Vaccination Errors and How to Prevent Them: The 2010 Edition

Background: The Immunization Action Coalition (IAC) is a nonprofit organization that works to increase immunization rates and prevent disease. Thousands of healthcare professionals call or write us every year with questions about vaccines and immunization, too many of which are cries for help regarding medical errors.

Setting: Healthcare professionals can contact IAC via email and telephone. IAC keeps a record of the vaccination errors described by the email correspondents. We presented information about vaccine errors at the 2009 NIC; unfortunately, such errors seem to be mushrooming due to an increasingly complex immunization schedule and the addition of new vaccines (e.g., H1N1 influenza vaccines, combination vaccines Kinrix and Pentacel, and more).

Population: Healthcare professionals around the nation who provide immunization services, including physicians, nurses, medical assistants, physician assistants, pharmacists, and others.

Project Description: Common vaccination errors fall into the following categories: storage and handling, administration, scheduling, and documentation. This presentation will provide information about these types of errors, using real examples and emphasizing new situations. The presenter will provide CDC-approved guidance about what to do if such an error occurs, and most importantly, how to prevent mistakes in the first place. Emphasis will be placed on basic rules, such as knowing minimum ages and intervals. Related resources from CDC and other organizations will be highlighted.

Results/Lessons Learned: Unfortunately, vaccine errors occur all too frequently. The result of making such errors can be serious, including harm to the vaccinee from a side effect or vulnerability to disease, inconvenience to the parent/patient and likely related ill will, unreimbursed cost to the provider, and loss of trust in the provider with possible negative publicity or even legal action. Avoiding such errors benefits everyone.