Pharmacy Connection
Practice Insight explores concerns reported to the College as part of the complaints and reports process that present learning opportunities for pharmacists and pharmacy technicians. This close up on a complaint reminds pharmacy professionals to complete and maintain their injection training if administering injections, report incidents appropriately, continually identify areas of practice improvement and clearly communicate with patients about vaccine injections and possible side effects before administration.
Flu Administration Causes Patient Discomfort
After receiving a flu vaccination from a registrant, a patient reported they now have Shoulder Injury Related to Vaccine Administration (SIRVA). The patient stated that their arm was immediately sore after receiving the vaccine and they did not have a full range of motion in their arm. After the injection, the patient’s doctor ordered an ultrasound, X-ray and MRI. Due to ongoing pain, the patient is undergoing therapy for their arm.
Outcome of the Inquiries, Complaints and Reports Committee
The registrant provided a panel of the Inquiries, Complaints and Reports Committee details of their initial injection training and the refresher training they completed since then. The registrant asserted that the correct needle was chosen based on the patient’s weight and provided details of their landmarking process to the panel, which the registrant believes was done correctly.
The registrant asserted that SIRVA can sometimes occur when the vaccine is properly injected, and that they do not believe the needle penetrated too deeply, hit a bone or hit a nerve.
The panel noted that the registrant had the requisite training and certification to provide injections in accordance with the College’s requirements. The panel also noted that the registrant had significant experience providing injections and the registrant was not aware of any concerns or issues with the injections they provided. In addition, the panel observed that the registrant outlined their injection process, including the steps taken to landmark the injection site, and is of the view that the registrant’s typical process was appropriate.
The panel was of the view that the registrant properly conducted due diligence to assess the patient prior to administering the vaccine and that the needle selection was in accordance with the applicable guidelines based on the patient’s weight. The panel observed that the parties’ recollections diverged with respect to the location of the injection site and with respect to whether the patient moved during the injection as a result of pain or whether the movement resulted in pain.
The panel noted that the MRI results provided by the patient did not confirm or rule out SIRVA, and that no documentation was provided regarding the ultrasound and X-ray ordered by the patient’s doctor. Thus, the panel had no information with which to determine that the vaccination was improperly administered. In light of these reasons, the panel took no action against the registrant.
- Follow mandatory injection requirements, including completing College-approved injection training and registering this training with the College.
- Clearly communicate with patients about vaccine injections and possible side effects before administration.
- Inform your Designated Manager of any potential issues and areas of improvement. In this case, the registrant stated that they used this incident as an opportunity to review their practice as a pharmacist. As a result, the registrant made improvements to their own practice and suggested improvements to the pharmacy’s policies and procedures.
- Effectively document patient interactions
- Report incidents using the Pharmapod platform (a required component of the College’s AIMS program). In this case, the registrant submitted a report to Pharmapod out of caution.
- Engage with and report to your district health unit as required. In this instance, the registrant clarified with the district health unit that pain resulting from a vaccination is not an adverse effect that requires a report.
- Seek and review appropriate resources to addresses areas of development and support ongoing learning.
