Vaccination Management and Vaccination Errors: A Representative Online-Survey among Primary Care Physicians

Weltermann, Birgitta; Markic, Marta; Thielmann, Anika; Gesenhues, Stefan; Hermann, Martin

doi:10.1371/journal.pone.0105119

Cited by 17 publications

(15 citation statements)

References 15 publications

(21 reference statements)

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“…Previous studies investigating immunization-related safety incidents mirror our findings and demonstrate receipt of additional vaccines is a widespread problem often resulting from poor documentation e.g. where a child is immunized but this goes undocumented resulting in that child receiving that same vaccine later [4,7,23] . In one U.S. study, over 20% of children received unnecessary duplicate vaccinations [4] .…”

Section: Discussionsupporting

confidence: 81%

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database

Rees

Edwards

Powell

et al. 2015

Vaccine

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BackgroundChildren are scheduled to receive 18–20 immunizations before their 18th birthday in England and Wales; this approximates to 13 million vaccines administered per annum. Each immunization represents a potential opportunity for immunization-related error and effective immunization is imperative to maintain the public health benefit from immunization. Using data from a national reporting system, this study aimed to characterize pediatric immunization-related safety incident reports from primary care in England and Wales between 2002 and 2013.MethodsA cross-sectional mixed methods study was undertaken. This comprised reading the free-text of incident reports and applying codes to describe incident type, potential contributory factors, harm severity, and incident outcomes. A subsequent thematic analysis was undertaken to interpret the most commonly occurring codes, such as those describing the incident, events leading up to it and reported contributory factors, within the contexts they were described.ResultsWe identified 1745 reports and most (n = 1077, 61.7%) described harm outcomes including three deaths, 67 reports of moderate harm and 1007 reports of low harm. Failure of timely vaccination was the potential cause of three child deaths from meningitis and pneumonia, and described in a further 113 reports. Vaccine administration incidents included the wrong number of doses (n = 476, 27.3%), wrong timing (n = 294, 16.8%), and wrong vaccine (n = 249, 14.3%). Documentation failures were frequently implicated. Socially and medically vulnerable children were commonly described.ConclusionThis is the largest examination of reported contributory factors for immunization-related patient safety incidents in children. Our findings suggest investments in IT infrastructure to support data linkage and identification of risk predictors, development of consultation models that promote the role of parents in mitigating safety incidents, and improvement efforts to adapt and adopt best practices from elsewhere, are needed to mitigate future immunization-related patient safety incidents. These priorities are particularly pressing for vulnerable patient groups.

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Section: Discussionsupporting

confidence: 81%

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database

Rees

Edwards

Powell

et al. 2015

Vaccine

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“…Refrigerators were outside the target range 10.2 % of the total time, with single refrigerators outside the target range for as much as 66.3 % of the time. These results are in line with studies worldwide, which discuss the following key problems related to vaccine storage: 1) temperatures outside the target range [ 10 , 11 ], 2) lack of adequate temperature measurement devices [ 12 – 14 ], 3) lack of continuous temperature documentation [ 4 , 12 – 14 ], 4) use of inadequate refrigerators [ 9 , 10 , 12 ], 5) lack of separate refrigerators [ 13 – 15 ], 6) inadequate storage practices [ 2 , 12 , 14 , 15 ], 7) lack of designated personnel [ 14 ], and 8) insufficient staff training and guidance [ 12 , 14 , 16 – 18 ].…”

Section: Introductionsupporting

confidence: 86%

“…In a cross-sectional web-based questionnaire survey, we analyzed vaccination management among a 10 % random sample of primary care physicians from one of Germany’s largest federal states, North Rhine-Westphalia [ 4 ] using international recommendations for vaccine storage [ 5 – 9 ]. The survey (n = 211) revealed that 16 % of the primary care physicians have experience with cold chain breaches either as an error or near error; 8 % do not regularly control their storage with regard to vaccine wrapping, vaccine expiration date, and refrigerator temperature; 49 % do not keep a storage temperature log; and 21 % fail to use a separate refrigerator solely for vaccine storage.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a web-based education program to improve vaccine storage conditions in primary care (Keep Cool): study protocol for a randomized controlled trial

Thielmann

Viehmann

Weltermann

2015

Trials

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BackgroundImmunization programs are among the most effective public health strategies worldwide. Adequate vaccine storage is a prerequisite to assure the vaccines’ effectiveness and safety. In a questionnaire survey among a random sample of German primary care physicians, we discovered vaccine storage deficits: 16 % of physicians had experience with cold chain breaches either as an error or near error, 49 % did not keep a temperature log, and 21 % did not use a separate refrigerator for vaccine storage. In a recent feasibility study of 21 practice refrigerators, we showed that these were outside the target range 10.2 % of the total time with some single refrigerators being outside the target range as much as 66.3 % of the time. These cooling-chain deficits are consistent with the international medical literature, yet an effective, easy to disseminate, practice-centered intervention to improve storage conditions is lacking.Methods/designThis randomized intervention trial will be conducted in a random sample of primary care practices. Based on continuous temperature recordings over 7 days, all practices with readings outside the target range for vaccine storage (+2 °C to +8 °C) will be randomly allocated to a web-based education program or a waiting list control group. The practice physicians and their teams constitute the target population. Participants will be educated about best practices in vaccine storage and will receive a manual including storage checklists and templates for temperature documentation. In all practices, temperatures of the vaccine refrigerators will be monitored continuously using a data logger with a glycol probe as a surrogate for vaccine vial temperature. The effectiveness of the web-based education program will be determined after 6 months in terms of the proportion of refrigerators with vaccine vial temperatures within the target range (+2 °C to +8 °C) during 7-day temperature logging. Secondary outcome parameters include temperature monitoring, no critically low temperatures (≤ -0.5 °C), compliance with storage recommendations, knowledge of good vaccine storage conditions, and assignment of personnel as vaccine storage manager and backup.DiscussionKeep Cool will develop and evaluate a web-based education program to improve vaccine storage conditions in primary care and thereby ensure immunization safety and effectiveness.Trial registrationDRKS00006561 (date of registration: 20 February 2015)

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“…Erste Auswertungen dieser Querschnittsstudie, bei der zunächst die Antworten der Ärzte aus der Zufallsstichprobe und der Lehrärzte aus NRW analysiert wurden, zeigten ein gutes Impfmanagement bei 19 % der Praxen. Da die STI-KO-Empfehlungen keine detaillierten Hinweise zum Impfkühlschrank und Impfstoffmanagement beinhalten, wurde zur Bewertung ein von uns anhand US-amerikanischer, britischer und australischer Vorgaben [15][16][17][18][19], 3 Praxisbesuchen und der medizinischen Literatur erstellter Kriterienkatalog zur Impfstoff-, Patienten-, Personal-und lagerungsbezogenen Qualität zugrunde gelegt [20].…”

Section: Hintergrundunclassified

“…Dies ist insbesondere von Bedeutung, da Auswertungen der US Fehlerdatenbank "MEDMARX" ergeben haben, dass der "falsche Impfstoff" mit 25 % der am häufigsten aufgetretene Impffehler war und ursächlich meist eine namentlich bedingte Verwechslung mit anderen Impfstoffen ist [29]. In unserer Studie gaben 30 % der Ärzte an, dass in ihrer Praxis schon einmal ein falscher Impfstoff geimpft wurde [20]. Eine besondere Schwierigkeit ergibt sich durch die Tatsache, dass unterschiedliche Marken des gleichen Impfstoffs z. T. unterschiedliche Impfschemata haben.…”

Section: Praxisinterne Aufgabenverteilung Für Impfstoffauswahl Beschunclassified

Impfkühlschrank- und Impfstoffmanagement in Hausarztpraxen: Eine repräsentative, Web-basierte Umfrage unter Hausärzten (Keep Cool I)

et al. 2015

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The purpose of this study was to analyse vaccine refrigerator and vaccine management in primary care and to identify physician- and practice-related influencing factors. Adequate cooling of vaccines in a temperature range of 2-8°C is essential to assure vaccine effectiveness. Studies from various countries have demonstrated cooling chain problems. We surveyed general practitioners about the quality of their vaccine refrigerator and vaccine management and aimed at identifying physician- and practice-related influencing factors. A cross-sectional, web-based questionnaire survey was performed among 3 physician populations in primary care: a 10% random sample of general practitioners (n=954), all teaching physicians of the Universities Duisburg-Essen (n=221) and Halle-Wittenberg (n=92). Surveyed were items on the following 6 aspects: (1) responsibilities within practice teams, (2) vaccine ordering and storing, (3) criteria for the vaccine pre-selection, (4) stocking system inside the refrigerator, (5) wrapping, and use of stocking boxes, (6) refrigerator and temperature control. The quality indicator "comprehensive refrigerator management" was defined to include 4 aspects: (1) separate refrigerator, (2) written temperature documentation (temperature-logbook), (3) regular storage control (wrapping, temperature and expiration date), and (4) storage in original wrappings. A total of 278 physicians participated in the survey (22%). Of these, 80% had a separate refrigerator, 52% reported written temperature documentation, 93% documented regular storage control addressing vaccine wrappings, temperature and expiration dates, and 95% reported vaccine storage in original card box wrappings. A "comprehensive refrigerator management" was realised by 42% of the practices. This indicator was reached more frequently by practices with 3 or more physicians (p=0.01) and those with an additional qualification in travel medicine (p=0.036). Our survey showed good results for most aspects of the refrigerator and vaccine management but room for improvement with regard to temperature documentation.

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Vaccination Management and Vaccination Errors: A Representative Online-Survey among Primary Care Physicians

Cited by 17 publications

References 15 publications

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database

Pediatric immunization-related safety incidents in primary care: A mixed methods analysis of a national database

Effectiveness of a web-based education program to improve vaccine storage conditions in primary care (Keep Cool): study protocol for a randomized controlled trial

Impfkühlschrank- und Impfstoffmanagement in Hausarztpraxen: Eine repräsentative, Web-basierte Umfrage unter Hausärzten (Keep Cool I)

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