APhA Immunization Technician Pre-Assessment

Before you administer an immunization:

- Before you administer an immunization: -Make sure the alcohol on the patient's arm is still wet. -Ask the patient to stand up when you administer the vaccine. -Check that your injection site will avoid scars, tattoos, or moles when possible. -Aspirate while the needle is in the patient's arm.

Which of the following are proper techniques when preparing a vaccine?

- Use an alcohol pad to swab the top of the vial using a sweeping motion -Always check and document the expiration date and lot of the vaccine -Tap the syringe to remove air bubbles -All of the above

choosing the correct needle and syringe

-subcutaneous: use a 23-25 gauge, 5/8" needle -intramuscularly: use a 23-25 gauge, usually 1" by may vary -a 5/8" needle may be used for patients weighing less than 130 lbs for IM injection in the deltoid muscle only if the subcutaneous tissue is not bunched and the injection is made at a 90-degree angle

influenza vaccine overview

-the vaccine is different each year and immunity may decrease over time -takes about 2 weeks for flu shot to provide protection -difference trivalent vs quadrivalent is three flu viruses vs four flu viruses

roles performed by pharmacists

-verifying the vaccine is appropriate for the patient -verifying the prescription -counseling the patient -answering clinical questions -medical decision making -responding to a medical emergency

When should you give someone who receives a vaccine the vaccine information statement (VIS)? a. Before they receive the vaccine b. Immediately after they receive the vaccine c. Only upon request from the patient or their representative

A

Which combination of vaccine, route, and site is correct? a. Zoster vaccine, subcutaneous, fatty tissue over the triceps (back of arm) b. Zoster vaccine, Intramuscular, fatty tissue over the triceps (back of arm) c. Influenza vaccine, intranasal, in the nose

A

immunization

A process by which a person becomes protected against a disease through vaccination; used interchangeably with vaccination or inoculation

Emergency preparedness

Being properly equipped and trained for any medical crisis or disaster

what is immunity?

It's all about the antibodies -proteins produced by the body to neutralize or destroy toxins or disease-carrying organisms Types of immunity Active- persons produces their own antibodies -after exposure to a disease -long lasting, sometimes life-long Passive-person is given antibodies -passed from mother to baby, or injected blood products -short lasting, weeks to months Do vaccines create active immunity or passive immunity?

pneumococcal conjugate vaccine 13-valent (PCV13)

Prevnar (pfizer) -12 serotypes same as PPSV23 -1 steotype not in PPSV23 (6A) indicated for ages 6 weeks through 5 years (2,4,6,12 to 15 months) -ACIP recommended in all adults > 19 years with -cochlear implants -CSF leaks -immunosuppression -asplenia (includes sickle cell disease) -ACIP shared clinical decision making for immunocompetent adults > 65 years

What is the best position for the patient to be in when administering a vaccination?

Seated Standing Kneeling

How often should the temperatures on the fridge and freezer be checked?

Twice, once in the morning, once at the end of the day

reconstituting vaccine

What does it mean to reconstitute a vaccine? -mix the vaccine with a dilute (liquid) Only used dilute recommended by manufacturer steps for reconstitution -check labels (expiration date, lot number, names of production) -check how much of the dilute you need -mix together just prior to use -check the appearance (cloudy, disolored, particles)

site

a physical location on the body (left deltoid or right thigh)

vaccine

a product that stimulates a person's immune system to produce immunity to a specific disease, protecting the person from that disease

administer

dispense or apply. in this case, the act of getting the vaccine ready and injecting it into the patient

what is the best position for the patient to be in when administering a vaccine?

seated

route of administration

the path by which a drug is brought into contact with the body

route of admintration

the pathway by which the product is put into the body -intramuscularly -subcutaneously -intranasally

Which of the following is true about drawing up vaccine out of a vial?

-Verify the name of the vaccine and expiration date before you draw up the vaccine. -You do not need to wipe off the vial with alcohol if the vaccine vial is brand new. -You do not need to practice hand hygiene before drawing up the vaccine. -Vaccine brands are interchangeable, so you can draw up any brand of vaccine in place of another brand if it is the same disease.

influenza

-contagious virus affecting nose, throat, lungs -signs and symptoms -fevers, chills, sore throat -runny/ stuffy nose, achy muscles, headaches, fatigue

roles performed by technicians

-drawing up vaccine -preparing vaccine supplies -administering vaccine to the patient -documentation vaccination

tips for intranasal vaccine

-give patient with a tissue prior to administration -tell patient not to sniff or inhale spray -remember to remove the rubber tip protector -place the tip of the sprayer just inside the nose and depress the plunger to spray half the dose into the first nostril -remove the dose-divider clip and administer second dose in the other nostril -no need to repeat if sneezing or coughing occur

immunization preparation supplies

-gloves -bandages -cotton balls -alcohol swabs -absorbent pad -sharps container, biohazard bag, garbage can -emergency kit

The role of the pharmacy technician is

-identifying patients who may be eligible for immunizations -scheduling patient appointments -vaccine and supply inventory control -assisting with billing and documentation

administering an intramuscular injection

-inject the vaccine into the middle of the thickest part of the deltoid muscle -insert the needle at a 90 degree angle with a quick thrust -if more than one vaccine in the same arm, separate injection sites by at least 1 inch

Locating the intramuscular injection site

-intramuscular injections are administered into the deltoid muscle -to locate the deltoid, use anatomical landmarks -in adults, the midpoint of the deltoid is the middle of the upper arm and approximately 2 inches (2-3 fingers breadth) below the acromion process and above the armpit

preventing SIRVA

-know the anatomy of the upper arm -target the lower portion of the deltoid muscle -pay attention to proper technique -sitting next to the patient rather than standing over the patient can help avoid SIRVA

technicians administering immunizations

-licensed and nationally certified technician -under the supervision of an immunizing pharmacist -have completed an immunization training course -CPR certification

expiration dates and lot numbers

-make sure to check and document all expiration dates and lot numbers -this includes diluents -using expired products puts you, your pharmacy, and patient at risk of harm -patient might not be protected -tracking and recalls -quality control

administering a subcutaneous injection

-pinch the tissue (gently) to prevent injection into the muscle -insert the needle at a 45-degree angle -if giving more than one vaccine in the same arm, separate injection sites by at least 1 inch

why should we immunize?

-reduce/eradicate the spread of disease -must be continued until disease is elimination -vaccinating a population protects those who are not able to vaccinated -if immunization was stopped, many diseases would return (measles) -protection of future generations

vaccine schedules

-two schedules for adults and two for children -one schedule for recommended vaccine for all -one schedule based on medical conditions catch up schedule available -lists minimal intervals for vaccines requiring more than one dose schedule is approved by ACIP in fall -released in january or february of each year

tdap vaccine during pregnancy

-vaccination of mother transfers antibodies to fetus provides protection until administration of first few doses of DTaP -one dose every pregnancy -preferably 27-36 weeks gestation -if not given in pregnancy, administer as soon as possible postpartum -encourage vaccination of all family members and caregivers of the infant

drawing up the vaccine

-verify correct type and name -check expiration date -check liquid for clarity, color -practice proper hand hygiene -drawing up air into syringe equal to the volume of vaccine you will draw from the vial (air will be injected into the vial when vaccine is drawn up to equalize vial pressure) -if using a prefilled syringe and needle tip, do NOT expel air from the syringe

herpes zoster (shingles)

-viral infection which causes a painful skin rash. caused by the same virus that causes chickenpox -signs and symptoms- rash on one side of the face or body -pain, itching, tingling -single "stripe" following nerve tract (dermatome) Who is at risk? -immunocompromised -advanced age ? 60 years old can cause the following complications -postherpetic neuralgia (PHN) -scarring -bacterial infection ocular abnormalities

reading the package

-what is the gauge -what is the needle length -what is the volume

items to check before you begin immunizing

1. Have you met the criteria from state administrative rules (i.e. CPR certification, licensed and nationally certified technician)? 2. have you completed any required training? -blood-borne pathogens training must completed annually -other training required by employer? 3. Are you covered by liability insurance? 4. Do you have approval from the supervising pharmacist?

subcutaneous injection steps

1. wash hands, put on gloves 2. the patient should be seated 3. identify injection site and uncover area 4. wipe with alcohol and let alcohol dry 5. pinch fold of skin 6. tell patient to relax or ask a distracting. question 7. insert needle at 45 angle to skin while bracing against the arm 8. depress the plunger 9. wait 2-3 seconds to allow vaccine to absorb 10. withdraw the needle swiftly 11. activate safety device immediately 12. dispose of syringe in sharps container (do not recap or set down) 13. press cotton or gauze if needed, apply adhesive bandage 14. wash hands

If a patient experiences anaphylaxis (serious allergy) after receiving a vaccination, what is the first line recommendation for the patient? (Choose all that apply) a. Epinephrine if the patient is experiencing generalized symptoms (rashing, swelling, difficulty breathing) b. Water c. Call 911 and assess the airway, breathing, circulation, and consciousness d. Instruct the patient to return home and rest

A & C

additional considerations for PPSV23

recommended a total of 2 doses 5 years apart for patients younger than 65 years with -immunosuppression -asplenia (included sickle cell disease) -recommend 1 dose of PPSV23 for patients younger than 65 years with: -cochlear implants -CSF leaks -recommended one dose of PPSV23 for patients 65 years and older who received 1 or 2 doses at least 5 years ago and when younger than 65 years

Pneumococcal Polysaccharide Vaccine 23-Valent

recommended dose for -all people 65 years and older -people 19-64 years old who smoke cigarette -people 19-64 years old who have asthma -people at least 2 year old with chronic illness -not adequately effective in children younger than 2 years -dose and route: 0.5 mL IM or SC

Which needle length would be best to use for a female patient who is small (less than 130 lbs) receiving an influenza shot? a. 1" needle b. 5/8" needle c. 1.5" needle

B

Where should you deposit used syringes and needles for disposal? a. In the garbage b. In the red Biohazard bag c. In the Sharps container d. In the garbage only if the safety device is activated

C

Which combination of vaccine, route, and site is correct? a. Influenza, intramuscular, deltoid (shoulder) b. Influenza, intradermal, deltoid (shoulder) c. Both are correct

C

tdap: combination vaccine for tetanus, diphtheria, and pertussis

Tetanus -caused by clostridium tetani -spores found in soil, dust, feces -symptoms of trismus (lockjaw), muscle rigidity, and spasms -10% case-fatality rate Diphtheria -caused by corynebacterium diphtheriae -rare in US due to vaccination rates -widespread in other countries -transmission respiratory or contact with lesion -case fatality rate 5-10% -manage with antitoxin and antibiotics Pertussis -caused by bordetella pertussis -symptoms of paroxysmal cough with whooping sound caused by inspiration against a closed glottis -disease is more severe among children -among those <1 year of age, 50% hospitalized and 1.6% die

Where can you find up-to-date comprehensive information about common vaccines and the diseases they prevent?

The Pink Book

recombinant zoster vaccine (RZV)

shingrix (GSK) -recombinant, adjuvanted zoster vaccine -two 0.5 mL doses administered IM at months 0 and 2 -antigen and adjuvant stored refrigerated FDA approved and ACIP recommended for prevention of herpes zoster in adults aged 50 years and older -also ACIP recommended for immunocompetent adults who previously received ZVL -RZV is preferred over ZVL for prevention of herpes zoster and related complication

locating the subcutaneous injection site

subcutaneous vaccines are administered into the fatty tissue overlying the triceps

Syncope (fainting)

the brief loss of consciousness caused by the decreased flow of blood to the brain

the RIGHTS of medication administration

-right patient -right time (age, interval, expiration) -right dose -right route -right site -right documentation

Where can you find up-to-date comprehensive information about common vaccines and the diseases they prevent?

Pink Book

Vaccine Information Statement (VIS)

federal requirement that provides valuable info for each vaccine

Which of the following tasks is the responsibility of the pharmacy technician?

-Counseling the patient about the vaccine -Answering the patient's clinical questions -Checking the prescription -Administering the vaccine

Which of the following are proper techniques when preparing a vaccine? a. Use an alcohol pad to swab the top of the vial using a sweeping motion b. Always check and document the expiration date and lot of the vaccine. c. Tap the syringe to remove air bubbles. d. All of the above

D

needle length and size

Gauge -thickness of the needle barrel -a smaller gauge means a bigger needle -example: 23 gauge is bigger than 25 gauge length -measured in inches -most common 5/8" or 1" needles volume -amount of liquid the syringe will hold (1mL, 3 mL)

vaccine types

Live attenuated vaccines -made from viruses or bacteria -must replicate to work -replication mimics natural infection, which stimulates immune response -may be contraindicated in immunocompromised or pregnant patients Inactive vaccines -made from viruses or bacteria -do not replicate because they are killed

epinephrine

Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline.

Shoulder injury related to vaccine administration (SIRVA)

What is SIRVA? -an injury caused by the injection of a vaccine too high in the shoulder -vaccine is inappropriately injected into the shoulder capsule rather than the deltoid muscle -resulting inflammation of the shoulder structure causes patients to experience pain, a decreased range of motion, and a decreased quality of life -ensure you DO NOT vaccinate too high!!

Site of administration

What is a site? -Where on the body you will be injecting the vaccine Common Sites -Deltoid (for intramuscular injections) -Tissue over the triceps (for subcutaneous injections)

zoster vaccine live

Zostavax (merck) -live attenuated virus vaccine -higher than varicella (chickpoz) vaccine FDA approved for adults at least 50 years old but ACIP recommendations still apply to adults 60 years and older -dose and route: 0.65 mL (entire contents of vial) SC -vaccine stored in freezer, diluent stored separately at room temperature

pneumococcal disease

caused by streptococcus pneumoniae -bacteria with a polysaccharide cellular capsule colonizes upper respiratory tracts as part of normal flora - a leading cause of vaccine-preventable illness and death -frequently cause of secondary bacterial pneumonia following influenza -threat exists year-round, not just in winter -antibiotic resistance is common -there are two pneumococcal vaccine available (PPSV23 and PCV13)