Nursing

LVN STANDING ORDERS

Effective Date: 
Sun, 09/01/1996
Reviewed: 
Sun, 08/28/2011
Revised: 
Tue, 01/19/2016
Policy: 

Under standing orders from the Student Health Center Medical Director, eligible Licensed Vocational Nurses who have demonstrated competence at the Student Health Center may perform the following tasks:  give CDC recommended Adult and Adolescent vaccinations, perform hearing tests, perform ear lavage, remove sutures, care for wounds and throat swab for strep culture or gonorrhea.

This policy is in compliance with Section 2860.7 of the California Business and Professions Code.

Procedure: 

Experience, Training and/or Education

This policy is limited to those LVNs who have met the following criteria:

Current LVN licensure

Completion of UCSC orientation specific to vaccination administration, including, for vaccinations and PPDs, direct observation by an RN of at least 10 of these procedures prior to approval for performing this procedure under standing order.  

As part of this observation period the LVN must satisfactorily demonstrate competence in the administration of Immunizations (and their diluents), including knowledge of all indications and contraindications for the administration of such agents, and in the recognition and treatment of any emergency reactions to such agents which constitute a danger to the health or life of the person receiving the immunization. 

Completion of the standard orientation for LVNs which will include orientation to hearing tests, ear lavage, suture removal and wound care.  An orienting LVN should be observed at least twice for each of these procedures to be considered competent and more direct supervision may be required at the discretion of the nursing supervisor. 

 

Scope of Supervision

RN and physician available on-site at all times for immediate consultation and supervision.  No direct supervision required.

 

Criteria for Consultation and Referral

Any questions or concern about the appropriateness of the vaccination or the procedure should be clarified with a provider in advance.

Any contraindication or precaution for vaccine administration or for performing the procedure.

Questions or concerns about a patient’s medical condition or medication plan.

Any indication of adverse reaction to vaccine or procedure including and not limited to rash, swelling, altered respirations or agitation.

 

Vaccinations

1.  Identify adults in need of CDC recommended vaccination.

2.  Screen all patients for contraindications and precautions to the specific vaccine.

3.  Provide all patients with a copy of the most current federal Vaccine Information Statement (VIS). Allow them time to review the document.

4.  Provide all patients with a vaccine consent form to read and sign.  The signed copy is routed to the Medical Records department for scanning into the student’s  medical record

5. Administer vaccine per manufacturer guidelines. 

6. Document each patient’s vaccine administration information and follow up in

the following places:

a. Medical chart: Record the following information:

Name  of vaccine given

Date the vaccine was administered

Vaccine manufacturer

Dosage administered

Specific Vaccine Lot number and expiration date

Vaccination site and route

Name and title of the person administering the vaccine

Date of VIS given.

If vaccine was not given, record the reason(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal).

b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

c.  Student Health Center Vaccination Log: Complete each section of the vaccination log for every vaccine given.

7. Observe the patient for 15 minutes following vaccine administration.  Note any adverse reactions including local or generalized swelling, difficulty breathing, or agitation. 

8. Report any adverse reactions to the charge nurse and initiate emergency response per policy as necessary.

9. Report all adverse reactions to vaccines to the federal Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or (800) 822-7967. VAERS report forms are available at www.vaers.hhs.gov.

 

Ear Lavage

The LVN may perform ear lavage.  The RN or a clinician should evaluate the ears prior to and after lavage.

 

PPDs

The LVN may place and read a PPD.  All positive PPDs are to be confirmed by an RN.

 

Suture Removal

The LVN may remove sutures. 

 

Wound Care

The LVN may clean and bandage wounds using a cleaning solution and applying ointments at the direction of the RN or clinician. 

Throat Swab

The LVN may perform a throat swab for strep culture or gonorrhea at the direction of the RN or clinician.

 

Documentation

LVN documents according to the standards delineated in the UCSC Student Health Center Policy on Documentation of Care.

LVN documents all vaccines administered in the Vaccine Log as well as the Student’s Health Record.

Medical Director’s signature:

Electronically signed by Dr. Drew Malloy; original signed hard copies on file in the Assistant to the Executive Directors office.  8/28/11

LVN STANDING ORDERS FOR ADMINISTRATION OF SEASONAL INFLUENZA VACCINE TO ADULTS

Effective Date: 
Fri, 10/09/2009
Reviewed: 
Sun, 08/28/2011
Revised: 
Mon, 08/29/2011
Policy: 

Purpose: To reduce morbidity and mortality from seasonal influenza by vaccinating all adults who meet the criteria established by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

Policy: Under these standing orders, eligible Licensed Vocational Nurses allowed by state law andwho have demonstrated competence in administration of routine immunizations, may vaccinate patients who meet any of the criteria below.

Procedure: 

1. Identify adults in need of influenza vaccination based on meeting any of the following criteria:

a. Want to reduce the risk of becoming ill with influenza or of transmitting it to others

b. Age 18 years or older

c. Having any of the following conditions: chronic pulmonary (including asthma), cardiovascular (excluding hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic (including diabetes) disorders; immuno- suppression, including that caused by medications or HIV

d. Being pregnant during the influenza season

e. All healthcare personnel

g. All adults who are household contacts, caregivers, or workplace contacts of persons listed in category 1.c. above or of children age 0–59 months, or of adults age 50 years or older

2. Screen all patients for contraindications and precautions to influenza vaccine:

a. Contraindications: serious reaction (e.g., anaphylaxis) after ingesting eggs or after receiving a previous dose of influenza vaccine or an influenza vaccine component. For a list of vaccine components, go to www.cdc.gov/vaccines/pubs/pinkbook/ downloads/appendices/B/excipient-table-2.pdf. Do not give live attenuated influenza vaccine (LAIV; nasal spray) to an adult who is pregnant or who has any of the conditions described in 1.c. or 1.d. above.

b. Precautions: moderate or severe acute illness with or without fever; history of Guillain Barré syndrome within 6 weeks of a previous influenza vaccination; for LAIV only, close contact with an immunosuppressed person when the person requires protective isolation

3. Provide all patients with a copy of the most current federal Vaccine Information Statement (VIS). You must document in the patient’s medical record or office log, the publication date of the VIS and the date it was given to the patient. Provide non- English speaking patients with a copy of the VIS in their native language, if available and preferred; these can be found at www.immunize.org/vis.

4.  Provide all patients with a vaccine consent form to read and sign.

5. Administer inactivated influenza vaccine IM per manufacturer guidelines.  Alternatively, in healthy adults younger than age 50 years without contraindications may give intranasal live influenza vaccine per manufacturer guidelines.

6. Document each patient’s vaccine administration information and follow up in one the following places:

a. Medical chart: Record the date the vaccine was administered, the manufacturer and lot number, the vaccination site and route, and the name and title of the person administering the vaccine. If vaccine was not given, record the reason(s) for non-receipt of the vaccine (e.g., medical contraindication, patient refusal).

b. Personal immunization record card: Record the date of vaccination and the name/location of the administering clinic.

7.  Maintain a log of Immunizations given per unit guidelines.  All Medical Records including vaccine logs, visit notes, and consents are maintained by the UCSCStudent Health Centerper unit guidelines.

8. Be prepared for management of a medical emergency related to the administration of vaccine by having a written emergency medical protocol available, as well as equipment and medications.

9. Report all adverse reactions to influenza vaccine to the federal Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or (800) 822-7967. VAERS report forms are available at www.vaers.hhs.gov.

This policy and procedure shall remain in effect for all patients of the UCSC Student Health Center until rescinded.

Medical Director’s signature:

Electronically signed by Dr. Drew Malloy; original signed hard copies on file in the Assistant to the Executive Directors office.  10/9/09

III. RN STANDARDIZED PROCEDURES

Effective Date: 
Thu, 08/04/2011
Reviewed: 
Sat, 08/27/2011
Revised: 
Sun, 08/28/2011

II.A.4.b.

Immunization and vaccine name(s), dosage form, dosage administered, lot number, and quantity

Notes: 
AIT Forms
Location: 
Travel Clinic Plan & Recommendations Pt visit record, Standardized Nursing Protocols - Routine Immunizations, Universal Immunization Consent Form. Immunization Logs

II.A.4.c.

Prescription medications given, quantity and date, dosage and directions for use

Notes: 
P&P, AIT Forms
Location: 
Travel Medicine Consultations, Standing Orders for Travel Medicine Rx, Travel Clinic Plan & Recommentations Pt visit record

II.A.3.b.

Appropriate preventative medicine interventions

Notes: 
P&P, AIT Forms
Location: 
Travel Medicine Consultations, Travel Clinic Plan & Recommendations Pt visit record

II.A.3.c.

Education in risk and risk reduction

Notes: 
P&P, AIT Forms
Location: 
Travel Medicine Consultations, Travel Clinic Plan & Recommendations Pt visit record

II.A.4.a.

Travel destination and current health status

Notes: 
AIT Forms
Location: 
Travel Clinic Plan & Recommendations Pt visit record, Travel Clinic Questionnaire

II.A.3.a.

Comprehensive travel destination-specific risk assessment

Notes: 
P&P
Location: 
Travel Medicine Consultations, Travel Advisor, Travax website, CDC
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