In response to a request for OUTREACH SERVICE from a primary health care provider, and following standardized procedures for CP patient visits, the CP will:

• Assess the patient, obtain informed consent, prepare, and educate the patient
• Prepare the vaccine, administer the vaccine, monitor, and manage any adverse events
• Document, in the appropriate public health database, all suitable clinic patients as requested by the regional Medical Health Officer delegated Physician, Nurse Practitioner or Registered Nurse

In response to provide homebound vaccination an urgent primary care service request is required for each address.  Homebound service requires a virtual clinical supervisor be assigned by the Health Authority to support the CP. If this is not provided, the paramedic is not in compliance with the PHO, and must decline the request. 

In all situations of relative contraindications, the patient should be reviewed by one of the aforementioned health professionals before proceeding with vaccination.

Procedure

1. Obtain service request
   • Complete clinic orientation for available equipment and document entry into database during clinic. Clinics may work as teams with specific roles or may work as a group of independent practitioners.
   • For homebound patients, conduct a clinical review of suitability, liaising with home support team and consulting with a virtual clinical supervisor prior to administration. 
2. Explain purpose of the Influenza vaccine and assess patient’s understanding of procedure and discuss any concerns the patient may have prior to immunization.
   • Confirm suitability for vaccine with an RN, NP or MD if any relative contraindications exist
   • Use BCCDC Q&A resources to support discussions with patient
3. Review possible complications or reactions with the patient and verify their understanding of when follow-up care from the primary health care provider would be required.
   • Refer to and follow the BCCDC immunization manual for best practice guidance to direct provision of immunization services
4. Confirm identity and obtain verbal consent prior to undergoing any procedure
5. Wash your hands with soap & water, or with alcohol-based hand sanitizer
6. Review any issues with safe storage of vaccine
   • Check three times that it is the correct product: 1) when removing from refrigerator, 2) when drawing up/reconstituting and 3) prior to administration
7. Practice the 8 RIGHTS of safe medication administration:
   • Right patient
   • Right drug
   • Right dose
   • Right route
   • Right time
   • Right reason
   • Right frequency
   • Right documentation
8. Administer vaccine
   • Always read product-specific page in the BC Immunization Manual, Part 4 – Biological Products to ensure vaccine is prepared appropriately
   • Select appropriate site for administration
   • Use sterile technique for administration of intramuscular injections
   • Practice principles of safe sharps handling

9. Communicate with the primary care provider if any other concerns arise. It is recommended that all immunized clients are observed for 15 minutes post-immunization and stay on-site for a total of 30 minutes. 
10. Review BCCDC Immunization Manual, Part 5 – Adverse Events Following Immunization as required. If severe adverse reaction, refer the BCEHS CPG E09: Anaphylaxis.
11. Report any adverse events following immunization immediately to the primary health care provider