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Immunization Action Coalition Saint Paul, Minnesota 651-6 47-9009 content reviewed by the Centers for Disease Control and Item #P7010 (10/17)Adapted from California Department of Public Health, Immunization BranchThe Skills Checklist is a self-assessment tool for healthcare staff who administer immuni-zations. To complete it, review the compe-tency areas below and the clinical skills, techniques and procedures outlined for each area. Score yourself in the Self-Assessment column. If you check Needs to Improve, you indicate further study, practice, or change is needed. When you check Meets or Exceeds, you indicate you believe you are performing at the expected level of competence, or higher. Supervisors: Use the Skills Checklist to clar-ify responsibilities and expectations for staff who administer vaccines. When you use it to assist with performance reviews, give staff the opportunity to score themselves in advance. Next, observe their performance as they administer vaccines to several patients, and score in the Supervisor Review columns. If improvement is needed, meet with them to develop a Plan of Action (see bottom of page X) to help them achieve the level of competence you expect; circle desired actions or write in DVD Immunization Techniques: Best Practices with Infants, Children, and Adults helps ensure that staff administer vaccines correctly. It may be ordered online at Another helpful resource is CDC s Vaccine Administration eLearn course, available at Skills Checklist for Vaccine AdministrationSupervisor Review competency clinical skills, techniques, and procedures 1. Welcomes patient/family and establishes rapport. 2. Explains what vaccines will be given and which type(s) of injection(s) will be done. 3. Answers questions and accommodates language or literacy barriers and special needs of patient/parents to help make them feel comfortable and informed about the procedure. 4. Verifies patient/parents received Vaccine Information Statements (VISs) for indicated vaccines and has had time to read them and ask questions. 5. Screens for contraindications (if within employee s scope of work). 6 . Reviews comfort measures and aftercare instructions with patient/parents, and invites questions. 1. Identifies the location of the medical protocols ( , immunization protocol, emergency protocol, reference material). 2. Identifies the location of epinephrine, its administration technique, and clinical situations where its use would be indicated. 3. Maintains up-to-date CPR certification. 4. Understands the need to report any needlestick injury and to maintain a sharps injury log. 5. Demonstrates knowledge of proper vaccine handling, , maintains vaccine at recommended temperature and protects MMR from EducationBMedical and Office Protocolscontinued on the next page needs toimproveneeds toimproveplan of actionmeets or exceedsmeets or exceedsSelf-AssessmentSkills Checklist for Vaccine Administration (continued) page 2 of 3Immunization Action Coalition Saint Paul, Minnesota 651-6 47-9009 Item #P7010 (10/17)Supervisor Review competency clinical skills, techniques, and procedures 1. Performs proper hand hygiene prior to preparing vaccine. 2. When removing vaccine from the refrigerator or freezer, looks at the storage unit s temperature to make sure it is in proper range. 3. Checks vial expiration date. Double-checks vial label and contents prior to drawing up. 4 . Prepares and draws up vaccines in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. 5. Selects the correct needle size for IM and Subcut based on patient age and/or weight, site, and recommended injection technique. 6. Maintains aseptic technique throughout, including cleaning the rubber septum (stopper) of the vial with alcohol prior to piercing it. 7 . Shakes vaccine vial and/or reconstitutes and mixes using the diluent sup-plied. Inverts vial and draws up correct dose of vaccine. Rechecks vial label. 8 . Prepares a new sterile syringe and sterile needle for each injection. Checks the expiration date on the equipment (syringes and needles) if present. 9. Labels each filled syringe or uses labeled tray to keep them identified. 1. Rechecks the provider s order or instructions against the vial and the prepared syringes. 2 . Utilizes proper hand hygiene with every patient and, if it is office policy, puts on disposable gloves. (If using gloves, changes gloves for every patient.) 3. Demonstrates knowledge of the appropriate route for each vaccine. 4. Positions patient and/or restrains the child with parent s help. 5. Correctly identifies the injection site ( , deltoid, vastus lateralis, fatty tissue over triceps). 6. Locates anatomic landmarks specific for IM or Subcut injections. 7. Preps the site with an alcohol wipe, using a circular motion from the center to a 2" to 3" circle. Allows alcohol to PreparationDAdministering Immunizationscontinued on the next page needs toimproveneeds toimproveplan of actionmeets or exceedsmeets or exceedsSelf-AssessmentSkills Checklist for Vaccine Administration (continued) page 3 of 3Immunization Action Coalition Saint Paul, Minnesota 651-6 47-9009 Item #P7010 (10/17)Supervisor Review competency clinical skills, techniques, and procedures 8. Controls the limb with the non-dominant hand; holds the needle an inch from the skin and inserts it quickly at the appropriate angle (90 for IM or 45 for Subcut). 9 . Injects vaccine using steady pressure; withdraws needle at angle of insertion. 10. Applies gentle pressure to injection site for several seconds (using, , gauze pad, bandaid). 11. Uses strategies to reduce anxiety and pain associated with injections. 12. Properly disposes of needle and syringe in sharps container. 13. Properly disposes of vaccine vials. 1. Fully documents each vaccination in patient chart: date, lot number, manufacturer, site, VIS date, name/initials. 2 . If applicable, demonstrates ability to use state/local immunization registry or computer to call up patient record, assess what is due today, and update computerized immunization history. 3. Asks for and updates patient s vaccination record and reminds them to bring it to each visit. DAdministering Immunizations(continued)ERecords ProceduresPlan of Actionneeds toimproveneeds toimproveplan of actionmeets or exceedsmeets or exceedsSelf-Assessment a. Watch video on immunization techniques and review CDC s Vaccine Administration eLearn, available at b. Review office protocols. c. Review manuals, textbooks, wall charts, or other guides. d. Review package inserts. e. Review vaccine storage and handling guide- lines or video. f. Observe other staff with patients. g. Practice injections. h. Read Vaccine Information Statements. i. Be mentored by someone who has demonstrated appropriate immunization skills. j. Role play (with other staff) interactions with parents and patients, including age appropriate comfort measures. k. Attend a skills training or other appropriate courses/training. l. Attend healthcare customer satisfaction or cultural competency training. m. Renew CPR certification. OtherCircle desired nextsteps and write in the agreed deadline for completion, as well as date for the follow-up performance the Skills Checklist in the employee s personnel folder. employee signature datesupervisor signature dateplan of action deadlinedate of next performance review

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