patient, who was a 22 year old recovering from a brain injury. For the most part, she is alert and oriented times three and aware of her care. I asked this patient if she wanted to receive her flu shot and if she wanted to wait until her parents came to ask them. She told me to go ahead and give her the flu shot that night. I questioned her twice, and each time she said it was okay.

I come to find out today (the day after) that her mom became very angry that it wasn't cleared with her, especially because she feels it may have affected her leg on the side where the shot was given. I gave it in the left deltoid and the next day she was having pain in her left leg. I didn't have this patient today, but I didn't want to go reading through the records to see what is happening.

So I'm extremely paranoid on this part, wondering if I will be in the blame for anything to happen? My charge nurse today questioned why I did this without getting a doctors order, which I responded by saying it is part of the nursing standardized order set for the hospital, where we don't have to get the order from the doctor. But I still feel extremetly worried about this and about my license. I'm still a new RN and I'm scared to lose my license and job . And has anyone ever given a flu shot where it resulted in an adverse reaction? Please any advice will help.

[nursepotter05, RN]

I highly doubt that an injection given in the deltoid muscle is going to cause probelms with the pt's leg, even if it is the same side! The pt is 22 years old, unless mom has power of attorney or pt is not competent to make her own decisions, the pt's permission is all that was needed.

As far as the doctor's order for the shot, if you have routine standing orders, you should not have to have an order

[CrystalClear75, BSN, RN]

Exactly, and she is old enough to make her own decisions, plus she was alert and oriented and answered yes twice. I wouldn't worry about it in the slightest, she is a fully grown 22 year old adult.

[Lacie, BSN, RN]

Also with her current condition she would be high risk and should have the vaccine! No way the injection caused difficulty with her leg. They use the deltoid primarily as it lacks the major vessels and/or nervations to potentially be damaged by a needle/injection. You did the right thing.

[Katnip, RN]

Did she sign a consent. I thought everyone needs to fill out that form form flu shots.

[whichone'spink, BSN, RN]

Isn't the normal adverse reaction soreness around the injection site? I just got mine, and I got warned I would feel sore for a day or two. An information sheet just like the one you get when you have your shot at Walgreens should be given to patients.

[tewdles, RN]

Typical adverse reactions to the influenza vaccine would include localized reactions...pain, redness, swelling at injection site. Pain in an extremity unrelated to injection site is likely just a coincidence.

Sounds like you are dealing with a mother who is trying to create and/or maintain some control in her young adult daughter's life. It is understandable that she is concerned following what was likely a serious accident and subsequent brain injury in her child. The bottom line is that you followed acceptable policy/procedure/protocol and provided an appropriate vaccine to her vulnerable daughter. It is possible that there was some prior (and unknown to you) agreement with staff that they would communicate any changes or additions to the POC with the mother prior to implementation. It would be perfectly acceptable, and likely appreciated by the parents, for you to discuss their expectations when you next encounter them. While their daughter is a consenting adult they are, obviously, interactive in her life and it is important that the nursing POC reflects how you and your peers should engage them in the process of her care. Don't worry too much, or be hard on yourself...sounds like you did fine.

[angelkim63]

Thank you for all the advice, it really helps. It was unknown to myself and the charge nurses that the parents have power of attorney, which was found out after the fact. It was something that was not put on her chart visible to all nor was it ever mentioned in reports. But the policy/procedure regarding immunizations is what is covering me if there is no specific order that it was contraindicated in her case. I guess I'll find out what happens when I go back to work tomorrow.

[CrunchyMama, ASN, RN]

As anti-vaccine as I am...I'm not with the mother on this one. The pt is 22 years old and can make her own decisions. As far as it being a reaction from the vaccine....it's possible. This is why pts. should be informed beforehand.

[dishes, BSN, RN]

The biggest concern with giving a vaccine under the circumstances you describe, is that the patient is recovering from a brain injury and may not have the capacity to give true informed consent. A person's capacity post ABI fluctuates and is complicated to assess, because of this, family members frequently maintain power of attorney over their adult children for extended periods of time.

Perhaps you can use this incident as an opportunity to find out how the healthcare team at your workplace, determines the decision making capacity of patients with acquired brain injury.

kindest regards

dishes