Practice dilemma: Wrong flu vaccine
A patient has returned to your surgery with a rash after receiving the flu vaccine. You discover she is slightly allergic to egg but wasn’t asked before she received the injection and was given the wrong type. What should you do now?
A patient has returned to your surgery with a rash after receiving the flu vaccine. You discover she is slightly allergic to egg but wasn't asked before she received the injection and was given the wrong type. What should you do now?
It is important that you tell the patient straight away that she has received a vaccine that is contraindicated for egg allergy sufferers. You need to explain the likely short-term and long-term effects and what treatment and follow-up will be required to put things right, such as antihistamine treatment, or referral to the hospital.
When something goes wrong, you are expected to say sorry, in line with paragraph 30 of Good Medical Practice (GMC, 2006). Occasionally, GPs may be worried about apologising because they believe it could be used as an admission of liability in a future claim. However, that is not the case.
Section 2 of the Compensation Act 2006, which applies to England and Wales, reads: ‘An apology, offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.'
Your patient is unlikely to make a complaint if they feel they have received an explanation of what happened and an apology. However, if your patient does indicate that she wants to take this further, you should provide her with information about the NHS complaints procedure. The complaint should be investigated by the practice complaints manager who will need to:
- Talk to the complainant about their concerns and the outcome they expect;
- Have a clear management plan and agree with the complainant how long it will take to investigate and provide a response.
Even if there has been no complaint, this error would still usually be considered as an adverse incident for your practice to review, and consider any lessons that can be learned. In this case, that might be further training for the staff who administer vaccines, or ensuring that your practice's vaccine administration protocol requires the administrator to ask the patient about existing allergies.
It is a good idea to tell the patient about any changes made to practice procedures to prevent a repeat of what has occurred. Adverse incidents should also be reported to the National Patient Safety Agency's National Reporting and Learning System.
GPs with concerns about the most appropriate vaccine for patients with egg allergies can find up-to-date information in the DH's Green Book of Immunisations1.
Dr Caroline Osborne-White MDU medico-legal adviser anda former GP, now based in Cambridgeshire
1. Immunisation against infectious disease - 'The Green Book', Department of Health, last updated 7 November 2011