The guiding principles for the administration of medications are outlined in Guidance for Registered Nurses and Midwives on Medication Administration (2020). These guiding principles are designed to assist you to understand your roles and professional responsibilities to safely administer medication across all practice settings.
To support you in the administration of the Covid-19 vaccines, you should apply this guidance in conjunction with the relevant legislation, professional standards and guidelines, national policy, evidence-based practice and ethical conduct. Specifically:
Legislation
- Medicinal Products (Prescription and Control of Supply) (Amendment) (No. 7) Regulations 2020 (SI 698 2020, SI 8 of 2021, SI 43 of 2021)
Professional standards and guidance
National/local policies
The National Immunisation Office’s standard operating procedures required to support the rollout of the Covid-19 vaccination programme may in some circumstances differ from that required in your local medication management policy. When this occurs, the recommendations in the NIO guidelines, which are based on current expert advice from the National Immunisation Advisory Committee, should be followed.
NMBI has addressed some of the circumstances arising and provides the guidance below:
Double checking medicines: The vaccines being used for the Covid-19 response are not high-alert medications (ISMP, 2018) whose dosage can change, are based on weight and require arithmetical calculations. Nurses and midwives can therefore administer Covid-19 vaccines without double checking if they ensure the 10 ‘rights’ of medication administration are adhered to:
1.Right patient; 2. Right reason; 3. Right medication; 4. Right route; 5. Right time i.e. Within the required time window for administration; 6. Right dose; 7. Right form; 8. Right action; 9. Right documentation; 10. Right response (NMBI 2020 p.16).
The vaccines being used for the Covid-19 response have been granted a conditional licence by the EMA and are available in multi-dose vials (MDV). In circumstances where a nurse/midwife is required to carry out the dilution of a MDV, an independent double check of the dilution process should be carried out (if staffing permits).
If an MDV is being used by more than one nurse or midwife (e.g. at the end of the day), independent double checking of the dilution process should be carried out (if staffing permits).
Both of these processes should be supported through quality assurance policies.
Please note: Where dilution of the MDV vaccine is conducted by Pharmacy support, there is no requirement for nurses or midwives to conduct a double check prior to administration once the nurse or midwife ensures the 10 ‘rights’ of medication administration are adhered to.
Preparation of Covid-19 vaccines for administration: To ensure safe administration, best practice requires that medicines should only be prepared for administration immediately before its prescribed administration time and not in advance, unless required (NMBI, 2020).
The HSE Infection Prevention and Control Interim Guidance advises staff that when the medication is presented in a MDV, they should prepare to administer the injection in a physically separate clean controlled environment with minimal risk of distraction. To minimise distraction in the busy environment of a Vaccination Centre, a nurse/midwife may prepare syringes for administration in advance of the vaccine recipient coming into their vaccination booth. This practice can only occur once the nurse/midwife has read the relevant National SOP (see National Medicines Management Guidance document below).
Patient Safety: The key issue for medicines management is the safety of the patient, which is dependent on the appropriate person who has the competency, knowledge and authority to safely administer medicines along with the other aspects of monitoring and evaluating for medicines effect.
Whilst the dispensing (includes reconstitution and labelling) of medications is an essential component of pharmacy practice, nurses and midwives in some settings may find themselves without pharmacy support in the delivery of the vaccination programme. For this reason, it is important that nurses and midwives understand the critical points in the medication management pathway so that any risks of adverse outcomes are alleviated. Local risk assessment should be introduced to ensure optimal stewardship of vaccination processes. Specific guidance should be followed as outlined in the National Medicines Management Guidance for Use in Centralised HSE Vaccination Clinics (HSE, 2021).
