Good governance guidance when handling multiple COVID-19 vaccines

Tim Root, Assistant Head, Medicines Assurance, NHS Specialist Pharmacy Service, Specialist Pharmacy ServicePublished Last updated See all updates

Six practice points will ensure good governance: right patient, right vaccine, right dose, right route, right time and right records

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

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, and it will be a local decision about which measures need to be implemented to mitigate the risks associated with the availability of multiple vaccines to vaccinate a population requiring a two dose course of the same vaccine to optimise immunity.

Right Patient

Issue

Process design for engaging with patients should maximise safety

Consider

  • Appropriate flow of patients through building to minimise the risk of the wrong vaccine being administered
  • Assessing potential to run separate sessions for 1st and 2nd  and booster dose patients
  • Ensure patient/carer is clear on whether they are to receive first, second 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
  • Patient information card completed at first dose administration is brought and checked at the second dose administration and again if relevant at booster dose administration

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 are required 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 clarity of COVID-19 vaccine terminology in all documents and records.

Additional materials to support right vaccine

The following will help you use the right vaccine:

Nomenclature for COVID-19 Vaccines

Each COVID-19 Vaccine has different nomenclature specific to the vaccine and the context of use.

Minimising the risk of administration of the wrong COVID-19 vaccine

A series of steps will help sites separate multiple vaccines as much as possible throughout the vaccination process, from receipt through to administration

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

Consider

  • All staff involved should have been assessed as being competent in the preparation and administration of the vaccine being used in that session.
  • Team-based vaccination services should operate safety briefings 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.
  • 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.
  • Checks should be 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.

Right route

Issue

Ensuring that all COVID-19 vaccinations are administered intramuscularly.

Consider

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

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

A range of IT systems are in use across vaccination centres and it is important that staff understand which system is used at each stage in the vaccination process. IT systems capture which brand of vaccine is required for the second dose.

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.
  • Ensure that the approved name is used to record the vaccine given on the IT system.
  • Ensure 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.
  • Where packaging carries a barcode can steps be taken to use this to support recording of the administration thus reducing the potential for error?
  • Where it is unclear which vaccine a patient has received as a first dose accessing the Summary Care Record (with the patient’s permission) to help confirm which vaccine was administered.
  • 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.

Change history

  1. Reviewed and confirmed up to date
  1. Updated to reflect booster dose programme
  1. Updates to reflect risks of booster dose selection & measurement
  1. Minor edits for clarity
  1. Published