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Practice dilemma: Use of an expired vaccine

It comes to your attention that one of the practice nurses has given an expired vaccine. How should you handle the situation?

Rachel Birch, medicolegal adviser at Medical Protection says:

It is important to act quickly in such a scenario to avoid anxiety on behalf of the patient, as well as a potential complaint.

Firstly, talk to the nurse and find out exactly what vaccine was given to the patient and how the adverse event occurred. You should also contact both your local public health team and the vaccine manufacturer to inform them of what happened and to seek their expert opinion on potential risks and how they can be minimised.

The GMC requires doctors to be open and honest with patients if things go wrong, so the practice should provide the patient with an explanation of what has happened, without delay, and offer an appropriate apology.

The patient is likely to be distressed, and also concerned about potential short and long term effects. Support should therefore be given, and as much information as possible should be provided. Revaccination should also be offered, if appropriate.

It is a good idea to familiarise yourself with the HPA’s vaccine incident guidance, as Section 6 addresses risks of administering expired vaccines and Section 7 provides information on the risks and benefits of re-vaccination.

Continual support should be given to the practice nurse, as they are likely to be feeling upset about the incident. As part of this, you may like to offer them further training, as well as any other clinicians undertaking vaccinations.

Going forward, you should undertake a significant event analysis (SEA) to investigate in detail how the adverse incident occurred and to determine what the practice can do to prevent a similar incident happening again.

As part of this, you may like to consider developing a practice vaccination protocol that outlines an approved procedure to be followed when administering vaccines. It could also include details of regular stock checks and pre-vaccination checks to be undertaken.

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