Background

The NHS in England uses several COVID-19 vaccines each with unique handling conditions relating to their storage, reconstitution where necessary, and dose.

Requirement

Several different vaccines may be stored and used within a single vaccination site. It is vital that all vaccines are stored, selected, handled and administered correctly, and that staff are trained in and practise safe preparation and administration of the vaccine, to ensure that every patient receives the right dose of the right product at the right time.

Principles

Vaccine safety is everyone’s responsibility. The focus should be on 6Rs:

• Right Patient
• Right Vaccine
• Right Dose
• Right Route
• Right Time
• Right Records

All staff need to be fully engaged in making sure the vaccination process is safe.

Our guidance focuses primarily on large vaccination sites, but the principles are largely relevant to all other settings. It is however, recognised that not all the recommendations are directly applicable to every setting. Local decisions will be needed to identify which measures are required mitigate the risks associated with the availability of multiple vaccines

Right Patient

Issue

Process design for engaging with patients should maximise safety

Consider

• Appropriate flow of patients through the vaccination site to minimise the risk of the wrong vaccine being administered
• Ensure patient/carer is clear on whether they are to receive a primary vaccination dose or booster dose and, confirm which brand of vaccine is to be given.
• Clear statement/record of the identity of the vaccine during booking, arrival check-in, consenting and administration station.
• Ensure that patient identity is confirmed using two separate identifiers (eg name and date of birth) before the vaccine is administered

Right Vaccine

Issue

Process design should result in:

• the correct vaccine being used,
• adequate supplies of the right vaccine (and associated documentation and accessories) being available to meet anticipated requirements,
• any potential for vaccine wastage being minimised.

Consider

• Detailed inventory and thorough reconciliation processes to ensure ordering and stock control process are robust and that the right vaccine is available at the right time every time
• Contingency planning if supply constraints limit availability of a specific vaccine
• Delivery of second or booster doses for patients will require careful planning with additional diligence to ensure that patients receive the correct vaccine
• When planning vaccination sessions, sites MUST ensure that there is as much separation of the different brands of vaccine as is practically possible throughout the process, from receipt through to administration.
• When more than one vaccine is available, it is vital to ensure that the vaccine and dose given on each occasion are unambiguously detailed in all documents and records.

Additional materials to support right vaccine

The following will help you use the right vaccine:

Right Dose

Issue

Process design should result in the correct dose being drawn up and administered. Since the preparation and dose of vaccines differ, robust processes are needed to ensure that errors do not occur.

Consider

• All staff involved should have been assessed as being competent in the preparation and administration of the vaccine being used in that session.
• Putting checks in place at the start of sessions to confirm that all staff are clear on the volume of vaccine to be drawn up for administration.
• Operating safety briefings for team based vaccination services to ensure safe practice during the shift, consistency of care, and good communication. Safe practice will need to reflect the environment in which the vaccine is being given. The risks of switching between vaccines in a large vaccination centre are different to those involved in care home or domiciliary administration.
• Systems to ensure that the correct needle and syringe combination is available, is used for each vaccine, and that the recommended needles are available for use in obese patients.

Right route

Issue

Ensuring that all COVID-19 vaccinations are administered intramuscularly.

Consider

• Systems to ensure that all staff involved have been assessed as being competent in the preparation and administration of the vaccine being used in that session.
• Systems to ensure that a supply of the correct needles is available; Intramuscular administration to obese patients will require use of a different sized needle to that routinely supplied.

Right time

Issue

Process design should ensure that sufficient vaccine and consumables are available in a timely manner to meet anticipated caseload. Similarly, these processes need to ensure that vaccine wastage is minimised.

Consider

• The logistical, storage, preparation and administration requirements are specific for each vaccine, so absolute clarity is required on which vaccine is being used and that the staff involved correctly identify which vaccine is being used and are competent in its administration
• Systems to ensure that adequate supplies of the correct consumables and documentation are in place
• Patients may also need to be observed for differing periods after vaccine administration and this needs to be included in planning and safety briefings

Right records

Issue

IT systems capture which vaccine formulation is required and it is important that staff understand which system is used at each stage in the vaccination process.

Consider

• Ensuring that IT systems have been configured correctly to record administration of the vaccine being used in each vaccination session.
• Making staff aware of the possibility of selection errors when using drop down lists and that errors can lead to incorrect information being uploaded to the patient’s permanent record.
• Ensuring that the correct nomenclature is used to record the vaccine given on the IT system.
• Ensuring that where possible the IT records are updated in real time and that retrospective data entry is limited to situations where IT access is not possible at the time of administration.
• Using IT solutions where feasible, including product barcode recognition, to support recording of the administration
• For primary vaccination schedules, where appropriate, checking which vaccine a patient has received as a first dose
• Ensuring that staff are aware that it is also important to ensure the correct vaccine is identified when completing inventory and waste records as these are used to plan for future vaccine supplies.

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