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TDAP Immunization

Specializes in L&D, Nursery, NICU & Post Partum. Has 25 years experience.

Hi,

Does anyone offer the TDAP vaccine at their hospital? If so, do you have th patient sign a consent?

Thanks,

D

All of our area hospitals offer it, and the patient doesn't have to sign a consent, but they really should.

Personally, I am not in favor of the idea. First of all, fever is a known side effect and pretty common. I think it's dangerous to have that in the postpartum phase, it confuses the infection issue.

Secondly, the woman already feels like crap, then we give her tetanus, now her muscles ache and she feels like she has the flu and feels just miserable. Why do that to someone? Why not give it at her 6 week checkup? That would give her time to get used to being a mom, get breastfeeding established and then give the immunization.

I understand the community health issue, but I think in our overzealous attempt to get these vaccines, we are causing more problems and suffering. Just not a fan.

PedsAtHeart, LPN

Specializes in LPN, Peds, Public Health.

The reason they want it given before their 6 week post partum is because an infant less that 6 weeks old has not had their Pertussis vaccine at all and mothers and close family contacts are the #1 source spreading it to these infants. I understand where you are coming from about the achiness and all that, but I would rather be a little sore and achey than take the chance of transmitting pertussis to my newborn. Personally, I received my Tdap a couple of months ago and had no reactions or side effects at all, no fever, no soreness.

To the OP, I do believe that most hospitals do offer this now.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

Yes, and yes. Vaccines should ALWAYS require consents.

rickdon19

Specializes in L&D, Nursery, NICU & Post Partum. Has 25 years experience.

Hi,

Thanks for all the response. Are you able to share your consent? Who gets it: RN or MD. Is there an information sheet that goes with it?

Thanks,

D

Faeriewand, ASN, RN

Specializes in med/surg/tele/neuro/rehab/corrections. Has 10 years experience.

We students just learned about this too on our OB rotation. It's a new thing to keep parents from giving pertusis to their NB. They also ask that grandparents get it and anyone who might come in contact with the new babe. It was sad to learn about it because they had us read a sad story about a mom who didn't know she had it (had a cough) then had her baby and her baby got it and died. :( It was a good learning experience for us students. We will never forget that lesson.

PedsAtHeart, LPN

Specializes in LPN, Peds, Public Health.

Pertussis is awful and no baby should ever have to go through it...

One thing I dont understand about Tdap is this... its only approved up to age 64. To me, the elderly population would also be at a higher risk of having complications from Pertussis, just like how the flu hits the youngest and the oldest hardest. I know this is simply because they have not done their clinical studies in that age group, but I really wish they would and open that age range up to EVERYONE. I think Tdap is an extremely important vaccine for health care workers to receive also.

As far as consents go, there is no federal law (might be a state law, depending on where you are at, you can always check with your state health department) saying that you must have a written consent for vaccines. BUT there is federal law stating that you MUST give out VIS (Vaccine Information Statements) with every vaccine that you give. The way we do this at my facility (I am Public Health Nurse and give all immunizations at my clinic) since we are total electronic charting, is that we document that the VIS was given, the date of the VIS, and all the typical info you document for your injections. Then we also make a note in our nurse's note that consent was given for said vaccine. As far as WHO gets the consent if you do have written consent forms, it can be either the Dr or the nurse giving the vaccines.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

The consent is obtained by the RN. Yes, there is an information sheet that goes with it - the VIS that the CDC publishes. There is a VIS for every vaccine offered, and IMO we're obligated to give that to the patient to read prior to obtaining the consent. It's a state law that we have to provide the VIS (may even be a federal law, I'd don't know).

You can download copies of the VIS for each vaccine at the CDC website:

Vaccines: Pubs/VIS Mobile Downloads

My problem with this new recommendations is that hospitals tend to pick and choose, if we are going to follow the recommendations and make a "campaign", then do so to the fullest.

This means that

-ALL health workers need to be up to date with the Tdap and MMR, otherwise, you and your facility could be exposing babies.

-ALL family members should be up to date. Is your facility giving out information stressing the importance to other family members? If our goal is to really make a dent and prevent it, why do it half way? Why not make up some handouts and show the importance for all family members. That's the recommendation, not just new moms.

And as an FYI, the current statistic is 30 deaths in the neonatal period PER YEAR...so statistically, giving the shot is not going to make a huge difference if you look at how many babies are born, how many die from other causes.

If you look at how many women get infections, if you look at the fact we are somewhere like 18th on mortality in mothers, then anything that could potentially hide an infection (such as fever, chills, pain, etc) is a huge risk factor that should be eliminated.

Sometimes I think we do things to make ourselves feel better, but we don't really take the time to look at all the evidence and really stop to look at it from a common sense approach. We'd save more than 30 lives a year doing so many other common sense things, and if we're doing to do the vaccination promotion, then just giving the moms the shots without following the FULL RECOMMENDATIONS is really just fooling ourselves and giving ourselves a pat on the back. If the health care workers are walking around not up to date and we aren't pushing the other family members who are in the home, then we aren't making a difference. We're just making mom's uncomfortable and possibly could see more than 30 moms get sick or die over a year's time from masked infection (we've already had 2 in our facility, so I'm sure the numbers will be there over the whole country).

And giving a mom the VIS while she's recovering from birth, on narcotics, hasn't slept, and often giving it to her right as we're prepping the shot is a joke as far as informed consent. Informed consent should never be given when mom is under the influence of narcotics. We do it all the time in ob, especially with such short stays. These are moms who have been given huge packets of information, bombarded with all kinds of educational materials, and we hand them some information about vaccines, and then give them the shot a few minutes later, and think we gave them informed consent. I find that we should at least be embarassed by that and at worst should be thinking about malpractice if there's a reaction and mom can't even remember it and you find out she just had percocet 2 hours ago.

PedsAtHeart, LPN

Specializes in LPN, Peds, Public Health.

My problem with this new recommendations is that hospitals tend to pick and choose, if we are going to follow the recommendations and make a "campaign", then do so to the fullest.

This means that

-ALL health workers need to be up to date with the Tdap and MMR, otherwise, you and your facility could be exposing babies.

-ALL family members should be up to date. Is your facility giving out information stressing the importance to other family members? If our goal is to really make a dent and prevent it, why do it half way? Why not make up some handouts and show the importance for all family members. That's the recommendation, not just new moms.

And as an FYI, the current statistic is 30 deaths in the neonatal period PER YEAR...so statistically, giving the shot is not going to make a huge difference if you look at how many babies are born, how many die from other causes.

If you look at how many women get infections, if you look at the fact we are somewhere like 18th on mortality in mothers, then anything that could potentially hide an infection (such as fever, chills, pain, etc) is a huge risk factor that should be eliminated.

Sometimes I think we do things to make ourselves feel better, but we don't really take the time to look at all the evidence and really stop to look at it from a common sense approach. We'd save more than 30 lives a year doing so many other common sense things, and if we're doing to do the vaccination promotion, then just giving the moms the shots without following the FULL RECOMMENDATIONS is really just fooling ourselves and giving ourselves a pat on the back. If the health care workers are walking around not up to date and we aren't pushing the other family members who are in the home, then we aren't making a difference. We're just making mom's uncomfortable and possibly could see more than 30 moms get sick or die over a year's time from masked infection (we've already had 2 in our facility, so I'm sure the numbers will be there over the whole country).

And giving a mom the VIS while she's recovering from birth, on narcotics, hasn't slept, and often giving it to her right as we're prepping the shot is a joke as far as informed consent. Informed consent should never be given when mom is under the influence of narcotics. We do it all the time in ob, especially with such short stays. These are moms who have been given huge packets of information, bombarded with all kinds of educational materials, and we hand them some information about vaccines, and then give them the shot a few minutes later, and think we gave them informed consent. I find that we should at least be embarassed by that and at worst should be thinking about malpractice if there's a reaction and mom can't even remember it and you find out she just had percocet 2 hours ago.

I don't work OB, never have, and I really have no desire to, so this is based on my own personal experience. I had c-sections with both of my children. On the day I was discharged from the hospital, on both occasion, I was more than lucid enough to read a paper and make an informed decision about whether I wanted a vaccine or not.

And if those 30 something deaths per year could be prevented? Why not? I mean seriously... I give Tdap vaccine to patients ALL the time, I have yet to even have 1 single person who had reactions bad enough to even call the office afterward. I don't think its going to mask any underlying infection in a post partum mom. Obviously if mom starts running a fever and having s/s of infection, whether she got Tdap or not, she should be evaluated by a Dr.

I do agree with you in the regards to complying with the full recommendations of the vaccine. Every 11 or 12 year old should be boostered with a Tdap and anyone older than that who has had a Td >2 yrs ago should be boostered with a Tdap. For instance, if I see a new parent in my clinic with their 2 month old child for immunizations, I should check her Tdap status while she is here with child and fathers status and the status of any sibling. BUT I work in a Native American clinic, so if one parent is not native then all I can do is advise them of the importance of being vaccinated and following up with their own private physician.

Obviously, I'm very pro-vaccine. Its what I do every single day. For me, the benefits far outweigh the risks. On another personal note, I have been administering vaccines for 8 years now and I have yet to have a patient have any serious side effects to any of them *knock on wood* I pray that it never happens. As medical professionals it is our obligation to make sure that our patients are informed of the risks/benefits of anything we do. I would say that if you feel a mother is not in the right state of mind to make that decision when she is leaving the hospital, then by all means, wait until her follow up appt. and do it at that time.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

We don't give out TdaP to women on the postpartum floor. We do give out MMR and during flu season we did flu vaxes too. Usually it's the RN that gets the consent signed, and we give out VISs too. I don't like giving out the MMR for the same reasons others mentioned about not liking giving the TdaP. I'm generally in favor of vaccines but some of the side effects can mimic infection symptoms - it has happened, and what usually ends up happening is mom ends up on IVFs and IV abx unnecessarily until the docs r/o infection. (I mean, we nurses generally know the difference, but the docs feel like they have to cover their butts.)

Edited by ElvishDNP

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

I'm generally in favor of vaccines but some of the side effects can mimic infection symptoms

Yep, at my last facility, when we'd have to give the rubella vaccine, we would do it last thing, practically just as she was walking out the door.

Pro vaccine isn't the issue I'm talking about. I'm talking about common sense vaccinations. The question to ask is not "can this save 30 babies lives per year?", but rather "can this kill more than 30 mothers per year?" or "how many infections will this hide and potentially increase health care costs, cause lost uteruses, etc?".

Informed consent is not legal under narcotics. That's just the way it is, and in a lawsuit it looks bad. Doing it as they walk out the door might protect you there, but it sets them up even further for an infection when they get home and have infection symptoms and don't them treated right away.

The question should be "has this been studied throroughly and thought out or is a reaction?" That's not good science, not good nurse, not evidence based practice.

I do care about babies getting sick. But I care about sick mom's, moms who might lose a uterus (which we did have one this past year) and moms who might die.

I think we're in uncharted territory, not practicing evidence based nursing practice, but rather going on a reaction of what might happen case scenario, which is fear based. We don't even have consents signed in our area hospitals, which further ups the risks. I would hope that nursing would be improving by now in these areas, but we're still reacting,instead of being ahead of the game.

In another few years when the numbers come out and we see the harmed mothers and the effects, we might rethink this policy, just like we do every 5-10 years, too late for them, and shame on us for poor science and poor research (and picking and choosing recommendations in this case instead of either enforcing all of them or none of them).

This is one area I illustrate to my students how we left common sense at the door and all lined up without thinking it through. I want my students to think, to practice evidence-based nursing, to question, and especially to not react with fear, but with reason.

My daughter is one who gets "reactions" to Tdap imunizations-been told that she is reacting to the adjudant. She developes sterile abcesses-resulted in hospitalization when she was 2, outpt abcess I and D when she was 12, following a dog bite. Very uncomfortable, but I still feel that the immunizations outweigh the disease..

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

I hear what you're saying Maggi, but I guess I just don't agree. A doctor who would perform a hysterectomy on a woman because she has a fever of "unknown idiology" that was caused by a vaccine is one stupid doctor. A lot more goes into diagnosing chorio than just "huh, she has a lowgrade fever. Guess we should take out her girlie parts."

How do you know we're not practicing evidence-based nursing practice by providing the TDaP to postpartum women? Is there research?

And just so you know where I'm coming from, I'm not pro-vax. None of my children are vaccinated (although my son, 12, is due to get some vaxes that I think are important to protect him as an adolescent/future sexually active person). I'm just not convinced that offering the TDaP to postpartum women in order to protect their newborns is of the debil.

Edited by klone

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

Also wanted to mention, at not every point during a woman's stay in OB is she under the influence of narcotics. Of course I wouldn't ask for an epidural consent to be signed right after giving her a dose of Nubain, but at not every point during her stay is she high on narcotics. There is plenty of opportunity to obtain informed consent, and like the myriad other bits of info we provide to parents during their stay the VIS is something for them to have and read when they have the opportunity. My legal obligation is to provide it to them, not sit down and read it to them or make sure they've read it front and back before giving consent.

NO,you're missing the point..these women do sometimes have infection, however, the s/s are the same as the vaccines, so the women read the s/s, think that's the problem and don't call or come in...when it finally gets bad and they do come in, it's so far gone, they end up losing their uterus or worse, their lives. The vaccines and their side effects mask the infections and they aren't caught in time.

As a lactation consultant, I see that frequently too. Moms are sore from the tetanus portion, especially their arms and can't nurse properly. They become engorged, and end up with blocked ducts and mastitis.

It's great you want to protect 30 babies per year. And there's tons of ways to do that. but what about protecting the moms? There's lots more that suffer complications from these shots given during this time,they are forgotten or tossed to the side. Are the babies more important than the moms?

I do know how horrible pertussis is. My children and I have had pertussis and yes it is horrible. My grandmothers sister died from it.

Is this evidence based? No, I can tell you it's not. Do a literature review, i have for a class. And for my students, it's not. So, I can speak and say it's fear based, not evidence based. Evidence base would look at the statistics, how many babies are born in the US, then divide that number by 30. Then look at how many women have had infections that are hidden by the s/s after receiving the immunizations, have had problems with breastfeeding and quit (and there is percentage out there that have quit and having the shot and being sore and sick feel has contributed to it), and take all those numbers to see which is of the great risk and greater benefits.

I think you're thinking we're saying that doctors are operating because they see a fever from the vaccine and think it's an infection. It's the opposite. And it's dangerous. And unethical.

Plenty of time to obtain informed consent? Do you work in ob? Because those of us that do would disagee with that. Some women get discharged in 24 hours, are tired and haven't slept, deliver a baby, sleep, wake up with a room full of visitors, start popping the pain killers right up til they walk out the door! I chuckle when my students get a taste of what a busy ob floor can feel like after a couple of days, especially with a few episodes of drama thrown in for good taste. Maybe you're floor is different, but for a test, give them the VIS and informed consent, leave, come back and ask if they can spit the info back to you before you give the shot. That way you'll know if true informed consent has taken place. Do a literature search on "informed consent definition" and you'll see that the definition is whether the patient understands and can repeat back the information. I have my students do this and they are surprised to see the patients have no clue what shot they are getting, what's it's for, what the side effects will be, or most anything else we just told them...

My legal obligation is not my greatest concern, it's my ethical obligation. My patient advocacy concern. And that is to BOTH my patients, mom and baby. It's a different world in ob when you have two patients who equally need protected and cared for. If nurses are only worried about the legalism, then they are in the wrong field, I would take a student to task for that attitude. I want a nurse who is looking out for MY best interest, no matter what.

Again, it's about whether it's an appropriate time. Whether statistically we're making a difference or making things worse. Time will tell, I know we've started to keep track and probably will start reporting these infections, I know insurance companies are NOT happy and may end up not paying for them, just like they don't pay for cath related UTI's.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 14 years experience.

NO,you're missing the point..these women do sometimes have infection, however, the s/s are the same as the vaccines, so the women read the s/s, think that's the problem and don't call or come in...when it finally gets bad and they do come in, it's so far gone, they end up losing their uterus or worse, their lives. The vaccines and their side effects mask the infections and they aren't caught in time.

Well, then their discharge nurses aren't doing their jobs. We tell them any time they develop a fever of 100F or greater, they should immediately call their doctor. It's up to the doctor to determine if their fever is caused by a vaccine (which generally only causes low-grade fevers) or something more serious.

redbeads

Specializes in L&D. Has 16 years experience.

Yep, at my last facility, when we'd have to give the rubella vaccine, we would do it last thing, practically just as she was walking out the door.

I believe a reason for giving the rubella vaccine right before the mom leaves the hospital is b/c it has a small amount of live virus in it....so this decreases exposure for others in the hospital.

Edited by redbeads

redbeads

Specializes in L&D. Has 16 years experience.