Pneumonia Vaccine Fell Through the Cracks

[Daliadreamer]

A few weeks ago, I received report from the night shift that this particular patient was transferred from another unit to ours the day before. I don't remember the diagnosis or the patient. What I do know is that on the MAR, I saw that I needed to give my patient the pneumonia vaccine. Our system prompts the vaccine to be profiled and given on the second day of admission.

I found this odd, because the patient had been in the hospital for over the two day mark. I called over to the other unit, and they went back and found that it had been taken out of the pyxis and that it had been charged to the patient, but no documentation showed that it had been given, and the RN that had the patient on the second day was not working. I asked the patient, and they could not remember if it was given or not. I did not give it, and stated why in the MAR. I wasn't comfortable giving another dose if the patient had possibly gotten it already. The patient was discharged the next day.

Now there is a chart audit being done because someone noticed that the vaccine had not been given. The patient is fine, no pneumonia, thank goodness. I just don't know what I could have done other than document. I guess I could have kept calling the other unit to find out, but what if the other RN did not remember either?

[nurse2033, MSN, RN]

It's not your responsibility. You did your best to find out. Whomever had the medication in hand should have given it.

[rkitty198, BSN, RN]

I had something similar happen to me.

I was going to give the vaccine to my patient and it had already been given.

My patient didn't remember getting it. I called pharmacy and sure enough it was already pulled from the Accudose. The patient denied ever getting the vaccine and swore she would have remembered as she hates vaccines.

That morning I noticed she had on a nicotine patch on her left arm and under that was a very red circle- shaped like the patch, but a little smaller. I pulled the patch and replaced it to her right arm, as she said that she has been taking the patch for a few weeks and never had a red spot before.

The next day I removed the nicotine patch and noticed no red spot. The red spot on her left arm was even bigger and warm, with a small amount of tenderness.

The patient had discharge orders and I didn't want her leaving until we figured out what was going on with her arm. Her sister was there to pick her up and said "isn't that where you got your shot?"

Well the patient then rememered that she did indeed get the shot, but was so out of it when she was admitted that she forgot about it.

I dont understand why they dont just contact who pulled the drug and ask them? It was pulled under their name.

Well in my situation the nurse didnt remember giving it to the patient. I was relieved for her that indeed it was given- but she would still be in some trouble for the lack of documentation.

[merlee]

The patient is fine, no pnuemonia, thank goodness. Will someone be following this patient for the next 5-10 years? A vaccine is a long-term type of prophylaxis, not something specific for a particular hospitalization.....

[ckh23, BSN, RN]

Nothing you can do. I think the person to be questioned is the nurse that drew it out of the pyxis. Perhaps they did give and did not chart it or maybe the vile was broken, etc. They are the only person that really knows if it was administered or not.

[Orange Tree]

In many cases, it's recommended that the vaccination be given if vaccination status is uncertain. I guess you could have checked with pharmacy to see what your hospital's policy is....

Is it possible that the patient was febrile at the time the vaccination is normally given? We will hold off on administration if a patient has been febrile within the past 24 hours. And I can't count how many times I've pulled meds, not given them for some reason and forgotten to restock them (at least right away). Maybe the nurse who pulled it just didn't restock?

In any case, you did the best that you knew how to do with the information you had to work with. And I'm not trying to trivialize vaccinations, but in the grand scheme of things I don't think this was a huge "error".

[shiccy]

The pneumococcal vaccine is a government standard of care. It doesn't treat the patient for pneumonia, and IIRC doesn't actually give a good amount of immunity for a few weeks. The reason why it's important, however, is that if a person qualifies for it then they area already at a higher chance of getting the illness and possibly dying from it.

This being said, if it were me and it was not on the new MAR then it should be carried over for clarification for the next shift so it can be taken care of before discharge. It's ultimately day shift's responsibility to make sure that it was given prior to discharge, HOWEVER it's also your responsibility to make sure day shift knows you didn't give it and it might be an issue.

Ultimately if it comes down to anybody it'd be the person doing the discharge, so technically you're off the hook or should be.

[wooh, BSN, RN]

In many cases, it's recommended that the vaccination be given if vaccination status is uncertain. I guess you could have checked with pharmacy to see what your hospital's policy is....

If uncertain, but is it a good idea to give it the day after it may or may not have been given? (I'm curious now and would really like to know!)

To the OP: You did the best you could. You charted appropriately. If anyone at your workplace tries to say otherwise, let me know and I'll cyber-smack them for ya!