August is National Immunization Awareness Month, and with the recent outbreak of measles leading to proposed changes in vaccination laws across the country, including passage of new legislation in California, vaccinations remain a hot topic. Physicians should always be attentive to the importance of timely vaccines against infectious diseases for patients of all ages.

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. 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.

Take these steps to reduce liability risks and promote patient safety in your practice:

• Ensure that immunization tracking is up to date and well documented in the medical record so that patients remain on schedule. Obtain copies of vaccination records from previous providers or state registries. Create easy-to-read office forms for documenting administration.
• Educate patients and parents regarding vaccination schedules.
• Designate a staff member to monitor for revisions/new recommendations of FDA/CDC vaccination schedules. Ensure that new vaccination schedules are incorporated with office procedures and are included on office vaccination forms.
• Provide accurate information to patients. Conduct and document a thorough informed consent discussion; use Vaccine Information Statements prior to vaccine administration.
• Obtain patient or parent signatures on an informed consent form that includes potential side effects and complications.
• Document the discussion in the progress notes when the immunization is refused. Consider using an informed refusal form, which includes the patient or parent signature.
• Check state laws regarding exemptions, and educate patients. Be aware that religious and philosophical exemptions vary by state.
• Monitor patients closely post-administration for anaphylaxis, vasovagal response, and reaction at the injection site. Document any reactions, suspected side effects, and complications in the medical record.
• Educate staff and conduct skills verification on accepted procedures, new standards, and risk prevention methods. Document these efforts in administrative training files.
• Store and handle vaccinations in accordance with Vaccines for Children/CDC guidelines. Monitor these practices with staff -- don’t just assume they are being followed correctly.
• Follow basic medication administration safety protocols for vaccine administration. Be aware of the most common vaccine-related errors by reviewing "Confusion Abounds! 2-Year Summary of the ISMP National Vaccine Errors Reporting Program" Part I and Part II.
• Be responsive to patients who express concerns about reactions from their vaccines. Document these discussions in the medical record.
• Report errors or hazards (anonymously) to the ISMP National Vaccine Errors Reporting Program.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.