Essential Immunization Practices

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6. Communication

Competency: Communicates effectively about immunization, as relevant to the practice setting(s).

Learning Objectives

The health professional will be able to perform the following:

1. List the components of the evidence-based decision-making process.
2. Explain the importance of risk perception for immunization decision making.
3. Respond appropriately following an assessment of client knowledge, attitudes, and beliefs regarding immunization.
4. Deliver clear, concise messages about the risks of vaccine-preventable diseases and the benefits and risks of vaccines.
5. Provide appropriate evidence-based information and resources to clients regarding immunization and vaccines.
6. Provide guidance to clients so they can correctly identify credible sources of information on immunization and vaccines.
7. Apply, as appropriate to the practice setting, mass media strategies for public communication.

Key Terms: Credible sources, evidence-based decision making, informed decision making, risk communication, risk perception.

Suggested Content for Training

• Issues that affect and influence parents/caregivers in their vaccination decision making
• Responding to commonly asked questions and misconceptions
• Local and national sources of further information and advice for parents
• Importance of risk perception for immunization decision making
• Basic principles of risk communication
• The effect of media reporting on parental views and acceptance of vaccination

7. Storage and Handling of Immunization Agents

Competency: Implements Canadian guidelines when storing, handling, or transporting vaccines.

Learning Objectives

The health professional will be able to perform the following:

1. State where to access the most recent national guidelines dealing with vaccine storage, handling, and transportation.
2. Describe the national guideline requirements for vaccine storage, handling, and transportation and their importance in maximizing the potency and efficacy of each vaccine.
3. Outline the key steps for maintaining the cold chain in the practice setting.
4. Explain actions taken to report and manage breaks in the cold chain or other insults that compromise vaccine integrity.

Key Terms: Min-Max thermometers, National Vaccine Storage and Handling Guidelines for Immunization Providers, potency, efficacy, cold chain, stock rotation.

Suggested Content for Training

• Effects of temperature on potency, efficacy, and adverse events of vaccines
• Daily monitoring and written temperature records
• Correct use of designated purpose-built vaccine fridge
• Importance of regular checks for expired vaccine
• Ordering appropriate vaccine stock
• Management of breakdowns in the cold chain
• Disposal of heat- or cold-damaged vaccine
• Monitoring and maintaining the cold chain during vaccine transportation
• Maintenance of the cold chain during a clinic session
• Taking responsibility for ensuring that all vaccines administered have been stored correctly
• Importance of protocols/standard operating procedures in each practice setting
• Fulfillment of National Vaccine Storage and Handling Guidelines for Immunization Providers

8. Administration of Immunizing Agents

Competency: Prepares and administers immunization agents correctly.

Learning Objectives

The health professional will be able to perform the following:

1. Prepare a checklist for pre-immunization patient assessment, including precautions, contraindications, and indications for rescheduling.
2. Ensure the seven "Rights" of immunization: right drug, right client, right dose, right time, right route, right reason, and right documentation.
3. Demonstrate the steps involved in vaccine preparation, including reconstitution, if appropriate, administration, and disposal.
4. Name the resources that are used to guide the immunization administration process and decision making.
5. Develop a table listing the vaccine, age, dose, route, site, contraindications/precautions, and side effects for each vaccine used in the practice setting.
6. Demonstrate the age-appropriate injection sites and proper client positioning used for immunization.
7. Choose the correct needle length and gauge for the age and size of the client.
8. Describe actions taken to increase safety in immunization clinics related to the provider, the recipient, and the environment.
9. Demonstrate the appropriate technique for immunization.
10. Describe techniques to reduce the pain associated with immunization.

Key Terms: Aseptic technique, Canadian Immunization Guide (CIG), contraindications, expired stock, expiry date, immunization schedules (delayed, interrupted, etc.), injection error, injection site, medication error, minimum vaccine intervals, needle length and gauge, needle stick injury, precautions, reconstitution, rotation of stock, route of administration (intramuscular, subcutaneous, intradermal, intranasal, oral), routine practices, safety-engineered injection devices.

Suggested Content for Training

• Assessment of fitness for vaccination and identification of true contraindications to vaccination
• Route, needle size, and injection site for administration of vaccine based on research, current recommendations, and effects on efficacy and local reactions
• Dosage and reconstitution of each vaccine
• Preparation and disposal of vaccination equipment

9. Adverse Events Following Immunization

Competency: Anticipates, identifies, and manages adverse events following immunization, as appropriate to the practice setting.

Learning Objectives

The health professional will be able to perform the following:

1. Use reliable, evidence-based resources to list the frequencies of the common, uncommon, and rare adverse events associated with vaccines.
2. Inform recipients and/or their caregivers on what to expect and what to do regarding adverse events that could follow immunizations.
3. Draft in detail an effective step-by-step response to anaphylaxis.
4. Document all adverse events following immunization on the appropriate form and submit it to the appropriate agencies.
5. Distinguish between reporting an adverse event following immunization and proving that immunization caused an adverse event.

Key Terms: Abscess, active surveillance, adverse event following immunization, adverse vaccine reaction, anaphylaxis, anxiety attack, causality, cellulitis, encephalitis, encephalopathy, Guillain-Barré syndrome, hypotonic hyporesponsive episode, induration, injection site reaction, local reaction, nodule at injection site, oculorespiratory syndrome, passive surveillance, serious adverse events, syndromic surveillance.

Suggested Content for Training

• Physiology of anaphylaxis and allergic reactions
• Potential causes of anaphylaxis and ways of decreasing the risks
• Signs and symptoms of and differences between anaphylaxis and fainting
• Treatment of anaphylaxis, equipment required, adrenaline dosages, and sites for its administration
• Definition and types of adverse events
• Where and how to report adverse events to vaccines – Canadian Adverse Events Following Immunization Surveillance System
• Recording of adverse events to vaccinations – Use of the Adverse Event Following Immunization Reporting Form

10. Documentation

Competency: Documents information relevant to each immunization encounter in accordance with national guidelines for immunization practices and jurisdictional health information processes.

Learning Objectives

The health professional will be able to perform the following:

1. Describe the role and importance of immunization records.
2. Identify the information to be documented on an immunization record.
3. Record an immunization encounter on the appropriate documentation instruments accurately and completely.
4. Facilitate the transfer of information in the vaccination record to other providers and to appropriate agencies in accordance with requirements.
5. Record the reason and planned follow-up action when a scheduled immunization is not given.

Key Terms: Bar coding, immunization coverage, immunization record professional chart, immunization record take-home, immunization registry, lot number.

Suggested Content for Training

• Requirements and importance of accurate documentation
• Where and why vaccinations should be recorded and reported
• Policy for reporting and recording vaccine errors
• Importance of and reasons for recording lot numbers

11. Populations Requiring Special Considerations

Competency: Recognizes and responds to the unique immunization needs of certain population groups.

Learning Objectives

The health professional will be able to perform the following:

1. Describe the unique immunization needs of certain populations, as relevant to the practice setting, including
   • individuals who are off course of a recommended immunization schedule;
   • individuals who have had a serious adverse event following a prior immunization;
   • individuals with certain medical conditions, including transplant recipients;
   • pregnant women;
   • women who are breastfeeding;
   • occupational risk groups;
   • travellers;
   • new Canadians;
   • international students;
   • individuals with behaviours that put them at risk for vaccine-preventable diseases;
   • "hard-to-reach" individuals; and
   • outbreak populations.
2. Appropriately refer to expert professionals/resources when required to address the immunization needs of certain populations.

Key Terms: International students, medical conditions and pregnancy, new Canadians, occupational risk groups, risk behaviours, special populations, "hard-to-reach" individuals/populations/groups, travellers.

Suggested Content for Training

• Designing schedules for people with uncertain or incomplete vaccination status with the minimum number of visits
• National and provincial guidelines that guide travel immunization
• Expert advice available to consult regarding travel immunization and recommendations
• Citizenship and Immigration Canada's policy – distinguish when newcomers are immunized before arrival and when they are not

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