Patient Screening for Immunization
A 32-year-old woman comes to the pharmacy for a flu shot. She reports that she is 20 weeks pregnant and has a history of a severe allergic reaction to eggs (hives and difficulty breathing) after eating eggs. She also mentions that she has a cold with a low-grade fever (100.2°F) and mild cough. She has no other chronic conditions and takes no medications. The pharmacy administers inactivated influenza vaccine. The state allows pharmacists to administer vaccines to patients aged 18 and older. The pharmacy has a protocol for handling egg allergies.
1. Should the patient receive the flu shot today? Explain your reasoning.
Read the worked answer
The patient should not receive the flu shot today for two reasons:
- Acute illness: She has a low-grade fever and cough, which may be a contraindication to vaccination. The CDC recommends deferring vaccination for moderate or severe acute illness, including fever >100.4°F (38°C). Her fever is 100.2°F, which is borderline, but with other symptoms, it's prudent to defer until she recovers.
- Egg allergy: She has a history of a severe allergic reaction to eggs (hives and difficulty breathing), which is a contraindication to egg-based influenza vaccines. However, the CDC states that persons with egg allergy can receive any age-appropriate influenza vaccine, but those with a history of severe allergic reaction (e.g., anaphylaxis) should be vaccinated in a medical setting with a provider who can recognize and manage severe allergic conditions. The pharmacy may not have the capability to manage anaphylaxis. Therefore, she should be referred to a healthcare provider for vaccination.
2. What documentation should be recorded for this patient encounter?
Read the worked answer
Document the following:
- Patient information: Name, date of birth, date of encounter.
- Reason for visit: Flu shot request.
- Screening findings: Pregnancy (20 weeks), egg allergy with severe reaction (hives and difficulty breathing), current symptoms (low-grade fever 100.2°F, cough).
- Vaccination status: Vaccine not administered.
- Reason for deferral: Acute illness and egg allergy requiring medical setting.
- Referral: Advise patient to follow up with her primary care provider or allergist for influenza vaccination. Provide written information if available.
- Counseling provided: Explained reasons for deferral and recommended follow-up.
- Signature: Pharmacist or technician who performed screening, date and time.