1174 / Safe immunixation in primary health care centers

SPAIN
Classification of the PSP
Type of Patient Safety Practice Potentially Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Medical devices / Equipment
Medication / IV Fluids There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Vaccination is one of the most important and frequent procedures performed in primary health care centers. It is a complex procedure that involves risks for the patients. A high number of vaccination errors are notified by General Practitioners and practice nurses every year. Vaccination errors are frequently preventable. These errors, most of the time, do not cause harm to the patients and do not have short-term consequences, but they can reduce the effectiveness of the vaccines. The aim of this Patient Safety Practice is to establish and communicate to all general practice centers about the standards for the correct maintenance and administration of vaccines, in order to prevent the occurrence of adverse events that can affect patients who receive a vaccine in a primary health care center in Madrid.
Description of the Patient Safety Practice
 
After the evaluation of the incidents reported in our regional adverse event database we found that errors frequently occur at the time of the vaccine selection (selection of an inappropriate vaccine for the patient, vaccines administered twice or inappropriate vaccine dose), in the handling previous to the administration of the vaccine (only solute of the vaccine or an expired vaccine), or at the time of registration in the patient clinical records. In order to address these problems, an interdisciplinary team with representative members of all parties involved in the procedure was gathered. This professional team has designed a complete vaccination management pathway integrating different sub-processes. These sub.-processes were assessed in order to identify critical points in patient safety and establish security barriers (as summarized below). Also accurate indicators were developed to track and evaluate each sub-process for a continuous improvement. Critical points identified in safe immunization process: Sub-process 1: Estimate, ordering and delivery of vaccines in General Practice Centers 1. In order to make an appropriate vaccine estimate it is necessary to count the remaining vaccines in stock. 2. Make a vaccine estimate taking into account the previous month running total, stock and estimated use. 3. Accurately fill vaccine order form. 4. Check that vaccines order form is send by fax and it is correctly received. 5. Deliver vaccines on time when requested as express delivery. 6. Keep cold chain during transport. Sub-process 2: Transport of vaccines from main general practice centers to other small medical centers. 7. Ensure adherence to “cold chain” system of transporting and storing vaccines when vaccines are transported. Sub-process 3: Reception, storage, management and disposal of vaccines in General Practice Centers. 8. Make the delivery directly to the person responsible for vaccines in your center. Check vaccines conditions on arrival. 9. Place and store stock in the different areas according to their characteristics. 10. Measure and record temperature of vaccine refrigerators twice daily. 11. Report temperatures outside the range to the Regional Vaccination Department and follow advice if cold chain breach. 12. If a ‘cold chain breach’ has occurred, follow recommendations given by your prevention service. Sub-process 4: Safety vaccination by practice nurses. 13. Check that the patient is the correct patient. 14. Check patient’s immunization record. 15. Ensure the chosen vaccine you are going to administer is the correct one. 16. Record in patients general practice records before administering the vaccine. Sub-process 5: Administration of unscheduled vaccines 17. Ensure a proper vaccine transport from supplier (pharmacy) to the General Practice Center. 18. Record in patients general practice records before you vaccinate. 19. Nurses should be familiar with the route of administration for each vaccine administered. Besides, recommendations for the person responsible of vaccination and nurses were proposed. These recommendations are shown below and are applicable to all those who make use of the vaccines and for those responsible of their maintenance. Recommendation applicable to the person/s responsible of vaccination: 1. In order to make an appropriate vaccine estimate, a correct stocktake must be carried out before. 2. The person/s responsible of vaccinations should be trained to carry out appropriate vaccines estimate: reserve stock, maximum stock available, estimated use, etc. (Document 1, annexed). 3. Always use the vaccine order form available in website. 4. Once the vaccine order form has been sent via fax to the Prevention Service, it is necessary to verify the correct delivery of the fax. 5. Report any vaccine delivery event by using the reporting system in the next 15 days if vaccines are delivered by the laboratory, or 72 hours if they are delivered by the Prevention Service (Document 2, annexed). 6. Check a proper vaccine delivery system is in place in the general practice center. 7. On receiving the vaccines: check that the number and type of vaccines, original packaging, transport and expire date. Sing the delivery note, promptly place vaccines into the monitored fridge and notify delivery events if necessary. 8. Verify vaccines storage follows recommendations. 9. Monitor and record in a chart the current, minimum and maximum temperatures of the vaccines fridge (for both, domestic and purpose-built models) twice daily (at the beginning and the end of every working day). 10. Check temperature chart/graph. 11. Check all stock is rotated according to expiry date, so vaccines with the shortest expiry dates are used first. 12. Notify to the Prevention Service if a 'cold chain breach' has occurred by using the event reporting system. 13. After reporting a cold chain breach, wait and follow the advice given by the Regional Vaccination Department. 14. Place in visible areas the immunization program schedule. 15. Give vaccination training to everyone involved in the vaccination procedure. 16. When possible, place in different fridges children and adult vaccines. 17. Place different areas of the fridge those vaccines with similar boxes or names. 18. Place Poster: “Register before you vaccinate” in the places where vaccines are administered (Document 3, annexed). 19. Place stickers: “watch out, need to add solute to solvent”, when solute and solvent of a vaccine are separated and need to be reconstituted prior to administration. 20. Monitor process indicators (Document 4, annexed) Recommendation for practice nurses 1. Always check patient identity to make sure the person who is receiving the vaccines the correct one, Health ID Card can be asked for this purpose. 2. Follow all steps required for a proper vaccination procedure (Document 5, annexed). 3. Register in patient’s clinical records before vaccination. 4. Give to the patient a personal vaccination record card. 5. Check expiration dates; check conditions of the vaccine (temperature, appearance…) before administration. 6. When somebody needs a vaccine not include in Immunization Program, it is necessary to inform them and advise them about optimum conditions to store the vaccine since its acquisition in the pharmacy until its administration in general practice center. 7. Ensure adherence to “cold chain” system of transporting and storing vaccines when vaccines are transported from general practice centers to other smaller medical centers.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Regional or national level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
Effect not known or the intervention has not yet been evaluated
Type of before-and after evaluation
Not known
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Primary care
Community care facility
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Not known or not relevant
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
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Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Dolores Martinez Patino
Country: SPAIN
Organisation: Primary Care Management, Madrid Health Service
E-mail: mmartinezp@salud.madrid.org
Phone: 0034913700663
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