Lecture 4 - Health Management: Immunization Flashcards
Name some of the benefits of allowing pharmacists to vaccinate patients
The community pharmacy is convenient (optimal access to pharmacists as health care providers). Patients often prefer to receive vaccines in a pharmacy. Pharmacist immunization has lead to increased vaccination rates disproportionate to the increased number of vaccinators in the US
Name some of the pharmacy immunization venues
Community (it’s on demand or patients can schedule appointments or the pharmacy can have “clinic” days; it’s the most common)
Institutional (inpatient interventions)
Mass immunization response (pandemic)
What is involved in the pre-injection phase?
Counseling (effective communication about immunization, informed consent)
Patient history and assessment (contraindications, precautions, pain and anxiety reduction techniques)
Explain what is effective communication about immunization and its importance
The low public profile of immunization-preventable diseases leads to public concerns of safety and necessity of immunization (out of sight, out of mind). Provide current, evidence-based information while respecting different viewpoints. Discuss the risks and benefits of immunization. Highlight the large scope of immunization benefits. Contrast known and theoretical risks of immunization with risks or the preventable disease
Name some of the risks
Allergic reaction to the medication component (most serious). Local pain, swelling and redness. Systemic fever. Irritability. Pharmacists needs to stress that risks are rare
Can a person get the flu from a flu shot?
Regular flu shots, no, because the virus is attenuated. However in intranasal vaccines, the virus is live, so the person could potentially get the flu
Name some of the public misconceptions regarding vaccines
Vaccines cause autism (not causal link). Multiple vaccines overwhelm the immune system (the immune system handles thousands of antigens every day). Vaccines contain harmful additives (thimerosal, not dangerous but removed due to public perception). Vaccine-preventable diseases are “gone”. Other immunized individuals will protect unimmunized individuals from the disease (true to an extent).
Name some of the benefits of vaccination
Vaccines have saved more lives in Canada in the last 50 years than any other health intervention. The fear of acquiring a vaccine preventable disease is gone (older patients may remember this, but others take it for granite). Vaccines result in both a direct health benefit as well as direct savings in medical care costs
Describe the patient history and assessment phase
Check for indication (is the immunization indicated based on current schedule and immunization history?)
Check for contraindications
Check for precautions
Assess need for pain and anxiety reduction techniques
What is a contraindication?
Condition that greatly increases the risk of adverse events after immunization. Vaccines should not be administered if contraindicated
What is a precaution?
Condition that could increase the risk of adverse events after immunization or could compromise the ability of the vaccine to produce immunity. The presence of a precaution may warrant the delay of vaccine administration. However, benefits and risks should be weighed
If someone is allergic to a vaccine, should they get one?
The patient should never get a vaccine (live or attenuated)
If a patient is severely immunocompromised, shoud they get a vaccine?
The patient may be able to receive an inactivated vaccine, but the pharmacist must take precaution. The patient should never receive a live vaccine
If a patient is pregnant, can they receive a vaccine?
The patient can receive an attenuated vaccine, but not a live vaccine
If a patient was recently administered a blood product containing antibodies, can they receive a vaccine?
They may receive both live or attenuated vaccines, however the pharmacist must take precaution with the live vaccine
If a patient was recently administered a live virus vaccine, can they receive another vaccine?
They may receive both live or attenuated vaccines, however the pharmacist must take precaution with the live vaccine
If the patient has a severe bleeding disorder, can they receive a vaccine?
They may receive both live or attenuated vaccine, however the pharmacist must take precaution with both
Name some conditions that are not contraindications
Mild common illness. Concurrent antibiotic therapy (with some exceptions). Breast-feeding. Gastrointestinal intolerance to eggs (differentiate between a GI intolerance and a true allergy). Allergies not involving vaccine components. Antigen “overexposure”
Assessment can be conducted through asking a few questions to the patient or guardian. Give some example questions
Do you have any allergies to food or medications? Have you had any reactions to vaccines in the past? Have you ever fainted after receiving a vaccine? Do you have any problems with your immune system? (for live vaccines). Have you received any blood products or transfusions in the last year? (for live vaccines)
Injection-related anxiety can be pronounced and must be looked for during the pre-injection assessment. What are some ways to reduce anxiety?
Much pre-injection anxiety can be managed with environment. Seat patients. Assess the need or desire for topical anesthetics. Provide a quiet environment. Privacy. Prepare injection out of sight of the patient
Pain from injections is generally moderate and brief in duration, however, fear of it can be a cause of pre-injection anxiety. What are some ways to reduce pain related to vaccines/anxiety
Distraction techniques. Deep breathing. Comforting restraint (upright holding). Topical anesthetics. Prophylactic oral pain relievers are not recommended; some evidence indicates a decrease in vaccine efficacy
Name some topical anesthetics? What are the problem with topical anesthetics?
EMLA (takes 60 minutes). Ametop gel (30-40 minutes). Vapocoolants (immediate efficacy). Many topical anesthetics take a while, whereas patients want to get in and get out
