Steps

Action

1

Dr/NS-ANP has prescribed the immunisation on medication chart stat drugs page.

2

Both Nurses check consent for vaccine has been signed by parent on Auckland District Health Board Tuberculosis – Consent Form for Neonatal BCG (AHTB3). (Ensure criteria 1, 2, 3 or 4 is circled.)

3

Check with baby's Nurse that it is appropriate to administer vaccine at that time.

4

Remove BCG vaccine and accompanying diluent from vaccination fridge.

5

Draw up diluent with 20G needle/2ml syringe, add diluent gently to ampoule containing BCG pellet, do not shake vigorously:

• allow to stand for one minute, an opalescent liquid forms.
• agitate the ampoule gently. Then withdraw 0.5mls air from ampoule.

6

Check dose to be given: (0.05mls intradermally)

• using the 27G needle/1ml tuberculin syringe or insulin syringe, draw up the required amount. Change the needle.

7

One Nurse to position and hold baby correctly, the gazetted Nurse administers the immunisation into the left arm intradermally adhering to the Ministry of Health guidelines.

8

Documentation is done:

1. Baby's medication sheet, batch no, expiry date and both nurses' signatures.
2. Baby's feeding/observation notes and care map.
3. Multidisciplinary notes:
   • Visit Record Front Sheet – stamped.
   • State batch number, date and signature.
   • Nursing report.
4. Well Child Health Book (Tamariki Ora)
5. BCG notebook in FLN mail box NICU office.
6. Send consent and assessment forms to Public Health Services, 2 Owens Road, Epsom (via internal mail).