Immunization experts focus on issues in vaccine delivery

Abstract

In May 2014, the SHARP Vaccine Delivery Working Group published a conference report on key issues in vaccination delivery as a critical first step to improve the process. The group highlighted the complexity of the vaccine delivery process, which encompasses proper training, handling and storage, and preparation and administration. In May 2014, the SHARP Vaccine Delivery Working Group published a conference report on key issues in vaccination delivery as a critical first step to improve the process. The group highlighted the complexity of the vaccine delivery process, which encompasses proper training, handling and storage, and preparation and administration. “Independent retailers are more likely to face challenges with proper handling and storage of vaccines, while chain stores are probably better equipped at keeping the cold chain intact,” lead author Litjen Tan, MS, PhD, Chief Strategy Officer, Immunization Action Coalition, told Pharmacy Today. “However, both settings face challenges with preparation and administration, as busy pharmacies filled with potential distractions can easily lead to vaccine errors,” Tan said.A key issue identified by the working group was the lack of standardized education and training on vaccine storage, handling, and administration. As adult immunization recommendations are expanded, more and more adult providers are administering vaccinations to their patients. A key issue identified by the working group was the lack of standardized education and training on vaccine storage, handling, and administration given to these providers. Therefore, the level of vaccine expertise among adult providers varies greatly compared with that of their pediatric counterparts, who are generally well versed in vaccine delivery. “Pediatric and family practice physicians are accustomed to administering vaccines in their practices, but other specialties such as obstetrics and gynecology may not administer vaccines that frequently,” Tan told Today. “These providers may benefit from a standardized training or certification course that would ensure they are familiar with proper vaccine storage and administration.” The working group noted that the current gap in the availability of training programs spans the spectrum of health care providers. Failure to maintain cold chain was anotherkey issue identified by the workinggroup. Specifically, temperaturevariations during vaccine storage maycompromise vaccine efficacy. Coldchain can be compromised at severalsteps in the vaccine delivery process,such as by use of an inadequate storageunit, inadequate placement of vaccineswithin storage units, or impropervaccine transport. Most organizations strongly recommendthe use of a separate refrigeratorand freezer unit to store vaccines. Use of dormitory units with a singleexterior door is not recommended. Interms of transport, lack of standardson appropriate transport of vaccinesto different locations such as offsiteclinics has contributed to cold chainissues. Handling issues identified bythe group include lack of vaccine managersand backup managers who aretrained in accepting vaccines, managinginventory, and handling compromisedvaccines. Lack of both routineand emergency vaccine managementplans in case problems arise, such aspower outages, is another. The group noted that preparing vaccines from multidose vials instead of using vaccines supplied as prefilled syringes increases the chance for errors. Predrawing vaccines from multidose vials can increase the risk of contamination and lead to possible misidentification of the syringe. Another vaccine preparation issue identified was inadequate preparation of lyophilized vaccines by not reconstituting properly, not adding diluents properly, or using an incorrect diluent. Because of these potential issues, unit-dose, ready-to-administer vaccines are the preferred choice. Administration issues include errors in time of vaccination, inappropriate routes of injections, and inappropriate use of needle gauges and lengths, especially for patients who may require modifications (e.g., patients with obesity). Although it was not discussed in the conference report, the Institute for Safe Medication Practices's (ISMP) National Vaccine Error Reporting Program (ISMP VERP), launched in September 2012, captures unique causes and consequences of vaccine-related errors. This program, and results from the first annual report, revealed a total of 433 reports submitted to ISMP VERP. Most reports (90%) involved vaccine errors that reached patients. A detailed review of ISMP's VERP will be covered in November's Immunization Update column. In the coming months, the working group will publish a follow-up report focusing on solutions to the identified issues. Currently, focus groups are being held across the country to get expert input on proposed solutions with the hope of publishing the most practical ones that will be accepted by a broad range of health care providers, Tan said. Tan noted that the main goal is to simplify the process and have some general standards that will apply to all aspects of the vaccine delivery process. "The increasing awareness of the challenges allows us to have continual process improvement, which, in addition to simplification and standardization, will hopefully reduce the potential for vaccine-related errors," he said.