Vaccinating Hospital Patients Before Discharge

[CaliRN2019, BSN]

My hospital has been offering the J&J vaccine to patients on discharge. I feel uncomfortable with this because I know how many people feel quite ill for a time period after getting vaccinated and I don't feel this is the right time to be giving hospitalized patients their vaccine.  They are already weak and still recovering from whatever brought them in the hospital and a harsh vaccine response may complicate their recovery. I also wonder if patients may delay coming back to the hospital for readmissions because they think they are just dealing with vaccine side effects when in reality it is their diagnosis that needs attention. Thoughts?

[toomuchbaloney]

Mild illness is not a contraindication to vaccination.  

Quote

a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.

The presence of a moderate or severe acute illness with or without a fever is a precaution to administration of all vaccines (Table 4-1). The decision to administer or delay vaccination because of a current or recent acute illness depends on the severity of symptoms and etiology of the condition. The safety and efficacy of vaccinating persons who have mild illnesses have been documented (8-11). Vaccination should be deferred for persons with a moderate or severe acute illness.

ACIP

[CaliRN2019, BSN]

I guess the debate then is "mild illness". Many patients I discharge I feel are more then mildly ill. Many go home with after extensive multiple surgeries, PICCS for long term ABX, drains, complicated wounds, and many are so weak they are not able to currently ambulate at the present time. I know this puts them at high risk for complications from covid, but at the same time I feel like the possibility of adding harsh side effects from the vaccine might not be a good idea in their current delicate state. Perhaps the J&J vaccine has less side effects since it isn't MRNA like Moderna and Pfiser. 

[SmilingBluEyes]

29 minutes ago, CaliRN2019 said:

I guess the debate then is "mild illness". Many patients I discharge I feel are more then mildly ill. Many go home with after extensive multiple surgeries, PICCS for long term ABX, drains, complicated wounds, and many are so weak they are not able to currently ambulate at the present time. I know this puts them at high risk for complications from covid, but at the same time I feel like the possibility of adding harsh side effects from the vaccine might not be a good idea in their current delicate state. Perhaps the J&J vaccine has less side effects since it isn't MRNA like Moderna and Pfiser. 

Then I would consult with the doctor and get his/her advice on when it is appropriate, or not, to give this vaccine on discharge. Get orders to do so when appropriate.

[toomuchbaloney]

36 minutes ago, CaliRN2019 said:

I guess the debate then is "mild illness". Many patients I discharge I feel are more then mildly ill. Many go home with after extensive multiple surgeries, PICCS for long term ABX, drains, complicated wounds, and many are so weak they are not able to currently ambulate at the present time. I know this puts them at high risk for complications from covid, but at the same time I feel like the possibility of adding harsh side effects from the vaccine might not be a good idea in their current delicate state. Perhaps the J&J vaccine has less side effects since it isn't MRNA like Moderna and Pfiser. 

Likely, the preferring provider is responsible for determining if the illness is mild enough to vaccinate or severe enough to delay.  This assessment is SOP in the vaccination world.  Mild illness doesn't buy most children out of routine childhood immunizations when they present at their provider office...or at least they shouldn't.  If you have concerns you should discuss them with the provider. 

[CaliRN2019, BSN]

At my hospital it isn't up to the provider. The hospital offers it to anyone on discharge, just like the flu vaccine during flu season. There are no stipulations at all.

[toomuchbaloney]

24 minutes ago, CaliRN2019 said:

At my hospital it isn't up to the provider. The hospital offers it to anyone on discharge, just like the flu vaccine during flu season. There are no stipulations at all.

If you think there is a medical contraindication for vaccination with a patient, shouldn't you contact the discharging provider & note your concerns in the record? You should not administer any vaccine that you believe is contraindicated. IMV

Having said that, we are in a pandemic and the way to the end is with vaccination of most people living in any given area. The society and your community is trying to make every encounter with health care an opportunity to identify unvaccinated individuals and convince them to vaccinate.