Vaccine administration is usually regarded as a simple office procedure, often performed without the direct supervision of the physician or a licensed professional. Although vaccinations are a routine procedure, physicians and staff should remain vigilant about patient safety considerations. Whether you are seeing children for back-to-school immunizations or adults for travel abroad or general disease prevention, take time now to assess the vaccine administration protocol in your practice.
As with any medical intervention, the risks, benefits, and alternatives of the vaccination must be discussed and documented in the medical record, as well as ensuring that safety protocols are followed.
The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, performed a closed claims analysis of vaccine-related events in the medical office setting. Could similar situations occur in your office?
A 4.5-month-old male infant received the pneumococcal conjugate vaccine (PCV) Prevnar 7, which provided protection against seven serotypes of pneumococcus. The following year, the FDA approved the use of Prevnar 13, which provided protection against an additional 6 serotypes of the disease. The American Academy of Pediatrics recommended that those vaccinated with Prevnar 7 also receive Prevnar 13. The physician did not update recommended immunization protocols in her office. Even though the child returned for three additional well visits, the child never received Prevnar 13. At age 39 months, the child developed serotype 6A pneumococcal meningitis, which resulted in left hemiparesis, seizures, and vision and hearing impairment. This disease could have been prevented if the child had received Prevnar 13.
A 13-year-old female received a Gardasil vaccine. Even though her mother was monitoring her in the exam room, the patient fainted and fell off the exam table, resulting in a tooth avulsion, another tooth luxation, a fractured wrist, and a laceration to her hand.
A 35-year-old female complained of redness and swelling at the injection site for a flu vaccine, interfering with her ability to perform her job over the course of several months and resulting in several weeks of physical therapy. No informed consent was obtained. She stated she would never have had the injection had she known of the potential complications.
A 41-year-old female with a history of ankylosing spondylitis requested a Pneumovax vaccination. No informed consent was obtained. The patient was queried regarding whether she had previously received pneumovax, which the patient denied. Actual vaccination status was never verified by the physician; however, the patient had actually received the vaccine two years earlier. The patient developed inflammatory response syndrome, including the amputation of a toe, which was alleged to have resulted from administering the vaccine without checking her immunization history and because the vaccine was not indicated for patients younger than 65 years old.
To help avoid these types of issues:
It is a physician’s obligation to talk with all patients (or their guardians) about what could happen if they decline vaccination. This discussion should include these points:
Parents should be reminded to alert medical personnel of their child’s immunization status each time the child seeks healthcare in case distinctive care is needed.
You can also help raise awareness of the benefits of immunizations:
Inform pregnant women about getting vaccinated to protect newborns from disease such as whooping cough.
This post was sponsored by The Doctors Company, the nation’s largest physician-owned medical malpractice insurer.