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Mass Immunization Clinicsby Carina Herman, RN, Cheryl McIntyre, RN and Karen Pielak, RN

QAs public health nurses, we give

many immunizations. We often

provide a large volume of

immunizations at mass clinics in schools,

seniors centres, etc. These settings are

very busy and hectic and it is often

difficult to maintain CRNBCs Standards

of Practice. Are there different standardsthat apply when we are working in these

mass clinic settings?

AMass immunization clinics

provide immunizations to a large

number of individuals and usually

involve many nurses in the delivery

processes. They are organized, planned

events, but because many people are

immunized in a short period of time often

outside of health care facilities uniquelogistical and safety challenges are present.

Nurses registered with CRNBC are

responsible and accountable for meeting the

CRNBC Standards of Practice

(Professional Standards, Practice Standards,

and Scope of Practice Standards), even in

mass immunization settings. Questions

often arise regarding standards related to

consent, documentation and preparing and

administering immunizations in mass

immunization clinics.

ConsentCRNBCs Standards of Practice require

nurses (includes registered nurses, nurse

practitioners and licensed graduate nurses)

to obtain consent for nursing activities they

undertake for clients. This includes

immunizations. Consent may be given

verbally, in writing, via an alternativecommunication system (e.g., computer-

assisted) or through behaviour that implies

consent (e.g., client rolls up sleeve when

nurse approaches with immunization).

Nurses provide information that a

reasonable person would require in order to

make a decision about being immunized.

This includes information about the disease

for which the vaccine offers protection,

benefits and risks of both receiving and not

receiving the immunization, possiblealternatives to immunization in the form of

post-exposure prophylaxis and the

voluntary nature of the health intervention.

Discussion about risks includes the more

common as well as the most serious

adverse events following immunization.

Nurses must assess that the client

understands the information. This may be

done by asking clients if they have any

questions, if they are satisfied with the

nurses response to the questions, or to

restate what has been communicated to

them in terms of the benefit and risk.

The CRNBC Practice Standard Consent

(pub. 359 available at www.crnbc.ca) states

that the person performing the care . . . is

responsible for obtaining consent from the

client. It is important to remember that

consent is a process, not just a signature on

a form. For example, in a mass

immunization clinic, one nurse may obtain

written consent and another nurse may give

the immunization. At other times, written

information may be given prior to the clinic

or while the client is waiting for his or her

turn. Regardless of how the consent

process is initiated, it is always the

responsibility of the nurse giving the

immunization to verify with the client that

he or she understands the information that

has been provided and to answer anyquestions the client might have.

DocumentationCRNBCs Standards of Practice require

nurses to document on the legal health

record, either in writing or electronically,

the care or service they provide to a client.

Documentation promotes good nursing

practice, facilitates communication and

meets professional and legal standards. A

mass immunization clinic is a planned,non-emergency event and nurses are

responsible and accountable for

documenting the immunizations they

provide.

An official health record may be an

individuals electronic or paper health care

record, a service record or a permanent

office log or file. For example, in some

settings, the signed consent card on which

the nurse has documented the vaccine

provided will be the official document that

needs to be retained, even though a clerk

may enter the information into a registry.

Regardless of the system used, the nurse is

responsible and accountable to ensure that

the information entered is accurate and

timely.

Whatever system for documentation is

used, it needs to allow for easy retrieval of

the information when needed. Some

employers require clerks to enter the

information into the official health record,

which registered nurses must then verify as

You Asked

Carina Herman, RN, MSN is a

Nursing Practice Consultant with

CRNBC. Cheryl McIntyre, RN,

BScN is Associate Nurse

Epidemiologist and Karen Pielak,

RN, MSN is Nurse Epidemiologist

with the BC Centre for Disease

Control.

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being accurate. This is not considered best

practice. This process carries an inherent

risk of error should the information be

accessed by the health care team and

inadvertently acted upon before it has beenverified by the registered nurse.

Furthermore, some electronic systems do

not have mechanisms in place for the nurse

to indicate that he or she has verified the

record. Immunization documentation

includes recording the product given, the lot

number, dose, route, site, provider name and

date. For more on documentation, see the

CRNBC Practice Standard Documentation

(pub. 334 available at www.crnbc.ca).

Preparing and AdministeringMedications

Nurses administering immunizations

need to follow the seven rights of

medication administration: right drug, right

client, right dose, right time, right route,

right reason and right documentation. To

ensure that the seven rights are met, the

same nurse should prepare and administer

the immunization. To facilitate timely and

efficient administration of a single vaccine

to a large number of people in an

immunization clinic, preloading of syringes

is sometimes considered. However, if

implemented, each nurse should pre-draw

his/her own syringes and ensure that they

are safely and securely stored until they are

administered. This practice should be

limited to these mass settings. The pre-

loaded syringes should be accompanied by

information about how long the pre-loaded

product is stable (i.e., an expiration time)

and the cold chain must be maintained. Pre-

drawing of vaccine by a nurse other than

the one administering the immunization is

discouraged because it blurs accountability

and increases potential for vaccine

administration errors, uncertainty of

vaccine stability in syringes, risk of

contamination and vaccine wastage. For

more on administering medications, see the

CRNBC Practice Standard Administration

of Medications (pub. 408 available at

www.crnbc.ca).

CRNBCs Standards of Practice are

requirements for registered nurse practice

in British Columbia. Nurses are responsible

for knowing the Standards of Practice and

applying them to their practice, regardlessof their setting, role or area of practice.

They are also responsible for advocating

for policies that will support them to meet

these Standards. Employers are responsible

for ensuring that the systems are in place so

that nurses can meet the CRNBC Standards

of Practice.

For further information about this or any

other practice issue, contact a CRNBC

nursing practice consultant or regional

nursing practice advisor. Contactinformation can be found on the CRNBC

website www.crnbc.ca

In British Columbia, registered

nurses have the authority to

administer immunizations with or

without an order. Nurses whoadminister immunizations with an

order are required to have the

competence to do so and to meet the

CRNBC Standards for Carrying out

Reserved Actions With an Order.

As influenza season approaches,

please note that nurses who

administer influenza immunizations

without an order are required to

have additional education (i.e., a

course provided by the employer or aformal course or program of study).

For more information about

requirements for nurses giving

immunizations, refer to CRNBCs

Scope of Practice for Registered

Nurses: Standards, Limits and

Conditions (pub. 433 available at

www.crnbc.ca). It includes CRNBC

Standards for Acting Without an

Order and CRNBC Standards for

Carrying Out Reserved Actions With

an Order.

If you have a question about

registered nurse practice that you

would like to see answered in

Nursing BC, please forward it by

e-mail to nursingbc@crnbc.ca

Include your name and a phone

number where you can be reached

during normal business hours.

CANADIAN REGISTERED NURSEEXAMINATION SCHEDULE

Graduates from British Columbia who are writing for the first time can obtain applications from their

school of nursing offices. All other candidates must obtain applications from:

Writing Date

Feb. 7, 2007

June 6. 2007

Oct. 10, 2007

Designated Writing Centres

Lower Mainland (3 centres)

Lower Mainland (3 centres), Victoria,Nanaimo, Kelowna, Kamloops,Castlegar and Prince George

Lower Mainland (3 centres), Kamloops,Nanaimo

Apply by

Nov. 7, 2006

April 2, 2007

Aug. 11, 2007

CRNBC REGULATORY SERVICES

2855 ARBUTUS ST., VANCOUVER, BC V6J 3Y8

TEL 604.736.7331 or 1.800.565.6505 (B.C. ONLY) E-MAIL exams@crnbc.ca